Helping Our Toddlers, Developing Our Children's Skills (HOT DOCS): A Problem-Solving Approach for Parents of Young Children with Autism Spectrum Disorders

Overview of Young Children with ASD Autism Spectrum Disorder (ASD) is a developmental disorder that impairs social skills and interactions, delays communication, and is marked by restricted and repetitive behaviors (American Psychiatric Association [DSM-IV-TR], 2000). The current prevalence rate of children with ASD in the United States is 1 in 110 (Centers for Disease Control and Prevention [CDC], 2009), making ASD more common in the pediatric population than some other widely known disorders such as diabetes, cancer, or Down syndrome (Filipek et al., 1999). As early as in the first year of life, infants may show signs of the communication deficits which are characteristic of ASD (Osterling, Dawson, & Munson, 2002 ;Woods & Wetherby, 2003). Such deficits include attention to people, social smiling, gaze and eye contact, orienting to name, pretend play, and imitation. The absence of three key communication strategies by 18 months (i.e., proto- declarative pointing, gaze monitoring, and pretend play) presents a reliable risk of ASD (Baron-Cohen et al., 1996). Later difficulties include difficulties with emotional regulation, attention, and organization of goal directed behavior. Social emotional development is often affected by weak attachment relationships, which later disrupts social exchanges. While research has shown that earlier detection of ASD results in improved outcomes for children, the average age of diagnosis remains at 48 months (Goin-Kochel, Mackintosh, & Myers, 2006). Given the increasing concern to detect and treat ASD early in development, the American Academy of Pediatrics (AAP, 2007) has developed guidelines which call for screening for ASD at the 12-month and 24-month well child visits. While screening and detection systems have improved, few treatment options have been well documented for this very young population (National Autism Center, 2009). Behavioral Intervention for Young Children with ASD With the increased number of young children identified with ASD, there is a critical need for interventions that are effective for this population and their families. The majority of intervention research for ASD has been focused on older, school-aged children and often consists of intensive amounts (i.e., up to 40 hours per week) of behavioral training for the child and caregivers (Peters-Scheffer, Didden, Korzilius, & Sturmey, 2011; Rogers, 1998). Only recently have results of a randomized study of a comprehensive intervention for toddlers with ASD been published (Dawson et al., 2010). This study assessed the efficacy of the Early Start Denver Model, consisting of 20 hours per week of intensive behavioral intervention delivered in the home setting, in which parents delivered five or more hours of intervention per week to toddlers ages 2! /! > years old. Dawson and her colleagues reported significant improvements in IQ, language, adaptive behavior, and a reduced severity of autism diagnosis. Behavioral training for children with ASD typically employs the principles of applied behavior analysis (ABA) (Matson & Smith, 2008). ABA involves careful measurement of behavior and its consequences, and utilizes behavioral technology to improve or strengthen desired behaviors and to weaken undesirable behaviors (Cooper, Heron, & Heward, 2007). These approaches are applied to address a targeted behavioral skill set for children with ASD, such as increasing social interaction (Strain & Schwartz, 2001), communication skills (Woods & Wetherby, 2003), or improving sleep hygiene (Durand, Gernet-Dott, & Mapstone, 1996), and thus are referred to as discrete trial learning. Focused behavioral treatment strategies are typically conducted as single-case or small group designs, as an intense amount of work with the child and caregivers is typically required (Peters- Scheffer et al., 2011; Rogers, 1998). Evidence for behavioral interventions to improve the core deficits of ASD specifically targeted to young children is much more limited. …