Social involvement of children with autism spectrum disorders in elementary school classrooms. Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. Early identification and intervention in autism spectrum disorders: Some progress but not as much as we hoped Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized, Controlled Trial Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting The Effect of Karate Techniques Training on Communication Deficit of Children with Autism Spectrum Disorders A systematic review of peer-mediated interventions for children with autism spectrum disorder. Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. Incorporating a Peer-Mediated Approach Into Speech-Generating Device Intervention: Effects on Communication of Preschoolers With Autism Spectrum Disorder. Autism spectrum disorders in extremely preterm children. Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Sleep behaviors and sleep quality in children with autism spectrum disorders. Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial. Use of Social Stories to Improve Self-Regulation in Children with Autism Spectrum Disorders Effect of Omega-3 and -6 Supplementation on Language in Preterm Toddlers Exhibiting Autism Spectrum Disorder Symptoms Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model Teacher-implemented joint attention intervention: pilot randomized controlled study for preschoolers with autism. Effects and Moderators of a Short Theory of Mind Intervention for Children with Autism Spectrum Disorder: A Randomized Controlled Trial The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study
BACKGROUND Children with autism spectrum disorders ( ASD ) are increasingly included in general education classrooms in an effort to improve their social involvement . METHODS Seventy-nine children with ASD and 79 r and omly selected , gender-matched peers ( 88.6 % male ) in 75 early ( K-1 ) , middle ( 2nd-3rd ) , and late ( 4th-5th ) elementary classrooms across 30 schools completed social network surveys  examining each child 's reciprocal friendships , peer rejection , acceptance , and social involvement . RESULTS Across grade levels , peers less frequently reciprocated friendships with children with ASD than students in the matched sample . While children with ASD were not more likely to be rejected by peers , they were less accepted and had fewer reciprocal friendships than matched peers at each grade level . Although 48.1 % of children with ASD were involved in the social networks of their classrooms , children with ASD were more likely to be isolated or peripheral to social relationships within the classroom across all grade levels , and this difference is even more dramatic in later elementary grade s. CONCLUSIONS In inclusive classrooms , children with ASD are only involved in peers ' social relationships about half of the time , and appear to be even less connected with increasing grade level . Promoting children with ASD 's skills in popular activities to share with peers in early childhood may be a key preventive intervention to protect social relationships in late elementary school grade The purpose of this pilot study was to establish a model for r and omized controlled trial research , identify appropriate outcome measures , and address the effectiveness of sensory integration ( SI ) interventions in children with autism spectrum disorders ( ASD ) . Children ages 6 - 12 with ASD were r and omly assigned to a fine motor or SI treatment group . Pretests and posttests measured social responsiveness , sensory processing , functional motor skills , and social-emotional factors . Results identified significant positive changes in Goal Attainment Scaling scores for both groups ; more significant changes occurred in the SI group , and a significant decrease in autistic mannerisms occurred in the SI group . No other results were significant . The study discusses considerations for design ing future outcome studies for children with ASD Abstract Camarata 's ( 2014 ) review summarizes the progress that has been made in the field of early identification and early intervention in autism spectrum disorders ( ASD ) over the past few decades , but also provides a salutary reminder that much still needs to be done . Whilst it is possible to prospect ively identify cases of ASD using screening instruments ; it is critical that those using such screens in clinical practice underst and how to interpret data from published studies and consider how screening information is communicated to parents . After several decades when few r and omized controlled trials of early intervention in ASD were conducted , the last decade has seen an explosion of new studies . Despite initial optimism , as more trials are published they have highlighted the limits of , and challenges to , early intervention in ASD . Given the complex nature of ASD these sobering lessons are perhaps not surprising . Rather than promote despondency , they need to inspire and inform the next decade of clinical research to move the field forward to the benefit of young children with ASD and those who care for them This study compared cognitive behavioral therapy ( CBT ) and treatment-as-usual ( TAU ) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders ( ASD ) . Thirteen children with ASD ( 7–11 years old ) were r and omly assigned to 32 sessions of CBT or community-based psychosocial treatment ( TAU ) for 16 weeks . The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills . Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment , using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms .  CBT outperformed TAU at posttreatment on the frequency of self-isolation , the proportion of time spent with peers , the frequency of positive or appropriate interaction with peers , and the frequency of positive or appropriate peer responses to the target child ( d effect size range 1.34–1.62 ) . On average , children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment , compared to 25 % of intervals for children in TAU . Further investigation of this intervention modality with larger sample s and follow-up assessment s is warranted This prospect i ve , longitudinal , study charted the developmental profiles of young children with Autism Spectrum Disorders ( ASD ) identified through routine developmental surveillance . 109 children with Autistic Disorder ( AD ) , ‘ broader ’ ASD , and developmental and /or language delays ( DD/LD ) were assessed using the Mullen Scales of Early Learning ( MSEL ) at 12-months ( n = 10 assessment s ) , 18-months ( n = 45 assessment s ) , and 24-months ( n = 99 assessment s ) . The children with AD performed most poorly , overall , than the ASD and DD/LD groups on the MSEL . Furthermore , the children with AD/ASD displayed an uneven cognitive profile , with poorer performance on verbal ( particularly receptive language ) relative to nonverbal skills . There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum , especially those with AD . Given that the poor receptive , relative to expressive , language profile emerges very early in life for children with AD/ASD , this cognitive profile may serve as an additional red flag to social attention and communication deficits . Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life Abstract This investigation examined the long term effect of Karate techniques training on communication of children with autism spectrum disorders ( ASD ) . Thirty school aged children with ASD were r and omly assigned to an exercise ( n = 15 ) or a control group ( n = 15 ) . Participants in the exercise group were engaged in 14 weeks of Karate techniques training .  Communication deficit at baseline , post-intervention ( week 14 ) , and at 1 month follow up were evaluated . Exercise group showed significant reduction in communication deficit compared to control group . Moreover , reduction in communication deficit in the exercise group at one month follow up remained unchanged compared to post-intervention time . We concluded that teaching Karate techniques to children with ASD leads to significant reduction in their communication deficit BACKGROUND Peer mediated intervention ( PMI ) is a promising practice used to increase social skills in children with autism spectrum disorder ( ASD ) .  PMIs engage typically developing peers as social models to improve social initiations , responses , and interactions . METHOD The current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group design s. Five studies met the pre-specified review inclusion criteria : four r and omized controlled trials and one pre- and post-test design . RESULTS Four of the studies were conducted in school setting s , whereas one study was conducted in a camp setting . The studies all reported that participants improved in social skills ( e.g. , social initiations , social responses , social communication ) post intervention . Additionally , sustainment , generalization , and fidelity of implementation were examined . CONCLUSION PMI is a promising approach to address social skills in children with ASD , and this approach can be conducted in meaningful real-word context s , such as schools . Limitations of the studies as well as future directions are discussed OBJECTIVE This study evaluated the efficacy of a targeted social skills training group in school-aged children with autism spectrum disorder ( ASD ) . The intervention , Seaver-NETT ( Nonverbal communication , Emotion recognition , and Theory of mind Training ) , is a 12-session cognitive-behavioral intervention ( CBI ) for verbal , school-aged children targeting ASD-specific social behavioral impairments . METHOD Sixty-nine children with ASD , 8 to 11 years of age , with verbal IQs greater than 70 , participated in a r and omized comparative trial to examine the efficacy of NETT relative to a facilitated play group . Treatment outcomes included caregiver reports of social behavior and neuropsychological assessment s of social cognition conducted by blinded raters . Outcomes were collected at baseline , endpoint , and 3 months posttreatment . RESULTS Significant improvements were found on social behavior outcomes such as nonverbal communication , empathic responding , and social relations in the NETT condition relative to the active control at endpoint . Verbal IQ moderated the interaction effect on social behavior , with higher verbal IQ associated with improvements in the CBI condition . No significant improvements were found on social cognitive outcomes . No significant group differences were found at 3-month follow-up conducted with approximately half the sample ( n = 34 ) . CONCLUSION These data indicate that targeted CBI social skills groups such as NETT improve social communication deficits in verbal , school-aged children with ASD . The moderating effects of high verbal IQ suggest a need to consider participant and treatment characteristics associated with outcomes in future studies . Clinical trial registration information-Neural and Behavioral Outcomes of Social Skills Groups in Children With Autism Spectrum Disorder ; https:// clinical trials.gov ; NCT01190917 Objective : Sleep problems are common in children with autism spectrum disorders ( ASD ) and ADHD and impact adversely on child and parent well-being . The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD – ASD . Method : A sub sample of children with ADHD – ASD ( n = 61 ; 5 - 13 years ; 89 % male ) participating in the Sleeping Sound With ADHD study were included in the current investigation . The sub sample comprised of 28 children r and omized to the sleep intervention group , while 33 were r and omized to usual clinical care .  The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and st and ardized behavioral strategies . Results : Children with ADHD – ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-r and omization . Conclusion : These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD – ASD BACKGROUND Children with high-functioning autism spectrum disorders ( ASD ) are at high risk for developing significant anxiety . Anxiety can adversely impact functioning across school , home and community environments . Cognitive behavioral therapies ( CBT ) are frequently used with success for children with anxiety symptoms . Modified CBT interventions for anxiety in children with ASD have also yielded promising results . METHODS Fifty children with high-functioning ASD and anxiety were r and omizedto group CBT or treatment-as-usual ( TAU ) for 12 weeks . Independent clinical evaluators , blind to condition , completed structured interviews ( Anxiety Disorders Interview Schedule – Parent Version;ADIS-P ) pre- and post-intervention condition . RESULTS Forty-seven children completed either the CBT or TAU condition . Results indicated markedly better outcomes for the CBT group . Significant differences by group were noted in Clinician Severity Ratings , diagnostic status , and clinician ratings of global improvement . In the intent-to-treat sample , 10 of 20 children ( 50 % ) in the CBT group had a clinical ly meaningful positive treatment response , compared to 2 of 23 children ( 8.7 % ) in the TAU group . CONCLUSIONS Initial results from this r and omized , design ed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety . Limitations of this study include small sample size , lack of an attention control group , and use of outcome measures normed with typically developing Purpose This study examined the effects of incorporating a peer-mediated approach into a speech-generating device ( SGD ) intervention on communication of 45 nonverbal and minimally verbal preschoolers with autism spectrum disorder ( ASD ) and 95 peers without disabilities . The SGD was an iPad 2 ( Apple ) with voice output app . Method Effects were evaluated using a multivariate r and omized control trial design with repeated measures for 4 cohorts across baseline , intervention , generalization , and maintenance phases . Children were r and omly assigned to an experimental treatment that trained peers on use of the SGD or a business-as-usual comparison condition with untrained peers .  Communication outcomes were measured for both children with ASD and peers . Results Children receiving the treatment demonstrated significant increases in rates of communication and more balanced responses and initiations ( a measure of reciprocity ) than children in the comparison group . They were able to generalize improvements and maintain communication gains . Treatment fidelity was high for school staff and peer implementation . Conclusions Results support positive effects on communication of teaching young children with ASD and peers without disabilities to use the same SGD system in typical preschool activities . SGD interventions that utilize peer-mediated approaches may improve core deficits in communication and reciprocity and allow for greater classroom social participation and interactions with peers OBJECTIVES To investigate the prevalence , correlates , and antecedents of autism spectrum disorders ( ASD ) in extremely preterm children . STUDY DESIGN We conducted a prospect i ve study of all births < 26 weeks gestation in the United Kingdom and Irel and in 1995 . Of 307 survivors at 11 years , 219 ( 71 % ) were assessed and compared with 153 term-born classmates . Parents completed the  Social Communication Question naire ( SCQ )  to assess autism spectrum symptoms , and ASD were diagnosed by using a psychiatric evaluation . An IQ test and clinical evaluation were also administered . Longitudinal outcome data were available for extremely preterm children . RESULTS Extremely preterm children had significantly higher SCQ scores than classmates ( mean difference , 4.6 points ; 95 % CI , 3.4 - 5.8 ) . Sixteen extremely preterm children ( 8 % ) were assigned an ASD diagnosis , compared with none of the classmates . By hospital discharge , male sex , lower gestation , vaginal breech delivery , abnormal cerebral ultrasound scanning results , and not having had breast milk were independently associated with autism spectrum symptoms . By 6 years , independent associates were cognitive impairment , inattention and peer problems , withdrawn behavior at 2.5 years , and not having had breast milk . CONCLUSIONS Extremely preterm children are at increased risk for autism spectrum symptoms and ASD in middle childhood . These symptoms and disorders were associated with neurocognitive outcomes , suggesting that ASD may result from abnormal brain development in this population BACKGROUND Autism spectrum disorder ( ASD ) is a frequent developmental disorder characterized by pervasive deficits in social interaction , impairment in verbal and nonverbal communication , and stereotyped patterns of interests and activities . It has been previously reported that there is vitamin D deficiency in autistic children ; however , there is a lack of r and omized controlled trials of vitamin D supplementation in ASD children . METHODS This study is a double-blinded , r and omized clinical trial ( RCT ) that was conducted on 109 children with ASD ( 85 boys and 24 girls ; aged 3 - 10 years ) . The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children . ASD patients were r and omized to receive vitamin D3 or placebo for 4 months . The serum levels of 25-hydroxycholecalciferol ( 25 (OH)D ) were measured at the beginning and at the end of the study . The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale ( CARS ) , Aberrant Behavior Checklist ( ABC ) , Social Responsiveness Scale ( SRS ) , and the Autism Treatment Evaluation Checklist ( ATEC ) . TRIAL REGISTRATION NUMBER UMIN-CTR Study Design : trial number : UMIN000020281 . RESULTS Supplementation of vitamin D was well tolerated by the ASD children . The daily doses used in the therapy group was 300 IU vitamin D3/kg/day , not to exceed 5,000 IU/day . The autism symptoms of the children improved significantly , following 4-month vitamin D3 supplementation , but not in the placebo group . This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD . CONCLUSIONS This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients . Depending on the parameters measured in the study , oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD . At this stage , this study is a single RCT with a small number of patients , and a great deal of additional wide-scale studies are needed to critically vali date the efficacy of vitamin D in ASD BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention STUDY OBJECTIVES ( 1 ) Compare sleep behaviors of children with autism spectrum disorders ( ASD ) with sleep behaviors of typically developing ( TD ) children using the Children 's Sleep Habits Question naire ( CSHQ ) ; ( 2 ) compare sleep quality --defined as mean activity , sleep latency , number of awakenings , sleep efficiency and total sleep time -- of the cohort of children with ASD and TD , as measured by 10 nights of actigraphy ; and ( 3 ) estimate the prevalence of sleep disturbances in the ASD and TD cohorts . DESIGN Descriptive cross-sectional study . SETTING The Children 's Hospital of Philadelphia . PARTICIPANTS R and omly selected children from the Regional Autism Center . The ASD cohort of 59 children , aged 4 to 10 years , ( 26 with autism , 21 with pervasive developmental disorder-not otherwise specified [ PDD-NOS ] , and 12 with Asperger disorder ) were compared with 40 TD control subjects . MEASUREMENTS AND RESULTS The  CSHQ  ,  sleep diaries  , and 10 nights of actigraphy  using the Sadeh algorithm of children with ASD and TD control subjects were compared . CSHQ showed 66.1 % of parents of children with ASD ( 62.5 % autism , 76.2 % PDD-NOS , 58.3 % Asperger disorder ) and 45 % of parents of the control subjects reported that their children had sleep problems . Actigraphic data showed that 66.7 % of children with ASD ( 75 % autism , 52.4 % PDD-NOS , 75 % Asperger disorder ) and 45.9 % of the control subjects had disturbed sleep . CONCLUSIONS The prevalence estimate of 45 % for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern . The prevalence estimate of 66 % for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face . The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment .  This study tested a modular cognitive behavioral therapy ( CBT ) program for children with this profile . A st and ard CBT program was augmented with multiple treatment components design ed to accommo date or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction . METHOD Forty children ( 7 - 11 years old ) were r and omly assigned to 16 sessions of CBT or a 3-month waitlist ( 36 completed treatment or waitlist ) . Therapists worked with individual families . The CBT model emphasized behavioral experimentation , parent-training , and school consultation . Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist . RESULTS In intent-to-treat analyses , 78.5 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 8.7 % of the waitlist group . CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety , but not children 's self-reports . Treatment gains were maintained at 3-month follow-up . CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence -based treatment for children with autism spectrum disorders . Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism OBJECTIVE This study was carried out to examine the efficacy of a 12-week , low-intensity ( 1-hour/wk of therapist contact ) , parent-delivered intervention for  toddlers at risk for autism spectrum disorders ( ASD ) aged 14 to 24 months and their families . METHOD A r and omized controlled trial involving 98 children and families was carried out in three different sites investigating the efficacy of a parent delivery of the Early Start Denver model ( P-ESDM ) , which fosters parental use of a child-centered responsive interaction style that embeds many teaching opportunities into play , compared to community treatment as usual . Assessment s were completed at baseline and 12 weeks later , immediately after the end of parent coaching sessions . RESULTS There was no effect of group assignment on parent-child interaction characteristics or on any child outcomes . Both groups of parents improved interaction skills , and both groups of children demonstrated progress . Parents receiving P-ESDM demonstrated significantly stronger working alliances with their therapists than did the community group . Children in the community group received significantly more intervention hours than those in the P-ESDM group . For the group as a whole , both younger child age at the start of intervention and a greater number of intervention hours were positively related to the degree of improvement in children 's behavior for most variables . CONCLUSIONS Parent-implemented intervention studies for early ASD thus far have not demonstrated the large effects seen in intensive-treatment studies . Evidence that both younger age and more intervention hours positively affect developmental rates has implication s for clinical practice , service delivery , and public policy ABSTRACT A multiple baseline across participants design was used to evaluate the effects of Social Stories to help preschool-aged children with characteristics of Autism Spectrum Disorders ( ASD ) increase their engagement in functional behaviors and use sensory integrative-based strategies to promote self-regulation . Three children , 3–5 years old , from a self-contained preschool classroom were selected to participate in the study . The intervention package included reading individualized Social Stories that discussed desired behaviors and self-regulation strategies . The research ers measured the percentage of intervals in which participants engaged in desired behaviors . The frequency of desired behaviors increased for all participants . The use of self-regulation strategies varied across participants . These findings suggest that the intervention was successful in increasing desired behaviors of the three children . Further research is recommended on the effectiveness of embedding sensory integrative strategies into Social Stories . Practitioners may consider the use of Social Stories as a tool to increase independence and encourage self-regulated behaviors in children with characteristics of ASD Delayed language development may be an early indicator of autism spectrum disorder ( ASD ) . Early intervention is critical for children with ASD , and the present study presents pilot data on a clinical trial of omega-3 and -6 fatty acid supplementation and language development , a secondary trial outcome , in children at risk for ASD . We r and omized 31 children to receive an omega-3 and -6 supplement or a placebo for 3 months , and measured their language abilities at baseline and after supplementation . Gesture use , but not word production , increased for children in the treatment group more than children in the placebo group . These results suggest possible effectiveness of omega-3 and -6 supplementation for language development in children at risk for ASD OBJECTIVE : To conduct a r and omized , controlled trial to evaluate the efficacy of the Early Start Denver Model ( ESDM ) , a comprehensive developmental behavioral intervention , for improving outcomes of toddlers diagnosed with autism spectrum disorder ( ASD ) . METHODS : Forty-eight children diagnosed with ASD between 18 and 30 months of age were r and omly assigned to 1 of 2 groups : ( 1 ) ESDM intervention , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years ; or ( 2 ) referral to community providers for intervention commonly available in the community . RESULTS : Compared with children who received community-intervention , children who received ESDM showed significant improvements in IQ , adaptive behavior , and autism diagnosis . Two years after entering intervention , the ESDM group on average improved 17.6 st and ard score points ( 1 SD : 15 points ) compared with 7.0 points in the comparison group relative to baseline scores . The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children . In contrast , over the 2-year span , the comparison group showed greater delays in adaptive behavior . Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder , not otherwise specified , than the comparison group . CONCLUSIONS : This is the first r and omized , controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis . Results of this study underscore the importance of early detection of and intervention in autism OBJECTIVE The vast majority of children with an autism spectrum disorder ( ASD ) attend public preschools at some point in their childhood . Community preschool practice s often are not evidence based , and almost none target the prelinguistic core deficits of ASD . This study investigated the effectiveness of public preschool teachers implementing a vali date d intervention ( the Joint Attention and Symbolic Play/Engagement and Regulation intervention ; JASP/ER ) on a core deficit of autism , initiating joint attention . METHOD Sixteen dyads ( preschoolers with ASD and the public school teachers who worked in the child 's classroom ) were r and omly assigned to the 6-week JASP/ER intervention or a control group . RESULTS At the end of the intervention , JASP/ER teachers used more  JASP/ER strategies than the control teachers , and JASP/ER preschoolers used more joint attention in their classroom than control children . Additionally , JASP/ER children spent more time in supported engagement and less time in object engagement than control preschoolers on a taped play interaction . CONCLUSIONS Findings suggest that teachers were able to improve a core deficit of children with ASD in a public preschool context Limited perspective taking or “ Theory of Mind ” ( ToM ) abilities are a core deficit of autism , and many interventions are aim ed to improve ToM abilities . In this study , we investigated the effectiveness of a ToM treatment for children with autism spectrum disorders ( ASD ) and , for the first time , the moderating roles of social interaction style ( SIS ) and disruptive behavior ( DB ) , to determine which children are most likely to respond to this intervention . The trial protocol is registered at www.trialregister.nl , trial number 2327 and published before the data collection was finished ( www.trialsjournal.com ) . Children with autism aged 7–12 years ( n = 97 ) were r and omized over a waitlist control or a treatment condition . Outcome measures included ToM and emotion underst and ing , parent and teacher question naires on children 's social skills , ToM‐related social behavior , and autistic traits . Six‐month follow‐up parent reported data were collected for the treatment group . The treatment had a positive effect on ToM underst and ing , parent‐reported ToM behavior , and autistic traits , but not on parent or teacher‐reported social behavior . Passive SIS was associated with diminished treatment effects on autistic traits , but DB was unrelated to outcomes . The ToM intervention  improved conceptual social underst and ing and ToM‐related behavior of children with ASD . However , broader application of learned skills to other domains of functioning was limited . Individual differences with regard to treatment response are discussed . Autism Res 2015 , 8 : 738–748 . © 2015 International Society for Autism Research , Wiley Periodicals , Background Sleep difficulties are prevalent in children with autism spectrum disorder ( ASD ) . The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking . Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder . Methods Repeated sleep measures were available at 1.5 , 3 , 6 , and 9 years of age in 5151 children participating in the Generation R Study , a large prospect i ve birth cohort in the Netherl and s. Autistic traits were determined with the Pervasive Developmental Problems score ( PDP ) of the Child Behavior Checklist ( CBCL ) at 1.5 and 3 years and the Social Responsiveness Scale ( SRS ) at 6 years . This cohort included 81 children diagnosed with ASD . Results Sleep problems in early childhood were prospect ively associated with a higher SRS score , but not when correcting for baseline PDP score . By contrast , a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages , even when adjusting for baseline sleep problems . Likewise , a trajectory of increasing sleep problems was associated with ASD . Conclusions Sleep problems and ASD are not bidirectionally associated . Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood . Over time , children with ASD have an increase in sleep problems , whereas typically developing children have a decrease in sleep problems . Our findings suggest that sleep problems are part of the construct ASD
RESULTS A review of these studies showed that children with ASD are less school ready emotionally than their peers and those children with ASD appear to have more externalising behaviours and self-regulation difficulties that affect their school engagement and their relationships with their teachers .
There was a paucity of research looking at interventions targeting school readiness .
However , school-based behavioural interventions appear to improve cognitive , language and daily living skills , but have less impact on socialisation and peer inclusion .
CONCLUSION Children with ASD face more challenges transitioning to school , particularly with social interaction .
AIM To identify factors that promote a positive start to school for children with autism spectrum disorder ( ASD ) .