title: Brief Report: Randomized Test of the Efficacy of Picture Exchange Communication System on Highly Generalized Picture Exchanges in Children with ASD Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. How much change is true change? The smallest detectable difference of the Preschool Imitation and Praxis Scale (PIPS) in preschoolers with intellectual disabilities of heterogeneous aetiology. Randomized Controlled Trial for Early Intervention for Autism: A Pilot Study of the Autism 1-2-3 Project Brief Report: Pilot Randomized Controlled Trial of Reciprocal Imitation Training for Teaching Elicited and Spontaneous Imitation to Children with Autism A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Randomized Controlled Caregiver Mediated Joint Engagement Intervention for Toddlers with Autism Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials. Behavioral manifestations of autism in the first year of life Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial Low intensity behavioral treatment supplementing preschool services for young children with autism spectrum disorders and severe to mild intellectual disability. Brief Report: Longitudinal Improvements in the Quality of Joint Attention in Preschool Children with Autism A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial. Brief Report: Effect of a Focused Imitation Intervention on Social Functioning in Children with Autism Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments Early Language and Communication Development of Infants Later Diagnosed with Autism Spectrum Disorder Epidemiology of autism spectrum disorders in adults in the community in England. Qigong massage treatment for sensory and self-regulation problems in young children with autism: a randomized controlled trial. Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders. 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 Autism from 2 to 9 years of age. Effectiveness of a novel community-based early intervention model for children with autistic spectrum disorder. Randomized Controlled Trial of the Focus Parent Training for Toddlers with Autism: 1-Year Outcome Treatment of Children with Autism: A Randomized Controlled Trial to Evaluate a Caregiver‐Based Intervention Program in Community Day‐Care Centers Randomized trial of intensive early intervention for children with pervasive developmental disorder. Clinical variables at age 2 predictive of mental retardation at age 5 in children with pervasive developmental disorder. Outcome at 7 years of children diagnosed with autism at age 2: predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Brief Report: Mediation of Treatment Effect in a Communication Intervention for Pre-School Children with Autism Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial. Effectiveness of a Home Program Intervention for Young Children with Autism Retrospective evaluation of an intensive method of treatment for children with pervasive developmental disorder Home-Based Behavioral Treatment of Young Children with Autism Social-communicative effects of the Picture Exchange Communication System (PECS) in autism spectrum disorders. The Scottish Centre for Autism Preschool Treatment Programme Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness. A randomised group comparison controlled trial of ‘preschoolers with autism’: A parent education and skills training intervention for young children with autistic disorder Imitation from 12 to 24 months in autism and typical development: a longitudinal Rasch analysis. A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior Outcomes of a pilot training program in a qigong massage intervention for young children with autism. Preschool Based JASPER Intervention in Minimally Verbal Children with Autism: Pilot RCT Transcutaneous electrical acupoint stimulation in children with autism and its impact on plasma levels of arginine-vasopressin and oxytocin: a prospective single-blinded controlled study. A prospective study of the emergence of early behavioral signs of autism. A prospective study of autistic-like traits in unaffected siblings of probands with autism spectrum disorder. A Parent-Mediated Intervention to Increase Responsive Parental Behaviors and Child Communication in Children with ASD: A Randomized Clinical Trial Patterns of adaptive behavior in very young children with autism. Learning through interaction in children with autism: Preliminary data from asocial-communication-based intervention 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 Parent inclusion in Early Intensive Behavioral Intervention: the influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes. A randomized controlled trial of preschool-based joint attention intervention for children with autism. Cognitive, behavior and intervention outcome in young children with autism. Using the preschool language scale, fourth edition to characterize language in preschoolers with autism spectrum disorders. Development and Initial Validation of a Parent Report Measure of the Behavioral Development of Infants at Risk for Autism Spectrum Disorders Clinical assessment of autism in high-risk 18-month-olds A play and joint attention intervention for teachers of young children with autism: A randomized controlled pilot study
abstract: A r and omized control trial comparing two social-communication interventions in young children with autism examined far-transfer of the use of picture exchange to communicate .  Thirty-six children were r and omly assigned to one of two treatment conditions , one of which was the Picture Exchange Communication System ( PECS ) . All children had access to picture symbols during assessment s. Post-treatment measurement of the number of picture exchanges in a far-transfer , assessment context favored the PECS intervention . These findings were interpreted as support for the hypothesis that the PECS curriculum can successfully teach a generalized means of showing coordinated attention to object and person without requiring eye contact to children with ASD BACKGROUND Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism . These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts ( see Kasari , Freeman , & Paparella , 2001 ) . In this study , we examine the efficacy of targeted interventions of joint attention and symbolic play . METHODS Participants were 58 children with autism aged 3 and 4 years ( 46 boys ) . Children were r and omized to a joint attention intervention , a symbolic play intervention , or control group . Interventions were conducted 30 minutes daily for 5 - 6 weeks . Both structured assessment s of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors . RESULTS Results indicate that both intervention groups improved significantly over the control group on certain behaviors . Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction . The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers . CONCLUSIONS This r and omized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism . Future studies need to examine the long-term effects of these early interventions on children 's development The teaching of imitation skills is often the first step in interventions for young learners with intellectual disabilities . The main goal of this study was to determine the smallest detectable difference ( SDD ) at 95 % confidence of the Preschool Imitation and Praxis Scale ( PIPS ) in preschoolers with intellectual disabilities . Two raters independently scored videotapes of the imitation performance of 44 preschoolers ( 27 with Down syndrome , 10 with Non-Specific Mental Retardation and 7 with Low-functioning Autism ) between 13 and 58 months of age ( mean age 39.6 months , SD 11.9 months ) . Results revealed that the PIPS demonstrated acceptable interrater reliability on item level ( weighted kappa values ranged from 0.52 to 0.96 ) and scale level ( ICC = 0.986 ; 95 % CI : 0.975 - 0.993 ) . The SDD of the PIPS was 7.2 % , indicating that the change score rated by different raters for an individual child with an intellectual disability is valid and that the PIPS can be used by early interventionists and research ers as an outcome measure to determine children 's maturation or improvement We piloted a 2-week “ Autism-1 - 2 - 3 ” early intervention for children with autism and their parents immediately after diagnosis that targeted at ( 1 ) eye contact , ( 2 ) gesture and ( 3 ) vocalization/words .  Seventeen children were r and omized into the Intervention ( n = 9 ) and Control ( n = 8) groups . Outcome measures included the Autism Diagnostic Observation Schedule , Ritvo-Freeman Real Life Rating Scale , Symbolic Play Test , and Parenting Stress Index .  Children with autism improved in language /communication , reciprocal social interaction , and symbolic play . Parents perceived significant improvement in their children ’s language , social interaction , and their own stress level . This intervention can serve as short-term training on communication and social interaction for children with autism , and reduce the stress of their parents during the long waiting time for public health services Children with autism exhibit significant deficits in imitation skills .  Reciprocal Imitation Training ( RIT ) , a naturalistic imitation intervention , was developed to teach young children with autism to imitate during play . This study used a r and omized controlled trial to evaluate the efficacy of RIT on elicited and spontaneous imitation skills in 21 young children with autism . Results found that children in the treatment group made significantly more gains in elicited and spontaneous imitation , replicating previous single-subject design studies . Number of spontaneous play acts at pre-treatment was related to improvements in imitation during the intervention , suggesting that children with a greater play repertoire make greater gains during RIT PURPOSE This r and omized group experiment compared the efficacy of 2 communication interventions ( Responsive Education and Prelinguistic Milieu Teaching [ RPMT ] and the Picture Exchange Communication System [ PECS ] ) on spoken communication in 36 preschoolers with autism spectrum disorders ( ASD ) . METHOD Each treatment was delivered to children for a maximum total of 24 hr over a 6-month period . Spoken communication was assessed in a rigorous test of generalization at pretreatment , posttreatment , and 6-month follow-up periods . RESULTS PECS was more successful than RPMT in increasing the number of nonimitative spoken communication acts and the number of different nonimitative words used at the posttreatment period . Considering growth over all 3 measurement periods , an exploratory analysis showed that growth rate of the number of different nonimitative words was faster in the PECS group than in the RPMT group for children who began treatment with relatively high object exploration . In contrast , analogous slopes were steeper in the RPMT group than in the PECS group for children who began treatment with relatively low object exploration This study aim ed to determine if a joint attention intervention would result in greater joint engagement between caregivers and toddlers with autism . The intervention consisted of  24 caregiver-mediated sessions  with follow-up 1 year later . Compared to caregivers and toddlers r and omized to the waitlist control group the immediate treatment ( IT ) group made significant improvements in targeted areas of joint engagement . The IT group demonstrated significant improvements with medium to large effect sizes in their responsiveness to joint attention and their diversity of functional play acts after the intervention with maintenance of these skills 1 year post-intervention . These are among the first r and omized controlled data to suggest that short-term parent-mediated  interventions can have important effects on core impairments in toddlers with autism . Clinical Trials # : NCT00065910 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 In the interest of more systematic ally documenting the early signs of autism , and of testing specific hypotheses regarding their underlying neurodevelopmental substrates , we have initiated a longitudinal study of high-risk infants , all of whom have an older sibling diagnosed with an autistic spectrum disorder . Our sample currently includes 150 infant siblings , including 65 who have been followed to age 24 months , who are the focus of this paper . We have also followed a comparison group of low-risk infants . Our measures include a novel observational scale ( the first , to our knowledge , that is design ed to assess autism-specific behavior in infants ) , a computerized visual orienting task , and st and ardized measures of temperament , cognitive and language development . Our preliminary results indicate that by 12 months of age , siblings who are later diagnosed with autism may be distinguished from other siblings and low-risk controls on the basis of : ( 1 ) several specific behavioral markers , including atypicalities in eye contact , visual tracking , disengagement of visual attention , orienting to name , imitation , social smiling , reactivity , social interest and affect , and sensory-oriented behaviors ; ( 2 ) prolonged latency to disengage visual attention ; ( 3 ) a characteristic pattern of early temperament , with marked passivity and decreased activity level at 6 months , followed by extreme distress reactions , a tendency to fixate on particular objects in the environment , and decreased expression of positive affect by 12 months ; and ( 4 ) delayed expressive and receptive language . We discuss these findings in the context of various neural networks thought to underlie neurodevelopmental abnormalities in autism , including poor visual orienting . Over time , as we are able to prospect ively study larger numbers and to examine interrelationships among both early-developing behaviors and biological indices of interest , we hope this work will advance current underst and ing of the neurodevelopmental origins of autism 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 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 Children with autism exhibit deficits in their quantity and quality of joint attention . Early autism intervention studies rarely document improvement in joint attention quality . The purpose of this study was to determine whether there was a change in joint attention quality for preschoolers with autism who were r and omized to a joint attention intervention , symbolic play intervention , or a control group .  Quality was defined as shared positive affect during joint attention as well as shared positive affect and utterances during joint attention . Interactions of group and time were found for both types of joint attention quality . During the follow up visits , the joint attention and symbolic play intervention groups produced more of these two types of joint attention quality than the control group 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 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 Imitation is an early skill thought to play a role in social development , leading some to suggest that teaching imitation to children with autism should lead to improvements in social functioning . This study used a r and omized controlled trial to evaluate the effect of a focused imitation intervention on initiation of joint attention and social-emotional functioning in 27 young children with autism . Results indicated the treatment group made significantly more gains in joint attention initiations at post-treatment and follow-up and social-emotional functioning at follow-up than the control group . Although gains in social functioning were associated with treatment , a mediation analysis did not support imitation as the mechanism of action . These findings suggest the intervention improves social functioning in children with ASD 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 ABSTRACT . It is well recognized that delayed " first words " is among the most common presenting symptoms of autistic spectrum disorders ( ASD ) . However , data on earlier language and communication development in children with ASD are limited to retrospective reports from parents and from home videos . In this study , we prospect ively collected parent report data on early communication and language development in 97 infant siblings of children with ASD and 49 low-risk controls . Parents completed the  MacArthur Communicative Development Inventory-Infant Form  at 12 and 18 months . Analysis compared 3 groups defined on the basis of diagnostic assessment at 24 months : ( 1 ) siblings with ASD ( n = 15 ) , ( 2 ) siblings not meeting diagnostic criteria for ASD ( n = 82 ) , and ( 3 ) low-risk controls , none of whom had ASD ( n = 49 ) . Children with ASD showed delays in early language and communication compared with non-ASD siblings and controls . At 12 months , the ASD group was reported to underst and significantly fewer phrases and to produce fewer gestures . At 18 months , they showed delays in their underst and ing of phrases , comprehension and production of single words , and use of gestures . Siblings not diagnosed with ASD also used fewer play-related gestures at 18 months than low-risk controls , even when children with identified language delays were excluded . Overall , this prospect i ve study confirms that delays in communication and language development are apparent early in life in children with ASD , and emphasizes that developmental surveillance should include monitoring for delays in gesture , which may be among the earliest signs of ASD CONTEXT To our knowledge , there is no published information on the epidemiology of autism spectrum disorders ( ASDs ) in adults . If the prevalence of autism is increasing , rates in older adults would be expected to be lower than rates among younger adults . OBJECTIVE To estimate the prevalence and characteristics of adults with ASD living in the community in Engl and . DESIGN A stratified , multiphase r and om sample was used in the third national survey of psychiatric morbidity in adults in Engl and in 2007 . Survey data were weighted to take account of study design and nonresponse so that the results were representative of the household population . SETTING General community ( ie , private households ) in Engl and . PARTICIPANTS Adults ( people 16 years or older ) . MAIN OUTCOME MEASURES Autism Diagnostic Observation Schedule , Module 4 in phase 2 vali date d against the Autism Diagnostic Interview-Revised and Diagnostic Interview for Social and Communication Disorders in phase 3 . A 20-item subset of the Autism-Spectrum Quotient self-completion question naire was used in phase 1 to select respondents for phase 2 . Respondents also provided information on sociodemographics and their use of mental health services . RESULTS Of 7461 adult participants who provided a complete phase 1 interview , 618 completed phase 2 diagnostic assessment s. The weighted prevalence of ASD in adults was estimated to be 9.8 per 1000 ( 95 % confidence interval , 3.0 - 16.5 ) . Prevalence was not related to the respondent 's age . Rates were higher in men , those without educational qualifications , and those living in rented social ( government-financed ) housing . There was no evidence of increased use of services for mental health problems . CONCLUSIONS Conducting epidemiologic research on ASD in adults is feasible . The prevalence of ASD in this population is similar to that found in children . The lack of an association with age is consistent with there having been no increase in prevalence and with its causes being temporally constant . Adults with ASD living in the community are socially disadvantaged and tend to be unrecognized Autism is commonly associated with sensory and self-regulatory disturbances . This article presents a r and omized controlled study evaluating the effect of a 5-month intervention directed toward improving sensory impairment , digestion , and sleep in 46 children with autism < age 6 . The intervention , Qigong Sensory Training ( QST ) , is a qigong massage intervention based in Chinese medicine . It is two-pronged : Trainers work with children directly 20 times over 5 months , and parents give the massage daily to their children . Improvement was evaluated in two setting s -- preschool and home -- by teachers ( blind to group ) and parents . Teacher evaluations showed that treated children had significant classroom improvement of social and language skills and reduction in autistic behavior compared with wait-list control participants . These findings were confirmed by parent data , indicating that the gains had generalized across context s. A model and supporting data for underst and ing and treating sensory and self-regulation problems in autism is presented This r and omized group experiment compared the efficacy of 2 communication interventions ( Responsive Education and Prelinguistic Milieu Teaching [ RPMT ] and the Picture Exchange Communication System [ PECS ] ) in 36 preschoolers with autism spectrum disorders . Each treatment was delivered 3 times per week , in 20-min sessions , for 6 months . The results revealed that the RPMT facilitated the frequency of generalized turn taking and generalized initiating joint attention more than did the PECS . The latter effect occurred only for children who began treatment with at least some initiating joint attention . In contrast , the PECS facilitated generalized requests more than the RPMT in children with very little initiating joint attention prior to treatment . These effect sizes were large 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 CONTEXT Autism represents an unusual pattern of development beginning in the infant and toddler years . OBJECTIVES To examine the stability of  autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis . DESIGN Prospect i ve study of diagnostic classifications from st and ardized instruments including a parent interview  ( Autism Diagnostic Interview-Revised [ ADI-R ] ) , an observational scale ( Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ ADOS ] ) , and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team 's criterion st and ard diagnoses . SETTING Three inception cohorts : consecutive referrals for autism assessment to ( 1 ) state-funded community autism centers , ( 2 ) a private university autism clinic , and ( 3 ) case controls with developmental delay from community clinics . PARTICIPANTS At 2 years of age , 192 autism referrals and 22 developmentally delayed case controls ; 172 children seen at 9 years of age . MAIN OUTCOME MEASURES Consensus best-estimate diagnoses at 9 years of age . RESULTS Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67 , with a weighted kappa of 0.72 . Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism . Each measure at age 2 years was strongly prognostic for autism at age 9 years , with odds ratios of 6.6 for parent interview , 6.8 for observation , and 12.8 for clinical judgment . Once verbal IQ ( P = .001 ) was taken into account at age 2 years , the ADI-R repetitive domain ( P = .02 ) and the ADOS social ( P = .05 ) and repetitive domains ( P = .005 ) significantly predicted autism at age 9 years . CONCLUSIONS Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified . Judgment of experienced clinicians , trained on st and ard instruments , consistently added to information available from parent interview and st and ardized observation 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 This r and omized controlled trial compared results obtained after 12 months of nonintensive parent training plus care-as-usual and care-as-usual alone . The training focused on stimulating joint attention and language skills and was based on the intervention described by Drew et al. ( Eur Child Adolesc Psychiatr 11:266–272 , 2002 ) . Seventy-five toddlers with autism spectrum disorder ( 65 autism , 10 PDD-NOS , mean age = 34.4 months , SD = 6.2 ) were enrolled . Analyses were conducted on a final sample of 67 children ( lost to follow-up = 8) . No significant intervention effects were found for any of the primary ( language ) , secondary ( global clinical improvement ) , or mediating ( child engagement , early precursors of social communication , or parental skills ) outcome variables , suggesting that the ‘ Focus parent training ’ was not of additional value to the more general care-as-usual & 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 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 This study attempted to find clinical variables evaluated at age 2 that would predict mental retardation ( MR , IQ/cognition-adaptation developmental quotient [ C-A DQ]<70 ) at age 5 in 57 children with pervasive developmental disorder ( PDD ) . About two-thirds of subjects had MR  at both initial and outcome evaluations . The C-A DQ at initial evaluation was significantly lower in mentally retarded PDD ( MRPDD ) than in high-functioning ( IQ > or= 70 ) PDD ( HFPDD ) . MRPDD changed less than HFPDD in IQ/C-A DQ between ages 2 and 5 . The C-A DQ at age 2 was a potent predictor for MR at age 5 and the total score and three item scores of Childhood Autism Rating Scale-Tokyo Version evaluated at age 2 were also useful in predicting MR at age 5 OBJECTIVE To examine the predictive validity of symptom severity , cognitive and language measures  taken at ages 2 and 3 years to outcome at age 7 in a sample of children diagnosed with autism at age 2 . METHOD Twenty-six children diagnosed with autism at age 2 were re-assessed at ages 3 and 7 years . At each age  symptom severity , cognitive and language assessment s  were completed . RESULTS The pattern of autistic symptom severity varied over time by domain . Across time , children moved across diagnostic boundaries both in terms of clinical diagnosis and in terms of instrument diagnosis on the Autism Diagnostic Interview-Revised ( ADI-R ) . On all measures group variability in scores increased with age . Although non-verbal IQ ( NVIQ ) for the group as a whole was stable across the 3 assessment s , this masked considerable individual instability . St and ard assessment s at age 2 did not predict outcome at age 7 even within the same domain of functioning . In contrast , st and ard assessment s at age 3 did predict outcome . However , a measure of rate of non-verbal communicative acts taken from an interactive play-based assessment at age 2 was significantly associated with language , communication and social outcomes at age 7 . CONCLUSIONS The trajectory of autism symptoms over time differed in different domains , suggesting that they may be , at least in part , separable . Variability in language , NVIQ and symptom severity increased over time . Caution is required when interpreting the findings from assessment s of children with autism at age 2 years . At this age measures of rate of non-verbal communication might be more informative than scores on st and ard psychometric tests . Predictive validity of assessment s at age 3 years was greater Tests of mediation in treatment trials can illuminate processes of change and suggest causal influences in development . We conducted a mediation analysis of a previously published r and omised controlled trial of parent-mediated communication-focused treatment for autism against ordinary care , with 28 children aged 2–5 years ( Aldred et al. in J Child Psychol Psychiatr 45:1–11 , 2004 ) . The hypothesised mediating process , targeted by the intervention , was an increase in parental synchronous response within parent – child interaction . The results showed partial mediation , with change in synchrony accounting for 34 % of the positive intervention effect on autism symptomatology ( Autism Diagnostic Observation Schedule communication and social domain algorithm ) ; the result was confirmed by bootstrap estimation . Improved parental synchronous response to child communication can alter short-term autism symptom outcome with targeted therapy 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 This project evaluated the effectiveness of a TEACCH-based home program intervention for young children with autism . Parents were taught how to work with their preschool autistic child in the home setting , focusing on cognitive , academic , and prevocational skills essential to later school success . To evaluate the efficacy of the program , two matched groups of children were compared , a  treatment group and a  no-treatment control group , each consisting of 11 subjects . The treatment group was provided with approximately 4 months of home programming and was tested before and after the intervention with the Psychoeducational Profile-Revised ( PEP-R ) . The control group did not receive the treatment but was tested at the same 4-month interval . The groups were matched on age , pretest PEP-R scores , severity of autism , and time to follow-up . Results demonstrated that children in the treatment group improved significantly more than those in the control group on the PEP-R subtests of imitation , fine motor , gross motor , and nonverbal conceptual skills , as well as in overall PEP-R scores . Progress in the treatment group was three to four times greater than that in the control group on all outcome tests . This suggests that the home program intervention was effective in enhancing development in young children with autism The objective of this preliminary study was to evaluate a novel intensive therapy program in young children with pervasive developmental disorder ( PDD ) . Twenty-three children treated at the Mifne Institute in Israel between 1997 and 1999 were assessed .  Videos taken before coming to Mifne and after intensive treatment at the institute and before and after another 6 months of continued treatment at children 's homes were coded and blind rated by trained personnel using the Childhood Autism Rating Scale ( CARS ) and the Social Behavior Rating Scale ( SBRS ) . Total scores on both scales improved significantly after 3 weeks and after 6 months . There were some significant improvements at item level although the magnitude of the changes was modest . Despite the small number of participants , the modest increase in test scores , and the retrospective study design , these preliminary results are promising . There is a case for performing a full prospect i ve , comparative investigation of this treatment approach This study evaluated the impact of intensive behavioral treatment on the development of  young autistic children .  The treatment reported in this study was home based and was implemented by parents of autistic children with the assistance of community-based clinicians . Although treatment was unable to be observed directly , parents reported that therapy was based on methods developed by Lovaas et al. ( 1981 ) . Treatment differed from that described in previous reports of intensive behavior therapy for this population in that it was implemented outside an academic setting and for a shorter period . In addition , children received fewer hours per week of therapy than in previous reports . Children in the experimental treatment group were pairwise matched to children in a control group ( who received conventional school-based and brief one-on-one interventions ) on the basis of pretreatment chronological and mental age , diagnosis ( autism vs. PDD ) , and length of treatment . The groups did not differ on pretreatment IQ . Children receiving the experimental treatment had significantly higher posttreatment IQ scores . Smaller , but still statistically significant effects on symptom severity were also found , though experimental subjects still met diagnostic criteria for autism or PDD BACKGROUND The Picture Exchange Communication System ( PECS ) is a common treatment choice for non-verbal children with autism . However , little empirical evidence is available on the usefulness of PECS in treating social-communication impairments in autism . AIMS To test the effects of PECS on social-communicative skills in children with autism , concurrently taking into account st and ardized psychometric data , st and ardized functional assessment of adaptive behaviour , and information on social-communicative variables coded in an unstructured setting . METHODS & PROCEDURES Eighteen preschool children ( mean age = 38.78 months ) were assigned to two intervention approaches , i.e. PECS and Conventional Language Therapy ( CLT ) . Both PECS ( Phases I-IV ) and CLT were delivered three times per week , in 30-min sessions , for 6 months . Outcome measures were the following : Autism Diagnostic Observation Schedule ( ADOS ) domain scores for Communication and Reciprocal Social Interaction ; Language and Personal-Social subscales of the Griffiths ' Mental Developmental Scales ( GMDS ) ; Communication and Social Abilities domains of the Vinel and Adaptive Behavior Scales ( VABS ) ; and several social-communicative variables coded in an unstructured setting . OUTCOMES & RESULTS Results demonstrated that the two groups did not differ at Time 1 ( pre-treatment assessment ) , whereas at Time 2 ( post-test ) the PECS group showed a significant improvement with respect to the CLT group on the VABS social domain score and on almost all the social-communicative abilities coded in the unstructured setting ( i.e. joint attention , request , initiation , cooperative play , but not eye contact ) . CONCLUSIONS & IMPLICATION S These findings showed that PECS intervention ( Phases I-IV ) can improve social-communicative skills in children with autism . This improvement is especially evident in st and ardized measures of adaptive behaviour and measures derived from the observation of children in an unstructured setting This article evaluates the effectiveness of a developmentally based early intervention programme .  Two groups of children were compared , a  treatment group and a no-treatment control group .  St and ardized assessment s were administered before and after the intervention period by an independent clinician . Pre-treatment comparisons revealed that the control group had a significantly higher pre-treatment IQ ; but the two groups were comparable for age , mental age , socioeconomic status and number of hours of non-experimental therapy . Results demonstrated that children in the treatment group improved significantly more than those in the control group on measures of joint attention , social interaction , imitation , daily living skills , motor skills and an adaptive behaviour composite . A measure of requesting behaviour fell short of statistical significance . The total stress index reduced for treatment group parents and increased for the control group parents ( but not significantly ) . The results of the study are considered to support the efficacy of this treatment approach CONTEXT To our knowledge , no prospect i ve studies of the developmental course of early and later diagnosis of autism spectrum disorders from 14 months of age exist . OBJECTIVE To examine patterns of development from 14 to 24 months in children with early and later diagnosis of autism spectrum disorders . DESIGN Prospect i ve , longitudinal design in which 125 infants at high and low risk for autism were tested from age 14 to 36 months . Comprehensive st and ardized assessment s included measures of social , communication , and play behavior . SETTING Testing occurred at a major medical and research institution as part of a large , ongoing longitudinal study . PARTICIPANTS Low-risk controls ( n = 18 ) and siblings of children with autism , grouped on the basis of outcome diagnostic classification at 30 or 36 months : autism spectrum disorders ( early diagnosis , n = 16 ; later diagnosis , n = 14 ) , broader autism phenotype ( n = 19 ) , and non-broader autism phenotype ( n = 58 ) . MAIN OUTCOME MEASURES Social , communication , and symbolic abilities were assessed . RESULTS Social , communication , and play behavior in the early-diagnosis group differed from that in all other groups by 14 months of age . By 24 months , the later-diagnosis group differed from the non-autism spectrum disorder groups in social and communication behavior , but not from the early-diagnosis group . Examination of growth trajectories suggests that autism may involve developmental arrest , slowing , or even regression . CONCLUSION This study provides insight into different patterns of development of children with early vs later diagnosis of autism spectrum disorders 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 BACKGROUND Psychosocial treatments are the mainstay of management of autism in the UK but there is a notable lack of a systematic evidence base for their effectiveness . R and omised controlled trial ( RCT ) studies in this area have been rare but are essential because of the developmental heterogeneity of the disorder . We aim ed to test a new theoretically based social communication intervention targeting parental communication in a r and omised design against routine care alone . METHODS The intervention was given in addition to existing care and involved regular monthly therapist contact for 6 months with a further 6 months of 2-monthly consolidation sessions . It aim ed to educate parents and train them in adapted communication tailored to their child 's individual competencies . Twenty-eight children with autism were r and omised between this treatment and routine care alone , stratified for age and baseline severity . Outcome was measured at 12 months from commencement of intervention , using st and ardised instruments . RESULTS All cases studied met full Autism Diagnostic Interview ( ADI ) criteria for classical autism . Treatment and controls had similar routine care during the study period and there were no study dropouts after treatment had started . The active treatment group showed significant improvement compared with controls on the primary outcome measure -- Autism Diagnostic Observation Schedule ( ADOS ) total score , particularly in reciprocal social interaction-- and on secondary measures of expressive language , communicative initiation and parent-child interaction . Suggestive but non-significant results were found in Vinel and Adaptive Behaviour Scales ( Communication Sub-domain ) and ADOS stereotyped and restricted behaviour domain . CONCLUSIONS A R and omised Treatment Trial design of this kind in classical autism is feasible and acceptable to patients . This pilot study suggests significant additional treatment benefits following a targeted ( but relatively non-intensive ) dyadic social communication treatment , when compared with routine care . The study needs replication on larger and independent sample s. It should encourage further RCT design s in this area 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 The development of imitation during the second year of life plays an important role in domains of sociocognitive development such as language and social learning . Deficits in imitation ability in persons with autism spectrum disorder ( ASD ) from toddlerhood into adulthood have also been repeatedly documented , raising the possibility that early disruptions in imitation contribute to the onset of ASD and the deficits in language and social interaction that define the disorder . This study prospect ively examined the development of imitation between 12 and 24 months of age in 154 infants at familial risk for ASD and 78 typically developing infants who were all later assessed at 36 months for ASD or other developmental delays . The study established a developmental measure of  imitation ability  and examined group differences over time , using an analytic Rasch measurement model . Results revealed a unidimensional latent construct of imitation and verified a reliable sequence of imitation skills that was invariant over time for all outcome groups . Results also showed that all groups displayed similar significant linear increases in imitation ability between 12 and 24 months and that these increases were related to individual growth in both expressive language and ratings of social engagement but not in fine motor development . The group of children who developed ASD by age 3 years exhibited delayed imitation development compared with the low-risk typical outcome group across all time-points , but were indistinguishable from other high-risk infants who showed other cognitive delays not related to ASD 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 ) Sensory impairment is a common and significant feature of children on the autism spectrum . In 2005 , a qigong massage intervention based on Chinese medicine and delivered by a doctor of Chinese medicine was shown to improve sensory impairment and adaptive behavior in a small controlled study of young children with autism . In 2006 , the Qigong Sensory Training ( QST ) program was developed to train early intervention professionals to provide the QST intervention . This article describes the preliminary evaluation of the QST program as piloted with 15 professionals and 26 children and outcomes testing using st and ardized tests of sensory impairment and adaptive behavior . Results of outcomes comparing delivery by QST-trained therapists with delivery by a doctor of Chinese medicine showed that both groups improved and that there was no difference in outcome between the two groups . The intervention and training program are described , and implication s for future research are discussed In this pilot study , we tested the effects of a novel intervention ( JASPER , Joint Attention Symbolic Play Engagement and Regulation ) on 3 to 5 year old , minimally verbal children with autism who were attending a non-public preschool . Participants were r and omized to a control group ( treatment as usual , 30 h of ABA-based therapy per week ) or a treatment group ( substitution of 30 min of JASPER treatment , twice weekly during their regular program ) . A baseline of 12 weeks in which no changes were noted in core deficits was followed by 12 weeks of intervention for children r and omized to the JASPER treatment . Participants in the treatment group demonstrated greater play diversity on a st and ardized assessment . Effects also generalized to the classroom , where participants in the treatment group initiated more gestures and spent less time unengaged . These results provide further support that even brief , targeted interventions on joint attention and play can improve core deficits in minimally verbal children with ASD Acupuncture increases brain levels of arginine-vasopressin ( AVP ) and oxytocin ( OXT ) , which are known to be involved in the modulation of mammalian social behavior . Transcutaneous electrical acupoint stimulation ( TEAS ) is often used clinical ly to produce a similar stimulation to that of acupuncture on the acupoints . In the present study , TEAS was applied to children with autism to assess its therapeutic efficacy . Seventy-six autistic children receiving rehabilitation training were divided into 2 groups : a treatment group receiving TEAS 30min per day , 5 days per week for 12 weeks ( n=37 ) and a control group without TEAS treatment ( n=39 ) . A series of rating scales was used in outcome assessment . Plasma levels of AVP and OXT were determined by enzyme immunoassay ( EIA ) before and after treatment . The TEAS group showed a significant improvement over the control in their emotional response , fear or anxiety , level/consistency of intellective relations and general impressions on the Childhood Autism Rating Scale ( CARS ) as well as improvements in the sensory and related factors in the Autism Behavior Checklist ( ABC ) . In addition , the varieties of accepted food increased after TEAS treatment . It appears that TEAS was effective in autistic children who showed passive and aloof behavior , but not in those who were active but odd . The plasma level of AVP was significantly higher in the TEAS group than in the control group after the intervention . In addition , the change in the plasma AVP level paralleled the improvement of some of the behavior factors in CARS , including adaptation to environmental change , listening response , perceptive response and fear or anxiety . It is concluded that TEAS is effective for the treatment of autistic children with a passive and aloof social interaction style . Changes in plasma levels of AVP and possibly OXT may be involved in mediating the therapeutic effect of TEAS OBJECTIVE To examine prospect ively the emergence of behavioral signs of autism in the first years of life in infants at low and high risk for autism . METHOD A prospect i ve longitudinal design was used to compare 25 infants later diagnosed with an autism spectrum disorder ( ASD ) with 25 gender-matched low-risk children later determined to have typical development . Participants were evaluated at 6 , 12 , 18 , 24 , and 36 months of age .  Frequencies of gaze to faces , social smiles , and directed vocalizations were coded from video and rated by examiners . RESULTS The frequency of gaze to faces , shared smiles , and vocalizations to others were highly comparable between groups at 6 months of age , but significantly declining trajectories over time were apparent in the group later diagnosed with ASD . Group differences were significant by 12 months of age on most variables . Although repeated evaluation documented loss of skills in most infants with ASD , most parents did not report a regression in their child 's development . CONCLUSIONS These results suggest that behavioral signs of autism are not present at birth , as once suggested by Kanner , but emerge over time through a process of diminishment of key social communication behaviors . More children may present with a regressive course than previously thought , but parent report methods do not capture this phenomenon well . Implication s for onset classification systems and clinical screening are also discussed CONTEXT The presence of autistic-like traits in relatives of individuals with autism spectrum disorder ( ASD ) is well recognized , but , to our knowledge , the emergence of these traits early in development has not been studied . OBJECTIVE To prospect ively investigate the emergence of autistic-like traits in unaffected ( no ASD diagnosis ) infant siblings of prob and s diagnosed as having ASD . DESIGN Two groups of children unaffected with ASD were assessed prospect ively-siblings of prob and s diagnosed as having ASD ( high risk [ HR ] ) and control subjects with no family history of ASD ( low risk [ LR ] ) . Scores on a measure of autistic-like traits at 12 months of age were used in a cluster analysis of the entire sample . SETTING A prospect i ve study of infant siblings of prob and s with ASD from 3 diagnostic centers in Canada . PARTICIPANTS The study included 170 HR and 90 LR children , none of whom was diagnosed as having ASD at age 3 years . MAIN OUTCOME MEASURES The Autism Observation Scale for Infants was used to measure autistic-like traits and derive clusters at 12 months of age . Clusters were compared on ASD symptoms , cognitive abilities , and social-emotional difficulties at age 3 years . RESULTS Two clusters were identified . Cluster 1 ( n = 37 ; 14.2 % of total sample ) had significantly higher levels of autistic-like traits compared with cluster 2 . Within cluster 1 , 33 children came from the siblings ( 19.4 % of HR group ) and only 4 came from the control subjects ( 4.5 % of LR group ) . At age 3 years , children from cluster 1 had more social-communication impairment ( effect size > 0.70 ; P < .001 ) , lower cognitive abilities ( effect size = -0.59 ; P < .005 ) , and more internalizing problems ( effect size = 0.55 ; P = .01 ) . Compared with control subjects , HR siblings had a relative risk of 4.3 ( 95 % CI,1.6 - 11.9 ) for membership in cluster 1 . CONCLUSIONS Study findings suggest the emergence of autistic-like traits resembling a broader autism phenotype by 12 months of age in approximately 19 % of HR siblings who did not meet ASD diagnostic criteria at age 3 years Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder . To investigate the underlying causal mechanisms , we conducted a r and omized clinical trial of an experimental intervention ( Focused Playtime Intervention , FPI ) that aims to enhance responsive parental communication ( N = 70 ) . Results showed a significant treatment effect of FPI on responsive parental behaviors . Findings also revealed a conditional effect of FPI on children ’s expressive language outcomes at 12-month follow up , suggesting that children with baseline language skills below 12 months ( n = 24 ) are most likely to benefit from FPI .  Parents of children with more advanced language skills may require intervention strategies that go beyond FPI ’s focus on responsive communication The Vinel and Adaptive Behavior Scales were used to investigate patterns of adaptive behavior in children with autism who were under 36 months of age . Subjects were 30 children with autism and 30 children with developmental delay matched on CA and MA . Relative to controls , the autistic group demonstrated weaker socialization and communication skills and greater discrepancies between adaptive behavior and MA . Different patterns of relations between adaptive behavior domains and cognitive and language skills were obtained for the two groups . Preliminary support for the utility of adaptive  behavior  profiles in identifying subgroups of children with autism is provided . Results are discussed in terms of their implication s for early diagnosis of autism The study evaluates a social-communication-based approach to autism intervention aim ed at improving the social interaction skills of children with autism spectrum disorder . We report preliminary results from an ongoing r and omized controlled trial of 51 children aged 2 years 0 months to 4 years 11 months . Participants were assigned to either a target treatment or community treatment group . Families in the target treatment group were given 2 hours of therapy and coaching each week in an intervention emphasizing social-interaction and the parent-child relationship . Children in the community treatment group received a variety of services averaging 3.9 hours per week . After 12 months , outcomes were measured to determine changes in the groups in social interaction and communication . In addition , a regression analysis was conducted to determine whether changes in social interaction skills were associated with language development . Results suggest that children in the treatment group made significantly greater gains in social interaction skills in comparison to the community treatment group , but no between-group differences were found for st and ard language assessment s. Initiation of joint attention , involvement , and severity of language delay were found to be significantly associated with improvement of language skills in children with autism . Finally caregiver skills targeted by the intervention were found to be significantly associated with changes in children ’s interaction skills 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 Although early intensive behavior interventions have been efficient in producing positive behavior outcome in young children with Autism Spectrum Disorder , there is a considerable variety in the children 's progress . Research has suggested that parental and treatment factors are likely to affect children 's response to treatment . The purpose of the current study was to examine the interrelating factors that impact children 's progress , highlighting the influence of parent inclusion in treatment provision captured by parental stress , how faithfully the parents followed the treatment protocol s and the intensity of treatment provided at home . Twenty-four children received cross- setting staff- and parent-mediated EIBI , including continuous parent training and supervision . A comparison group of 20 children received  eclectic intervention . St and ardized tests were carried out by independent examiners at intake and after six months . The intervention group outperformed the eclectic group in measures of autism severity , developmental and language skills . Parent training and constant parent-mediated treatment provision led to reduced challenging behaviors from the children , increased treatment fidelity and child direct behavior change as measured by performance in correct responding on behavior targets . Variables of treatment progress and potential predictors of child outcome were analyzed in detail and mapped with regard to their relationships drawn from multiple regression analysis . Particularly , the study highlights an association between parental stress and staff treatment fidelity that interferes with decision making in treatment planning and consequently with positive behavior outcome . Such results provide important scientific and clinical information on parental and treatment factors likely to affect a child 's response to treatment BACKGROUND Deficits in joint attention ( JA ) and joint engagement ( JE ) represent a core problem in young children with autism as these affect language and social development . Studies of parent-mediated and specialist-mediated JA-intervention suggest that such intervention may be effective . However , there is little knowledge about the success of the intervention when done in preschools . AIM Assess the effects of a preschool-based JA-intervention . METHODS 61 children ( 48 males ) with autistic disorder ( 29 - 60 months ) were r and omized to either 8 weeks of JA-intervention  , in addition to their preschool programs  ( n = 34 ) , or to preschool programs only  ( n = 27 ) . The intervention was done by preschool teachers with weekly supervision by trained counselors from Child and Adolescent Mental Health Clinics ( CAMHC ) . Changes in JA and JE were measured by blinded independent testers using Early Social Communication Scale ( ESCS ) and video taped preschool teacher-child and mother-child play at baseline and post-intervention . CLINICAL TRIALS REGISTRATION Clinical trials.gov : NCT00378157 . RESULTS Intention-to-treat analysis showed significant difference between the intervention and the control group , with the intervention group yielding more JA initiation during interaction with the preschool teachers . The effect generalized to significantly longer duration of JE with the mothers . CONCLUSIONS This is the first r and omized study to show positive and generalized effects of preschool-based JA-intervention UNLABELLED The relations between cognition and autism severity , head size and intervention outcome , were examined . Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities ( DD ) . Eighty-one children ( mean age 25.9 months ) with autism ( n=44 ) and DD ( n=37 ) were assessed at pre- and post 1 year of intervention . Cognitive abilities and autism severity were measured by st and ardized tests . Three pre-intervention cognitive level groups : normal ( IQ>90 ) , borderline ( 70<IQ<89 ) and impaired ( 50<IQ<69 ) were examined . The impaired group had more severe autism symptoms than the borderline and the normal cognitive groups . However , following intervention the groups did not differ in the change in core autism symptoms . IQ scores increased significantly more in the autism group than in the DD group . IQ improvements correlated significantly with reduction in autism symptoms and mostly in stereotyped behaviors . CONCLUSIONS Cognitive ability in autism is associated with autism severity . Two distinct subtypes based on cognitive level are identified . However , baseline cognitive level can not predict the progress rate in autism symptoms with intervention . Improvement of social-communicative behaviors and the intensive intervention are related to significant cognitive increments in autism PURPOSE The Preschool Language Scale , Fourth Edition ( PLS-4 ; Zimmerman , Steiner , & Pond , 2002 ) was used to examine syntactic and semantic language skills in preschool children with autism spectrum disorders ( ASD ) to determine its suitability for use with this population . We expected that PLS-4 performance would be better in more intellectually able children and that receptive skills would be relatively more impaired than expressive abilities , consistent with previous findings in the area of vocabulary . METHOD Our sample consisted of 294 newly diagnosed preschool children with ASD . Children were assessed via a battery of developmental measures , including the PLS-4 . RESULTS As expected , PLS-4 scores were higher in more intellectually able children with ASD , and overall , expressive communication was higher than auditory comprehension . However , this overall advantage was not stable across nonverbal developmental levels . Expressive skills were significantly better than receptive skills at the youngest developmental levels , whereas the converse applied in children with more advanced development . CONCLUSIONS The PLS-4 can be used to obtain a general index of early syntax and semantic skill in young children with ASD . Longitudinal data will be necessary to determine how the developmental relationship between receptive and expressive language skills unfolds in children with ASD We developed and evaluated a new parent report instrument — Parent Observation of Early Markers Scale (POEMS)—to monitor the behavioral development of infants at risk for autism spectrum disorder ( ASD ) because they have older affected siblings . Parents of 108 at-risk infants ( 74 males , 34 females ) completed the POEMS from child age 1–24 months . The POEMS had acceptable psychometric properties and promising predictive validity . Most concerning items were social and communication deficits , and intolerance to waiting . Results provide preliminary evidence that prospect i ve parent report measures can help to detect early ASD symptoms in infants at biological risk . We invite research ers to join us in multi-center studies of the POEMS Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD The aim of this study was to pilot test a classroom-based intervention focused on facilitating play and joint attention for young children with autism in self-contained special education classrooms . Thirty-three children with autism between the ages of 3 and 6 years participated in the study with their classroom teachers ( n = 14 ) . The 14 preschool special education teachers were r and omly assigned to one of three groups : ( 1 ) symbolic play then joint attention intervention , ( 2 ) joint attention then symbolic intervention , and ( 3 ) wait-list control period then further r and omized to either group 1 or group 2 . In the intervention , teachers participated in eight weekly individualized 1-h sessions with a research er that emphasized embedding strategies targeting symbolic play and joint attention into their everyday classroom routines and activities . The main child outcome variables of interest were collected through direct classroom observations . Findings indicate that teachers can implement an intervention to significantly improve joint engagement of young children with autism in their classrooms . Furthermore , multilevel analyses showed significant increases in joint attention and symbolic play skills . Thus , these pilot data emphasize the need for further research and implementation of classroom-based interventions targeting play and joint attention skills for young children with autism
target: In particular , there is little evidence that the identified tools would be good at detecting change in intervention studies .
  The obvious gaps in available outcome measurement include well-being and participation outcomes for children , and family quality -of-life outcomes , domains particularly valued by our informants ( young people with ASD and parents ) .
  This is the first systematic review of the quality and appropriateness of tools design ed to monitor progress and outcomes of young children with ASD .
background: BACKGROUND The needs of children with autism spectrum disorder ( ASD ) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children 's progress .
  Relevant outcomes include improvement in core ASD impairments , such as communication , social awareness , sensory sensitivities and repetitiveness ; skills such as social functioning and play ; participation outcomes such as social inclusion ; and parent and family impact .
  OBJECTIVES To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years .
  To identify outcome areas regarded as important by people with ASD and parents .