Co-Principal Investigator: Reichle, Joe; Pustejovsky, James

Purpose: Individuals with autism spectrum disorder (ASD), and/or moderate-to-severe intellectual delay (ID), who have complex communication needs (CCNs) typically require highly intensive, costly, and individualized educational interventions to develop a communicative repertoire. However, there is little information to guide parents and instructional personnel in selecting the most effective dose and duration of treatment. Similarly, there is a lack of guidance about when and how treatment integrity and generalization and maintenance strategies affect treatment outcomes. The purpose of this project is to evaluate the effects of these treatment parameters on expressive communication outcomes for students with ASD and/or ID, and CCNs through a meta-analysis. This investigation ultimately aims to lead to the development of protocols for instructional personnel and parents to guide them in implementing efficient, acceptable, and effective treatment for improving communication for individuals with ASD and/or ID and CCN.

Project Activities: The research team will conduct a meta-analysis to investigate associations between treatment intensity and communication outcomes for children with ASD and/or ID and CCNs exposed to a range of different communication interventions.  They will first identify articles focused on communication interventions for individuals with ASD and/or ID and CCN and evaluate the quality of research designs. Then they will use data from these studies to evaluate the effects of treatment integrity, dose, duration, and generalization and maintenance strategies on child outcomes.

Products: The project will result in a meta-analysis describing relationships between treatment intensity parameters and communication outcomes in individuals with ASD and/or ID and CCN. Products will also include a shared final dataset, peer-reviewed publications and presentations, and products that reach education stakeholders, such as practitioners and caregivers.

Structured Abstract

Setting: For inclusion in this meta-analysis, studies will (a) include at least one participant with ASD and/or documented moderate to severe ID and with CCNs, (b) report a study that uses a single-case experimental design or between-groups design that meets minimum design quality standards, (c) report the results of a vocal and/or gestural (unaided) and/or graphic (aided, including low- or high-tech application) communication interventions, (d) include social-communicative outcomes, (e) implement strategies for communication outcomes measured in natural settings, and (f) are written in English or a published translation.

Sample: Participants in included articles will be students from 3 to 21 years old with a special education designation of ASD and/or ID with CCNs, as defined by the American Speech-Language-Hearing Association.

Factors: Factors of interest in this project include parameters of treatment intensity and related intervention characteristics: (a) dosage rate, (b) dosage duration, (c) dosage form, (d) dose frequency, (e) total intervention duration, (f) degree that the treatment is implemented with integrity, and (g) implementation of generalization and maintenance strategies.

Research Design and Methods: Researchers will use meta-analysis, a method of quantitative research synthesis that aggregates results of previously reported research. First, the researchers will conduct a literature search that focuses on the use of communication interventions for individuals with ASD and/or ID and CCN. The team will search electronic databases and reference lists of identified articles, articles referencing the identified articles, and other articles published by the first authors of the included articles. Published manuscripts and gray literature (unpublished) will be included. After determining which studies meet inclusion criteria, they will be reviewed for adherence to basic quality criteria for study design. The research team will conduct a meta-analysis to examine the effectiveness of early communication production interventions as a function of treatment intensity with consideration of the mediators and moderators.

Control Condition: Due to the nature of this research design, there is no control condition.

Key Measures: The outcomes will be measures of communication reported in identified articles, including standardized and observational measures of social communication. Reported outcomes will be analyzed as standardized effect sizes calculated for each eligible study.

Data Analytic Strategy: For included single-case design studies, the following effect sizes will be calculated using available data: Tau-U index and between-case standardized mean difference effect sizes. Group designs will be analyzed using standardized mean difference effect sizes and associated sampling variances will be calculated from the reported summary statistics. The research team will code included articles for potential mediating and moderating factors, including parameters of treatment intensity and related factors. The researchers will use mixed-effects meta-regression models with robust variance estimation to investigate the magnitude of effects, related to the intensity or implementation of treatment. Separate analyses will be calculated for each effect size and for between-group and single-case designs. The researchers will use multi-level modeling for the Tau-U analysis and mixed-effects meta-regression for the other effect size metrics.

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