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SCIENCE IN AUTISM TREATMENT
Vol. 9 No. 2

Newsletter of the Association for Science in Autism Treatment

Spring 2012

Autism Treatment Reviews for Physicians: The Take
Take--home Messages

Table of Contents
Autism Treatment Reviews for Physicians ............. 1
Science in Autism Treatment Team ………………….. 1
Shout Outs, Accolades, and Appreciations ............ 5
Letter from the Editor.............................................. 8
ASAT Conference ..................................................... 8
Review: RCT of DIR/Floortime Therapy ................. 9
Focus on Science: Pitfalls of Testimonials ........... 12
ASAT Advisory Board ............................................. 12
Treatment Summary: Son-Rise............................. 13
New CDC Autism Numbers Highlights .................. 13
Annual Rock’n 4 Autism Awareness Concert ....... 14
ASAT 2011 Sponsors ............................................ 15
Clinical Corner: Expanding Interest ...................... 16
ASAT Advertising Policy ......................................... 18
ASAT Sponsorship ................................................. 192011 ASAT Donor Wall ......................................... 20
ASAT Board of Directors ........................................ 21
Media Watch Update ............................................ 21
Research Review: RCT of Manualized Tx ............. 22
Research Review: Effectiveness of PECS ............ 23
Research Review: Synchronous Engagement .... 24
International News ................................................ 25
ASAT Committee Members ................................... 25
ASAT’s Facebook Update ...................................... 25

By Peggy Halliday, MEd, BCBA, Zachary Houston, MS, BCBA, Elisabeth
Kinney, MS, BCBA & Scott M. Myers, MD
Although screening and early recognition of autism spectrum disorders(ASDs) are important, the role of the primary healthcare provider does not
end with diagnosis. Management responsibilities after the diagnosis of ASDs
include providing high quality medical care and guiding families to effective
interventions and accurate information sources. Primary healthcare
providers, such as pediatricians, family physicians, nurse practitioners, andphysician assistants, may take part in any or all of these duties in addition to
making referrals to subspecialists and coordinating services.

In a national survey conducted in 2007, pediatricians and family physicians
reported low self-perceived competency in providing care for children with
ASDs and a desire for education (Golnik, Ireland, & Borowsky, 2009).
Fortunately, in recent years, literature reviews and guidelines have been
published which summarize the evidence and help medical professionals tomanage their patients with ASDs. In this article, we summarize the treatment
recommendations of five reviews that have been published in the medical
literature in the last four years, including the American Academy of Pediatrics(AAP) guidelines (Carr & LeBlanc, 2007; Myers & Johnson, 2007; Golnik,
Ireland, & Borowsky, 2009; Myers, 2009; Carbone, Farley & Davis, 2010;
Munshi, Gonzalez-Heydrick, Augenstein, & D’Angelo, 2011).

General Management Issues
Broad treatment goals include improving quality of life by: (1) correcting or minimizing the core deficits (social
impairment, communication impairment, and restricted, repetitive behaviors and interests) and associated deficits, (2)maximizing functional independence by facilitating learning and academic achievement, acquisition of self-care anddaily living skills, and development of play and leisure skills, and (3) eliminating or minimizing problem behaviors thatinterfere with functioning (Myers & Johnson, 2007; Myers, 2009). Most interventions that are helpful for achieving
these goals are carried out by parents and professionals such as teachers, therapists, and behavior specialists- not byphysicians. However, efforts to optimize health are likely to have a positive impact on educational progress and qualityof life.
The medical home model of care, which is advocated for children with ASDs and other special healthcare needs,
includes provision of care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate,(Continued on page 2)

Science in Autism Treatment (SIAT) Team
Co-Editors
David Celiberti, PhD, BCBA-D
Joshua K. Pritchard, PhD, BCBA
Focus On Science
Daniel W. Mruzek, PhD, BCBA-D
International Updates
Daniela Fazzio, PhD, BCBA-D

Research Synopses
Sharon Reeve, PhD, BCBA-D

Treatment Summaries
Tristram Smith, PhD

Clinical Corner
Nicole Pearson, PsyD

EventsDenise Grosberg, MA, BCBA

Consumer Corner
Kate Fiske, PhD, BCBA-D

Shout Outs
Kerry Ann Conde, MS, BCBAMedia Watch
Barbara Jamison, BA

From The Archives
Sara Jane Gershfeld, MA, BCBA

ASAT, P.O. Box 188, Crosswicks,
ASAT New Jersey 08515-0188

www.asatonline.org
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Pediatric Guide continued...
and culturally effective (Myers,2009). Reviewers point out that in
the case of patients with ASDs,
office visits and physicalexaminations may be challenging
and require extra time and effort.

guidelines to guide families toward childhood educational programs
evidence-based educational
most often used, and which differ
treatments. There is generalin basic philosophy, are behavior
agreement among well-researched analytic, developmental, andguidelines that educational
structured teaching.
treatment should begin early andtreatment goals should be
There are five decades of
In addition to issues specific tocomprehensive. Treatments should controlled studies in university andtheir neurodevelopmental disorder, strive to minimize core social,community settings showing theindividuals with ASDs have thecommunication, and behavioral
effectiveness of applied behavior
same basic healthcare needs as
deficits, and to maximize self-care, analysis (ABA) based interventions
other children and they benefit
academic independence, andin helping remediate social andfrom routine health promotion and leisure skills, while at the samelanguage impairments as well as
disease prevention efforts,
time decreasing aberrant
helping children make sustained
including immunizations. In some behaviors that interfere withgains in IQ, academic performance,cases, medical therapy may playfunctioning (Myers & Johnson,
and adaptive skills, compared toan important role in treating
2007; Myers, 2009). Early
children in control groups (Carr &problem behaviors such as
diagnosis and early intervention
LeBlanc, 2007; Myers & Johnson,
aggression and self-injury, either by are associated with best outcomes 2007; Munshi, Gonzalez-Heydrick,treating a coexisting psychiatric or for children with ASDs. However, in Augenstein, & D’Angelo, 2011).
neurologic condition or addressing the United States the average age Early and intensive behavioral
an underlying medical problemof identification is still older thaninterventions (or EIBI) are skills(such as an ear infection orconstipation) to alleviate pain
or discomfort (Myers &Johnson, 2007; Myers, 2009;
Carbone, Farley, & Davis,
2010; Munshi, GonzalezHeydrick, Augenstein, &D’Angelo, 2011). Currently,
four despite the ability to identify
based treatment approaches
medical therapies are directed at
ASDs as early as two years of age based on the science of applied
specific symptoms or coexisting(Carr & LeBlanc, 2007).
behavior analysis. EIBI program
conditions rather than the ASD
models differ but share aitself. For example, children with
The role of the physician should
philosophy of starting when
ASDs who have seizures or
include guiding families tochildren are very young, intensity ofgastrointestinal problems (such as empirically supported educational treatment (25-40 hours per week),
chronic diarrhea or constipation)and habilitative practices anda focus on communication, social,should be evaluated and treatedhelping them evaluate theand pre-academic repertoires, andthe same way as any other childappropriateness of educational
the use of teaching methods
with these symptoms would beservices being offered (Myers &derived from the principles of
evaluated and treated.
Johnson, 2007). Of the many
operant conditioning (Carr &educational methods available for LeBlanc, 2007).
Educational/Habilitative/
the treatment of ASDs, someBehavioral Interventions
methods, such as facilitated
Such programs should be
Easy access to the Internet has
communication, have been proven individualized and based on
resulted in widespreadto be ineffective. Others, likeassessment (Carr & LeBlanc,
dissemination of both information auditory integration training,2007). Behavioral therapy can be
and misinformation aboutdolphin-assisted therapy, holding
provided by an early intervention
treatments for ASDs. Fortunately,
therapy, vision therapy, or
program, a special education
medical professionals can help
therapeutic touch lack evidence to program through a school, or bymanage the care of their patients show efficacy in treating individuals therapists in private practice.
with ASDs by drawing uponwith ASDs (Myers, 2009). The three Caregivers who are interested inpublished literature reviews andgeneral categories of early(Continued on page 3)

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Pediatric Guide continued...
pursuing this treatment approach should be referred to
the Behavior Analyst Certification Board to locate aprofessional qualified to oversee such a program.
Programs based on developmental theory include therelationship development intervention (RDI) anddevelopmental, individual-difference, relationship-basedmodel (DIR, also known as “floor-time”). Social deficits
are the primary focus of both interventions, and both are
popular and relatively widespread in their dissemination;
however, no well-controlled studies documenting theireffects have been published. Furthermore, the basic
developmental theories upon which RDI and DIR arebased have not been tested. When considering theseinterventions, the lack of empirical support should beconsidered.

eclectic educational methods.
There is a growing agreement that effective earlychildhood intervention for children with ASDs should
include the following components (Myers & Johnson,2007):
 Starting early, even before a definitive diagnosis has

been made; Intensive teaching for at least 25 hours a week, allyear long; One-on-one and small group instruction, with low

student-to-teacher ratios; Parent or caregiver training; Ongoing measurement and data analysis in order toindividualize instruction as required; Structured environments, including visual schedules,

Structured teaching is best exemplified by Project
clear physical boundaries and predictable routines;
TEACCH (Treatment and Education of Autistic and Strategies to promote generalization and
Related Communication-Handicapped Children). The
maintenance of learned skills;
goal of structured teaching is to use strategies like visual  Assessment based curricula that includes functional
supports, individual work stations which minimize
communication, social skills, self-management,
distractions, and picture schedules to aid withcognitive and academic skills and functionaltransitions. These strategies cater to the learning styles
adaptive skills to increase independence;of many individuals with autism. The National Research  Reduction of disruptive behavior using strategies
Council considers Project TEACCH a “plausible”
that employ functional assessment.
intervention; however, there are currently no wellcontrolled studies of its outcomes.
Psychotropic Medications
Medications that are used to produce behavioral,
Many educational treatments for children andemotional, or cognitive changes are known as
adolescents with ASDs, despite their popularity, have not psychotropic medications.
been adequately evaluated, and some do not meet
Psychotropic medications havecriteria for “well-established” treatments due to a lack of not been proven to correct therobust experimental designs, independent replications or core social communication
peer-reviewed published data. This does not necessarily deficits of ASDs, and theymean that they are ineffective; however, efficacy has not obviously do not teach skills.
been established and replicated in well-designed clinical However, medications arestudies (Carr & LeBlanc, 2007).
sometimes effective fortreating associated problem
In many communities, an “eclectic” treatment approach behaviors or coexisting psychiatric conditions thatis used which combines ABA, structured teaching, and a interfere with educational progress, socialization, healthdevelopmental approach. While there are manyand safety, and quality of life (Myers & Johnson, 2007;
differences between the approaches, there are also
Myers, 2009; Munshi, Gonzalez-Heydrick, Augenstein, &areas in which they borrow from one another. For
D’Angelo, 2011).
example, behavioral programs address social
interactions like joint attention and imitation, borrowing Examples of problems that might potentially be targetedfrom developmental approaches, as well as utilizing
with psychotropic medications include irritability,
visual strategies borrowed from structured teaching;aggressive or self-injurious behavior, ADHD symptoms
some developmental models and structured teaching(inattention, distractibility, impulsivity, and hyperactivity),
approaches use behavioral techniques to meet theiranxiety, mood disorders, and sleep problems. The bestteaching goals. However, studies which have compared evidence of effectiveness of psychotropic medications
outcomes from the eclectic approach groups to intensive for specific symptoms in people with ASDs comes from
ABA groups have shown more favorable outcomes in the independently replicated studies involving randomized,
ABA groups, raising questions about the efficacy of(Continued on page 4)

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Pediatric Guide continued...
double-blind, placebo-controlled trial designs, with adequate sample sizes and well-characterized study
populations.
The atypical antipsychotic medications, risperidone and aripiprazole, are currently the only medications with
U.S. Food and Drug Administration-approved labeling specific to ASDs [for the symptomatic treatment of
irritability, including aggressive behavior, deliberate self-injury, and temper tantrums in children andadolescents with autism] (Myers & Johnson, 2007; Myers, 2009; Munshi, Gonzalez-Heydrick, Augenstein, &D’Angelo, 2011). There is also substantial evidence that these medications and others such as methylphenidate, guanfacine, and atomoxetine are helpful for attention-deficit/hyperactivity disorder (ADHD) symptoms insome individuals with ASDs. Some evidence supports the use of the atypical antipsychotics risperidone andaripiprazole and possibly selective serotonin reuptake inhibitors (SSRIs; such as fluoxetine or fluvoxamine) andthe anticonvulsant medication, valproate, for repetitive and rigid behaviors associated with ASDs. However, thelargest published controlled trial did not demonstrate that citalopram, a SSRI, was superior to placebo for
repetitive behavior associated with autism. Melatonin may be effective for those who have difficulty falling
asleep at night.
Functional assessment often reveals that problem behaviors in individuals with disabilities, including ASDs,
serve as a way to reach an outcome such as attention, access to a preferred object or activity, or escape from ademand or non-preferred activity. In these cases, behavioral interventions are the most effective treatments,
and they should be used before medication is considered (Myers & Johnson, 2007; Carr & LeBlanc, 2007;
Myers, 2009; Carbone, Farley, & Davis, 2010; Munshi, Gonzalez-Heydrick, Augenstein, & D’Angelo, 2011). Even
when medication is used, behavioral strategies are important, and there is growing evidence that the
combination of behavioral intervention with medication results in better outcomes, with lower doses of
medication required (Munshi, Gonzalez-Heydrick, Augenstein, & D’Angelo, 2011). In the case of rapid onset or
intensification of problem behaviors, children with ASDs should be evaluated by their physicians to rule out
potential medical causes, such as a hidden source of pain or discomfort. Middle ear infections, dental
abscesses, reflux esophagitis, constipation, medication side effects, menstrual periods, or other medical
problems may be identified and treated, and resolution of the underlying medical issue may alleviate thebehavioral difficulties.
All medications can have adverse effects, and it is important for healthcare providers to only prescribe
medications with which they have sufficient expertise. When the decision is made to start a therapeutic trial of
medication, the specific target symptoms or behaviors for the medication should be identified, and a planshould be in place for monitoring of outcomes, including desired effects and adverse, or undesired, effects(Myers & Johnson, 2007; Myers, 2009; Carbone, Farley, & Davis, 2010). This could be done using a tool as
simple as a daily behavior data sheet, counting the desired outcomes and associated signs of adverse orundesirable reactions. Once done, this can be compared to a baseline of data obtained before the medication
was put in place (Munshi, Gonzalez-heydrick, Augenstein, & D’Angelo, 2011).
The treatment reviews noted some of the common pitfalls of treatment with psychotropic medication. For
example, although monotherapy (use of a single medication) is desirable, patients with complex problems are
sometimes treated with more than one psychotropic medication (polypharmacy).
There is very little information available about combinations of medications, and
it is critical that physicians have a good understanding of the potential
interactions among medications and monitor closely for adverse effects,
especially if the individual being treated has limited communication skills and isunable to clearly identify if something is not right. Because of the widespreaduse of the Internet and the highly-variable quality of available information, it iscommon for parents and other care providers to be exposed to strong advocacy
for treatments that have not been shown to be effective in properly designed
scientific studies. It is important for physicians to be aware of the empiricalevidence behind the treatments they are considering and strive to ensure thatthe most safe and effective interventions (based on well-designed scientific(Continued on page 5)

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Pediatric Guide continued...
studies) are the ones that are selected (Carr & LeBlanc, 2007).
Complementary and Alternative Medicine
Complementary and alternative medicine (CAM) has been defined by the National Center for Complementary andAlternative Medicine (NCCAM) as “a group of diverse medical and health care systems, practices, and productsthat are not presently considered to be part of conventional medicine” (NCCAM, 2000). The NCCAM has organized
CAM practices into five domains: mind-body medicine, manipulative and body-based practices, energy medicine,
biologically-based practices, and alternative medical systems, such as homeopathy and naturopathy, which may
utilize therapies found in the other four domains.
Many CAM therapies from all 5 of the NCCAM domains have been advocated for the treatment of children with
ASDs. The reviews that address CAM therapies state that the vast majority have been inadequately evaluated andcannot be recommended for treatment of ASDs based on the available evidence (Myers & Johnson, 2007; Carr &LeBlanc, 2007; Carbone, Farley & Davis, 2010). Potential risks of CAM treatments include direct toxic effects ofbiological agents or manipulative techniques, presence of contaminants, interactions with prescribed
medications, interference with appropriate nutrition, interruption or postponement of valid therapies, andunwarranted expenditure of time, effort and financial resources (Myers & Johnson, 2007; Carr & LeBlanc, 2007;
Carbone, Farley & Davis, 2010).
CAM interventions are sometimes divided into two categories, biological and nonbiological; although this is amisnomer because ultimately, the mechanism of action of any effective intervention would necessarily be throughimpacting central nervous system biology. The most thoroughly evaluated biological CAM treatment for autism, the(Continued on page 6)

Shout Outs, Accolades, and Appreciations! By Kerry Ann Conde, MS , BCBAASAT would like to recognize those individuals and organizations who strive to support our mission. Specifically, we
would like to thank and send a “shout out” to…








The Association for Behavior Analysis International for reaching out to all 2012 members to share our special Autism Awareness Month call for subscriptions to Science in Autism Treatment
Deb Harris from the ELIJA Foundation for listing ASAT on their home page: www.elija.org and in their January
2012 Newsletter
Behaviorbabe (www.twitter.com/behaviorbabe) for supporting ASAT on Twitter
Autismoaba (www.twitter.com/autismoaba) for supporting ASAT on Twitter
Zaira Santana and Adriana Cristóbal for translations of ASAT material into Spanish
DJ Cindy Vero of KTU 103.5 FM in NYC for her interview withDavid Celiberti and Barbara Wells showcasing ASAT and theRock'n 4 Autism Awareness concert. Listen here: http://tinyurl.com/ASATradioDena Russell of the Hoboken Special Needs Parent Group for
spreading the word about ASAT's concert
Larry and Kathy Hannon for sharing ASAT materials throughout
April within their Dairy Queen stores in Maine
McLean in the Morning for the Tyler McLean radio interview
with David Celiberti http://soundcloud.com/search?q%5bfulltext%
5d=David+Celiberti

If you would like to share information about any initiatives you haveundertaken to support ASAT, please write us at
publicity@asatonline.org.

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Science in Autism Treatment

Pediatric Guide continued...
hormone secretin, has been thoroughly evaluated and proven to be ineffective. Some of the under-evaluatedbiological CAM treatments that have been popular in recent years include hyperbaric oxygen, immunoregulatoryinterventions (such as dietary restrictions, immunoglobulins, and antiviral agents), detoxification therapies (suchas chelation), various gastrointestinal treatments (such as digestive enzymes, antifungal agents, probiotics, yeastfree diets, vancomycin, and gluten- and casein-free diet), dietary supplements (large doses of vitamins,
magnesium, folic acid), and even stem cell infusions. Examples of non-biological CAM therapies that have waxed
and waned in popularity include auditory integration training, behavioral optometry, craniosacral manipulation,
dolphin-assisted therapy, and facilitated communication, none of which has been proven to be effective.
The AAP has stated that pediatricians should: (1) critically evaluate the scientific evidence of efficacy and risk ofharm of various treatments and convey this information to families, (2) help families understand how to evaluatescientific evidence and recognize unsubstantiated treatments and pseudoscience, and (3) insist that studies thatexamine CAM treatments be held to the same scientific standards as all clinical research (Myers & Johnson,2007). This requires open lines of communication and families should not be discouraged from sharing
information about any CAM treatments that they may be considering (Myers & Johnson, 2007). According to a
recent survey, only 36-62% of caregivers who used CAM therapies for their children with ASD shared that
information with their child’s primary care physician, yet they indicated that that they wanted more information on
CAM therapies from physicians (Myers & Johnson, 2007). If families are reluctant to disclose CAM treatments totheir child’s physicians, the physicians may inadvertently prescribe medication that has a potential interaction with
the CAM treatment. When speaking with families, physicians should encourage families to seek additional
information if:

The treatment is based on overly simplified scientific theories;
It is claimed that the therapy is effective for multiple different unrelated conditions or symptoms;
It is claimed that children will respond dramatically and some will be cured;Support for the treatment is based on case reports and anecdotes rather than carefully designed studies;
There is a lack of reference to peer-reviewed -scientific literature or, denial of the need for controlled
studies, or the existing literature directly contradicts the claims of proponents of the CAM treatment;The treatment is said to have no potential or reported adverse effects.
Conclusions
All treatments should be based on sound, plausible theoretical constructs and objective scientific evidence ofefficacy. When treatments are evaluated, well-designed, and ppropriately controlled studies using rigorous
methodologies are required to prove that the observed effects are attributable to the intervention being studied. In
the published scientific literature, the evidence is strongest for behavior analytic strategies for both teaching new
skills and reducing problem behaviors in children with ASDs. In some cases, when serious problem behaviors
remain after a function-based approach has been utilized, a trial of psychotropic medication may be warranted totarget certain specific symptoms, usually in conjunction with behavioral interventions. By providing their patientswith ASDs with ongoing high-quality medical care and guiding them to effective interventions, healthcare providers
can help to maximize important outcomes including functional independence and quality of life.
References:
Carbone, P.S., Farley, M., & Davis. T. (2010). Primary care for children with autism. American Family Physician, 81, 453-460.
Carr, J.E. & LeBlanc, L.A. (2007). Autism spectrum disorders in early childhood: An overview for practicing physicians. Primary
Care: Clinics in Office Practice, 34, 343-359.
Golnik, A., Ireland, M., & Borowsky, I.W. (2009). Medical homes for children with autism: A physician survey. Pediatrics, 123,
966-971.
Myers, S.M., Johnson, C.P., & American Academy of Pediatrics Council on Children With Disabilities (2007). Management ofchildren with autism spectrum disorders. Pediatrics, 120, 1162-1182.
Munshi, K.R., Gonzalez-Heydrich, J., Augenstein, T., & D'Angelo, E.J. (2011). Evidence-based treatment approach to autism
spectrum disorders. Pediatric Annals, 40, 569-574.
Myers, S.M. (2009). Management of autism spectrum disorders in primary care. Pediatric Annals, 38, 42-49.
National Center for Complementary and Alternative Medicine (2000). Expanding horizons of healthcare: five year strategicplan 2001-2005. Washington, D.C.: U.S. Department of Health and Human Services.

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Science in Autism Treatment

Message from SIAT Co-editor, Josh Pritchard, PhD, BCBA
Wow! Each issue of the Science in Autism Treatment leaves me amazed. Each quarter we have such great content contributors
for our issue. As with any publication, we have great ideas and articles pitched for the issue that for some reason or anothertend to lag behind schedule. Each issue, as this happens, we say things like, well, this might be a short issue. We always strive tobalance the endless amount of information with compassion for you, our readers in mind. We try not to create 100 page issues!
However, even when we shift content from a planned issue to the next (and this happens every issue), we still find our pages
filled to the brim. I have edited several professional science-based newsletters before, and one of the most difficult roles has
been to scrounge up enough content to pull together a 3-4 page newsletter worth reading. Because of our stellar volunteer
contributors (too numerous to mention by name here!), this is not a problem that we encounter.

Volume 9,2 Spring 2012

We are seeing a lot of discussion about the “epidemic that is autism” in the news and social media. As Dan mentioned in thisissue (p 14), this is sure to generate an even larger amount of treatment options that are simply not supported by science, evidence, and sometimes even logic. As an organization, we see an enormous amount of work ahead in our future to try and keep
abreast of all those who are trying to cash in on the vulnerable families affected. I urge you to take a moment and look at ourboard and our volunteers. You will notice that this is a group of very busy professionals, parents and science advocates who give
freely because they care.

From our tireless president supported by his veteran officers to the newest board members, we are abusy, productive group. I marvel at how much ASAT accomplishes with a 100% volunteer board. However, the best is yet tocome. I think 2011 will pale in comparison to what ASAT has in store for 2012. Here is where youcome in. We need support.
In 1999, when SIAT began, it cost $15 per year. With inflation calculated, that would be about $20
today. If you find SIAT informative, and you want to support science-based treatment of autism,
we ask that you consider donating at least that much. Any amount helps us to accomplish our
mission. Our children deserve better than much of what passes as “treatment” for autism. Help us
make sure they get what they deserve: http://asatonline.org/donate.
Yours in Science,

ASAT conference by Denise Grosberg, MA BCBA
We are very pleased to announce that for
the first time ever, the Association for
Science in Autism Treatment and Bilinguals Inc. Pediatric Therapy(http://www.bilingualsinc.com/)co-hosted an autism conference on
April 3, 2012 titled Science andTechnology: Driving Autism Intervention. This all day conference
took place at Baruch College in
New York City, bringing togetherthefamilies of children with autism accessand learn about scientifically validated
treatments and interventions. This confer-ber, who spoke about improving observational learning skills in children with
autism. Also of note was a workshop
entitled “Technology and Learning: developing innovative teaching methods
for individuals with autism spectrum
disorders,” presented by ASAT Vice
President Mary McDonald, and “Using
sharedence featured autism specific vendors,
the Principles of Science in Everyday
agenda of
networking opportunities and educational Educational Practices with Young Chilboth organ- presentations by ASAT members. Ourdren with Autism,”,presented by ASAT
izations to keynote speaker was Bridget Taylor,
Board Member Daniel W. Mruzek.
help ALL
Psy.D., BCBA-D andASAT Board mem-

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Review of Randomized Control Trial of DIR/Floortime Therapy: “Learning throughinteraction in children with autism: Preliminary data from a social -communicationbased intervention” by Sara Gershfeld, MA, BCBA and Tristram Smith, PhD
Backgroundand a behavioral perspective.
sample size, it is unclear how many
Parents and clinicians frequently
Over the course of development children did not qualify for this study,
face the issue of making informedof DSP approaches, treatment opdid not enroll, or dropped out. Casendecisions amongst heated debates
tions such as the Hanen Method
hiser and colleagues also mentioned
over the most effective approaches(Manolson, 1992), Relationship De- that recruitment occurred with parfor treating young children with auvelopment Intervention (RDI;
ents that were interested in receiving
tism (Prizant & Wetherby, 1998). Of Gutstein, 2001), and Developmental a DIR-based intervention. It is not
the current approaches used to treat Individualized Relationship-based
articulated whether parents who
autism, there lies a continuum rang- (DIR) Intervention (Greenspan &were eligible but did not have a speing from intensive discrete-trialWieder, 2006) have received atten- cific interest in DIR therapy were nottraining, to behavior analytic treattion from parents of individuals with included in this sample.
ment that combines many different
autism despite a lack of research
Numerous exclusionary criteria
instructional methods, to socialthat uses the “gold standard” of rewere applied that are not atypical for
pragmatic and developmental apsearch methodology – a randomized these types of comparison studies
proaches. This article provides acontrolled trial.
(Dawson et al., 2009). Twenty-fivebasic description of a class of interIn this study, Casenhiser and col- participants were assigned to a tarventions that have recently received leagues (2011) examine a DSP apget group that received 2 hours ofincreased attention – Developmental proach known as a developmental,
DIR®-based therapy per week andSocial Pragmatic (DSP) interventions. individual-difference, relationshipparent coaching at the Milton & Ethel
Casenhiser, Shanker and Stieben based (DIR®) model, which is often
Harris Research Initiative (MEHRIT).
(2011) evaluate DSP as a method of interchangeably referred to as Floor- Twenty-six participants were asimproving social interaction skills of time Therapy. The DIR®/Floortime
signed to a community group thatchildren with autism spectrum disor- approach focuses on helping individ- received an average of 3.9 hours/der (ASD) and state that these differ- uals with ASD master skills related to week of a variety of different services
ent approaches may teach the same communication, thinking throughranging from an unspecified combitypes of behavior, but approach them understanding of developmental
nation of speech therapy, applieddifferently than a traditional behavmilestones, respecting a child’s indi- behavior analysis (ABA), occupational
ioral approach.
vidual differences and challenges,
therapy, social skills, day care, and/For example, most interventions and asserting the importance ofor other alternative treatments inacknowledge that eye contact is rebuilding relationships with primarycluding diets and hyperbaric oxygen
lated to increased joint attention and caregivers to encourage developtherapy.
language (Casenhiser, 2011). As
ment. Although the theory behind
Although the community groupsuch, interventions aim to teach chil- this type of approach is well explored represents a diverse spectrum ofdren with autism to make eye conusing anecdotal evidence in Greentreatments that a typical individualtact. A DSP perspective might sugspan and Weider’s book “Engaging
with autism might receive, neither
gest that exhibiting eye contact is not Autism,” there is a lack of robust evi- treatment groups received intervenwhat is important, but rather that it is dence to validate its effectivenesstion at the suggested intensity docuimperative to share the eye contact experimentally (Greenspan & Weider, mented through experimental literain a social or play experience. Thus, 2006). As such, Casenhiser and col- ture to show progress in a number ofCasenhiser (2011) reasons that aleagues evaluate the DIR®/Floortime developmental domains. Additionally,
DSP model focuses on the function
approach as an intervention aimed
the intervention received by the comof the behavior to engage sociallyat improving the sociomunity group was well below thewith a peer or adult, whereas a becommunication skills of individuals
hourly level of researched lowhavioral approach might look at the with autism using a randomized con- intensity interventions (Eldevik, Eiktopography of the behavior as imtrol trial.
eseth, Jahr,& Smith, 2006), despite
portant independent of whether it
numerous past research studies indioccurs in a social experience or not
Methodcating that intensive behavioral inter(for example, attending to instrucThis study enlisted 51 children
vention is more effective than eclection). This basic assumption forms a ranging from 2 to 5 years old. Though tic therapy (Howard, Sparkman, Codivide between the DSP perspective this highlights the relatively large(Continued on page 10)

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Volume 9,2 Spring 2012

Science in Autism Treatment

Review of RCT continued...
hen, Green, & Stanislaw, 2005). Lastly, the authors
cantly greater on these items than those made by the
did not indicate whether the community group partici- community group, except in the domain of compliance.
pants received this eclectic combination of services
In all measures, the community treatment group didfrom the same providers or if there were any standard worse at the end of 12 months except in the category
methods documenting whether staff had the properof independent thinking.
training necessary to administer the therapy used in
Speech-language pathologist staff, blind to the parthe community group. For example, for an individual
ticipant condition, conducted pre- and postreceiving ABA, training and supervision should assure assessments and found no significant difference oncompetencies in a number of areas including experitwo standardized language scales (PLS-4, Zimmerence designing and implementing comprehensive ABA man, Steiner, & Pond, 2006; CASL, Carrow-Woolfolk,
programming for individuals with autism, which should 1999). A modified standardized measure had predicinvolve areas ranging from “learning to learn” (e.g. lis- tors of language change (mCBRS, Kim & Mahoney,
tening, imitating, following directions), social interac2004), but the authors noted that it was difficult totion, self-care, school-readiness, communication, toensure validity since this scale had been modified folplay and leisure (Celiberti, Buchanan, Bleecker, Kreiss, lowing scale standardization. Caregiver behavior was& Rosenfeld, 2004). If these and other competencyalso investigated and statistical differences showedbased measures are not met, it is expected that anthat the MEHRIT group showed improvement on all
individual with autism receiving this type of service at items except a Sensory-Motor Support item. No signifiany intensity or duration will likely make minimal (or at cant associations for compliance were indicated inleast less than optimal) progress. Thus, concerns can this scale either.
be raised regarding the control group chosen in thisThough these results indicate some improvement
trial.
based on the intervention, statistical significance only
Treatment implementation for the target groupindicates that the differences between groups
occurred by licensed speech-language pathologists or (however small) are not likely due to chance factors,
occupational therapists. These staff members were
but does not indicate that these differences are mean®
trained for 3 weeks on a number of DIR techniques. ingful. It is also unclear how the group averages apply
The authors do not address a basic question regarding to individual children within the groups (for example,
external validity: Is the training received by these staff how many children within each group made significant
members aligned with the training level of typicallygains or to what extent outcomes varied from child totrained DIR/Floortime therapists? The authors menchild). In addition, because the intervention containedtion that there is a certification offered through Serena multiple components, it is uncertain how each compoWeider, but many DIR/Floortime therapists do therapy nent influenced the behavior of the parent and child.
without this certification. Even with a certification,
there lacks a manual or guide used to standardize the Discussionintervention techniques. There is no measure of
By standards of experimental autism literature,whether the providers implemented the intervention
this experiment has notable strengths. Casenhiser andas intended by the developers of the intervention.
colleagues enrolled a relatively large sample size. The
Thus, it is difficult to say what occurred in the interven- randomized control trial used a randomized designtion session or how it could be replicated. As such,consisting of two groups – a treatment (“target”) groupresults of the study may not reflect those that would
and a control group. Participants were randomly asbe observed if an individual with autism received this signed to either group. Participants were paired based
treatment in a natural setting.
on age and baseline language level. This sampling procedure ensured that both treatment groups were simiResults & Data Analysis
lar before intervention. Well-established outcome
Results indicated that there were no significant
measures were used to identify participant progress,
differences observed on all scales prior to treatment. and included an assessment of whether parents acRatings were coded by trained staff blind to the treat- quired new skills. The experiment also monitored thement condition. After treatment, the researchers extreatments obtained outside of the study.
amined the relationship between participant group
Aside from these strengths, this study leaves conplacement and 5 scale items (attention to activity, in- siderable question regarding the validity of the treatvolvement, compliance, initiation of joint attention and ment group improvement when compared with a poorenjoyment in interaction). Improvement was signifi(Continued on page 11)

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Review of RCT
ly conceptualized control condition. This control condition was not a “no-treatment” control group, but instead
was an undefined blend of procedures with no evidence of procedural integrity, at a level considered less thanadequate in the research literature. A better comparison might have contrasted the MEHRIT treatment groupwith a no-treatment group; an eclectic group at the correct duration or dosage; or a group receiving a behaviorbased treatment with high procedural integrity. In addition, results were significant on a modified scale, potentially lacking validity.
A significant area of treatment administration that did not show significant results was in the domain of compliance. Compliance is an important skill for individuals with autism, and many demonstrate opposition whenrequired to complete basic tasks (Ducharme & Drain, 2004). The necessity of learning-to-learn skills such ascompliance, attending, orienting, choice-making and simple imitation must be taught early in the intervention
process before more complex skills, such as social communication and play, can be addressed (Luiselli, Russo,
Christian, & Wilczynski, 2008). It is standard to ensure that a foundation for these skills is present before addressing some of the variables that were explored in this study.
Treating an individual with autism often encompasses biological, developmental and/or behavioral approaches to autism treatment. These approaches all aim to remediate the most pertinent symptoms of an individual with autism. Among behavioral and developmental approaches, there are misconceptions about the difference between these two approaches and the utility of both. Casenhiser (2011) attempts to validate Developmental Social Pragmatic (DSP) Interventions, specifically DIR®/Floortime (Prizant & Wetherby, 1998). Although
this study provides an indication of the effectiveness of this approach, it should be independently replicated before it is considered empirically valid. DIR® is an emerging treatment, however families are urged to continue
with treatments that are currently empirically supported.
References:
Arnold, A., Randye, B.I., & Claire, C. M. (2000). Eye contact in children’s social interactions: What is normal behaviour? Journal ofIntellectual and Developmental Disability, 25(3), 207–217.
Casenhiser, D.M., Shanker, S.G., & Stieben, J. (2011).Learning through interaction in children with autism: Preliminary data from asocial-communication-based intervention. Autism, 0 (0), 1-22.
Carrow-Woolfolk, E. (1999). Comprehensive Assessment of Spoken Language. Circle Pines: MN: American Guidance Service.
Celiberti, D., Buchanan, S., Bleecker, F., Kreiss, D., & Rosenfeld, D. (2004). The road less traveled: Charting a clear course for Autism
Treatment.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., &Varley, J. (2009). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 125(1), 17-23.
Ducharme, J.M., & Drain, T.L. (2004). Errorless academic compliance training: improving generalized cooperation with parental requests in children with autism. Journal of American Academy of Child Adolescent Psychiatry, 43(2), 163-171.
Eldevik, S., Eikeseth, S., Jahr, E., & Smith, T. (2006). Effects of low-intensity behavioral treatment for children with autism and mental
retardation. Journal of Autism and Developmental Disorders, 36, 211-224.
Green, G. (1996). Early behavioral intervention for autism: What does research tell us? In Behavioral intervention for young children
with autism: A manual for parents and professionals (pp. 29–44). Austin, TX: Pro-Ed, Inc.
Greenspan, S.I., & Wieder, S. (2006). Engaging autism: Using the floortime approach to help children relate, communicate, andthink. Cambridge: MA: Da Capo Press.
Gutstein S.E., Burgess, A.F., & Montfort, K. (2007). Evaluation of the relationship development intervention program. Autism: The
International Journal of Research and Practice, 11(5), 397–411.
Gutstein, S. (2001). Solving the Relationship Puzzle. Arlington, TX: Future Horizons.
Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359–383.
Kasari, C., Paparella, T., Freeman, S., & Jahromi, L.B. (2008). Language outcome in autism: Randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology,76(1): 125–137.
Kim, J.M., & Mahoney, G. (2004). The effects of mother’s style of interaction on children’s engagement: Implications for using responsive interventions with parents. Topics for Early Childhood Special Education, 24(1), 31.
Luiselli, J.K., Russo, D.C., Christian, W.P., & Wilczynski, S.M. (2008). Effective practices for children with sutism: Educational and behavior support interventions that work. New York, NY: Oxford University Press.
Manolson, A. (1992). It takes two to talk. Toronto: Hanen Centre.
Prizant, B.M., & Wetherby, A.M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches to communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19,329–353.
Smith, T., & Lovaas, O. I. (1998). Intensive and early behavioral intervention with autism: The UCLA Young Autism Project. Infants andYoung Children, 10(3), 67–78.
Zimmerman, I.L, Steiner, V.G., & Pond, R.E. (2006). Preschool Language Scale-4. New York: The Psychological Corporation and Harcourt Brace Jovanovich.

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Volume 9,2 Spring 2012

Science in Autism Treatment

Focus on Science: The Pitfalls of Testimonials by Daniel W. Mruzek, Ph.D., BCBA-D

ASAT Advisory Board
F. J. Barrera, PhD, BCBA-D

Stephen Barrett, MD
When searching for a great restaurant or choosing alearning channels” andMartha Bridge Denckla, MD
movie to go see, often we consider the personal re“promote language acquisiCurtis Deutsch, PhD
ports of neighbors, work associates and friends. Why tion”. Of those 100 parents, it
not? Their “testimonies” give us a quick method foris reasonable to expect that at
William V. Dube, PhD
judging the probability that a particular restaurant or
least a small number of themDeborah Fein, PhD
movie will be a good investment. Of course, ourperhaps 5 or 10%- may report
Eric Fombonne, MD
friends and associates are not always right, but theirthat the product “seems to
Richard Foxx, PhD, BCBA-D
testimonials serve as either short-cuts or as corrobora- help”, even if the trampoline is
Gina Green, PhD, BCBA-D
tion of other sources of information (e.g., restaurant or not at all effective as an interWilliam Heward, EdD, BCBA-D
movie reviews). As such, they contribute to efficientvention in the way describeddecision-making about relatively low-stakes events.
by the marketer. A savvy marRonald Kallen, MD
We commonly see testimonials made by happy conketer is watching for members
Alan Leslie, PhD
sumers presented by marketers of autism treatments. of this small subgroup of conBennett Leventhal, MD
Indeed, testimonials are a standard feature on websumers as their source of new
Johnny L. Matson, PhD
sites marketing pills, exercises, devices, interventions testimonials!
Joyce E. Mauk, MD
and therapies to potentially unwary consumers. Many And, how about all of the parCatherine Maurice, PhD
testimonials take the form of simple, quoted stateents who purchased the tramments (e.g., “The [marketed treatment] has had anpoline and, subsequently recBobby Newman, PhD, BCBA-D
amazing effect on my son!”). On the internet, video
ognized that it did not “openJohn Pomeroy, MD
testimonials may be particularly compelling. Marketers learning channels” andStephen Porges, PhD
know that the testimonials of“promote lanSharon Reeve, PhD, BCBA-D
some people, including attractive
guage acquisiJoyce Rosenfeld, MD, FACEP
people, familiar celebrities, andtion”? You canArthur Toga, PhD
people who may remind the potenbe assured
tial consumer of him- or herself
that their opinPaul Touchette, PhD
may be particularly effective. Addions will not
Roberto Tuchman, MD
ing pleasant theme music andgrace the marPaul Yellin, MD
using artful filming may complete
keter’s webthe effect and increase the probasite, social media or glossy print adbility that families separate fromvertisement. As a result, the markettheir hard-earned money.
ers promote an illusion of product efBut, how should we use testimonifectiveness where one may not exist
al evidence in selecting potential
at all.
autism treatments? When confronted with testimoni- It is for these reasons that parents and other consumals about possible autism treatments, it is recomers of autism “treatments” are cautioned to view testimended that families be especially cautious, particu- monials skeptically. Testimonials are a wonderful way
larly when the testimonials are the only source of support for the intervention. Marketers can find a few indi- for business people to market merchandise but a poorway for families to determine true effectiveness of aviduals who provide testimony that their product iseffective, even when the product is wholly ineffective. treatment, device or intervention. Decisions regarding
This is because, as consumers, our opinions about the autism treatment are best guided by the scientific recquality of a product- including perceived effectiveness- ord, as supplied by trusted sources (e.g., a competentare colored by our previous experience, what we have physician, psychologist or other autism expert). When
been told by others, and our expectations. Furtherit comes to making decisions about expensive autism
more, because human behavior- including the behavior of individuals with autism- is variable (i.e., changes interventions and the allocation of precious resources,
across time), a treatment benefit may appear to exist, persons with autism- and their families- deserve nothing less.
even when it does not exist at all.
For example, imagine that a marketer sold a “special”
Have an idea for Focus on Science? Send it to:trampoline to 100 parents with the guarantee thatdaily use of the trampoline by their child would “open Daniel_Mruzek@URMC.Rochester.edu

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Page 13Treatment Summary: Son-Rise
We chose this issue’s treatment summary to illustrate the dangers that Dr.
Mruzek warned us about on page 12: a treatment that relies extensively on testimonials as their evidence.
Description: The Son-Rise Program was developed and trademarked by Barry andSamahria Lyte Kaufman decades ago. The program offers training sessions toparents and others on how to implement home-based programs for children witha wide range of disabilities. The program is based upon the Kaufmans' own personal theories of learning and development. A central principle of the Son-Rise
program is that parents must convey an attitude of “total acceptance” of theirchild including all of his/her behaviors. The training that the Kaufmans offer places emphasis not on thechild’s skills, or behaviors, or challenges, but more on the parents and caregivers.
Research Summary: There have been no scientific studies of Son-Rise for individuals with autism spectrum
disorders.
Recommendations: Researchers may wish to conduct studies with strong scientific designs to evaluate SonRise. Professionals should present Son-Rise as untested and encourage families who are considering this intervention to evaluate it carefully.

New CDC Autism Numbers Highlights the Need for Effective Treatment By Daniel W. Mruzek, PhD, BCBA-D
As many readers have no doubt heard by now, theCenter for Disease Control (CDC) and Prevention’s
Autism and Developmental Disabilities Monitoring(ADDM) Network recently reported that about 1 in 88
children has been identified with an autism spectrum
disorder (ASD) in the United States, with the ASDs
almost 5 times more common inboys (1 in 54) than in girls (1 in252). These numbers represent a
sizable increase over previous estimates of the occurrence of ASD
and caught the attention of media
outlets all over the world.
The CDC attributed improved identification of autism, particularly inhistorically under-served populations, as one reason for the higher
estimate of prevalence, but more
research is needed to determine
whether there actually are moreindividuals with autism than in thepast. Regardless of all the factors that may be responsible for the increased prevalence estimate, these new estimates highlight the importance of helping
families access effective treatment quickly and helping families and others distinguish science-based
treatments from unproven or disproven treatments.
For marketers of fad “treatments”, “miracle cures”
and interventions lacking scientific validation, thesemost recent CDC numbers are no doubt interpreted
as signs of a “growth industry” for their trade. Unfortunately, this trade is too often conducted on thebacks of individuals with autism, on the hopes of consumers trying to make the best treatment decisions,and at the expense of hard-earned family income.
As a non-profit, volunteer-driven
organization dedicated to supporting individuals and families affected by autism, ASAT sees these new
CDC numbers as a striking reminder that the need for scientificallyvalidated autism interventions andsupports has never been greater.
This is true for young, newly diagnosed children who benefit from
effective early intervention, for students with autism who, with proper
supports, contribute to the richnessof our schools, and for adults with
autism who have a right to active,
meaningful participation in their communities.
We invite you to team up with ASAT in taking a firm
stand in the face of deceptive marketers and promoting effective, science-validated treatments for individuals with autism. Together, we can make a differencein the lives of individuals with autism and their families.

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Volume 9,2 Spring 2012

Science in Autism Treatment

The 2nd Annual Rock’n 4 Autism Awareness Concert: We rocked, we rolled, and we raised awareness forscience-based autism treatment by Denise Grosberg, MA, BCBA and David Celiberti, PhD, BCBA-D
The 2nd Annual Rock’n 4 Autism Awareness Concert, co-hosted by ASAT and Hoboken-based HOPES
CAP, Inc., rocked out on Saturday afternoon, April 28th. Beautiful weather and an enthusiastic crowd
contributed to the success of this indoor/outdoor event. Some highlights included: Attendees enjoyed two sets from the Fuzzy Lemons, a popular and beloved family-friendly rock band.
The kids tore up the dance floor!
 We were lucky to have another guest appearance by NY Jets Player, Mike Devito, who was available for
pictures and autographs! Thank you to Joe Epstein who took photographs of concert attendees with
Mike, as well as to Emily Krohn and Angel Davila who took wonderful photographs throughout theevent.
 Hoboken Mayor Dawn Zimmer stopped by and spoke to the crowd (Just a few days earlier, Mayor Zimmer had declared April 25th as Autism Awareness Day in Hoboken).
 ASAT Board members Barbara Wells, Ruth Donlin, Mary McDonald, Marianne Clancy, Peggy Halliday
and David Celiberti, ASAT Externs Lauren Schnell, Dena Russell, Caitlin Reilly, and Germaine Ibrahim
and Clinical Corner Coordinator Nicole Pearson were on hand to ensure a successful event. We were grateful to be joined by 50 volunteers including individuals from HOPES CAP Inc., Autism New Jersey,
Hoboken Mommies, Starbucks, Stevens Institute of Technology andHoboken Volunteers.
 Over 100 local businesses contributed money, merchandise and/or
services to make the event a success. We listed all donors who contributed money, services, or items worth over $200 on page 15. Attendees vied over some silent auction items such as a Jets-signed
football, a summer pool pass, artwork, gym memberships, and a hotel
stay in San Juan, just to name a few.
 Barbara Wells and David Celiberti were interviewed by Cindy Vero from KTU Radio in NYC. Listen here:
http://tinyurl.com/ASATradio
Aside from organizing a spectacular, family-friendly event here in Hoboken for families of children with
autism and the broader community, our goal was to leave an indelible imprint in the local area withrespect to awareness of autism, its treatment, and access to high-quality information to guide treatment decisions. Some of the many local initiatives that will be funded by this benefit concert include: Comprehensive compilations of resources for families of children with autism and service providers
who are attending this event, provided at no charge.
 Creation of autism lending libraries in HOPES Hoboken locations and one location in Plainfield, NJ;
as well as an additional lending library for the Hoboken Special Needs Parent Group.
 Full scholarships for several local parents to attend autism-related conferences.
 Information packets to be shared with local pediatricians for distribution to parents of children with
autism. Future plans include making this information available to family
physicians serving adults with autism as well; and Financial assistance for the Hoboken Special Needs Parent Group, whichis committed to supporting the broader community of parents of children
with special needs.
Additionally, some of the many national initiatives that will be supported bythis benefit concert included: Creation of a resource booklet for pediatricians and primary care physicians: Beyond an ASD Diagnosis: Supporting Families Over the Lifespan.
 Identification of 3000 new family members and service providers in the
US who will receive free subscriptions to Science in Autism Treatment;and Translation of printed material about autism treatment into Spanish.
We are already beginning to plan for next year’s concert!

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Benefactor Level Sponsors and Donors($1000 and higher)

Patron Level Sponsors ($200-499)
A & P Hoboken
A Room to Grow
BAMA Galleries
Bricks 4 Kidz
Court Street Restaurant & Bank
Dino and Harry’s
Domino’s Pizza
Dunkin Donuts
The Edison Hotel
Essence of the Garden
Full House Printing
Guitar Bar
Hoboken Hot House
Hoboken Mommies
Hudson Place Realty, Inc.
Intercontinental Hotel San Juan, PR
Johnny Rockets
Kicking the Spectrum
King’s Super Market, Inc. Downtown

Applied Companies
Candice Stern Graphic Design
KoKo Fit Club of Hoboken
Provident Bank Foundation
UCP of Hudson County
Alliance Level Sponsors ($500-999)
A Whole New World Academy
Chamonix Skin Care
Christopher Street Cookies
Clear Channel Radio
Different Roads to Learning
Joanne Shu, Prime Real Estate Group
Hartshorn Portraiture
Hoboken Boot CampHOPES CAP Inc.
K.C. Kids Hoboken
David Rees, New York Life
Party Decorations by Theresa
Party Faces by Rachel
Party with Purpose
PNC Bank Maxwell Lane
Riverside Pediatrics
Ellen Samitt
Hugo Gonzalez, State Farm
Sweet Nicholas
Travelin’ Tumblers
Ace Endico Company StoreWB Wood

LA Kick Boxing
Monroe Movement Center
Erika Muller, Muller Insurance
New Jersey Skate Shop
New York Jets
Taekwondo School
Progressive Pediatrics
Provident Bank
Rita’s Italian Ice
Safe Kids of Hudson County
SKF Books
Solares, Inc.
Small Business for Education Foundation
Starbucks
The Villa Salt River
Wise Vision and Hearing

Heartfelt thanks to HOPES CAP Inc. for being sucha wonderful partner in planning and hosting thisincredible event!

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Volume 9,2 Spring 2012

Science in Autism Treatment

Clinical Corner: Expanding Interest
My child is doing well with many of his ABA programs, even the ones that focus on play. Unfortunately, he doesn't
play with most of the toys that we give him, and he has worked for the same five things since our program began ayear ago (marshmallow peeps, Thomas trains, tickles, Wiggles songs, and raisins). What can I do to expand his
interests and maybe even get those interests to function as reinforcers for teaching targets?
Answered by Tanya Baynham, MS, BCBA
Program Director, Kansas City Autism Training Center
Inherent in a diagnosis of autism is the fact that thechild will engage in restricted or repetitive behavior
and may also have restricted interests. Expanding
those interests, specifically in the areas of toys andplay, is an important programming goal as it can resultin a number of positive effects. First, rates of sociallyappropriate behaviors may increase while rates of inappropriate behaviors may decrease. For example, engaging a child in looking at a book may decrease his
stereotypic behaviors or passivity (Nuzzolo-Gomez,
Leonard, Ortiz, Rivera, & Greer, 2002). Second, interest expansion can lead to new social opportunities forchildren and enable greater flexibility when bringing
them to new environments. For example, a child with a
new preference for coloring may be taken to a restaurant because he will sit and color the menu, or he canattend Sunday school because he will color a picture
when directed. Third, the addition of new reinforcers in
ABA programs may help prevent satiation or allow you
to allocate more highly preferred items for difficult
teaching targets and less preferred items for easiertargets.

Expanding the preferences, interests and playrepertoires of children with autism can be challenging but
the benefits of doing so, including greater flexibility andimproved social behavior, make the efforts worthwhile.
In this edition of Clinical Corner, Tanya Baynham offers
practical and fun strategies that both parents andteachers can use to successfully expand the interests ofchildren with autism in the areas of toys and play.
Nicole Pearson, PsyD
Clinical Corner Coordinatorsented, number of different toys approached/contacted across a week (in and/or out of session),engagement duration with new toys, and affect while
engaging with toys. It is sometimes helpful to trackchanges across specific categories (e.g., social activities, food, social toys, sensory toys, etc). If your child
only watches Thomas videos, you may narrow the focus to the category “videos” in order to track expansion of interests to different types of videos. Keeping in
mind the previous point about a teacher’s role in expanding a child’s interests, you may also want to set
goals to ensure changes in teacher behavior such as,“Present three new items each day.”

Stocco, Thompson, and Rodriguez (2011) showed that Once data are being taken, it is important to impleteachers are likely to present fewer options to individu- ment procedures likely to expand you child’s interests.
als with restricted interests and allow them to engage One way to expand toy play is to present, or pair, a prelonger with items associated with those restricted inferred item with the item you want to become moreterests. The authors suggest one possible reason for
preferred (Ardoin, Martens, Wolfe, Hilt and Rosenthal,
this is that teachers might be sensitive to the negative 2004). Here are a few examples:behaviors (e.g., whining, pushing the toy away) that can Use peeps as the game pieces in a game you
accompany the presentation of a new toy. The results
want your child to enjoy, then eat the peeps atof this study prompt us to be aware of our own role indifferent points during the game;
potentially limiting a child’s access to novel experienc Sing a favorite song as you help your child up
es or activities and to find effective ways of expanding
the ladder of an unfamiliar slide on the playa child’s interests without evoking tears and other negground; andative behavior.
 Tickle your child before turning each page while
reading a book.
Most importantly, make reinforcer expansion a teaching focus and take data. First, track the number of dif- A second way to expand interests is to think about why
ferent toys and activities with which your child engages your child engages in those restricted interests. If he
to identify your child’s current patterns. Then, measure likes Thomas because of the happy face, put Thomas
the effects of your attempts at reinforcer expansion on stickers on a ringstacker. If he likes Thomas because
your child’s behavior. Ala’i-Rosales, Zeug, andof the wheels, present other vehicles with wheels. If
Baynham (2008) suggested a variety of measures that your child likes peeps because they blow up in the mican be helpful in determining whether your child’s
crowave, put Mentos in a cola bottle or use baking soworld is expanding. These include: number of toys pre(Continued on page 17)

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Clinical Corner continued...
da to make a volcano. If he likes peeps because theylarge sets or on shelves, requesting items out ofare squishy, use marshmallows in art projects or in aview, requesting while watching television commatch by feel game. A third way to expand interests is
mercials);
described by Singer-Dudek, Oblak, and Greer (2011),  Teach the skill of making forced choices
who demonstrated that some children will engage(presenting a few options and asking the child tomore with a novel toy after simply observing anotherchoose) and then offer forced choices of items
child receiving reinforcers after playing with it. To apthat you would like your child to explore. Associatply these findings to your child, the teacher could giveing these items with choice may motivate yourThomas trains to a sibling who just played with novel
child to engage with them; anditems such as play dough or shaving cream.
 If your child does not initiate play, make sure component skills of games are mastered before teachThe methods described may only be effective in proing the play activity. For example, teach “Ned’s
ducing functional play if your child has the skills necHead” or “Memory” once your child can match.
essary to engage appropriately with the toys. If yourIntroduce “Hi Ho Cheerio” only after your child canchild is not spontaneously playing with toys with whichcount objects.
he has been taught to engage, consider the following
potential reasons: the play skill may not have been
References
taught to a natural criterion where the child has“mastered” it independently, the program may include Ala’i-Rosales, S., Zeug, N. M., & Baynham, T. (2008).
a verbal instruction required for the child to begin
The development of interests in children with auplaying, the teacher may place the toy in front of thetism: A method to establish baselines for analyses
child or present it in a visually different way from how
and evaluation. Behavioral Development Bulletin,
it would be on a shelf (e.g., a puzzle or ring-stacker
14, 3-16.
taken apart versus assembled). These features canArdoin, S. C., Martens, B. K., Wolfe, L.A., Hilt, A. M., &become discriminative for playing with the object. If
Rosenthal, B. D. (2004). A method for conditioning
spontaneous play is the goal, consider fading any verreinforce preferences in students with moderate
bal instructions, adding teaching steps until the childmental retardation. Journal of Developmental andis selecting the toy from a shelf or its natural place inPhysical Disabilities, 16, 34-55.
the home, and teaching the child how to initiate the
Nuzzolo-Gomez, R., Leonard, M., Ortiz, E., Rivera, C.,&
play sequence without any teacher interaction.
Greer, D. (2002). Teaching children with autism toprefer books or toys over stereotypy or passivity.
Here are some final strategies to consider when exJournal of Positive Behavioral Interventions, 4, 80
panding your child’s interests:–87.
 Prioritize toy rotation. Depending upon the number
and diversity of toys with which your child engagSinger-Dudek, J., Oblak, M., & Greer, R. D. (2011). Eses, you may rotate toys on an hourly, daily, weekly,
tablishing books as conditioned reinforcers foror monthly basis. Removing a high preference
preschool students as a result of observationalcommonly used toy from the rotation can result inintervention. Journal of Applied Behavior Analysis,
increased approach and engagement with other44, 421-434.
toys;
Stocco, C. S., Thompson, R. H., & Rodriguez, N. M.
 Provide the toy you want to become reinforcing for(2011). Restricted interests and teacher presenta“free” in addition to the toy your child chooses durtion of items, Journal of Applied Behavior Analysis,
ing a reinforcement break;44, 499-512.
 Teach skills that lead to independent initiations ofactivities (e.g., scanning and selecting among
Current ASAT Externs
Dena Buonarota Russell, MA
Germaine Ibrahim, MEd
Caitlin Reilly, BA
Lauren Schnell, MEd, BCBAMark Sullivan, BA

ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Volume 9,2 Spring 2012

Science in Autism Treatment

Page 18

ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Page 19

Does your agency
share ASAT’s values?

What it means to be asponsor…..

…..Become a 2012
Sponsor Now!

ASAT believes that individuals with
autism have the right to effective
treatments that are scientificallydemonstrated to make meaningful,positive change in their lives.

ASAT’s sponsors have indicatedtheir support of the following tenets:
1. All treatments for individuals with
autism should be guided by thebest available scientificinformation.
2. Service providers have a
responsibility to rely on sciencebased treatments.
3. Service providers should takesteps necessary to help consumers
differentiate between scientifically-validated treatments andtreatments that lack scientificvalidation.
4. Consumers should be informedthat any treatment lacking
scientific support should be
pursued with great caution.
5. Objective data should be used
when making clinical decisions.

These sponsorships not only provide
financial support used specificallyfor our dissemination efforts, butalso send a clear message that
ASAT's vision is shared by others
within the professional community.

We believe that it should not be sochallenging for families to findaccurate information about theefficacy of various autism
interventions.
ASAT works toward a time...
………. when all families would be
empowered with skills in identifying
and choosing the most effective,
scientifically-validated interventions
for their child.
……….when the media would
educate and not confuse parents byproviding accurate information andasking the right questions.
……….when all providers would be
guided by science when selecting
and implementing theirinterventions.

CHAMPION $2,000
Autism Partnership
Four Points, Inc.
Little Star Center
Central Valley Autism Project
BENEFACTOR $1,000
Different Roads to Learning
Rethink Autism
Accelerated Educational Software
Stepping Stones
Pacific Autism Learning Services
Organization for Research andLearning

The tasks of educating the public
about scientifically-validated
intervention and countering
pseudoscience are daunting ones,
and ASAT appreciates the supportof all of its sponsors.
If you are interested in becoming a
2012 Sponsor, please visit thesponsor page on our website atwww.asatonline.org/about_asat/sponsors.htm#learn.
Thank you for your consideration!

2011 Sponsors inReal Science, Real Hope Sponsorship Initiative
ALLIANCE $500
Autism Intervention Services
Autism New Jersey
Eden II Programs
ELIJA Foundation
ELIJA School
Providence Service Corporation
Quality Services for the Autism
Community (QSAC)
Quest Autism Program
Virginia Institute of Autism
PATRON $200
Aging with Autism
Alpine Learning Group
Autism Awareness
Asperger Syndrome and high Functioning
Autism Association (AHA), Inc.

Autism Research and Treatment
The Bay School
Behavioral Intervention Association
Brooklyn Autism Center
Child Study Center of Fort Worth
Connecticut Center for Child Development
First Steps for Kids, Inc
Gary Mayerson & Associates
Institute for Educational Achievement
Kansas City Autism Training Center
Lizard Children’s Learning Centre
New England Center for Children
New Haven Learning Center
NY Center for Autism- Charter School
Pyramid Educational Consultants, Inc.
Room to Grow
SKF Books
Somerset Hills

IMPORTANT DISCLAIMER: ASAT has no formal relationship with any of the sponsor organizations. Furthermore, their statedendorsement of the above tenets is not verified or monitored by ASAT. Although ASAT expects that all sponsoring organizations will act inaccordance with the above statements, ASAT does not assume responsibility for ensuring that sponsoring organizations engage in behavior thatis consistently congruent with the statements above.

ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Volume 9,2 Spring 2012

Science in Autism Treatment

Page 20

In addition to our entire board of directors, we
acknowledge the following donors in 2011.
Without their support, our important work
could not be carried out.

Champion $2000 and above
The Leah and Alain Lebec Foundation, Inc.
Alison & Bernard Webb, In Honor of Peggy Halliday
Alliance $100 - $1000
Rachel Angelos
Bangor Motorsports, Luke McCannell andKurt Thomas
Rusdy Budisusetyo
Warren & Judith Carter
Michele Clark-Groff
David Diosi
Tara Donohue
Sharon Q. Fitzgerald
Pamela Gorski
Gina Green
Nea Hanscomb
William Heward
Charla Hutchinson
Tracie Lindblad
Joyce Elizabeth Mauk
Dominic Mazzoni
Luke and Kelly McCannell
Beth McKee
Audrey Meissner
Nancy Phillips
Kristine Quinby
Donna Quinn
Howard Rachlin
Sharon Reeve
Carlos Rudge
Deborah Sedberry
Caroline Simard
Tom & Carol Sloan
Roberto Tuchman
Saralyn Walker
Key Bank
Mike & Kelly Windsor,
In Honor of Janice Windsor

Benefactors $1000 - $1999
Ethel & Nathan Cohen Foundation
Patrick & Kristen Ramsey
Anonymous
Patron $1 - $99
Toli Anastassiou
Linda Bekman,
In Memory of James & Ann Celiberti

Lea Bell
Gordon Bourland
Bernard Caputo
Douglas & Josette Celiberti,
In Memory of Carol Celiberti

Maricel Cigales
Marianne Clancy
Michael Cohen
Ed & Marianne Colangelo
Panagiota Debery
William Dube
Stephen Eversole
Wilfried Gehne
Megan Halliday,
In Honor of Peggy Halliday

Bethany Halliday
Sandra Harris
William Horn
Joel & Sandra HornsteinDaniel Kessler
Kate Lambert
Debbie Lancette,
In Honor of Sarah Jack

Toby Martin
Paul McDonnell
John & Marlene McElwee
Linda S. Meyer
Ellen Murphy
Elizabeth Neumann
Judy Newport
Diana Parisy
Wayne Piersel
Belinda Robinson
David & Joyce Roll
Johan Sanne
Mark Stafford
David Tornabene
Leanne Tull
Jenny Wells
Autism Early Intervention Clinics

If you were a 2011 donor and we inadvertently left you off this list, please accept our apologies
and e-mail us at donate@asatonline.org

ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Page 21Media Watch Update by Barbara Jamison, Media Watch Coordinator
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ASAT Board of Directors

David Celiberti, PhD, BCBA-D
ASAT Responds to ABC's "From Miracle to Nightmare" (January 08, 2012)
President
ABC's Chris Cuomo provides a stunning expose on facilitatedcommunication and the horrific effects on the family of a child with autism. Mary E. McDonald, PhD, BCBA-D
ASAT Responds to AP's “School accused of putting autistic student inVice Presidentbag” (January 12, 2012)
Barbara Wells
A startling and sad example of what can happen when school personnel"are neither prepared nor equipped to meet the unique needs of students Treasurer
with autism."
Florence DiGennaro, PhD, BCBA-D
ASAT Responds to NY Times story “A French Film Takes Issue With theSecretary
Psychoanalytic Approach to Autism" (January 22, 2012)
NY Times journalists Jolly and Novak take on the French psychoanalytic
Leigh Broughan, MA, BCBA
community and its abysmal failure to provide safe, effective treatment for
autism. Read response by Catherine Maurice (author of Let Me Hear Your Preeti Chojar, MCA
Marianne Clancy
Voice and Founding Member of ASAT) and David Celiberti (ASAT
Kathryn Dobel, JD
President).
Ruth Donlin, MS
ASAT Responds to Star Tribune piece “Autism foundation’s IRS filings raise
Elizabeth Dyer, MA, CCC-SLP
eyebrows” (January 27, 2012)
Thumbs up to Star Tribune reporter Jane Friedmann for her article alerting Daniela Fazzio, PhD, BCBA
consumers to so-called autism organizations who prey on unsuspecting
Joseph Forgione, MBAdonors.
Sabrina Freeman, PhD
ASAT Responds to LA Times story "Families Cling to Hope of Autism
Sara Jane Gershfeld, MA, BCBA
Recovery" (January 30, 2012)
Peggy Halliday, M.Ed., BCBA
Writer Alan Zarembo of the LA Times highlights the work of Ivar Lovaas
Barbara Jamison, BA
and the field of applied behavior analysis, but ASAT calls him to task
Scott Myers, MD, FAAP
about what is lacking in his article.
Daniel W. Mruzek, PhD, BCBA-D
ASAT Responds to the Cape Cod Institute Program (February 02, 2012)
Joshua K. Pritchard, PhD, BCBAThe Cape Cod Institute Summer 2012 Program lists several autism
Tristram Smith, PhD
treatment approaches as "evidence-based comprehensive treatments."
Bridget Taylor, PsyD, BCBA-D
But what research actually exists to back up that claim?
ASAT Responds to News.com.au's "Cost of autistic children cripples parents up
ASAT
to $50,000 a year" (February 14, 2012)
P.O. Box 188"The reality is that thousands and thousands of Australian children with
autism will soon become thousands and thousands of young adults with Crosswicks, NJ 08515-0188
autism..."E-mail: info@asatonline.org
ASAT Responds to Irish Times article "French film ban raises autism
Website: www.asatonline.org
issue" (February 17, 2012)
Facebook: www.facebook.com/Asatonline
We commend reporter Paul O’Donoghue for bringing to light France’s
Twitter: www.twitter.com/asatonline
unsubstantiated psychoanalytical theory and approach to treatment ofpeople with autism.
ASAT Responds to Des Moines Register's "Autistic man struggles in Iowa’s mental health system" (February 23,
2012)
ASAT applauds journalist Tony Leys for revealing the "heart-breaking reality that many individuals with autism in
Iowa face when they enter an adult system that is ill-equipped to address more severe behavioral needs."
ASAT Responds to Huffington Post's "The Autism Vaccine Controversy and the Need for Responsible Science
Journalism" (March 31, 2012)
Once an idea is promulgated and perpetuated in the media, it can be difficult to retract from the sphere of public
thinking — even if it has been discredited.
ASAT Responds to UPI.com's “Doctor fired over autism treatment” (April 5, 2012)
Why did a NJ hospital dismiss a neuroscientist over the proposed use of hyperbaric oxygen therapy for patientswith autism?
ASAT Responds to Palm Beach Post's "Autism rate rises; disorder now affects 1 in 88 children" (April 12, 2012)
Writers O'Connor and Elmore report on the latest CDC autism prevalence rates, but ASAT calls them to task about
misleading information in their article.

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Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Page 22

Volume 9,2 Spring 2012

Science in Autism Treatment

Research Review: RCT of a Manualized Social Treatment for High-Functioning Autism Spectrum
Disorders
Lopata, C., Thomeer, M. L., Volker, M. A., Toomey, J. A., Nida, R. E., Lee, G. K., Smerbeck, A. M., & Rodgers, J. D. (2010). RCT of amanualized social treatment for high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40,
1297-1310.
Reviewed by: Jessica Rothschild, Caldwell College
This newsletter contains two article summaries that examine ways to
Why research this topic?
Individuals with high-functioning autism improve social skills in children with autism, assessed through group
designs. Landa, Holman, O'Neill, and Stuart (2011) looked at the effects of aspectrum disorders (HFASDs) often haveclassroom-based intervention on the social development of 48 2-year-olds.
difficulty understanding abstract concepts, Lopata, Thomeer, Volker, Toomey, Nida, Lee, Smerbeck, and Rodgers (2010)
non-literal language, and identifying facialinvestigated a published curriculum's (Skillstreaming) effects on 36 7-12
year olds' peer interaction skills. We are also introducing our first summary of
expression. In addition, they may have aa research review. In general, a research review is a compilation of multiple
limited range of interests and engage instudies that all investigate one particular topic or intervention. The purpose
repetitive behavior that others regard asof the review is to present conclusions on the overall effectiveness of asocially inappropriate. These difficulties may particular intervention based on the current research. The topic evaluated incollectively interfere with social
this research review is The Picture Exchange Communication System. Enjoy!
relationships across their lifespan. However,
little research is available on interventions Sharon A. Reeve, Ph.D, BCBA-D
that might improve social relationships. The SIAT Research Corner Coordinatorpurpose of this randomized clinical trial wasto evaluate a social intervention program based on a What did the researchers find?
manual developed by the authors.
Results of standardized testing measures revealed
What did the researchers do?
a statistically significant improvement in social skills
Thirty-six children with HFASD between the ages of performance for the treatment group when compared
7 and 12 were randomly assigned to a treatment
to the wait-list control group. The areas of socialgroup or a wait-list control group. In the treatment
knowledge and understanding of idioms revealed thegroup, teaching was conducted in a group format that greatest statistically significant effect. Parent andfocused on improving peer interaction, expanding
staff rating measures also revealed that thechildren’s range of interests, and helping them
participants engaged in higher levels of targetedinterpret facial expression and non-literal language.
social skills after treatment.
Each meeting began with 20 minutes of intensive
What are the strengths and limitations of the study?
instruction, based on a published curriculum
What do the results mean?
(Skillstreaming). The instruction sequence included
The results of the direct child measures anddefining each skill, modeling the skill, identifying the behavioral ratings suggest that the manualized
individual’s needs, role-playing, providing feedback,program provided intensive instruction, targeted
and assigning homework. After the instructional time, appropriate social skills based on the social deficits
participants engaged in a 50-minute cooperative
those individuals with HFASDs experienced, andactivity to practice the skills taught during instruction increased these social skills. Some limitations of theand then reported which skills they used. A point
study included a lack of clearly defined skills which
system was implemented in which children received
could possibly result in inaccuracies in the
points for using their new social skills and lost points measurement of these skills and a lack of follow-up
if they engaged in problem behavior or did not follow data to indicate if the treatment gains wererules.
maintained over time. Both of these limitations should
be addressed in future studies.

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Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Page 23
Research Review: The Effectiveness of the Picture Exchange Communication System (PECS) on
Communication and Speech for Children with Autism Spectrum Disorders: A Meta-Analysis
Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the picture exchange communication system (PECS) on
communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of SpeechLanguage Pathology, 19, 178-195.
Reviewed by: Kathleen Moran, Caldwell College

Why this topic?
What were the strengths and limitations of the
The Picture Exchange Communication Systemstudy? What do the results mean?
(PECS), based on the principles of applied behavior Although PECS is well-researched compared to otheranalysis, is a popular approach for teaching children communication interventions, this review should bewith autism to communicate by selecting pictures
viewed with caution because there is still only aand handing them to a communication partner. Due small number of controlled empirical studies
to the lack of systematic reviews of the effectiveness evaluating PECS, especially for speech outcomes.
of the standard PECS protocol on communication
Also, if PECS does lead to vocal speech, it is unclear
and speech outcomes for children with autism, thefrom the available research which of its components
purpose of this review was to conduct a metais responsible for this development. Anotheranalysis (a method for statistically combining results limitation of the studies is that they did not measureacross studies) to integrate research findings in the how accurately PECS was implemented. A further
current PECS literature.
concern is that the studies did not show clear
What did the researchers do?
evidence that children’s speech and picture
The researchers reviewed and included
communication are maintained and generalized
eleven studies published in English peer-reviewed
from training to novel settings when using PECS.
journals. The included articles were publishedStrengths of the review included careful procedures
between 1994 and 2009 from four different
for identifying studies and abstracting information
databases. The researchers used different
from them. For example, the researchers included
combinations of four words during their searchtables summarizing the specifics of each study,(PECS, Autism, Picture Exchange Communication
outcome measures, identification of excluded
System, and Bondy and Frost). The researchers
studies and reasons for exclusion, and citations forincluded only articles that had at least one childall studies (excluded and included) referenced. In
participant with autism.
addition, they conducted reverse searches and crossWhat did the researchers find?
-referenced results with articles listed on the PECS
The researchers concluded that PECS is
official research page. The researchers also included
effective in helping children with autism use pictures a brief overview of PECS in the beginning of theto communicate; however, evidence that PECS helps study.
children acquire vocal speech is not as strong,
Further research should include assessment of
perhaps because the quality and quantity ofspeech development outcomes based on PECS
research on speech outcomes has been insufficient intervention, increased documentation of procedural
to produce a clear pattern of results. The
integrity across studies, evaluations ofresearchers also established three childgeneralization and maintenance of PECS,
characteristics that may be pretreatment identifiers comparisons of PECS to alternative treatments, andof children with autism likely to respond to PECS:
examinations of potential influence of prelimited motor imitation, strong object exploration,intervention characteristics.
and limited joint attention.

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Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Page 24

Volume 9,2 Spring 2012

Science in Autism Treatment

Research Review: Intervention targeting development of socially synchronous engagement in toddlers with autism
spectrum disorder: A randomized controlled trial
Landa, R. J., Holman, K. C., O’Neill, A. H., & Stuart, E. A. (2011). Intervention targeting development of socially synchronous
engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology andPsychiatry, 52, 13-21.
Reviewed by: ToniAnne Giunta, Caldwell College

Why review this topic?
Autism Spectrum Disorders (ASDs) are characterized by deficits in social skills and communication inareas including recognition and use of facial expression, imitation, reciprocity in interaction, social/affective signaling, joint attention, symbolic behavior, language understanding, and conventional use of
gestures. These deficits can greatly limit opportunities for language and social learning. However, little
research is available on interventions intended to alleviate such deficits. To address this gap, the present
study tested interventions for improving socially engaged imitation (SEI), imitation of joint attention (IJA),
and shared positive affect (SPA) in two-year-old children with autism. The primary questions were (a) are
there differences in outcome measures of SEI, IJA, and SPA with learners receiving a supplemental social
curriculum in their intervention?; (b) are there differences in expressive language growth and nonverbal
cognitive functioning with learners receiving a supplemental social curriculum?; and (c) will gains
established during interventions maintain throughout a six-month follow-up?
What did the researchers do?
Forty-eight learners with ASD, ages 21-33 months, were randomly assigned to one of two groups:
Interpersonal Synchrony (IS) and Non-Interpersonal Synchrony (Non-IS). Both groups received 2.5 hours ofclassroom-based intervention per day for four days a week over a six-month period. Instruction included
discrete-trial teaching and pivotal-response treatment, with an emphasis on the use of highly motivatingtasks, materials, and natural consequences. Target skills were selected from the Assessment, Evaluation,
and Programming System for Infants and Children developmental curriculum. Parent education classes
supplemented classroom instruction. The IS group received more opportunities to (a) respond to andinitiate joint attention to objects, people, and events (e.g., by placing interesting pictures on the walls toincrease the likelihood of using these skills); (b) imitate others during social interactions (e.g., modelingsocial targets and providing prompts when necessary); and (c) share positive affect (e.g., introducing
activities that involved imitation of peers and adults performing silly actions with objects). Learners wereassessed using the Communication and Symbolic Behavior Scales Developmental Profile (for IJA and SPA),
an imitation assessment (for SEI), and the MSEL developmental tests (for expressive language andnonverbal cognition).
What did the researchers find?
The researchers found significant differences in outcomes between groups for SEI, but not for IJA and
SPA (i.e., more SEI performed by the IS than Non-IS group). They also found significantly higher levels of
nonverbal cognition for the IS group at the follow-up, but minimal differences in expressive language
between the groups. In regard to growth over time (i.e., timing, rate, and direction of change that provides
insight to whether intervention gains remain after termination of the intervention), the IS group showedsignificantly more growth over time and more rapid growth on every outcome measure when compared to
the Non-IS group.
What are the strengths and limitations of the study? What do the results mean?
This was the first study conducted that assessed the effects of a classroom-based intervention onsocial development for two-year-olds. The findings show that gains in social development can be made in
relatively brief periods of time. Future research, however, is warranted in many areas, including in (a)determining whether toddlers with ASD who develop SEI learn more efficiently within other domains ofdevelopment and (b) separating the components of the intervention to determine which ones are mosteffective in increasing social development. Furthermore, a control group was not included, making it
difficult to infer that gains in secondary outcomes were affected by the interventions alone.

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Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment

Page 25
International News by Daniela Fazzio, PhD, BCBA-D
In this issue we are celebrating the variety of countries represented in Science and Autism Treatment’s subscriptions and welcoming a new country. We now have a subscription from Russia.
добро пожаловать!
We know that autism is in every country and the challenges weface in disseminating science in autism treatment and debunking
pseudoscience are also reality everywhere.
Below are the top countries outside of the United States with the most subscribers. If you havesuggestions about how we can improve ourreach, or if you would like to share an international story, write to us atinternational@asatonline.org.
CanadaFinally, we have translated two flyers into
Spanish; one with content about our website
and one with information about our newsletter.
They will be on our website soon, but if you
need one you can request by email at international@asatonlonline.org.

United Kingdom
Australia
IrelandIndia
BrazilIsraelNew Zealand

Looking forward to hearing from you!

Philippines

In addition to our Advisory Board, a number of individuals lend their time and talents to support ASAT's mission and initiatives.
As you can see, we have individuals who support each aspect of our organization. If you want to assist, please email us at
info@asatonline.org

ASAT Public Relations
Jennifer Hieminga, MEd, BCBA
Lewis Mazzone, MA
Audrey Meissner, MEd, BCBA
Sage Rose, PhD
Nancy Philips, BA
Jessica Zilski-Pineno, MSEd
Pediatrician and Physician
Awareness Project
Zachary Houston, MS, BCBA
Elisabeth Kinney, MS, BCBA
Lauren Schnell, MEd, BCBAASAT Finance Committee
Dena Buonarota Russell, MA
Denise Grosberg, MA, BCBA
Germaine Ibrahim, MEd

ASAT’s Newsletter,
Science in Autism Treatment
Laurie Brophy, LCSW
Kerry Ann Conde, MS, BCBA
Justin DiScalfani, MA
Kate Fiske, PhD, BCBA-D
Denise Grosberg, MA, BCBA
Amy Hansford, MS
Elizabeth Neumann, MA, BCaBA
Renita Paranjape, MEd, BCBA
Nicole Pearson, PsyD
Sage Rose, PhD
Caroline Simard-Nicolas, MS, BCBA
Leanne Tull, MADS, BCBAMedia Watch
Toli Anastassiou, MA, BCBA
Geoffrey Debery, MA, BCBA
Justin DiScalfani, MA
Mary Goward-Philips, BA
Hannah Hoch, PhD, BCBA–D
Sharon Reeve, PhD, BCBA-D
Anya K. Silver, MA, BCBA
Shannon Wilkinson, MADS, BCaBA

ASAT’s Website, www.ASATonline.org
Kerry Ann Conde, MS, BCBA
Caroline Simard-Nicolas, MS, BCBA
Amanda Wadsworth, MSEd

ASAT
Providing Accurate, Science-Based Information - Promoting Access to Effective Treatment