Measurement Tools and Target Symptoms/Skills Used to Assess Treatment Response for Individuals with Autism Spectrum Disorder Clinical assessment of autism in high-risk 18-month-olds Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder Development and Initial Validation of a Parent Report Measure of the Behavioral Development of Infants at Risk for Autism Spectrum Disorders Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study A controlled trial of a training course for parents of children with suspected autism spectrum disorder. Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model A randomized, placebo controlled trial of omega-3 fatty acids in the treatment of young children with autism A systematic review of peer-mediated interventions for children with autism spectrum disorder. Cluster Randomized Trial of the Classroom SCERTS Intervention for Elementary Students with Autism Spectrum Disorder A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. The design and implementation of a CBT-based intervention for sensory processing difficulties in adolescents on the autism spectrum.
This study examined the  measurement tools and target symptoms/skills  used to assess treatment response during Autism Spectrum Disorder ( ASD ) intervention trials from 2001 through 2010 . Data from 195 prospect i ve trials were analyzed . There were 289 unique  measurement  tools , of which 61.6 % were used only once , and 20.8 % were investigator- design ed . Only three tools were used in more than 2 % of the studies , and none were used in more than 7 % of studies . Studies investigated an average of 11.4 tool-symptom combinations per trial , with as many as 45 in one study . These results represent a lack of consistency in outcome measurements in ASD intervention trials . These findings highlight the need to set guidelines for appropriate outcome measurement in the ASD field Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD Early intervention has been reported to improve outcome in children with autism spectrum disorders ( ASDs ) . Several studies in the field have been r and omized controlled trials ( RCTs ) . The aim of this study was to assess ASD outcome in a large naturalistic study . Two hundred and eight children , aged 20 - 54 months , with a clinical diagnosis of ASD were given intervention and monitored prospect ively in a naturalistic fashion over a period of 2 years . The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county . They fell into three cognitive subgroups : one with learning disability , one with developmental delay , and one with normal intellectual functioning . Data on intervention type and intensity were gathered prospect ively in a systematic fashion . Intervention was classified into intensive applied behaviour analysis ( ABA ) and non-intensive , targeted interventions , also based on ABA principles . Children were comprehensively assessed by a research team before the onset of intervention , and then , again , 2 years later . Change in Vinel and adaptive behaviour scales composite scores from intake ( T1 ) to leaving the study ( T2 ) was set as the primary outcome variable . The research team remained blind to the type and intensity of interventions provided . One hundred and ninety-eight ( 95 % ) of the original sample s stayed in the study throughout the whole 2-year period and 192 children had a complete Vinel and composite score results both at T1 and T2 . Vinel and composite scores increased over the 2-year period . This increase was accounted for by the subgroup with normal cognitive functioning . There was no significant difference between the intensive and non-intensive groups . Individual variation was considerable , but no child in the study was " problem-free " at follow-up . Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA BACKGROUND Children with high-functioning autism spectrum disorders ( ASD ) are at high risk for developing significant anxiety . Anxiety can adversely impact functioning across school , home and community environments . Cognitive behavioral therapies ( CBT ) are frequently used with success for children with anxiety symptoms . Modified CBT interventions for anxiety in children with ASD have also yielded promising results . METHODS Fifty children with high-functioning ASD and anxiety were r and omizedto group CBT or treatment-as-usual ( TAU ) for 12 weeks . Independent clinical evaluators , blind to condition , completed structured interviews ( Anxiety Disorders Interview Schedule – Parent Version;ADIS-P ) pre- and post-intervention condition . RESULTS Forty-seven children completed either the CBT or TAU condition . Results indicated markedly better outcomes for the CBT group . Significant differences by group were noted in Clinician Severity Ratings , diagnostic status , and clinician ratings of global improvement . In the intent-to-treat sample , 10 of 20 children ( 50 % ) in the CBT group had a clinical ly meaningful positive treatment response , compared to 2 of 23 children ( 8.7 % ) in the TAU group . CONCLUSIONS Initial results from this r and omized , design ed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety . Limitations of this study include small sample size , lack of an attention control group , and use of outcome measures normed with typically developing This study evaluated a manualized intervention for sensory difficulties for children with autism , ages 4–8 years , using a r and omized trial design . Diagnosis of autism was confirmed using gold st and ard measures . Results show that the children in the treatment group ( n = 17 ) who received 30 sessions of the occupational therapy intervention scored significantly higher ( p = 0.003 , d = 1.2 ) on Goal Attainment Scales ( primary outcome ) , and also scored significantly better on measures of caregiver assistance in self-care ( p = 0.008 d = 0.9 ) and socialization ( p = 0.04 , d = 0.7 ) than the Usual Care control group ( n = 15 ) . The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol , and provides support for the use of this intervention for children with autism . Findings are discussed in terms of their implication s for practice and future research The purpose of this pilot study was to establish a model for r and omized controlled trial research , identify appropriate outcome measures , and address the effectiveness of sensory integration ( SI ) interventions in children with autism spectrum disorders ( ASD ) . Children ages 6 - 12 with ASD were r and omly assigned to a fine motor or SI treatment group . Pretests and posttests measured social responsiveness , sensory processing , functional motor skills , and social-emotional factors . Results identified significant positive changes in Goal Attainment Scaling scores for both groups ; more significant changes occurred in the SI group , and a significant decrease in autistic mannerisms occurred in the SI group . No other results were significant . The study discusses considerations for design ing future outcome studies for children with ASD The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention We developed and evaluated a new parent report instrument — Parent Observation of Early Markers Scale (POEMS)—to monitor the behavioral development of infants at risk for autism spectrum disorder ( ASD ) because they have older affected siblings . Parents of 108 at-risk infants ( 74 males , 34 females ) completed the POEMS from child age 1–24 months . The POEMS had acceptable psychometric properties and promising predictive validity . Most concerning items were social and communication deficits , and intolerance to waiting . Results provide preliminary evidence that prospect i ve parent report measures can help to detect early ASD symptoms in infants at biological risk . We invite research ers to join us in multi-center studies of the POEMS Clinical ly elevated anxiety is a common , impairing feature of autism spectrum disorders ( ASD ) . A modular CBT program design ed for preteens with ASD , Behavioral Interventions for Anxiety in Children with Autism ( BIACA ; Wood et al. , 2009 ) was enhanced and modified to address the developmental needs of early adolescents with ASD and clinical anxiety . Thirty-three adolescents ( 11 - 15 years old ) were r and omly assigned to 16 sessions of CBT or an equivalent waitlist period . The CBT model emphasized exposure , challenging irrational beliefs , and behavioral supports provided by caregivers , as well as numerous ASD-specific treatment elements . Independent evaluators , parents , and adolescents rated symptom severity at baseline and posttreatment/postwaitlist . In intent-to-treat analyses , the CBT group outperformed the waitlist group on independent evaluators ' ratings of anxiety severity on the Pediatric Anxiety Rating Scale ( PARS ) and 79 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 28.6 % of the waitlist group . Group differences were not found for diagnostic remission or question naire measures of anxiety . However , parent-report data indicated that there was a positive treatment effect of CBT on autism symptom severity . The CBT manual under investigation , enhanced for early adolescents with ASD , yielded meaningful treatment effects on the primary outcome measure ( PARS ) , although additional developmental modifications to the manual are likely warranted . Future studies examining this protocol relative to an active control are needed Youth with autism spectrum disorders frequently experience significant symptoms of anxiety .  Empirically supported psychosocial interventions exist , yet access is limited , especially for families in rural areas .  Telehealth ( i.e. videoconferencing ) has potential to reduce barriers to access to care ; however , little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality . This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders . The primary focus of this study is on feasibility , with evaluation of outcomes as a starting point for future r and omized trials . In all , 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study ( Telehealth Facing Your Fears ( FYF ) Intervention : n = 17 ; Wait-list control : n = 16 ) . Youth of all functioning levels were included .  Acceptability was strong ; however , the usability of the technology was problematic for some families and impeded some sessions significantly . Fidelity of the telehealth version to the critical elements of the original , in vivo version was excellent . More work is needed to improve delivery of exposure practice s and parent coaching . Preliminary efficacy analyses are promising , with improvements observed in youth anxiety over time ( relative to a comparison group waiting for live intervention ) and parent sense of competence ( within group ) . Clearly , stronger design s are necessary to evaluate efficacy sufficiently ; however , this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents OBJECTIVE To evaluate a training course for parents , design ed to help them underst and autism spectrum disorder and to facilitate social communication with their young child . STUDY DESIGN Controlled trial for 51 children aged 24 to 48 months , whose parents received either immediate intervention or delayed access to the course .  Outcome was measured 7 months after recruitment in parents ' use of facilitative strategies , stress , adaptation to the child ; and in children 's vocabulary size , behavior problems , and social communication skills . RESULTS Taking into account scores at recruitment , child 's level of ability , diagnostic grouping , and the interval between assessment s , a significant advantage was found for the intervention group in parents ' observed use of facilitative strategies and in children 's vocabulary size . CONCLUSIONS The training course is well received by parents and has a measurable effect on both parents ' and children 's communication skills OBJECTIVE : To conduct a r and omized , controlled trial to evaluate the efficacy of the Early Start Denver Model ( ESDM ) , a comprehensive developmental behavioral intervention , for improving outcomes of toddlers diagnosed with autism spectrum disorder ( ASD ) . METHODS : Forty-eight children diagnosed with ASD between 18 and 30 months of age were r and omly assigned to 1 of 2 groups : ( 1 ) ESDM intervention , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years ; or ( 2 ) referral to community providers for intervention commonly available in the community . RESULTS : Compared with children who received community-intervention , children who received ESDM showed significant improvements in IQ , adaptive behavior , and autism diagnosis . Two years after entering intervention , the ESDM group on average improved 17.6 st and ard score points ( 1 SD : 15 points ) compared with 7.0 points in the comparison group relative to baseline scores . The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children . In contrast , over the 2-year span , the comparison group showed greater delays in adaptive behavior . Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder , not otherwise specified , than the comparison group . CONCLUSIONS : This is the first r and omized , controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis . Results of this study underscore the importance of early detection of and intervention in autism Background Autism spectrum disorder ( ASD ) is a neurodevelopmental disorder affecting more than 1 % of children . It is characterized by social communication deficits and repetitive behaviors/restricted interests . In the absence of any medications known to improve core symptom domains , parents often use complementary alternative treatments , including omega-3 fatty acid supplements . Methods We conducted a 6-month , r and omized , placebo controlled trial of omega-3 fatty acid supplements ( 1.5 g ) vs placebo in children 2 to 5 years of age with ASD . Primary outcome measures included the autism composite score of the Pervasive Developmental Disorders Behavioral Inventory ( PDDBI ) and the externalizing problems score of the Behavior Assessment System for Children ( BASC-2 ) . Secondary outcome measures included clinical global improvement ( Clinical Global Impression-Improvement ( CGI-I ) ) , adaptive function ( Vinel and Adaptive Behavior Scale ( VABS-II ) ) , and language gains ( Preschool Language Scale ( PLS-4 ) ) , as well as safety . Exploratory analysis investigated potential correlations between changes in cytokine profiles and treatment response . Results Thirty-eight participants were r and omized in a 1:1 fashion . There was no significant difference between groups on the 0- to 24-week change in PDDBI autism composite scores ( p = 0.5 ) . There was a significant group by week interaction on the BASC-2 externalizing problem score , with participants r and omized to the treatment group demonstrating worsening scores ( p = 0.02 ) . There was no statistically significant week by group effect on either adaptive function ( p = 0.09 ) or language ( p = 0.6 ) . Omega-3s were relatively well tolerated . Changes in cytokines during the study did not significantly correlate with treatment response . Conclusions This study does not support high dose supplementation of omega-3 fatty acids in young children with ASD.Trial registration Clinical trials.gov NCT01248728 . Registered 22 November 2010 BACKGROUND Peer mediated intervention ( PMI ) is a promising practice used to increase social skills in children with autism spectrum disorder ( ASD ) .  PMIs engage typically developing peers as social models to improve social initiations , responses , and interactions . METHOD The current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group design s. Five studies met the pre-specified review inclusion criteria : four r and omized controlled trials and one pre- and post-test design . RESULTS Four of the studies were conducted in school setting s , whereas one study was conducted in a camp setting . The studies all reported that participants improved in social skills ( e.g. , social initiations , social responses , social communication ) post intervention . Additionally , sustainment , generalization , and fidelity of implementation were examined . CONCLUSION PMI is a promising approach to address social skills in children with ASD , and this approach can be conducted in meaningful real-word context s , such as schools . Limitations of the studies as well as future directions are discussed Objective : This cluster r and omized trial ( CRT ) evaluated the efficacy of the Classroom Social , Communication , Emotional Regulation , and Transactional Support ( SCERTS ) Intervention ( CSI ) compared with usual school-based education with autism training modules ( ATM ) . Method : Sixty schools with 197 students with autism spectrum disorder ( ASD ) in 129 classrooms were r and omly assigned to CSI or ATM .  Mean student age was 6.79 years ( SD 1.05 ) and 81.2 % were male . CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation . A CRT , with students nested within general and special education classrooms nested within schools , was used to evaluate student outcomes . Results : The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction . The CSI group also had significantly better outcomes on measures of adaptive communication , social skills , and executive functioning with Cohen ’s d effect sizes ranging from 0.31 to 0.45 . Conclusion : These findings support the preliminary efficacy of CSI , a classroom-based , teacher-implemented intervention for improving active engagement , adaptive communication , social skills , executive functioning , and problem behavior within a heterogeneous sample of students with ASD . This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention BACKGROUND Unusual reactions to sensory input now form part of the diagnostic criteria for autism . These features are common and can have an often-devastating impact on autistic individuals and their families . Yet there are few vali date d interventions that help to remediate or support autistic individuals ' adverse sensory experiences . To date , both measurement of sensory experiences and the result ing interventions have been based on assumptions of neurological sensitivities and largely ignored the role of cognition . This study therefore sought to assess the feasibility of a new 8-week CBT-based group intervention for self-regulation of sensory processing difficulties . METHOD Seven cognitively able adolescents diagnosed with autism aged 11 - 16 years from one mainstream secondary school received the 8-week intervention . Measures of sensory reactivity , anxiety and repetitive behaviours were taken at baseline , post-intervention and follow-up , 8 weeks after the intervention had ceased . Semi-structured interviews and focus groups were also conducted with adolescents and their parents to examine further the acceptability of the intervention . RESULTS The results showed that the intervention itself was feasible - both in its implementation and its acceptability to participants . Qualitative analysis clearly showed that the intervention was effective in raising meta-conscious awareness and self-regulation in these autistic adolescents . Analysis of outcome variables showed no significant change over the intervention period , although effect sizes were moderate-to-large . CONCLUSIONS These preliminary results are encouraging and should inform the design of a future pilot r and omized controlled trial to test its efficacy with a larger group of participants
Overall three question naires were found robust in their measurement properties , the Spence Children 's Anxiety Scale , its revised version - the Revised Children 's Anxiety and Depression Scale , and also the Screen for Child Anxiety Related Emotional Disorders .
Crucially the articles on measurement properties provided almost no evidence on responsiveness to change , nor on the validity of use of the tools for evaluation of interventions for children with ASD .
BACKGROUND Evidence about relevant outcomes is required in the evaluation of clinical interventions for children with autism spectrum disorders ( ASD ) .
However , to date , the variety of outcome measurement tools being used , and lack of knowledge about the measurement properties of some , compromise conclusions regarding the most effective interventions .
OBJECTIVES This two-stage systematic review aim ed to identify the tools used in studies evaluating interventions for anxiety for high-functioning children with ASD in middle childhood , and then to evaluate the tools for their appropriateness and measurement properties .