List of Studies

2007 Research Competition Grant Awards

Development of an Executive Function-based Intervention for Autism Spectrum Disorders

Laura Anthony, Ph.D.
Children’s National Medical Center

Children with Asperger Syndrome and High-Functioning Autism (AS/HFA) are bright, caring people plagued by problems with aspects of executive function (EF): flexible thinking/behavior, integration, planning, and organizing.  These EF problems interfere with learning and behavior in the classroom (e.g., trouble transitioning, getting stuck on things), and relate to the repetitive behaviors and social difficulties characteristic of AS/HFA.  This proposal seeks develop and investigate an intervention to address the core EF component of flexible thinking, while also building other, supporting EF skills.  Because there are no tested school-based EF interventions for children with AS/HFA, this project builds upon an EF cognitive remediation intervention for children with traumatic brain injury (TBI).  This project will employ a participatory research framework to (1) adapt the intervention components and develop a draft of the intervention materials, (2) conduct a pilot study evaluating the effectiveness of the intervention, and (3) revise the intervention and/or measures based on feedback and results.

Sleep Disturbance and Daytime Functioning in Children with Autism

Susan Mayes, Ph.D.
Penn State College of Medicine

More than half of parents of children with autism report a sleep disturbance in their children, including difficulty falling asleep, waking during the night, awaking early in the morning, short total sleep time, and nightmares. Little research has been conducted on sleep problems in children with autism. According to the National Institute of Health (2005), “Little is known about characteristics or consequences of sleep disturbances in most childhood psychiatric disorders” and “the consequent impact on mood, neurobehavioral and academic functioning, safety, and health is considerable.”  The goals of this study are to (1) determine the frequency, type, and severity of sleep problems in 200 children with autism as a function of child characteristics (age, IQ, gender, and severity of autism), (2) analyze differences in sleep disturbances in children with autism as a function of comorbid mood and behavior problems, anxiety, depression, and mental retardation, and (3) examine the relationship between sleep disturbance and academic, neuropsychological, behavioral, and emotional functioning.

Peer-mediated Intervention for Elementary School Students with Autism Spectrum Disorders

Audrey Blakeley-Smith, Ph.D. and Susan Hepburn, Ph.D.
University of Colorado at Denver Health Sciences Center

Social deficits have been described as the most defining feature of autism and are noted to cause difficulties across the life span. The socially inappropriate behavior and/or poorly developed social skills of elementary school students with ASD and the negative attributions that peers can make for their behavior place them at risk for peer rejection, adjustment difficulties, and problem behavior.  The proposed study is a peer training program designed to specifically target peer rejection and peer attributions towards elementary school students with ASD. The goals of the peer-mediated intervention are: (a) to assist peers in reframing perceptions/attributions of the behavior of students with ASD through psycho-education; (b) to increase opportunities for positive social interaction between students with ASD and their peers by identifying school activities that optimize positive social interaction; (c) to train peers in social interaction strategies; and (d) to decrease rejection and problem behavior in selected school activities.

An Examination of the Effectiveness of Manipulative Letter Instruction on the Decoding Skills of Young Children with Autism Spectrum Disorders

Maureen Conroy, Ph.D.
Virginia Commonwealth University School of Education

The ability to read is an essential skill in our society for learning and developing independence. Unfortunately, many students with Autism Spectrum Disorders (ASD) have difficulty acquiring early literacy skills, such as decoding and comprehension. Thus, the need to develop scientifically-based instructional strategies to address this critical skill deficit in individuals with ASD is imperative. The current proposal addresses this need by investigating the use of an innovative instructional reading strategy called Manipulative Letter Instruction on the development of early literacy skills in students with ASD. Manipulative Letter Instruction involves explicit and systematic instruction in the alphabetic principle that makes the abstract concept of blending and segmenting phonemes more concrete for students. Using a group design, the efficacy of Manipulative Letter Instruction will be compared to an alternative treatment (i.e., Repeated Reading of Connected Text). This study will help to provide additional information about early literacy skills in students with ASD and inform current instructional reading practices for teaching these skills to students with ASD. Additionally, a number of dissemination activities will be implemented to share the outcomes of the proposed research with other researchers and practitioners in the field.

Increasing Social Engagement in Young Children with Autism Spectrum Disorders using Video Self-modeling and Peer Training

Scott Bellini, Ph.D.
Indiana Resource Center for Autism

Impairments in social-emotional functioning are a central feature of autism spectrum disorders (ASD) and can create great difficulties in the life of an individual on the autism spectrum. Social skill deficits increase the likelihood of the individual experiencing social failure, peer rejection, and isolation leaving the individual vulnerable to developing anxiety, depression, and other forms of psychopathology. The proposed line of research will expand previous research addressing deficits in social functioning, through the implementation of a video self-modeling (VSM) procedure and a peer mediated intervention. VSM is a positive behavioral support strategy that integrates a powerful learning medium for children with ASD (visually cued instruction) with an effective intervention modality (modeling, coaching, and social problem solving).  Results from the present study will be the first step towards the development of a manualized treatment protocol that will be available to parents and professionals throughout the nation wishing to design data-driven social skills intervention procedures for students with ASD.

A Clinical Randomized Control Trial of Joint Attention Intervention in Young Children with ASD

Jennifer S. Durocher, Ph.D.
University of Miami Center for Autism and Related Disorders

Joint attention, of the capacity of coordinate attention between objects and people to share the experience with others, is an important hallmark of early development.  The ability to respond to and initiate joint attention is frequently impaired in children with ASD.  Joint attention skills have been found to predict play, language and cognitive abilities in typical children and in those with autism.  The primary purpose of this proposal is to conduct a randomized control study to evaluate the efficacy of joint attention intervention for 40 children with ASD between the ages of 2 and 5 years.  This study will add to the field by providing additional empirical evidence of the efficacy of joint attention intervention and, more importantly, allow us to better understand the characteristics of children with ASD that predict better response to intervention.

Identifying the Supports that Promote Success of College Students with Asperger Syndrome

Janet Graetz, Ph.D.
Oakland University School of Education and Human Services

All college students are faced with numerous challenges and stressful situations both within and outside the academic arena. For students with disabilities, and especially those with Asperger Syndrome, these challenges can be particularly overwhelming. This study examines the college experience for students with Asperger Syndrome and identifies the supports that lead to a successful college experience. The study will involve 15 to 20 students with Asperger Syndrome who are attending Oakland University in Rochester, Michigan. Participants will be asked to complete assessments and self-recording surveys that will provide researchers information regarding their study and learning skills, peer involvement, residential experiences, extracurricular involvement (both recreational and academic), family structure and support, interpersonal skills, stress management, and self-advocacy.  The self-reported surveys will be completed by participants through the use of a website. They will be asked to log on to a website that asks specific questions about their previous week at Oakland University. Questions will identify 1) the supports they utilized that week, 2) the extracurricular activities they attended, and 3) their use of peer supports. In addition, each website will have a section that will be a personal diary site where participants can share their thoughts and feelings regarding the previous week at Oakland University.

Joint Attention Intervention for Nonverbal Children with Autism

Connie Kasari, Ph.D.
UCLA Graduate School of Education

Children with autism demonstrate significant impairments in both responding to and initiating joint attention skills. Joint attention skills include showing, pointing and alternating looks that are used to share an event or object with another. These skills develop in very young children, and the lack of joint attention is often a first signal to alert parents to a possible diagnosis of autism. Joint attention skills are also associated with language outcome. Children who demonstrate more joint attention skill also develop better language abilities. Thus, joint attention skills are a potentially important target of early intervention for children with autism. In this study, we aim to test the effects of a theoretically and empirically derived treatment for joint attention skills for young, nonverbal children with autism.  A small controlled clinical trial is proposed where preschool aged children with autism are randomized to either an ABA-based preschool program plus manualized joint attention intervention or to ABA-based preschool services only. Participants will be thirty children with autism, aged 3 to 5 years, who are classified with autism, and are nonverbal with documented limited progress in language skill.  Our study addresses an important priority in the autism research matrix (National Institute of Mental Health, 2004) notably the goal of improving intervention efforts so that 90% of children with autism are able to speak.

Evaluating the Effectiveness of the Social Cognition Training Tool (SCOTT) in ASD on Behavioral, Occulomotor, and Neuronal Levels

Isabel Dziobek, Ph.D.
Max Planck Institute for Human Development

Social cognitive difficulties are central to autism spectrum conditions (ASC) and have some of the most vexing effects on the lives of people with ASC and their families. However, only a limited amount of intervention tools exist targeting social cognitive (dys)functions. Most of those tools use non-lifelike stimuli and are not sufficiently appealing to people with ASC to generate the high repetition training needed to significantly improve on social cognitive skills. Moreover, applied research is lacking that documents the effectiveness of those trainings on the behavioral as well as the brain level. Building on our expertise in designing and validating diagnostic and intervention tools for social cognitive functions for people with autism, we have developed the Social Cognition Training Tool (SCOTT). The SCOTT is a computer-based intervention that encompasses 4 different training modules of varying complexity using lifelike video-based stimuli and virtual reality environments. The central aim of the proposed study is to document effectiveness of the SCOTT. Towards that aim, we will perform a 12-week intervention program enrolling 40 adolescents and adults diagnosed on the autism spectrum. Using standard social cognition tests and ratings of social skills in everyday life, we are aiming at assessing treatment success at close and distant behavioral generalization levels. In addition, we are seeking to identify more objective correlates of improved social cognitive functions by measuring eye fixation patterns and brain structure as well as brain function. We believe that our research can be directly applied to benefit people with autism and their families. Our long-term goal is to improve social cognitive skills using the SCOTT and thereby optimizing the ability of people with autism to lead rewarding and productive lives.

Evaluating Intensive Behavioral Interventions in Autism

Phil Hineline, Ph.D., BCBA and Saul Axelrod, Ph.D., BCBA
Temple University

Lovaas et al. (1987) demonstrated that effective intervention for autism is within reach, indicating that early, intensive, carefully designed procedures based upon behavioral principles could improve the prognosis for nearly all children with this disorder. Subsequently, the Lovaas, or “Discrete-Trial” model, has evolved somewhat, while additional comparison studies have continued to indicate its effectiveness. Meanwhile, additional behaviorally-based techniques and interventions have been introduced. Two of these, known as the “Applied Verbal Behavior” approach (Sundberg & Partington, 1998) and the Competent Learner Model (Tucci, 1986) have been vigorously advocated, mainly on the basis of their underlying rationale and a few published single-case evaluations. Their adoption has occurred despite the lack of comparative evaluations of their respective effectiveness relative to the Discrete Trial model. The present project entails exploratory analyses and evaluations of the three approaches as implemented within public-school settings. Assessment of before-vs.-after standard outcome measures will indicate whether the Verbal Behavior and Competent Learner Model approaches produce improvements comparable to those that have already been reported for Discrete-Trial interventions, and thus whether subsequent head-to-head comparisons would be justified. In addition, by tracking progressive changes in detailed curriculum profiles for individual children this project will also assess the degree to which the two models differ in actual practice from each other and from the Discrete-Trial model, or whether they would better be viewed as hybrids of the Lovaas approach. A third objective will be to gather preliminary data regarding the degree to which each approach is dependent upon high-levels of staff competence. This objective concerns the possibility that a technique identified as “best practice” when implemented in a well-staffed research center may not be the most effective approach in settings with far fewer resources, such as public schools, which the majority of children must rely on for intervention.

Efficacy of Community-based Instruction and Supported Employment on the Competitive Employment Outcomes of Transition-age Youth with Autism

Paul Wehman, Ph.D.
Children’s National Medical Center

It has been estimated that 1.5 million Americans and their families are now affected by autism, costing the U.S. at least $35 billion annually. In light of this information, employment as a post-school outcome is critical if individuals with autism spectrum disorders (ASD) are to become participating members of society. The researchers for this study believe that employment is the "key" for opening the door to full inclusion for individuals with ASD in their communities. Therefore, the goal of this project is to demonstrate that transition age youth with autism can learn work skills in community businesses that result in the identification and selection of jobs of choice.
Virginia Commonwealth University (VCU) will work with the Faison School for Autism in Richmond, VA to identify students who will be provided the opportunity to participate in community-based work experiences and paid work opportunities. Community businesses will be identified and selected reflective of each student's interests and skills. Vocational and work related skills that are the actual job duties for the positions targeted will be taught using applied behavior analysis procedures. Single subject designs will be used to demonstrate that the effect of training ("treatment") results in consistent behavior change / increased vocational competence of students with autism within integrated community environments. In addition, the proposed project will produce and disseminate applied research that will aid students with autism, parents, families, and professionals in designing and implementing Individualized Education Programs (IEPs) that lead to competitive employment outcomes.

2006 Research Competition Grant Awards

Evaluating intensive behavioral interventions for autism: “Discrete trial” and “Applied Verbal Behavior”

Phil Hineline, Ph.D., BCBA and Saul Axelrod, Ph.D., BCBA
Temple University

Lovaas et al. (1987) demonstrated the effective intervention for autism was within reach, indicating that early, intensive, carefully designed procedures based upon behavioral principles could improve the prognosis for nearly all children with that disorder. Subsequently, the Lovaas, or “discrete trial” model has evolved somewhat, while additional comparison studies have continued to indicate its effectiveness.  Meanwhile, additional behaviorally-based techniques and interventions have been introduced.  One of these, known as the “Applied Verbal Behavior” approach (Sundberg & Partington, 1998) has been vigorously advocated, mainly on the basis of its underlying rational and a few published single-case evaluations.  The present investigation entails exploratory analyses and evaluations of the two approaches as implemented within public-school settings. Assessment of before-vs.-after outcome measures will indicate whether the Verbal Behavior approach produces improvements comparable to those reported for discrete trial interventions.

Adolescence is a difficult time period for individuals with autism spectrum disorders (ASDs) and their parents, and yet issues related to negotiating developmental transitions and the biological processes associated with growing up have been neglected in the field. It is generally accepted that sexuality needs to be taught within the context of human relationships, and that parents are the most important and best sex educators for their children (SIECUS, 2001; 1996). However, parents of children with ASDs are often apprehensive of teaching about sexuality, or are unsure about how to respond to their child’s emerging sexual behaviors, particularly if the behavior is inappropriate. The proposed program is the first to evaluate the effectiveness of a parent curriculum in targeting not only the needs of youth with ASDs regarding sexuality development, but also the needs of their parents in reducing stress and increasing parents’ sense of competence in dealing with this difficult set of issues.  Measures will assess parent stress and competence, parent knowledge of sexuality and developmental disabilities, and youth sexual behavior and knowledge. Individualized and general goals will be established for all participants. Findings from the current program will provide important information about sexual development and learning in youth with ASDs, and how to assist parents in educating their children. Outcome data will also serve as a starting point for much needed future program development, and also for best practices in addressing issues of sexuality and puberty for youth on the autism spectrum.

Parental sleep education program for children with autism spectrum disorder

Beth Malow, M.D., M.S.
Vanderbilt Kennedy Center for Research on Human Development

Sleep difficulties are common reasons why parents seek medical intervention for their children with ASD.  A major concern reported by parents of children with ASD is insomnia, characterized by difficulty getting their children to fall asleep or stay asleep.  Although there are many causes and treatments of insomnia in ASD, the contribution of parental sleep education to treating insomnia has been understudied.  In the proposed study, our goals are: 1) to examine the relationship between insomnia, sleep habits, daytime behavior, and parental stress and 2) to conduct a parental sleep education program and determine whether this education program improves sleep habits, minimizes time to fall asleep and night wakenings, positively affects daytime behavior, and impacts favorably on parental stress levels. To measure the program’s success, data will be obtained prior to and after the program in the form of surveys, sleep diaries, and actigraphy (wristwatch-like monitors that quantify movement and rest as a surrogate for wakefulness and sleep). 

2005 Research Competition Grant Awards—$30,000 each

Demonstration of a Parent Mediated Generalization
Program to Enhance Outcomes During EIBI for Children with
Autism Spectrum Disorders: PEPING Up EIBI

Eric M. Butter, Ph.D.
The Columbus Children’s Hospital Autism Center
Columbus Children’s Research Institute and
The Ohio State University Nisonger Center

In recent years, great interest has been focused on the increasing incidence of autism spectrum disorder and the development of effective treatments. Early Intensive Behavioral Intervention (EIBI) is one treatment with empirical support, however little is understood about what components of EIBI are critical to its efficacy and there is growing concern that clinical outcomes are falling short of those reported by Lovaas (1987). PEPING Up EIBI represents a manual based psychosocial treatment designed to complement on-going early intensive behavioral intervention (EIBI) for children with an autism spectrum disorder. The proposed treatment program is a 12 month parent training intervention designed to teach parents of children with autism spectrum disorders strategies to accelerate their child’s learning rate and to promote generalization of skills to settings outside of the EIBI treatment environment. A randomized clinical pilot trial comparing a uni-modal and combined treatment will be implemented. The experimental group will involve parents participating in a highly individualized but standardized and systematic parent training program in addition to the EIBI program their child has already been enrolled. The control group will receive EIBI treatment as usual with no additional parent training. Outcome assessment will include one year changes in specific target skills (as identified by the parent), learning rate (IQ, language, adaptive behavior), autism symptoms (ADOS, PDD-BI), and parenting stress. If the parent training program is effective, the practical implications for children and families pursuing effective autism treatments will be immediate. Additionally, the study design and evaluation measures offer further scientific value by evaluating the utility of several assessment measures and their sensitivity to treatment effects.

The Effects of Precision Teaching with Frequency
Building of Fine Motor Skills on the Performance of Functional Life Skills
in Adolescents and Adults with Autism

Marlene J. Cohen, Ed.D., BCBA
Douglass Developmental Disabilities Center
Rutgers, the State University of New Jersey

In the field of Applied Behavior Analysis, much focus is placed on the intense training needs of young children with autism. Many educators believe that adolescents and adults with autism are less likely to make significant strides than their younger counterparts. Precision Teaching with frequency building procedures is one method that holds promise as an efficient and effective means of instruction for older learners. The current research is proposed as an attempt to replicate previous clinical demonstrations of the profound impact of Precision Teaching with frequency building procedures on the functional use of fine motor skills in adolescents and adults with autism during activities of daily living. Further, this research seeks to explore whether instruction of component motor skills should end when minimum frequency aims are initially achieved, or if continuing instruction of component skills to higher frequencies of performance will yield greater, positive effects on performance of functional composite skills. In addition, the proposed research will begin to examine whether maximum improvement is seen when component skills that are addressed in teaching are directly related to the movements involved in composite skills, or whether more generalized improvements in adaptive skills can be seen in skills that are not topographically related to the trained component skills.

A comparison of simultaneous prompt and constant prompt delay
procedures on teaching skills to young children with autism

Kevin P. Klatt, Ph.D., BCBA
Department of Psychology
University of Wisconsin – Eau Claire

Various procedures have been used to teach new communication, social, and play skills to children with autism. One of the most common procedures used in both analog and natural settings is the use of a prompt delay procedure. This procedure requires the teacher to give the child an instruction, followed by a prompt to help the child respond correctly, and then the prompt is faded across trials until the child responds independently. More recently, a simultaneous prompt procedure also has been used to teach new skills to children and adults with developmental disabilities. This procedure requires the teacher to provide an immediate prompt on all teaching trials. This procedure presumably prevents the child from making errors because the prompt is immediate. Although both procedures have been used successfully to teach new skills to persons with developmental disabilities, little research has been conducted comparing the two procedures or evaluating the effectiveness of either with young children with autism. The purpose of this study is to investigate the effectiveness of two types of constant prompt delay and the simultaneous prompt procedure in teaching new skills to young children diagnosed with autism.

Development of an instrument for measuring change
in social behavior for children with autism spectrum conditions:
The Social Reciprocity Observation Measure

Kathleen Koenig, MSN
Yale Child Study Center

Autism spectrum disorders (ASDs) are severe, disabling conditions that impact affected individuals and their families throughout the lifespan. Treatments for ASDs have burgeoned in the last ten years, with many options available to families. The search for the best treatments is extremely costly to families, in terms of time, energy and other resources. Moreover, it is difficult to judge the efficacy of treatment if standard outcome measures are not employed for testing interventions.

The aim of this program of research is to test and refine an instrument, the Social Reciprocity Observation Measure (SROM), which is a ten item scale designed to measure children’s reciprocal social behavior in a naturalistic setting. The development of this instrument is modeled after the ADOS, in that it brings key knowledge about impairments in social functioning common to children with ASDs together with a well established method of measurement – direct observation. The SROM goes one step further in moving the observation to a naturalistic setting, for greater ecological validity.

30 children with an ASD will be observed and coded multiple times using the SROM after inter-rater reliability has been established. Construct validity will be examined through multi-trait, multi-method analysis of the SROM and measures of social functioning completed by parents and clinicians, and reliability of individual items will be examined as well. Once the psychometric properties of the instrument are sufficiently demonstrated, the SROM can be piloted as a change measure.

The development of this instrument addresses a critical methodological problem in the field of autism intervention-- the lack of adequate outcome measures. Use of the SROM will advance the measurement of treatment effects on this core symptom of autism in the real world. Further, it will make it easier for parents, teachers and researchers to compare the results of treatment studies addressing the social impairment of ASDs.

A Multi-Method Assessment and Treatment of
the Social Skills Core Deficit in ASD

Raymond G. Romanczyk, Ph.D., BCBA and Jennifer M. Gillis, M.A., BCBA
Binghamton University
Institute for Child Development

The significant social limitations of children with ASD lead to difficulty in perception and understanding of important social cues in the environment, in developing relationships with others, and in simple social interactions with others (e.g., smiling, waving hello when seeing someone familiar, expressing empathy, etc).

This project addresses social development in the full range of individuals with ASD, encompassing children who have little to no language or communication skills. The project applies a multi-method assessment of dimensions not used in the basic process of functional analysis, so that we can focus on process variables as well as simple behavior aggregation by environmental variables. Anxiety is one of the constructs frequently referred to in the social development literature, but understudied or simplistically studied. No systematic research on social development in children with ASD exists that objectively measures anxiety and the related factor of attention to specific social stimuli. We will conduct behavioral, psycho-physiological, and objective attention measurement (eye gaze) assessments of children’s response to a variety of child appropriate social and non-social stimuli.

Our goal is to create a synthesis of measurement of attention, anxiety, motivation, and specific stimulus – response characteristics to better understand the mechanisms of poor social development, and then intervene using this child-specific information. The combining of behavioral and biological measurement approaches will assist in integrating what are now often viewed as very separate conceptual approaches.

The project will develop a new assessment instrument for social development deficits, to be used by caregivers, to identify important child characteristics that directly lead to specific choice of intervention procedures. The instrument will be validated through this multi-method assessment. While the current study focuses on social skills and anxiety, the methodology we are proposing has broad applicability to numerous areas of clinical concern.

Joint Attention Intervention for Children with Autism

Emily A. Jones, Ph.D., BCBA
Kathleen M. Feeley, Ph.D., BCBA
Long Island University

Two of the three core areas of impairment in children with autism are social interaction and communication. Research has documented a key early developing social-communicative behavior that is specifically impaired in children with autism and reflects these two core areas of impairment, referred to as joint attention. Joint attention involves two people sharing attentional focus on interesting objects and events. Given the key role that joint attention plays in social and language development and its unique impairment in children with autism, we have suggested in previous work that it is important to examine the development of effective interventions to teach this key behavior. In a previous study we successfully utilized discrete trial instruction and pivotal response training strategies to teach joint attention to preschoolers with autism in their preschool programs. In the proposed investigation we seek to expand that work by demonstrating the effectiveness of the intervention with parents as interventionists within the home setting. Participants will take part in two studies. In Study 1, participants will be taught two joint attention skills (respond and initiate) by their parent(s) using the same procedures used in previous work. In Study 2, parents will teach joint attention within the context of routines (e.g., reading a book, watching the ducks at the park). In both studies, generalization and changes in more qualitative measures of social-communicative characteristics (e.g., involves two people sharing attentional focus on interesting objects and events) will be also be evaluated.

Assessment of Characteristics of Students with Asperger Syndrome
and the Evaluation of the Mind Reading Computer Software on the Emotion Recognition Ability
of Students with Asperger Syndrome

Brenda Smith Myles, Ph.D.
Department of Special Education
University of Kansas

The purpose of the proposed project is twofold: a) to identify the multi-faceted characteristics of children with Asperger Syndrome (AS) (Phase I) and b) to investigate the abilities of participants to learn to recognize emotions using a computer software program, Mind Reading program CD/DVD version 1.0 (Phase II) (Baron-Cohen, 2004.) Ninety students with AS and 30 neurotypical peers (Phase II only) between the ages of 8 and 11 will participate in the proposed study.

The first phase of this study is designed to develop a better understanding of AS. Specifically, this phase of the study will examine the following characteristics of children with AS: a) AS severity, b) family and student demographics, c) social/emotional profile, d) systemizing and empathizing ability, e) temperament, f) cognition, and g) adaptive behavior.

During Phase II the researcher will investigate the abilities of participants to learn to recognize emotions using a computer software program, Mind Reading Program CD/DVD version 1.0 (Baron-Cohen, 2004.) Since no studies have been conducted using the Mindreading software, the proposed project will improve understanding of a) the skills individuals with AS have in understanding emotions and b) their response to computer-aided instruction. Moreover, the project will investigate the feasibility of computer based intervention for children and youth with AS.

Family-Focused Cognitive-Behavioral Intervention for Anxiety Symptoms
in Children with High-Functioning Autism or Asperger Syndrome

Judy Reaven, Ph.D.
Susan Hepburn, Ph.D.
Health Sciences Center
University of Colorado

Children with high-functioning autism or Asperger Syndrome are at high risk for developing a variety of anxiety disorders. The few treatment studies conducted thus far have investigated the efficacy of medications in the reduction of anxiety symptoms for persons with ASD. Although psychosocial interventions are extremely effective in reducing anxiety symptoms in the general pediatric population, these strategies have yet to be systematically applied to children with ASD. Previous research has demonstrated that when traditional CBT protocols are modified for children with ASD and co-occurring anxiety symptoms, reductions in anxiety symptoms can occur. The primary purpose of this proposal is to assess the effectiveness of a family-focused intervention package on reduction of anxiety symptoms with high-functioning ASD.

Twelve children (and their parents) will participate in the pilot group treatment study, which employs a single subject, multiple baseline design. Three treatment groups will run for 12 consecutive weeks and include both a child and a parent component. Start dates for the group will be staggered, and multiple measures of child anxiety and parenting sense of competence will be collected during the extended baseline period. The 12 weeks of treatment will be divided into two intervention blocks: a) a neurobehavioral introduction to anxiety disorders and an introduction to CBT strategies, and b) implementation and generalization of tools and strategies to treat the anxiety symptoms. Common CBT relaxation training will be included in the intervention package. Anticipated outcomes of this pilot study include completion of a set of treatment manuals describing a family-focused approach to reducing anxiety symptoms in children with ASD. In the future, these treatment manuals will be used in randomized clinical trials of the intervention.

2004 Research Competition Grant Awards—$30,000 each

Improving Social Skills Using Computer-Based Interventions

Kevin Ayres, M.A.
Department of Education
The University of Georgia

The purpose of this study is to investigate a computer and video based intervention to improve social skills of children with autism. By collaborating with parents, teachers and students, the program will specifically target for each student, those social skills that they and their caregivers determine are most critical. Research on direct instruction of social skills is important for individuals with autism because of the deficits these individuals commonly show and the amount of repeated explicit practice they need to begin to succeed in social situations. Computer mediated instruction can provide the high intensity repetition and variety of exemplars that these learners may require to increase their social competence.

While many programs have targeted social skill intervention for children with autism and document improvements, one factor that is rarely considered is the degree to which small changes in a student’s social behaviors may influence peers. With positive influences on peer attitudes, a student may increase the opportunities they have to interact and assimilate into peer groups. This study will directly evaluate student performance but also evaluate change in the larger social context of the student’s classroom.

Further, successful evaluation of a program like the one described in this proposal could provide teachers and care givers another instructional tool to meet the needs of their students. Ultimately, the proposed project will consist of the development and evaluation of a computer based program that will then be made available via the Internet for teachers and parents. Educators can then customize the program for their students needs by following a set of accompanying instructions that will lead them through individualizing social skill objectives and instruction.

Early Identification of Autism: Warning Signs from Brain and Behavior

Karen Pierce, Ph.D.
Eric Courchesne, Ph.D.
Department of Neurosciences
University of California, San Diego

Objective:
To develop a protocol for identifying infants at-risk for autism at the 1-year well-baby check-up based on a combination of behavioral and brain growth indices. A further objective is to study the brain and behavior characteristics of infants at-risk for autism.

Methods:
Pediatricians will participate in a seminar that will teach them to identify the possible brain growth (i.e., dramatic changes in head circumference from birth to 1-year) and behavioral profiles (e.g., a failure to respond to their name) of infants at-risk for autism. Parents from participating pediatrician practices will complete an autism screening and behavioral and neurobiological testing. Results from brain and behavioral tests will be compared between those at-risk for autism and their normally developing peers. The overall success of the program for identifying autism at 1-year will be evaluated when a firm diagnosis can be determined at age 3.

Hypothesized Results:
First, it is anticipated that the project will be successful in training pediatricians to identify infants at-risk for an autism spectrum disorder (ASD). Second, it is anticipated that the at-risk infants will display differences from normal on both head circumference measures as well as behavioral indices of social awareness, attention and exploration. Third, for those infants who go on to receive an MRI, it is anticipated that brain abnormalities will be present at 1-year that mimic the predictions based on head circumference findings. Specifically, we hypothesize increased overall brain volume. Other brain abnormalities that may be detected via MRI await discovery.

Long Term Significance:
The importance of identifying autism at the youngest ages possible cannot be overestimated. Caring for a child with autism is costly both financially and emotionally for parents and school systems alike. Earlier identification means earlier treatment and thus a better outcome for the child and family. Furthermore, given the relative absence of information regarding autism during the first year of life, this research may pave the way for pivotal discoveries regarding the first stages of behavioral and biological dysfunction in this disorder.

2003 Research Competition Grant Awards—$30,000 each

Removal of Social Barriers to Employment For Persons with Autism Spectrum Disorders

John C. Burke, Ph.D.
Kentucky Autism Training Center
University of Louisville

The present study endeavors to improve opportunities for individuals with autism to become socially integrated into the workplace by providing brief training to employers and co-workers of individuals with autism related to the specifics of autism as a diagnosis. The goal of the study will be to determine if data reflects an increase in the subjects' scores on attitude and interaction scales from baseline measurement. Of further inquiry will be whether the measured level of severity is contributory to any statistically significant changes in subjects’ attitude or interaction scores using a repeated measures analysis of variance design involving two groups with random assignment. If the training is found to be effective, the intervention model will be disseminated using print and electronic media and professional development training activities.

This study is believed relevant based upon a review of the literature that suggests that while natural supports are increasingly utilized in supported employment settings, many individuals with severe disabilities, such as autism, may be at a disadvantage for the development of natural supports due to issues of impaired social communication and behavior. If brief training specific to autism is related to increased scores on attitude and interaction scales, then the inclusion of such training into job placement for individuals with autism may prove an efficacious means of developing natural supports.

The New Friendship Study, Part III:
The Influence of Information on Middle School Students’ Attitudes
and Behavioral Intentions towards a Peer with Autism

Jonathan M. Campbell, Ph.D.
Department of Educational Psychology
The University of Georgia

Despite the increasing numbers of children with autism being included in regular education settings, recent research has demonstrated that, as a group, peers assign negative personality characteristics to children with autism and report negative attitudes about socializing with them. Peers’ negative evaluations of children with autism are robust across gender, more negative for older children, and have been shown to persist despite a brief educational intervention about the condition of autism. In contrast, Campbell, Ferguson, Herzinger, Jackson and Marino (2003) recently documented the benefits of providing information to typical third through fifth graders about autism as evidenced by less negative evaluations of the autistic child when information was present versus absent in a videotaped message. Ferguson, Campbell, Herzinger, Jackson and Marino (2003) also collected pilot data to investigate if source of information improved attitudes and behavior intentions towards children with autism. Ferguson et al. (2003) found that children reported more interest in working on academic tasks with an autistic child when teachers and parents provided information about autism versus an outside professional, defined as a “doctor” in the pilot investigation.
The purpose of this project is to continue our study of the influence of information on children’s impressions of an unfamiliar child diagnosed with autism by extending our findings to middle school children. The significance of the study is that it will provide information for regular and special educators in middle schools about how to introduce a new child with autism into a regular education setting.

References
Campbell, J.M., Ferguson, J.E., Herzinger, C.V., Jackson, J.N., & Marino, C. (2003). Brief information about autism improves typical children’s perceptions. Manuscript submitted for publication.
Ferguson, J.E., Campbell, J.M., Herzinger, C.V., Jackson, J.N., & Marino, C. (2003). (The impact of information source on peers’ initial impressions of children diagnosed with autism). Unpublished raw data.

Problem Behavior: The Development of a
Contextual Assessment Inventory for Use by Families

Edward G. Carr, Ph.D.
Department of Psychology
State University of New York at Stony Brook

Many children with autism engage in serious problem behavior such as aggression, self-injury, tantrums, property destruction, and high levels of disruption. These behaviors harm the quality of life for the families involved and prevent the child from being successfully integrated into the neighborhood school, peer social group, local community, and later in life, the workplace. Therefore, it is important to reduce or eliminate problem behavior. Research has shown that systematic assessment of the factors that set off problem behavior can produce information that is very helpful in designing effective treatment intervention. However, assessment is often a time-consuming, laborious process that is difficult for families and their service providers to perform in typical community contexts such as the home. Therefore, the purpose of the proposed research is to develop an efficient, user-friendly inventory that can be employed to help families identify the full range of factors that are involved in the child’s problem behavior. The Contextual Assessment Inventory (CAI) is designed to capture, in a simple format, what is known, from the current research literature, about the factors associated with problem behavior. With the help of a professional, families fill out the CAI at home. The factors involved may be biological in nature (e.g., illness-related, side effects of medication.) They may be social in nature (e.g., being teased, not being able to communicate about one’s needs.) Or, they may be related to some aspect of ongoing activities or routines (e.g., having to wait for something desirable, being asked to carry out a disliked chore.) An “information module” will be developed so that the data from the CAI can be used by families and their service providers to systematically select effective, relevant, evidence-based treatment interventions that currently exist in the published clinical and educational literature.

Teaching the imitation and spontaneous use of gestures
using a naturalistic behavioral intervention in young children with autism

Brooke Ingersoll, Ph.D.
Autism Treatment and Research Program
Hearing and Speech Institute

Children with autism exhibit deficits in the imitation and spontaneous use of descriptive, conventional and effective gestures both in structured settings and in more natural contexts such as play with others. These deficits are a barrier to both communication and socialization, and are thus an important focus of early intervention programs for children with autism. Reciprocal Imitation Training (RIT), a recently designed naturalistic imitation intervention, has been shown to increase spontaneous, generalized object imitation skills in young children with autism during play.

This study is designed to assess whether RIT can be adapted to target the imitation of descriptive, conventional, and affective gestures in young children with autism. Children who exhibit deficits in the spontaneous imitation and use of gestures will be selected to participate. This project will conduct a single-subject, multiple baseline design across five children with autism. Dependent measures will include behavioral and standardized measures of gesture imitation and spontaneous use, as well as additional related behaviors such as language and joint attention. This design will allow for fine-grained, detailed analysis of individual responsiveness to the treatment for both the targeted behaviors (gesture imitation and spontaneous use) and non-targeted behaviors (e.g., language and joint attention.)

It is expected that the participants will exhibit increases in their imitation ability in both the treatment setting and on measures of generalization. In addition, it is expected that the children will also exhibit increases in their spontaneous use of gestures and other social-communicative behaviors including language, joint attention, and social interaction skills. These results will provide support for the effectiveness of RIT to teach gesture imitation and use and will provide a new and exciting option for the treatment of young children with autism who are not yet using or imitating gestures.

Social Skills Development in Children with Autism Spectrum Disorders

Lawrence Scahill, MSN, Ph.D.
Yale Child Study Center

This is a one-year pilot study which will evaluate the acceptability and efficacy of a Social Skills Development Program (SSDP) for children with Autism Spectrum Disorders (ASDs.) The objectives of SSDP are to increase social motivation and to enhance appropriate social behaviors in reciprocal social interaction. These objectives have been chosen because they reflect core deficits in social and communication skills for children with ASDs, can be measured, and can be targeted in a structured social skills training program.

Thirty children with ASDs will be recruited in a rolling recruitment process beginning January, 2004. Each child will be fully assessed regarding the target behaviors, and then each will enter a group consisting of five children with as ASD and two typically developing peers, “peer trainers.” The treatment, which consists of a 12-week, 90-minute intervention, is based on applied behavioral strategies within the context of an intensive group socialization experience. Activities designed to promote social interaction will provide a basis for learning social initiation and appropriate social behavior. Moreover, these behaviors will be taught explicitly and practiced. Typical peers will be trained to provide practice and reinforcement of the target behaviors. Behavior change will be assessed using standard measures through parent interview and direct observation of the child in a naturalistic setting. These data will address the clinical significance of the program, whether the program is acceptable to families, and to what degree interview and observational data converge. A final outcome of the program will be the development of a manual in which the intervention program is described comprehensively, so larger, replication studies can be con ducted to answer the full range of questions regarding social skills intervention for children with ASDs.

Inaugural Research Competition Grant Awards - $30,000 each

Fluency Research for Children with Autism

Principal Investigator: Richard M. Kubina, Jr. Ph.D.
Assistant Professor of Special Education
The Pennsylvania State University

Background
The maintenance of program gains for children with autism is a significant issue for clinicians, educators, and parents of children with autism. While “Precision Teaching” has an established history of research in education, providing a viable measure for behavioral and decision-making progress in young learners, the technique, particularly as it pertains to “fluency’ in skill acquisition and retention, has not yet been researched with autistic students. Fluency means that a person can competently perform a behavior with high degrees of accuracy (Binder, 1993,1996). There are three recognized associated “critical learning outcomes” (according to Binder) that occur with fluency: (1) long-term retention of the behavior after practice has been terminated, (2) endurance – the ability to perform a behavior at a steady pace in the face of external distraction, and (3), application or the integration of one element or component behavior to a composite or compound behavior. As noted by Kubina in his proposal, several applied and experimental studies have demonstrated the positive effects of fluency, but these studies do not contain comparable information for students with autism. One common learning difficulty children with autism exhibit is lack of “maintenance” or the ability to perform an acquired behavior over a long period of time. This study will establish a series of experiments studying the effects of fluency for students with autism. The three experiments will critically examine the learning outcomes associated with fluency for these students. The first segment of the project will analyze the comparative effects of mastery and fluency on the retention of a receptive language skill. The second phase will compare the effects of fluency and traditional maintenance for a receptive language skill. The third experiment will explore the relationship of a fluent receptive labeling skill and the applications to an expressive labeling skill. All of these experiments will involve multiple students with autism. The outcomes may positively impact education and therapeutic interventions by experimentally demonstrating both practical and salubrious effects of fluency.

Study Timeline and Methods
Four students with autism between the ages of 4 and 8 will participate in this study. They will be selected (January – February, 2003) based on their previous experience with discrete trial instruction, demonstrated deficits in vocabulary, and evidence of some receptive picture identification skill. The study will take place during teaching sessions in the students’ classrooms. Program materials will include 10 pictures from a standard set, such as the “Picture This” computerized program. Dependent measures in this study will be accurate responding (defined as pointing to the correct picture within 3 seconds) and the independent variable will Fluency Research for Children with Autism Page 2 be the “mastery” and “fluency” conditions, based on a sampling of response rates of age matched typical peers within a similar task. During the teaching phase, the teacher will use a discrete trial teaching format. Each student will be prompted in their picture identification responses to a point of 90% accuracy or above for two consecutive days across two different therapists. The procedure will then be repeated until the student demonstrates mastery across 20 novel pictures. The pictures will then randomly be divided into two groups: mastery and fluency. Retention probes will be conducted at 1 day, 2 weeks, 1 month, and 3 month intervals following the termination of each respective condition. Probes will be conducted in 20-second timed trials, and data will be recorded on the number of items identified within 20-second trials as well as the accuracy of each response. The first experiment will take place March – May, 2003, the second June – August, 2003, and the final experiment September – October, 2003.

Evaluation
Each child will be assessed using the Receptive and Expressive One Word Vocabulary Test as well as the Peabody Picture Vocabulary Test. Baseline data of experimental pictures will also be established using trial-by-trial measures. The data from the probes portion of the study will be expressed as percentage of accurate responses, calculated by dividing the number of accurate response by the total number of responses multiplies by 100%. The data will also be expressed as frequency of correct responses per time interval. Conclusion and Application A chronic problem found in many programs for children with autism, especially slower learners, is that maintenance programs begin to get cumbersome. Frequently, it becomes less of a priority to practice maintenance skills then it is to work on new skill acquisition programs. As a result, it is often the case that a child looses skills that eventually need to be re-taught at a later time. While it is hypothesized that teaching to “fluency” may eliminate the need for maintenance work for many learners with autism, there is no empirical evidence to date to support this belief. The findings from this study would have a significant impact on the development and implementation of programs for children with autism.

Teaching Social Communication Using Picture Activity Schedules

Principal Investigator: Robert Stromer, Ph.D.
Associate Professor and Senior Scientist
University of Massachusetts Medical School, Shriver Center

Background
Teaching with activity schedules may yield social communication skills that are not readily achieved with discrete trial or naturalistic methods (e.g., Krantz, 2000; McClannahan & Krantz, 1997). To date, research has focused on developing the speech skills that children with autism were able to use to engage their communicative partners (e.g., Krantz & McClannahan, 1993, 1998). In contrast, the present project examines interventions to teach children to use pictures in their socialization, a repertoire resembling the Picture Exchange Communication Skills or PECS (e.g., Bond & Frost, 1998, 2002). Pilot work has demonstrated that activity schedules are procedures capable of accommodating a variety of instructional materials, learner entry skills, and children who use PECS. Research using activity schedules to broaden children’s PECS skills has not been done. Moreover, recent projects began exploring how computers might enhance learning by such methods. This study will also help determine the potential for computers to teach social communication skills in the context of activity schedules. Children selected for this study will possess few if any functional speech skills but are able to use pictures to communicate, as in the Picture Exchange Communication System (PECS). The specific aims of the project are to verify that: (1) computer enhanced activity schedules teach children to use pictures to make requests and comments and (2) the computer enhanced activity schedules teach children to use pictures to initiate and sustain social interactions.

Study Timeline and Methods
Eight children will be recruited for the study, four younger (ages 4 to 6 years) and four older (ages 7 to 10 years) who all have a diagnosis of severe autism (DSMV-IV criteria). The children will have receptive, but few if any expressive skills, based on the Peabody Vocabulary Test (Dunn & Dunn, 1997), Expressive One-Word Picture Vocabulary Test (Brownell, 2000) and analysis of language samples gathered in structured and free play settings (e.g., Hepting & Goldstein, 1996). Each child will then proceed through the following: a one-month preteaching of PECS, with a sentence construction goal of 80% correct for 10-trial blocks in each phase; one-to-three months of preteaching of activity schedules. For Study 1, Requesting and Commenting, over the following three months, targeted interventions will be used teach the child to use pictures to: (a) make requests (b) identify own activities (c) identify listener activities. For Study 2, Social Interactions, the following three months will be used to learn to use pictures to: (a) invite playmate (b) ask for attention and (c) attend to playmate.