Efficacy of a Comprehensive School-Based Intervention for Children with High-Functioning Autism Spectrum Disorders (HFASDs)
Co-Principal Investigator: Marcus Thomeer
Purpose: Core features of high-functioning autism spectrum disorders (HFASD) include a significant and pervasive deficit in social skills, and repetitive and restricted behaviors, interests, and/or activities. Associated features include problems in pragmatic communication, comprehension of affective information, and emotional-behavioral functioning. Together these impairments and features interfere with learning and academic performance because classroom learning involves social communication, sustained attention, and behavioral regulation. The increasing number of students with HFASD and the heterogeneity in symptoms are posing a major intervention challenge to schools. This has led to a significant need for manualized, school-based interventions for students with HFASD.
This project will use a cluster randomized controlled trial to evaluate the efficacy of a comprehensive school-based intervention (CSBI) on the outcomes of elementary school children with HFASD. Compared to a control group, students with HFASD who complete the CSBI are hypothesized to demonstrate significantly greater social-communicative understanding, fewer ASD symptoms, better social skills, higher rates of peer interactions, and greater academic achievement. In addition, the potential mediating role of fidelity of implementation and moderating role of IQ and language level will be examined.
Project Activities: Schools will be randomly assigned to the treatment and control conditions, with stratification by economic level. Ninety-six students and their parents will be recruited over a 4-year period. For the treatment group, the intervention will take place over the course of the full school year, with data collected on fidelity of implementation for each component. Pre- and post-testing of child outcomes will take place at the beginning and end of each school year for both groups using direct child measures, teacher and parent report, and behavioral observation. Data will be analyzed using linear mixed effects models and, for the potential mediating effect of implementation fidelity, structural equation modeling.
Products: Products include the evidence of the efficacy of the CSBI on elementary school students with HFASD, peer-reviewed publications, and presentations.
Setting: The study will take place in elementary schools in Western New York.
Sample: There will be 96 students with HFASD in grades 1–5, and their teachers and parents, participating in this research project.
Intervention: This comprehensive school-based intervention (CSBI) takes place over the course of a 10-month academic year. The intervention has five components: (1) social skills groups meet two to three times per week for students with social impairments to work on social skills; (2) individual daily notes administered throughout the school day to prompt, practice, and reinforce newly learned skills and collect data on skill and behavior targets; (3) Mind Reading computer instruction three times per week using an interactive software designed to teach recognition of emotions in facial and vocal formats; (4) therapeutic activities conducted twice per week in peer groups and aimed at practicing social skills, emotion recognition, non-literal language skills, and expansion of interests; and (5) parent training, conducted once per month by school staff to increase home-school communication and integrate the CSBI components across settings.
Research Design and Methods: In this cluster randomized trial, schools will be randomly assigned to the CSBI (treatment) and business-as-usual (control) conditions. The schools will be stratified by economic level (based on percentage of students receiving public assistance) because this factor is related to the availability of specialized education services, which could interact with the effects of the intervention. The participating students will be recruited over a 4-year period. For each cohort, pre-testing of child outcomes will take place at the beginning of the school year and post-testing of child outcomes will take place at the end of the school year. For the treatment group, the intervention will take place over the course of the full school year, with data collected on fidelity of implementation for each component.
Control Condition: In the control condition, children with HFASD will receive their usual educational programs and services, as mandated by their IEP. Children in the control group will receive free summer socialization programming after the completion of their participation in the 1-year trial.
Key Measures: The Autism Diagnostic Interview-Revised will be used for screening children for autism, and the Wechsler Intelligence Scale for Children 4th Edition (WISC-IV) and Comprehensive Assessment of Spoken Language (CASL) will be used for screening children for minimum IQ and language skills. Child outcome measures include the Cambridge Mindreading Face-Voice Battery for Children (direct measure of social-communication skills involving emotion recognition), Social Responsiveness Scale (teacher and parent ratings of autism symptom severity), Adapted Skillstreaming Checklist (teacher and parent scale assessing social skills, problem behaviors, and other features of HFASD), Social Interaction Observation Scale (observational assessment of peer interactions), and Woodcock-Johnson III Tests of Achievement (direct measure of child achievement). Additional data will be collected on school and classroom characteristics (e.g., size, staff background) that may impact fidelity of implementation. Researcher-developed forms and procedures will assess dosage and adherence to each treatment component.
Data Analytic Strategy: The data will be analyzed by fitting a linear mixed effects model using group as the independent variable with baseline data and stratification (economic level) as covariates. The potential role of fidelity as a mediator will be examined using structural equation modeling, and the potential moderating roles of IQ and language will be examined by adding interaction terms to the linear mixed models. Multiple imputation methods will be used as appropriate to account for missing data.
Project Website: https://www.canisius.edu/schoolmax
Related IES Projects: Development of an Intervention to Enhance the Social Competencies of Children with Asperger"s/High Functioning Autism Spectrum Disorders (R324A080136)
Lopata, C., Donnelly, J.P., and Thomeer, M.L. (in press). Anxiety and ASD in Schools – Schoolrelated Issues and Individualized Education Programs. In C.M. Kerns, P. Renno, E.A. Storch, P.C. Kendall, and J.J. Wood (Eds.), Evidence Based Assessment and Treatment of Anxiety in Children and Adolescents With Autism Spectrum Disorder. Atlanta, GA: Elsevier.
Thomeer, M.L., Rodgers, J.D., Lopata, C., Nelson, A.T., and Booth, A.J. (2015). Achieving and Maintaining Intervention Fidelity Using a Three-Component Implementation Model in a Comprehensive School-Based Psychosocial Treatment for Children With High-Functioning ASD. In A. Valdez (Ed.), Autism Spectrum Disorders: Early Signs, Intervention Options and Family Impact (pp. 129–155). Hauppauge, NY: Nova Science.
Journal article, monograph, or newsletter
Lopata, C., Donnelly, J.P., Jordan, A.K., Thomeer, M.L., McDonald, C.A., and Rodgers, J.D. (2016). Parent-Teacher Discrepancies on the Developmental Social Disorders Scale (BASC-2) in the Assessment of High-Functioning Children With ASD. Journal of Autism and Developmental Disorders, 46(9): 3183–3189 . doi:10.1007/s10803–016–2851–0 Full text
McDonald, C. A., Lopata, C., Donnelly, J. P., Thomeer, M. L., Rodgers, J. D., and Jordan, A. K. (2016). Informant Discrepancies in Externalizing and Internalizing Symptoms and Adaptive Skills of High-Functioning Children with Autism Spectrum Disorder. School Psychology Quarterly, 31(4): 467–477. doi:10.1037/spq0000150
Rodgers, J. D., Warhol, A., Fox, J. D., McDonald, C. A., Thomeer, M. L., Lopata, C., Darrow, A. M., Szyszkowski, A. L., Biscotto, A. A., and Scheffield, T. (2016). Minimal Risk of Internalizing Problems in Typically-Developing Siblings of Children with High-Functioning Autism Spectrum Disorder. Journal of Child and Family Studies, 25(8): 2554–2561. doi:10.1007/s10826–016–0407–8