Journal of Consulting and Clinical Psychology 2005, Vol. 73, No. 3, 525–538
Copyright 2005 by the American Psychological Association 0022-006X/05/$12.00 DOI: 10.1037/0022-006X.73.3.525
Individual Behavioral Profiles and Predictors of Treatment Effectiveness for Children With Autism Michelle R. Sherer and Laura Schreibman
University of California, San Diego
Differential responsiveness to intervention programs suggests the inadequacy of a single treatment approach for all children with autism. One method for reducing outcome variability is to identify participant characteristics associated with different outcomes for a specific intervention. In this investigation, an analysis of archival data yielded 2 distinct behavioral profiles for responders and nonresponders to a widely used behavioral intervention, pivotal response training (PRT). In a prospective study, these profiles were used to select 6 children (3 predicted responders and 3 predicted nonresponders) who received PRT. Children with pretreatment responder profiles evidenced positive changes on a range of outcome variables. Children with pretreatment nonresponder profiles did not exhibit improvements. These results offer promise for the development of individualized treatment protocols for children with autism. Keywords: autism, behavioral treatment, behavioral profiles, individualized treatment, pivotal response training
Initially identified by Kanner (1943), autism remains a perplexing disorder that results in significant lifelong disability for most affected individuals (e.g., Gillberg, 1990; Rogers, 1998). However, a substantial number of children who have received intensive behavioral treatment during the preschool years have shown remarkable improvement (see reviews by Erba, 2000; Smith, 1999). The early intervention research that has generated the greatest amount of interest has been Lovaas’s (1987) Early Intervention Project. In this investigation, 19 children with autism received intensive discrete trial training (DTT). The results from this study were dramatic: Of the intensive (40 hr per week) treatment group, nearly half (47%) achieved “normal intellectual and educational functioning” (Lovaas, 1987, p. 3). Partial replications of this methodology have been conducted (e.g., Eikeseth, Smith, Jahr, & Eldevik, 2002; Smith, Groen, & Wynn, 2000), and although no researchers have reported the level of recovery of Lovaas’s participants, they have reported improvement in the treatment groups compared with control groups not receiving the high-intensity intervention. These studies have produced remarkable changes in the lives of many children with autism and have raised optimism as to the prognosis for children with this disorder. They have also incited a proliferation of DTT programs in schools, clinics, and homes, with some leaders in the field promoting this approach as the interven-
Michelle R. Sherer and Laura Schreibman, Department of Psychology, University of California, San Diego. This research was supported by U.S. Public Health Service Grant MH 39434 from the National Institute of Mental Health. We thank Aubyn Stahmer for insightful comments on earlier versions of this article. Correspondence concerning this article should be addressed to Laura Schreibman, Department of Psychology, 0109, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0109. E-mail: firstname.lastname@example.org 525
tion to be prescribed for all children with autism (Green, 1996; Smith, 1996). This enthusiasm, however, is appropriate only for the subset of the children who achieved the most favorable response and fails to recognize the unexplained outcome variability that consistently has been documented with this approach. Of the 19 children in Lovaas’s (1987) intensive therapy group, 9 made significant progress. There is little information, however, regarding the poorest outcome participants in this and other DTT studies. There is also little insight as...
References: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Anderson, S. R., & Romanczyk, R. G. (1999). Early intervention for young children with autism: Continuum-based behavioral models. Journal of the Association for Persons With Severe Handicaps, 24, 162–173. Bayley, N. (1993). Bayley Scales of Infant Development (2nd ed.). San Antonio, TX: Harcourt. DiLavore, P. C., Lord, C., & Rutter, M. (1995). The Pre-Linguistic Autism Diagnostic Observation Schedule. Journal of Autism and Developmental Disorders, 25, 355–379. Dunn, L. M., & Dunn, L. M. (1981). Peabody Picture Vocabulary Test— Revised: Manual. Circle Pines, MI: American Guidance Service. Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4- to 7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 49 – 68. Elliott, C. D. (1990). Differential Abilities Scale (DAS). San Antonio, TX: Psychological Corporation. Erba, H. W. (2000). Early intervention programs for children with autism: Conceptual frameworks for implementation. American Journal of Orthopsychiatry, 70, 82–94. Fenson, L., Dale, P., Reznick, S., Thal, D., Bates, E., Hartung, J., et al. (1993). MacArthur Communicative Development Inventory. San Diego, CA: Singular Publishing. Gabriels, R. L., Hill, D. E., Pierce, R. A., Rogers, S. J., & Wehner, B. (2001). Predictors of treatment outcome in young children with autism. Autism, 5, 407– 429. Gardner, M. F. (1990). Expressive One-Word Picture Vocabulary Test. Norato, CA: Academic Therapy Publications. Gillberg, C. (1990). Outcome in autism and autistic-like conditions. Journal of American Academy of Child Adolescent Psychiatry, 30, 375–382. Green, G. (1996). Evaluating claims about treatments for autism. In C. Maurice, G. Green, & S. C. Luce (Eds.), Behavioral interventions for
young children with autism: A manual for parents and professionals (pp. 15–27). Austin, TX: Pro-Ed. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250. Koegel, L. K., Carter, C. M., & Koegel, R. L. (2003). Teaching children with autism self-initiations as a pivotal response. Topics in Language Disorders, 32, 134 –145. Koegel, R. L., Schreibman, L., Good, A., Cerniglia, L., Murphy, C., & Koegel, L. (1989). How to teach pivotal behaviors to children with autism: A training manual. Santa Barbara, CA: University of California. Kohler, F. W., Strain, P. S., Maretsky, S., & DeCesare, L. (1990). Promoting positive and supportive interactions between preschoolers: An analysis of group-oriented contingencies. Journal of Early Intervention, 14, 327–341. Leiter, R. G. (1979). Leiter International Performance Scale: Instruction manual. Chicago: Stoelting Company. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P., et al. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223. Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism Diagnostic Interview—Revised: A revised version of a diagnostic interview for caregivers in individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659 – 685. Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9. McClannahan, L. E., & Krantz, P. J. (1994). The Princeton Child Development Institute. In S. L. Harris & J. S. Handleman (Eds.), Preschool education for children with autism (pp. 107–126). Austin, TX: Pro-Ed. Olley, J. G., Robbins, F. R., & Morelli-Robbins, M. (1993). Current practices in early intervention for children with autism. In E. Schopler, M. E. VanBopurgondien, & M. M. Bristol (Eds.), Preschool issues in autism (pp. 223–245). New York: Plenum Press. Ozonoff, W., & Cathcart, L. (1998). Effectiveness of a home program intervention for young children with autism. Journal of Autism and Developmental Disorders, 28, 25–32. Pelios, L. V., & Lund, S. K. (2001). A selective overview of issues on classification, causation, and early intensive behavioral intervention for autism. Behavior Modification, 25, 678 – 697. Prizant, B. M., & Wetherby, A. M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19, 329 –352. Rogers, S. J. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical and Child Psychology, 27, 168 –179. Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980). Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10, 91–103. Schreibman, L. (1997). Theoretical perspectives on behavioral intervention for individuals with autism. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 920 –933). New York: Wiley. Schreibman, L. (2000). Intensive behavioral/psychoeducational treatments for autism: Research needs and future directions. Journal of Autism and Developmental Disorders, 30, 373–378. Schreibman, L., Stahmer, A., & Cestone, V. (2001, November). Turning treatment nonresponders into treatment responders: Development of individualized treatment protocols for children with autism. Paper presented at the International Meeting for Autism Research, San Diego, CA. Smith, T. (1996). Are other treatments effective? In C. Maurice, G. Green,
SHERER AND SCHREIBMAN Weiss, M. J. (1999). Differential rates of skill acquisition and outcomes of early intensive behavioral intervention for autism. Behavioral Interventions, 14, 3–22.
& S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: Pro-Ed. Smith, T. (1999). Outcome of early intervention for children with autism. Clinical Psychology: Research and Practice, 6, 33– 49. Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105, 269 –285. Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Interview Edition Survey Form Manual. Circle Pines, MN: American Guidance Service.
Received August 22, 2003 Revision received March 14, 2004 Accepted April 6, 2004
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