Testing the Long-Term Beneficial Impacts from a Comprehensive School Intervention for High-Functioning Children with ASD (HFASD): An Efficacy Follow-Up Study
Co-Principal Investigator: Thomeer, Marcus; Donnelly, James; Rodgers, Jonathan; Lodi-Smith, Jennifer
Purpose: The purpose of this study is to evaluate the long-term impacts of a comprehensive school-based intervention (CSBI) that yielded beneficial impacts for elementary school students with high-functioning autism spectrum disorder (HFASD). Results from the initial randomized controlled trial indicated that students in grades 1-5 with HFASD in the CSBI schools demonstrated significantly better outcomes on measures of social-cognition, social-communication skills, and ASD symptoms compared to students with HFASD who received typical instruction in the control schools. Although these results are encouraging, the long-term impacts of the CSBI are unknown. To date, school-based social interventions for students with HFASD have yielded mixed results regarding maintenance of gains over time and follow-up intervals have been relatively short (e.g., a few months). This study aims to overcome this limitation by conducting a 2-year follow-up study of students with HFASD who participated in the original study to test the long-term impacts of the CSBI.
Project Activities: The research team will follow students who participated in a previous cluster randomized trial of a CSBI in elementary school. For 2 years, the research team will collect assessment data at the start and end of the school year on student outcomes, including proximal outcomes (i.e., emotion recognition skills and adaptive skills in social-communication and behavior) and distal outcomes (i.e., ASD symptoms, achievement, and health-related quality of life). Data will be analyzed to determine the long-term impacts of the CSBI. The team will also examine whether fidelity of implementation mediates the impact of the intervention on outcomes and whether child IQ and language ability, as well as time since participation in the original study, moderates the impact.
Products: The products of this project will include evidence of the long-term impacts of the CSBI students on with HFASD, as well as peer-reviewed publications and presentations.
Setting: The research will take place in elementary, middle, and high schools in New York.
Sample: The 102 elementary school students with HFASD who participated in the original efficacy trial, now in Grades 6-10, will participate in the follow-up study.
Intervention: The original CSBI included the following five components: (1) social skills groups that met two to three times per week for students with social impairments; (2) therapeutic activities that were conducted twice per week in peer groups in order to promote the expansion of interests and provide opportunities for practicing social skills, emotion recognition, and non-literal language skills; (3) individual daily notes (i.e. behavioral contract/reinforcement system) that were administered throughout the school day to prompt, practice, and reinforce newly learned skills and collect data on skill and behavior targets; (4) interactive computer instruction that was implemented three times per week to teach recognition of emotions in facial and vocal formats; and (5) parent training which was conducted once per month by school staff to increase home-school communication and integrate the CSBI components across settings.
Research Design and Methods: The original efficacy study used a cluster randomized trial design in which 35 schools, stratified by percentage of students receiving public assistance, were randomly assigned to the CSBI group or the control group. A total of 103 children were enrolled, of which 102 children participated in the full efficacy study. Students were recruited in cohorts over a 4-year time period. For each cohort, students were assessed at the beginning and end of the school year. School staff in the CSBI group participated in training the summer before the academic year and implemented the intervention during the 10-month school year. The study examined whether children in the CSBI group made greater improvements in social-cognition, social-communication skills, ASD symptoms, and academic achievement. The current study will follow these same students for 2 more years with assessments in the fall and spring of each school year to examine longer-term effects of the intervention on emotion recognition, social-communication skills and behaviors, ASD symptoms (i.e., social-communication impairments and repetitive behaviors), and academic achievement. Exploratory analyses will also be conducted to determine whether fidelity mediates intervention effects and child IQ, language ability, and cohort from original study (i.e., time since participating in the intervention) moderates effects. The team will also assess the costs associated with the special education services received by students in each group during the 2 years of follow up.
Control Condition: In the original efficacy study, students in the control condition received their school's typical, business-as-usual education.
Key Measures: The primary, targeted outcome measures for the children include the Cambridge Mindreading Face-Voice Battery for Children (cognitive understanding/skills related to emotion recognition) and Adapted Skillstreaming Checklist (social-communication skills and behavior of children). Secondary outcome measures of broader child functioning include the Social Responsiveness Scale 2nd Edition (e.g., ASD-related symptoms such as social-communication impairment and repetitive behaviors and interests), Woodcock-Johnson III Tests of Achievement (letter-word identification, calculation, spelling, passage comprehension, and writing), and Pediatric Quality of Life Inventory (physical and psychosocial health for youth with chronic conditions). Mediator and moderators, measured in the original efficacy trial, include a researcher-developed fidelity monitoring checklist, Wechsler Intelligence Scale for Children-IV (IQ), and Comprehensive Assessment of Spoken Language(language ability). An additional moderator will be years since participation in the original study. For the cost analysis, costs for special education services will be calculated in both dollars and raw units (e.g., hours of time).
Data Analytic Strategy: The research team will examine the primary, targeted impacts of the intervention on students using linear mixed models. Follow-up analyses to examine growth will be conducted using growth curve trajectories within a multilevel mixed effects framework, with measures nested within students and students nested within groups. The more secondary outcomes of ASD symptoms and achievement will be examined using linear mixed effects models, and quality of life will be examined descriptively in relation to existing normative data as well as in a multilevel linear mixed model. Moderators will be examined using interaction terms within the models and the mediator will be examined using structural equation modeling. For the cost analysis, costs for the intervention, and the differences between costs for the intervention and control groups, will be reported descriptively.
Related IES Projects: Development of an Intervention to Enhance the Social Competencies of Children with Asperger's/High Functioning Autism Spectrum Disorders (R324A080136); Efficacy of a Comprehensive School-Based Intervention for Children with High-Functioning Autism Spectrum Disorders (HFASDs) (R324A130216)
Project Website: https://www.canisius.edu/schoolmax