title: Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials. Low intensity behavioral treatment supplementing preschool services for young children with autism spectrum disorders and severe to mild intellectual disability. Brief Report: Improvements in the Behavior of Children with Autism Following Massage Therapy Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments Factor structure and psychometric properties of the revised Home Situations Questionnaire for autism spectrum disorder: The Home Situations Questionnaire-Autism Spectrum Disorder Early intensive behavioral intervention: outcomes for children with autism and their parents after two years. Goal Attainment Scaling as an Outcome Measure in Randomized Controlled Trials of Psychosocial Interventions in Autism Effectiveness of a novel community-based early intervention model for children with autistic spectrum disorder. Randomized trial of intensive early intervention for children with pervasive developmental disorder. The Behavior Problems Inventory: An Instrument for the Assessment of Self-Injury, Stereotyped Behavior, and Aggression/Destruction in Individuals with Developmental Disabilities A randomised group comparison controlled trial of ‘preschoolers with autism’: A parent education and skills training intervention for young children with autistic disorder Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families. Measurement Tools and Target Symptoms/Skills Used to Assess Treatment Response for Individuals with Autism Spectrum Disorder
abstract: OBJECTIVE A consumer-oriented efficacy assessment in clinical trials should measure changes in chief complaint and consumer request ( symptoms of most concern to patient/caregiver ) , which may be diluted in change scores of multisymptom scales . METHOD In the Research Units on Pediatric Psychopharmacology ( RUPP ) Autism Network 8-week double-blind trial of risperidone versus placebo , the chief concerns of parents were collected at 0 , 4 , and 8 weeks ( endpoint ) , in addition to st and ardized primary measures . Blinded clinical judges rated change from baseline to 4 and 8 weeks on a 9-point scale ( 1 = normalized , 5 = unchanged , 9 = disastrous ) ; 94 participants had usable data . RESULTS The most common symptoms identified by parents were tantrums , aggression , and hyperactivity . Interrater reliability was excellent . Mean ratings at endpoint were 2.8 + /- 1.2 on risperidone and 4.5 + /- 1.3 on placebo ( p < .001 ) . Ratings were collinear with Clinical Global Impression-Improvement and Aberrant Behavior Checklist Irritability subscale ( primary dimensional measure ) . Effect size d was 1.4 , compared to 1.2 on the Aberrant Behavior Checklist Irritability subscale . Effect sizes varied twofold by symptom category , largest for self-injury ( 2.11 ) and tantrums ( 1.95 ) . CONCLUSIONS Risperidone was superior to placebo in reducing symptoms of most concern to parents of autistic children with irritable behavior .  Rating individualized participant-chosen target symptoms seems a reliable , sensitive , efficient , and consumer-friendly way to assess treatment effect and might have clinical application This study evaluated the effectiveness of low intensity behavioral treatment ( on average 6.5h per week ) supplementing preschool services in 3 - 6-year-old children with autism spectrum disorder and severe to mild intellectual disability . Treatment was implemented in preschools ( i.e. , daycare centers ) and a discrete trial teaching approach was used . Twelve children in the treatment group were compared to 22 children receiving regular intervention .  At pre-treatment , both groups did not differ on chronological age , developmental age , diagnosis and level of adaptive skills . Eight months into treatment , children receiving behavioral treatment displayed significantly higher developmental ages and made more gains in adaptive skills than children from the control group . No significant differences between groups were found on autistic symptom severity and emotional and behavioral problems Twenty children with autism , ages 3 to 6 years , were r and omly assigned to massage therapy and reading attention control groups .  Parents in the massage therapy  group were trained by a massage therapist to massage their children for 15 minutes prior to bedtime every night for 1 month and the parents of the attention control group read Dr. Seuss stories to their children on the same time schedule . Conners Teacher and Parent scales , classroom and playground observations , and sleep diaries were used to assess the effects of therapy on various behaviors , including hyperactivity , stereotypical and off-task behavior , and sleep problems . Results suggested that the children in the massage group exhibited less stereotypic behavior and showed more on-task and social relatedness behavior during play observations at school , and they experienced fewer sleep problems at home Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields Previously , we adapted the Home Situations Question naire to measure behavioral non-compliance in everyday setting s in children with pervasive developmental disorders . In this study , we further revised this instrument for use in autism spectrum disorder and examined its psychometric properties ( referred to as the Home Situations Question naire-Autism Spectrum Disorder ) . To cover a broader range of situations and improve reliability , we prepared seven new items describing situations in which children with autism spectrum disorder might display non-compliance . Parents completed ratings of 242 children with autism spectrum disorder with accompanying disruptive behaviors ( ages 4–14 years ) participating in one of two r and omized clinical trials . Results from an exploratory factor analysis indicated that the Home Situations Question naire-Autism Spectrum Disorder consists of two 12-item factors : Socially Inflexible ( α = 0.84 ) and Dem and Specific ( α = 0.89 ) . One-to-two-week test – retest reliability was statistically significant for all scored items and also for subscale totals . The pattern of correspondence between the Home Situations Question naire-Autism Spectrum Disorder and parent-rated problem behavior , clinician-rated repetitive behavior , adaptive behavior , and IQ provided evidence for concurrent and divergent validity of the Home Situations Question naire-Autism Spectrum Disorder . Overall , the results suggest that the Home Situations Question naire-Autism Spectrum Disorder is an adequate measure for assessing non-compliance in a variety of situations in this population , and use of its two subscales will likely provide a more refined interpretation of ratings An intervention group ( n=23 ) of preschool children with autism was identified on the basis of parent preference for early intensive behavioral intervention  and a comparison group ( n=21 ) identified as receiving treatment as usual .  Prospect i ve assessment was undertaken before treatment , after 1 year of treatment , and again after 2 years . Groups did not differ on assessment s at baseline but after 2 years , robust differences favoring intensive behavioral intervention were observed on measures of intelligence , language , daily living skills , positive social behavior , and a statistical measure of best outcome for individual children . Measures of parental well-being , obtained at the same three time points , produced no evidence that behavioral intervention created increased problems for either mothers or fathers of children receiving it Goal attainment scaling ( GAS ) holds promise as an idiographic approach for measuring outcomes of psychosocial interventions in community setting s. GAS has been criticized for untested assumptions of scaling level ( i.e. , interval or ordinal ) , inter-individual equivalence and comparability , and reliability of coding across different behavioral observation methods . We tested assumptions of e quality between GAS descriptions for outcome measurement in a r and omized trial ( i.e. , measurability , equidistance , level of difficulty , comparability of behavior sample s collected from teachers vs. research ers and live vs. videotape ) . Results suggest GAS descriptions can be evaluated for equivalency , that teacher collected behavior sample s are representative , and that varied sources of behavior sample s can be reliably coded . GAS is a promising measurement approach . Recommendations are provided to ensure method ological quality The Nova Scotia  early intensive behavior intervention model -NS EIBI ( Bryson et al. , 2007 ) for children with autistic spectrum disorders was design ed to be feasible and sustainable in community setting s. It combines parent training and naturalistic one-to-one behavior intervention employing Pivotal Response Treatment - PRT ( R. Koegel & Koegel , 2006 ) . We followed 45 children ( 33 males , mean baseline age = 50 months ) for 12months . Mean gains of 14.9 and 19.5 months were observed on expressive and receptive language measures , respectively , for children with an IQ of 50 or more at baseline versus 6.1 and 8.4 months for children with IQs less than 50 . Behavior problems decreased significantly over the 1-year treatment for both groups , but autism symptoms decreased only for those with an IQ of 50 or more Young children with pervasive developmental disorder were r and omly assigned to intensive treatment or parent training . The  intensive treatment group ( 7 with autism , 8 with pervasive developmental disorder not otherwise specified -- NOS ) averaged 24.52 hours per week of individual treatment for one year , gradually reducing hours over the next 1 to 2 years . The  parent training group ( 7 with autism , 6 with pervasive developmental disorder NOS ) received 3 to 9 months of parent training . The groups appeared similar at intake on all measures ; however , at follow-up the intensive treatment group outperformed the parent training group on measures of intelligence , visual-spatial skills , language , and academics , though not adaptive functioning or behavior problems .  Children with pervasive developmental disorder NOS may have gained more than those with autism The Behavior Problems Inventory ( BPI-01 ) is a 52-item respondent-based behavior rating instrument for self-injurious , stereotypic , and aggressive/destructive behavior in mental retardation and other developmental disabilities . Items are rated on a frequency scale and a severity scale . The BPI-01 was administered by interviewing direct care staff of 432 r and omly selected residents from a developmental center between the ages of 14 to 91 years . For 73 % of those selected , at least one problem was endorsed on the BPI-01 . A total of 43 % showed self-injury , 54 % stereotyped behavior , and 38 % aggressive/destructive behavior . Confirmatory factor analysis and item-total correlations supported the three a priori factors . Analyses of variance ( ANOVA ) showed that of the variables age , sex , and level of mental retardation , only the latter had a significant effect on the BPI-01 total score , the SIB subscale score , and the Stereotyped Behavior subscale score . Aggression/destruction was not significantly related to any of the three variables . Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without , whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without . The BPI-01 was found to be a reliable ( retest reliability , internal consistency , and between-interviewer-agreement ) and valid ( factor and criterion validity ) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications . Strengths and limitations of the instrument are discussed Aim : To determine the effect of parent education on adaptive behaviour , autism symptoms and cognitive/ language skills of young children with autistic disorder . Method : A r and omised group comparison design involving a parent education and counselling intervention and a parent education and behaviour management intervention to control for parent skills training and a control sample .  Two rural and two metropolitan regions were r and omly allocated to  intervention groups ( n = 70 ) or control ( n = 35 ) . Parents from autism assessment services in the intervention regions were r and omly allocated to parent education and behaviour management ( n = 35 ) or parent education and counselling ( n = 35 ) . Results : Parent education and behaviour management result ed in significant improvement in adaptive behaviour and autism symptoms at 6 months follow-up for children with greater delays in adaptive behaviour . Parent education and behaviour management was superior to parent education and counselling . We conclude that a 20-week parent education programme including skills training for parents of young children with autistic disorder provides significant improvements in child adaptive behaviour and symptoms of autism for low-functioning children IMPORTANCE Disruptive behavior is common in children with autism spectrum disorder . Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale r and omized trials . OBJECTIVE To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior . DESIGN , SETTING , AND PARTICIPANTS This 24-week r and omized trial compared  parent training ( n = 89 ) to parent education ( n = 91 ) at 6 centers ( Emory University , Indiana University , Ohio State University , University of Pittsburgh , University of Rochester , Yale University ) . We screened 267 children ; 180 children ( aged 3 - 7 years ) with autism spectrum disorder and disruptive behaviors were r and omly assigned ( 86 % white , 88 % male ) between September 2010 and February 2014 .  INTERVENTIONS Parent training ( 11 core , 2 optional sessions ; 2 telephone boosters ; 2 home visits ) provided specific strategies to manage disruptive behavior . Parent education ( 12 core sessions , 1 home visit ) provided information about autism but no behavior management strategies . MAIN OUTCOMES AND MEASURES Parents rated disruptive behavior and noncompliance on co- primary outcomes : the Aberrant Behavior Checklist-Irritability subscale ( range , 0 - 45 ) and the Home Situations Question naire-Autism Spectrum Disorder ( range , 0 - 9 ) . On both measures , higher scores indicate greater severity and a 25 % reduction indicates clinical improvement . A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression ( range , 1 - 7 ) , a secondary outcome , with a positive response less than 3 . RESULTS At week 24 , the Aberrant Behavior Checklist-Irritability subscale declined 47.7 % in parent training ( from 23.7 to 12.4 ) compared with 31.8 % for parent education ( 23.9 to 16.3 ) ( treatment effect , -3.9 ; 95 % CI , -6.2 to -1.7 ; P < .001 , st and ardized effect size = 0.62 ) . The Home Situations Question naire-Autism Spectrum Disorder declined 55 % ( from 4.0 to 1.8 ) compared with 34.2 % in parent education ( 3.8 to 2.5 ) ( treatment effect , -0.7 ; 95 % CI , -1.1 to -0.3 ; P < .001 , st and ardized effect size = 0.45 ) . Neither measure met the prespecified minimal clinical ly important difference . The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5 % for parent training vs 39.6 % for parent education ( P < .001 ) . CONCLUSIONS AND RELEVANCE For children with autism spectrum disorder , a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes , although the clinical significance of the improvement is unclear . The rate of positive response judged by a blinded clinician was greater for parent training vs parent education . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01233414 Guidance on effective interventions for disruptive behavior in young children with autism spectrum disorders ( ASDs ) is limited . We present feasibility and initial efficacy data on a structured parent training program for 16 children ( ages 3–6 ) with ASD and disruptive behavior . The 6-month intervention included 11 Core and up to 2 Optional sessions . The program was acceptable to parents as evidence d by an attendance rate of 84 % for Core sessions . Fourteen of 16 families completed the treatment . An independent clinician rated 14 of 16 subjects as much improved or very much improved at Week 24 . Using last observation carried forward , the parent-rated Aberrant Behavior Checklist-Irritability subscale decreased 54 % from 16.00 ( SD = 9.21 ) to 7.38 ( SD = 6.15 ) INTRODUCTION There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems . The aim of the study was to determine whether a home-based programme provided over 12 months result ed in sustained improvement in development and behaviour 12 months after the intervention ceased . The characteristics of the children and families who benefited most from the intervention were also studied . METHOD R and omized controlled trial . Participants A total of 59 children , aged 3 - 5 years , attending two early childhood intervention centres in Melbourne , Australia . Intervention  Half of the subjects received an additional home-based programme consisting of 40 weekly visits . MAIN OUTCOME MEASURES Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised , Preschool Behaviour Checklist , Bayley Behaviour Rating Scale and Behaviour Screening Question naire . All tests administered pre-intervention , following the intervention and 12 months later . Secondary outcome measures Family stress , support and empowerment . RESULTS Fifty-four children completed the assessment s 12 months after conclusion of the intervention . Compared with the control group , improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later ( P= 0.007 ) while significant behavioural differences post intervention were not . Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non-verbal areas . In contrast to the control group who deteriorated , language skills in the intervention group remained stable . Improvements were significantly associated with higher stress in the families . CONCLUSION Improvements following the provision of a home-based programme to preschool children with developmental disabilities were sustained 1 year later . Children from highly stressed families appeared to benefit most , reinforcing the importance of involving families in early childhood intervention programmes This study examined the  measurement tools and target symptoms/skills  used to assess treatment response during Autism Spectrum Disorder ( ASD ) intervention trials from 2001 through 2010 . Data from 195 prospect i ve trials were analyzed . There were 289 unique  measurement  tools , of which 61.6 % were used only once , and 20.8 % were investigator- design ed . Only three tools were used in more than 2 % of the studies , and none were used in more than 7 % of studies . Studies investigated an average of 11.4 tool-symptom combinations per trial , with as many as 45 in one study . These results represent a lack of consistency in outcome measurements in ASD intervention trials . These findings highlight the need to set guidelines for appropriate outcome measurement in the ASD field
target: Conclusions We found patchy evidence on reliability and validity , for only a few of the tools used to measure behaviour problems in young children with ASD .
background: Background Behaviour problems are common in young children with autism spectrum disorder ( ASD ) .
  There are many different tools used to measure behavior problems but little is known about their validity for the population .
  Objectives To evaluate the measurement properties of behaviour problems tools  used in evaluation of intervention or observational research studies with children with ASD up to the age of six years .