Classroom-Based Intervention Improves Core Autism Deficits

Pam Harrison

May 14, 2015

SALT LAKE CITY ― Significant improvements in productivity, social skills, and problem behavior are being reported in children with autism spectrum disorder (ASD) who are exposed to a classroom-based intervention.

Results of the stratified, randomized trial show the Classroom SCERTS Intervention Project (CSI), which was administered by teachers during the course of the 9-month school year, was associated with significantly greater gains in two core features of ASD ― social communication and emotional regulation.

The study was presented here at the International Meeting for Autism Research (IMFAR) 2015.

Significant Gains

"When we wrote this grant, it was with an eye towards creating something that could be executed in the public school system," Lindee Morgan, PhD, associate director of implementation, Autism Institute, Florida State University, in Tallahassee, told Medscape Medical News.

"And SCERTS [Social Communication, Emotional Regulation, and Transactional Support Model] is a readily available commercial curriculum that focuses on two of the core deficits that we see in children with autism — social communication and emotional regulation," she said.

"So we essentially developed the CSI straight from SCERTS but distilled the model down so that it's easier for teachers to take up and implement."

A total of 192 students with ASD in 140 classrooms nested within 64 schools participated in the study.

Teachers who administered the CSI had a 3-day training session and received ongoing coaching from a trained CSI coach throughout the school year.

Teachers whose students served as controls were provided with access to a series of webbased autism training modules (ATMs), but they were not required to use the available modules, nor did investigators track their use.

School pairs were matched on demographic variables and were randomly assigned to either CSI or ATM for a 9-month school year.

Baseline comparisons indicated that the school pairs were equivalent on most measures.

All of the active engagement behaviors were coded using Noldus Observer on the basis of a 15-minute systematically selected video sample that included three to five activities.

"After 9 months, students in CSI made significantly greater gains than students in AMT on two components of active engagement," the investigators note.

These two areas included measures of productivity and responding.

Meaningful Outcomes

Productivity means that the student is clearly engaged in the task at hand and that they are not passively watching or listening or receiving instruction — "in other words, students understand what their role is in the activity," said Dr Morgan.

Productivity was coded as a state behavior — meaning that for every second of video, the child was judged to be productive or not, she added.

At baseline, the CSI group averaged 362 seconds of productivity; the ATM group averaged 411 seconds of productivity.

"At the end of 9 months, productivity was 488 seconds for CSI and 464 seconds for ATM," said Dr Morgan.

"Thus, at the end of 9 months, children in CSI were spending a much greater proportion of time being productive than ATM students ([F 1, 51] = 5.51; P = .023)," she added.

Similarly, CSI children made significant gains in responding. "In other words, they were beginning to tune in more and listen more to teacher and peer language," Dr Morgan said.

For responding, this was coded as a point behavior, meaning that with every verbal bid offer, the percentage of responses was coded.

At baseline, the CSI group responded on average to 46.5% of verbal bids; the ATM group responded to 55.9% of verbal bids.

Again at the end of 9 months, the CSI group was responding at a rate of 46.5% of verbal bids; the ATM group, at 43% ([F, 1, 48] = 10.68, P = .002), she added.

In addition, using both teacher-reported measures (SSRS, BRIEF) and parent reports of adaptive behavior, as measured by Vineland and standardized measures of language, investigators found that students exposed to CSI made significantly greater improvements than the AMT group on social skills, as measured by the SSRS ([F, 1, 20.82] = 9.06; P < .05) as well as on the problem behavior scale relative to control children ([F, 1, 24.45] =.00; P < .05).

On the BRIEF measure, students also made significantly greater gains than AMT children on several subscales ― all of which were statistically significant, the authors observe.

On the basis of parent-reported measures of adaptive behavior, CSI students again made significantly greater gains than their AMT counterparts on the communication subscale ([F, 1, 115] = 6.80; P < .001) as well as on the adaptive behavior composite ([F, 1, 40.63] = 4.71; P < .05).

"Taken together, these finding just tell us that the students' classroom experience was richer — they were more engaged, they were more reciprocal when interacting with others, which is certainly where we want to go," Dr Morgan said.

"And a lot of it is about creating a structure that is meaningful to the student so they understand why they are being asked to do what they are doing and to predict what's going to happen in the activity when they do it and then what's next," she added.

In 2001, the National Academy of Sciences set a goal for children with autism to be actively engaged in instruction for 25 hours a week.

Durable Effect?

Commenting on the study for Medscape Medical News, Brian Boyd, PhD, associate professor of occupational science and occupational therapy, University of North Carolina, in Chapel Hill, said the study adds to growing evidence of the effectiveness of comprehensive treatment models to promote developmental and behavioral outcomes of children with ASD.

"In addition, this study advances knowledge on the types of training and ongoing support classroom-based practitioners need in order to successfully implement evidence-based practices," Dr Boyd noted.

"And the finding that children in the intervention group demonstrated more active engagement is important to highlight, because this behavioral skill has been associated, in general, with better learning outcomes as well as more positive adult and peer interactions in classrooms."

What remains to be learned, he added, is whether the effects of CSI are maintained over time for children and whether the intervention promoted sustained changes in teacher practices and behaviors as well.

Dr Morgan and Dr Boyd report no relevant financial relationships.

International Meeting for Autism Research (IMFAR) 2015. Abstract 18948. Presented May 14, 2015.


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