title: Preschool-based social communication treatment for children with autism: 12-month follow-up of a randomized trial. The pilot study. A Parent-Mediated Intervention That Targets Responsive Parental Behaviors Increases Attachment Behaviors in Children with ASD: Results from a Randomized Clinical Trial A Randomized Controlled Trial of the Social Tools And Rules for Teens (START) Program: An Immersive Socialization Intervention for Adolescents with Autism Spectrum Disorder. Changes in anxiety following a randomized control trial of a theatre-based intervention for youth with autism spectrum disorder Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder Exploring the Effectiveness of a Peer-Mediated Model of the PEERS Curriculum: A Pilot Randomized Control Trial Enhancing interactions during daily routines: A randomized controlled trial of a web‐based tutorial for parents of young children with ASD Cost Offset Associated With Early Start Denver Model for Children With Autism. PLAY Project Home Consultation Intervention Program for Young Children With Autism Spectrum Disorders: A Randomized Controlled Trial Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial A systematic review of peer-mediated interventions for children with autism spectrum disorder. A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms. Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial. Early Intervention with a Parent-Delivered Massage Protocol Directed at Tactile Abnormalities Decreases Severity of Autism and Improves Child-to-Parent Interactions: A Replication Study A Comprehensive Peer Network Intervention to Improve Social Communication of Children with Autism Spectrum Disorders: A Randomized Trial in Kindergarten and First Grade Treatment of Children with Autism: A Randomized Controlled Trial to Evaluate a Caregiver‐Based Intervention Program in Community Day‐Care Centers Cross‐site randomized control trial of the Social ABCs caregiver‐mediated intervention for toddlers with autism spectrum disorder Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial. Increasing Responsive Parent–Child Interactions and Joint Engagement: Comparing the Influence of Parent-Mediated Intervention and Parent Psychoeducation The influence of nonhandicapped peers on the social interactions of children with a pervasive developmental disorder Cluster Randomized Trial of the Classroom SCERTS Intervention for Elementary Students with Autism Spectrum Disorder The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia Social conversation skill improvements associated with the Social Tools And Rules for Teens program for adolescents with autism spectrum disorder: Results of a randomized controlled trial Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI): A randomized controlled trial Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): Pilot Randomised Controlled Trial of a New Parent Group Intervention Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism.
abstract: OBJECTIVE This study reports 12-month follow-up data from a r and omized controlled trial of preschool-based social communication treatment for young children with autism . METHOD A total of 61 children ( 48 males ) with autism , 29 to 60 months of age , had earlier been r and omized either to 8 weeks of preschool-based social communication treatment in addition to st and ard preschool program ( n = 34 ) or to st and ard preschool program only ( n = 27 ) . Significant short-term effects on targeted social communication skills have previously been published . Long-term gains in social communication , language and global social functioning and communication were assessed from video-taped preschool teacher-child and mother-child interactions , Early Social Communication Scales , Reynell Developmental Language Scale , and Social Communication Question naire . RESULTS Compared with those in the control group , the treated children achieved significantly larger improvements in joint attention and joint engagement from baseline to 12-month follow-up . However , no effects were detected on language and global ratings of social functioning and communication . The treatment effect on child initiation of joint attention increased with increasing level of sociability at baseline , whereas nonverbal IQ and expressive language had no moderating effect . CONCLUSIONS This study is the first to show that , similar to specialist-delivered treatment , preschool-based treatment may produce small but possibly clinical ly important long-term changes in social communication in young children with autism . The treatment did not affect language and global ratings of social functioning and communication . More studies are needed to better underst and whether treatment effects may be improved by increasing the intensity and duration of the treatment . Clinical trial registration information -- Joint Attention Intervention and Young Children With Autism ; http:// clinical trials.gov/ ; NCT00378157 This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer The current study is a r and omized clinical trial evaluating the efficacy of Focused Playtime Intervention ( FPI ) in a sample of 70 children with Autism Spectrum Disorder . This parent-mediated intervention has previously been shown to significantly increase responsive parental communication ( Siller et al. in J Autism Dev Disord 43:540–555 , 2013a ) . The current analyses focus on children ’s attachment related outcomes . Results revealed that children who were r and omly assigned to FPI showed bigger increases in attachment-related behaviors , compared to children assigned to the control condition . Significant treatment effects of FPI were found for both an observational measure of attachment-related behaviors elicited during a brief separation-reunion episode and a question naire measure evaluating parental perceptions of child attachment . The theoretical and clinical implication s of these findings are discussed Adolescents with ASD face numerous personal and context ual barriers that impede the development of social motivation and core competencies , warranting the need for targeted intervention . A r and omized controlled trial was conducted with 40 adolescents to evaluate the merits of a multi-component socialization intervention that places emphasis on experiential learning . This investigation evaluated the impact of the 20-week START program on the social functioning of adolescents with ASD . Significant Group × Time differences between START and waitlist control groups were found across multiple measures . Secondary analyses of the entire program cohort also yielded significant improvement trends across all measures . These findings may be an important step in identifying optimal strategies to target the complex factors limiting optimal social development in ASD Increased anxiety and stress are frequently found in children with autism spectrum disorder and are associated with social challenges . Recently , we reported changes in social competence following peer-mediated , theatre-based intervention . The purpose of this study was to examine the impact of the intervention on reducing anxiety and stress .  Participants included 30 youth with autism spectrum disorder ( 8–14 years old ) r and omly assigned to the experimental ( 17 ) or waitlist control ( 13 ) group . Pretest adjusted , between-group differences were analyzed for state-anxiety , trait-anxiety , play-based cortisol , and diurnal cortisol . Pearson correlations were conducted between anxiety , cortisol , and group play . Significant pretest-adjusted between-group differences at posttest were observed on trait-anxiety ( F(1 , 27 ) = 9.16 , p = 0.005 ) but not state-anxiety ( F(1 , 27 ) = 0.03 , p = 0.86 ) , showing lower trait-anxiety in the experimental group . There were no between-group differences on cortisol . There was a significant negative correlation between group play and trait-anxiety ( r = −0.362 , p = 0.05 ) . Playground cortisol correlated with group play , for the experimental group ( r = 0.55 , p = 0.03 ) . The theatre-based , peer-mediated intervention not only contributes to improvement in social competence in youth with autism spectrum disorder but also contributes to reductions in trait-anxiety associated with more social interaction with peers . Results suggest that some degree of physiological arousal is essential for social interaction The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention This study compared immediate and 4-month outcomes among adolescents with autism spectrum disorder r and omly assigned to the PEERS curriculum ( n = 10 ) , a peer mediated PEERS curriculum ( n = 12 ) , or a delayed treatment control group ( n = 12 ) . Findings suggest a modest advantage in social skills knowledge and social functioning for participants in the peer-mediated PEERS curriculum relative to Traditional PEERS , and gains in social skills knowledge , social functioning , and reductions in loneliness were maintained in one or both treatment groups at a 4-month follow-up . Typically developing peer mentors ( n = 16 ) showed improvements in social skills knowledge and marginal improvements in autism knowledge and loneliness . Future research with a larger sample and objective outcome measures is needed Children with Autism Spectrum Disorder ( ASD ) often experience difficulty participating in everyday home routines , such as bed time or bath time . This r and omized controlled trial examined the efficacy of an interactive , web‐based parenting tutorial for improving children 's engagement in daily routines ( i.e. , proximal outcomes ) as well improving children 's social communication and parenting efficacy and stress ( i.e. , broad outcomes ) . Parents of children with ASD between 18 and 60 months were r and omly assigned to the  Tutorial  group ( n = 52 ) or the  Control group ( n = 52 ) . All parents completed question naires at baseline ( T1 ) , 1 month after T1 ( T2 ; post‐tutorial completion ) , and 2 months after T1 ( T3 ) . Relative to the Control group , parents in the Tutorial group reported significantly higher use of evidence ‐based instructional strategies and higher levels of child engagement during routines at T2 and T3 . In addition , parents in the Tutorial group reported significantly lower parenting stress and higher parenting efficacy at T3 , as well as higher ratings of child social communication at T2 and T3 , compared to the Control group . Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial . These improvements in both proximal and broad parent‐child outcomes suggest that this tutorial may be a promising and accessible way for empowering some parents and improving parent‐child interactions . Autism Res 2018 , 11 : 667–678 . © 2018 International Society for Autism Research , Wiley Periodicals , OBJECTIVE To determine the effect of the Early Start Denver Model ( ESDM ) for treatment of young children with autism on health care service use and costs . METHOD We used data from a r and omized trial that tested the efficacy of the ESDM , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents , for 2 years . Parents were interviewed about their children 's service use every 6 months from the onset of the intervention to follow-up ( age 6 years ) . The sample for this study consisted of 39 children with autism who participated in the original r and omized trial at age 18 to 30 months , and were also assessed at age 6 years . Of this sample , 21 children were in the ESDM group , and 18 children were in the community care ( COM ) group . Reported services were categorized and costed by applying unit hourly costs . Annualized service use and costs during the intervention and post intervention for the two study arms were compared . RESULTS During the intervention , children who received the ESDM had average annualized total health-related costs that were higher by about $ 14,000 than those of children who received community-based treatment . The higher cost of ESDM was partially offset during the intervention period because children in the ESDM group used less  applied behavior analysis (ABA)/early intensive behavioral intervention ( EIBI )  and  speech therapy services than children in the comparison group . In the postintervention period , compared with children who had earlier received treatment as usual in community setting s , children in the ESDM group used less ABA/EIBI , occupational/physical therapy , and speech therapy services , result ing in significant cost savings in the amount of about $ 19,000 per year per child . CONCLUSION Costs associated with ESDM treatment were fully offset within a few years after the intervention because of reductions in other service use and associated costs . CLINICAL TRIAL REGISTRATION INFORMATION Early Characteristics of Autism ; http:// clinical trials.gov/ ; NCT0009415 Objective : To evaluate the effectiveness of the Play and Language for Autistic Youngsters ( PLAY ) Project Home Consultation model , in combination with usual community services ( CS ) , to improve parent-child interaction , child development , and autism symptomatology in young children with autism spectrum disorders ( ASDs ) compared with CS only . Methods : Children ( N = 128 ) with autism or PDD-NOS ( DSM-4 criteria ) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were r and omized in two 1-year cohorts . Using videotape and written feedback within a developmental framework , PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction . CS included speech/ language and occupational therapy and public education services . Primary outcomes included change in parent-child interactions , language and development , and autism-related diagnostic category/symptoms . Secondary outcomes included parent stress and depression and home consultant fidelity . Data were collected pre- and post-intervention . Results : Using intent-to-treat analysis ( ITT ) , large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales . Child language and developmental quotient did not differ over time by group , although functional development improved significantly . PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule ( ADOS ) . PLAY caregivers ' stress did not increase , and depressive symptomatology decreased . Home consultants administered the intervention with fidelity . Conclusions : PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents ' stress/depression . ADOS findings must be interpreted cautiously because results do not align with clinical experience . PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents Summary Background Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children . We therefore investigated the efficacy of such an intervention in a larger trial . Methods Children with core autism ( aged 2 years to 4 years and 11 months ) were r and omly assigned in a one-to-one ratio to a parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention or treatment as usual at three specialist centres in the UK . Those assigned to PACT were also given treatment as usual . R and omisation was by use of minimisation of probability in the marginal distribution of treatment centre , age ( ≤42 months or > 42 months ) , and autism severity ( Autism Diagnostic Observation Schedule-Generic [ ADOS-G ] algorithm score 12–17 or 18–24 ) . Primary outcome was severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months . Complementary secondary outcomes were measures of parent-child interaction , child language , and adaptive functioning in school . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N58133827 . Results 152 children were recruited . 77 were assigned to PACT ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=25 ] ) ; and 75 to treatment as usual ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=23 ] ) . At the 13-month endpoint , the severity of symptoms was reduced by 3·9 points ( SD 4·7 ) on the ADOS-G algorithm in the group assigned to PACT , and 2·9 ( 3·9 ) in the group assigned to treatment as usual , representing a between-group effect size of −0·24 ( 95 % CI −0·59 to 0·11 ) , after adjustment for centre , sex , socioeconomic status , age , and verbal and non-verbal abilities . Treatment effect was positive for parental synchronous response to child ( 1·22 , 0·85 to 1·59 ) , child initiations with parent ( 0·41 , 0·08 to 0·74 ) , and for parent-child shared attention ( 0·33 , −0·02 to 0·68 ) . Effects on directly assessed language and adaptive functioning in school were small . Interpretation On the basis of our findings , we can not recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms ; however , a clear benefit was noted for parent-child dyadic social communication . Funding UK Medical Research Council , and UK Department for Children , Schools and Families 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 BACKGROUND This r and omized controlled trial compared Hanen 's ' More than Words ' ( HMTW ) , a parent-implemented intervention , to a ' business as usual ' control group . METHODS Sixty-two children ( 51 boys and 11 girls ; M age = 20 months ; SD = 2.6 ) who met criteria for autism spectrum disorders ( ASD ) and their parents participated in the study . The HMTW intervention was provided over 3.5 months . There were three measurement periods : prior to r and omization ( Time 1 ) and at 5 and 9 months post enrollment ( Times 2 and 3 ) . Children 's communication and parental responsivity were measured at each time point . Children 's object interest , a putative moderator , was measured at Time 1 . RESULTS There were no main effects of the HMTW intervention on either parental responsivity or children 's communication . However , the effects on residualized gains in parental responsivity from Time 1 to both Times 2 and 3 yielded noteworthy effect sizes ( Glass 's Δ = .71 , .50 respectively ) . In contrast , there were treatment effects on child communication gains to Time 3 that were moderated by children 's Time 1 object interest . Children with lower levels of Time 1 object interest exhibited facilitated growth in communication ; children with higher levels of object interest exhibited growth attenuation . CONCLUSIONS The HMTW intervention showed differential effects on child communication depending on a baseline child factor . HMTW facilitated communication in children with lower levels of Time 1 object interest . Parents of children who evidence higher object interest  may require greater support to implement the HMTW strategies , or may require different strategies than those provided by the HMTW curriculum BACKGROUND Autism spectrum disorder affects more than 5 million children in south Asia . Although early interventions have been used for the treatment of children in high-income countries , no substantive trials have been done of the interventions adapted for use in low-income and middle-income countries ( LMICs ) . We therefore assessed the feasibility and acceptability of the parent-mediated intervention for autism spectrum disorder in south Asia ( PASS ) in India and Pakistan . METHODS A single-blind r and omised trial of the comparison of 12 sessions of PASS ( plus treatment as usual ) with treatment as usual alone delivered by non-specialist health workers was done at two centres in Goa , India , and Rawalpindi , Pakistan . Children aged 2 - 9 years with autism spectrum disorder were r and omly assigned ( 1:1 ) by use of probabilistic minimisation , controlling for treatment centre ( Goa or Rawalpindi ) , age ( < 6 years or ≥6 years ) , and functional impairment ( Vinel and Adaptive Behaviour Scale Composite score < 65 or ≥65 ) . The primary outcome was quality of parent-child interaction on the Dyadic Communication Measure for Autism at 8 months . Analysis was by intention to treat . The study is registered with IS RCT N , number IS RCT N79675498 . FINDINGS From Jan 1 to July 30 , 2013 , 65 children were r and omly allocated , 32 to the PASS group ( 15 in Goa and 17 in Rawalpindi ) and 33 to the treatment-as-usual group ( 15 in Goa and 18 in Rawalpindi ) . 26 ( 81 % ) of 32 participants completed the intervention . After adjustment for minimisation factors and baseline outcome , the primary outcome showed a treatment effect in favour of PASS in parental synchrony ( adjusted mean difference 0·25 [ 95 % CI 0·14 to 0·36 ] ; effect size 1·61 [ 95 % CI 0·90 to 2·32 ] ) and initiation of communication by the child with the parent ( 0·15 [ 0·04 to 0·26 ] ; effect size 0·99 [ 0·29 to 1·68 ] ) , but time in mutual shared attention was reduced ( -0·16 [ -0·26 to -0·05 ] ; effect size -0·70 [ -1·16 to -0·23 ] ) . INTERPRETATION Our results show the feasibility of adapting and task-shifting an intervention used in a high-income context to LMICs . The findings also replicate the positive primary outcome treatment effects of a parent-mediated communication-focused intervention in the original UK Preschool Autism Communication Trial , with one negative effect not reported previously . FUNDING Autism Speaks , USA Tactile abnormalities are severe and universal in preschool children with autism . They respond well to treatment with a daily massage protocol directed at tactile abnormalities ( QST massage for autism ) . Treatment is based on a model for autism proposing that tactile impairment poses a barrier to development . Two previous r and omized controlled trials evaluating five months of massage treatment reported improvement of behavior , social/communication skills , and tactile and other sensory symptoms . This is the first report from a two-year replication study evaluating the protocol in 103 preschool children with autism . Parents gave daily treatment ; trained staff gave weekly treatment and parent support . Five-month outcomes replicated earlier studies and showed normalization of receptive language ( 18 % , P = .03 ) , autistic behavior ( 32 % , P = .006 ) , total sensory abnormalities ( 38 % , P = .0000005 ) , tactile abnormalities ( 49 % , P = .0002 ) , and decreased autism severity ( medium to large effect size , P = .008 ) . In addition , parents reported improved child-to-parent interactions , bonding , and decreased parenting stress ( 44 % , P = .00008 ) . Early childhood special education programs are tasked with addressing sensory abnormalities and engaging parents in effective home programs . Until now , they have lacked research -based methods to do so . This program fulfills the need . It is recommended to parents and ECSE programs ( ages 3–5 ) at autism diagnosis The purpose of this r and omized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First- grade children with autism spectrum disorders . Trained school staff members provided direct instruction for 56 children in the intervention group , and 39 children participated in a comparison group . Results showed children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment social probes and generalization probes . Treatment session data showed significant growth for total communications over baseline levels . Children in treatment also showed more growth in language and adaptive communication . Finally , teachers ’ ratings of prosocial skills revealed significantly greater improvements for the intervention group & NA ; This study reports on the results of a r and omized controlled trial that evaluated a caregiverbased intervention program for children with autism in community day‐care centers . Thirty‐five preschool children with a DSM III‐R diagnosis of autism or pervasive developmental disorder were r and omized to an experimental or control group . Children in the experimental group were enrolled in day care and their parents and child care workers received a 12‐week intervention consisting of lectures and on‐site consultations to day‐care centers . In addition , supportive work was undertaken with families . Control subjects received day care alone . In the experimental group , there were greater gains in language abilities , significant increases in caregivers ' knowledge about autism , greater perception of control on the part of mothers , and greater parent satisfaction . We conclude that this research design demonstrated that the intervention was significantly superior to day care alone To evaluate the efficacy of the Social ABCs parent‐mediated intervention for toddlers with suspected or confirmed autism spectrum disorder ( ASD ) , through a cross‐site r and omized control trial , sixty‐three parent – toddler dyads ( toddler age : 16–30 months ) were r and omized into treatment ( Social ABCs ) or control ( service‐as‐usual ) conditions .  Video  data were obtained at three key time‐points : Baseline ; Post‐training ( PT ; week 12 ) ; and Follow‐Up ( week 24 ) . Analyses included 62 dyads . Treatment allocation significantly accounted for PT gains , all favouring the Treatment group , in ( 1 ) child functional vocal responsiveness to parent prompts ( R2 = 0.43 , P < .001 ) , ( 2 ) child vocal initiations ( R2 = 0.28 , P < .001 ) , ( 3 ) parent smiling ( R2 = 0.09 , P = .017 ) , and ( 4 ) fidelity of implementation ( R2 = 0.71 , P < .001 ) . A trend was observed for increased social orienting ( R2 = 0.06 , P = 0.054 ) ; gains in parent smiling significantly predicted increases in child smiling and social orienting . Parents in the treatment condition reported significant gains in self‐efficacy following the intervention ( P = 0.009 ) . No differential effects emerged for performance on st and ardized measures . The Social ABCs is a relatively low‐re source , efficacious intervention , with potential to be a cost‐effective means of intervening at the first signs of possible ASD . Autism Res 2017 , 10 : 1700–1711 . © 2017 International Society for Autism Research , Wiley Periodicals , This pilot RCT compared the effect of a self-directed and therapist-assisted telehealth-based parent-mediated intervention  for young children with ASD . Families were r and omly assigned to a self-directed or therapist-assisted program . Parents in both groups improved their intervention fidelity , self-efficacy , stress , and positive perceptions of their child ; however , the therapist-assisted group had greater gains in parent fidelity and positive perceptions of child . Children in both groups improved on language measures , with a trend towards greater gains during a parent – child interaction for the therapist-assisted group . Only the children in the therapist-assisted group improved in social skills . Both models show promise for delivering parent-mediated intervention ; however , therapist assistance provided an added benefit for some outcomes . A full-scale comparative efficacy trial is warranted A recent r and omized controlled trial ( RCT ) of a dual parent and trainer-delivered qigong massage intervention for young children with autism result ed in improvement of measures of autism as well as improvement of abnormal sensory responses and self-regulation . The RCT evaluated the effects of the parent-delivered component of the intervention . Forty-seven children were r and omly assigned to treatment and wait-list control groups . Treatment group children received the parent-delivered program for 4 mo . Trained therapists provided parent training and support . Improvement was evaluated in two setting s -- preschool and home -- by teachers ( blind to group ) and parents . Results showed that the parent-delivered program was effective in improving measures of autism ( medium effect size ) and sensory and self-regulatory responses ( large effect size ) . Teacher data on measures of autism were confirmed by parent data . Results indicate that the parent-delivered component of the program provided effective early intervention for autism that was suitable for delivery at home Enhancing immediate and contingent responding by caregivers to children ’s signals is an important strategy to support social interactions between caregivers and their children with autism . Yet , there has been limited examination of parents ’ responsive behaviour in association with children ’s social behaviour post caregiver-mediated intervention .  Eighty-five dyads were r and omized to one of two 10-week caregiver-training interventions .  Parent – child play interactions were coded for parental responsivity and children ’s joint engagement . Significant gains in responsivity and time jointly engaged were found post JASPER parent-mediated intervention over a psychoeducation intervention . Further , combining higher levels of responsive behaviour with greater adoption of intervention strategies was associated with greater time jointly engaged . Findings encourage a focus on enhancing responsive behaviour in parent-mediated intervention models This study investigated whether or not children with autism or a related pervasive developmental disorder ( PDD ) can benefit from regular opportunities to interact with a normally developing peer , matched as to sex and age . An experimental design with r and om assignment of subjects to treatment and control groups was used to demonstrate the impact of this peer-mediated intervention . In the treatment group , we found significant improvements in the social behavior of the children with PDD . Several gains were also generalized to interactions with an unfamiliar nonh and icapped peer , to interactions with another child with PDD , and to the large school setting . In the untreated control group , no positive changes were observed . Results suggest that children with PDD can develop peer relations if appropriate social context s are made available for them Objective : This cluster r and omized trial ( CRT ) evaluated the efficacy of the Classroom Social , Communication , Emotional Regulation , and Transactional Support ( SCERTS ) Intervention ( CSI ) compared with usual school-based education with autism training modules ( ATM ) . Method : Sixty schools with 197 students with autism spectrum disorder ( ASD ) in 129 classrooms were r and omly assigned to CSI or ATM .  Mean student age was 6.79 years ( SD 1.05 ) and 81.2 % were male . CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation . A CRT , with students nested within general and special education classrooms nested within schools , was used to evaluate student outcomes . Results : The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction . The CSI group also had significantly better outcomes on measures of adaptive communication , social skills , and executive functioning with Cohen ’s d effect sizes ranging from 0.31 to 0.45 . Conclusion : These findings support the preliminary efficacy of CSI , a classroom-based , teacher-implemented intervention for improving active engagement , adaptive communication , social skills , executive functioning , and problem behavior within a heterogeneous sample of students with ASD . This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures The treatment gap for autism globally is high . Our previous PASS intervention , delivered by community based lay health workers , showed effectiveness . This article reports the development and evaluation of a new “ PASS ‘ Plus ’ ” intervention in a rural population in India . Using formative research methods , we supplemented the PASS intervention with additional ( Plus ) modules to address autism comorbidities . This is the first time that a rigorous methodology has been used to evaluate autism symptom outcomes in a low and middle‐income country setting . 40 parent – child dyads were recruited in a pilot r and omized controlled trial against usual care ( mean age 65 months ( 34 boys ) ; n = 19 PASS Plus , n = 21 UC ) . 89 % of intervention families partially or entirely completed the 12‐session intervention . Intention to treat analysis showed a reduction in mean scores of autism symptom severity , though the confidence interval contains zero , ( adjusted mean difference AMD −2.42 95 % CI −7.75 , 2.92 ; ES 0.22 ) ; large treatment effects on proximal outcomes of proportion of parent synchronous responses ( AMD 0.35 ; 95 % CI 0.18 , 0.52 ; effect size ES 3.97 ) and proportion of child communication initiations with parent ( AMD 0·17 ; 95 % CI 0.03 , 0.32 ; ES 1.02 ) . Confidence intervals for effects on mutual shared attention ( AMD 0.10 ; 95 % CI −0.07 , 0.27 ; ES 0.5 ) and co‐morbid symptoms ( AMD −9.0 ; 95 % CI −24.26 , 6.26 ; ES 0.32 ) contained zero . There were significant effects to improve parental mental health . PASS Plus shows good feasibility and adds to the evidence of the effectiveness of task sharing complex autism interventions to lay health workers in India . Autism Res 2019 , 12 : 328–339 © 2018 International Society for Autism Research , Wiley Periodicals , This exploratory r and omised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor , imitation , language and social skills in young children with ASD who reside in regional areas . Fifty-nine participants were recruited and r and omised to either a therapy-as-usual group or intervention group . With the exception of the expressive language subscale on the Mullen Scales of Early Learning , no significant between-group differences were recorded for visual motor , imitation , receptive language and social skills of participants between baseline and post-intervention . When all participants were pooled and measured over time , improvements were shown in receptive and pragmatic language and social skills ; these gains were maintained , thus suggesting skill acquisition There has been a significant increase in the development of interventions to improve the social competence and success of adolescents with autism spectrum disorder . The current investigation used direct observation and coding of social conversations as a rigorous method to further assess the efficacy of the Social Tools And Rules for Teens socialization intervention for adolescents with autism spectrum disorder in the context of a r and omized controlled trial . A total of 35 adolescents with high-functioning autism spectrum disorder were r and omized to either a treatment or waitlist control group . The 20-week group intervention took place once a week for 90 min per session . Brief video-recorded conversations between participants and unfamiliar , untrained peers were recorded at pre- and post-time points and coded for selected social behaviors ( i.e. questions asked , positive facial expressions , and mutual engagement ) . Results revealed a significant Group × Time treatment effect for both questions asked and positive facial expressions . The findings support that the Social Tools And Rules for Teens intervention can positively impact specific , observable social behaviors through systematic coding of live social conversations within the context of a r and omized controlled trial . This investigation is one of the first r and omized controlled trials of a group socialization intervention to use systematic coding of live social conversations to assess social competence improvements In a r and omized controlled trial , we evaluated the early intervention program Video-feedback Intervention to promote Positive Parenting adapted to Autism ( VIPP-AUTI ) with 78 primary caregivers and their child ( 16–61 months ) with Autism Spectrum Disorder .  VIPP-AUTI is a brief attachment-based intervention program , focusing on improving parent – child interaction and reducing the child ’s individual Autism Spectrum Disorder – related symptomatology in five home visits . VIPP-AUTI , as compared with usual care , demonstrated efficacy in reducing parental intrusiveness . Moreover , parents who received VIPP-AUTI showed increased feelings of self-efficacy in child rearing . No significant group differences were found on other aspects of parent – child interaction or on child play behavior . At 3-months follow-up , intervention effects were found on child-initiated joint attention skills , not mediated by intervention effects on parenting . Implementation of VIPP-AUTI in clinical practice is facilitated by the use of a detailed manual and a relatively brief training of interveners Early intervention for autism spectrum disorder ( ASD ) tends to focus on enhancing social-communication skills . We report the acceptability , feasibility and impact on child functioning of a new 8 weeks parent-group intervention to manage restricted and repetitive behaviours ( RRB ) in young children with ASD aged 3–7 years . Forty-five families took part in the pilot RCT . A range of primary and secondary outcome measures were collected on four occasions ( baseline , 10 , 18 and 24 weeks ) to capture both independent ratings and parent-reported changes in RRB . This pilot established that parents were willing to be recruited and r and omised , and the format and content of the intervention was feasible . Fidelity of delivery was high , and attendance was 90 % . A fully powered trial is now planned OBJECTIVE This study compared effects of two parent-mediated interventions on joint engagement outcomes as augmentations of an early intervention program for toddlers with autism spectrum disorder ( ASD ) . METHOD Participants included 86 toddlers ( range 22 - 36 months ) with ASD and their primary caregiver . Caregiver-child dyads were r and omized to receive 10 weeks of h and s-on parent training in a naturalistic , developmental behavioral intervention ( joint attention , symbolic play , engagement and regulation-JASPER ) or a parent-only psychoeducational intervention ( PEI ) . Dose was controlled in terms of research er-parent contact and early intervention services received by the child . RESULTS Results yielded significant effects of the JASPER intervention on the primary outcome of joint engagement . The treatment effect was large ( Cohen 's f² = .69 ) and maintained over the 6-month follow-up . JASPER effects were also found on secondary outcomes of play diversity , highest play level achieved , and generalization to the child 's classroom for child-initiated joint engagement . The PEI intervention was found to be effective in reducing parenting stress associated with child characteristics . All secondary effects were generally small to moderate . CONCLUSIONS These data highlight the benefit of a brief , targeted , parent-mediated intervention on child outcomes . Future studies may consider the combination of JASPER and PEI treatments for optimal parent and child outcomes . Trial registry no. NCT00999778
target: CONCLUSION Non-specialist mediated interventions for autism spectrum disorder demonstrate effectiveness across a range of outcomes for children with autism and their caregivers
background: INTRODUCTION In recent years , several non-specialist mediated interventions have been developed and tested to address problematic symptoms associated with autism .
  These can be implemented with a fraction of cost required for specialist delivered interventions .
  This review represents a robust evidence of clinical effectiveness of these interventions in improving the social , motor and communication deficits among children with autism .