Autism

EDC529 Team Research Design Project LeeAnn Hooper, Kim Rawson, & Jen Morin


 * Early Intervention in Primary-Aged Boys with Autism**

While children with autism are capable of learning, there are however, many challenges to learning encountered by these children. Applied Behavior Analysis (ABA) specifically addresses those issues. The goal of ABA is to improve socially important behavior by using interventions that are based upon principles of learning theory and that have been evaluated in research studies using valid and objective measurements. ABA methods are intended to strengthen persons with autism in a variety of ways: To increase behaviors (e.g. to increase on-task behavior, or social interactions) and to teach new skills (e.g. life, communication, or social skills); to maintain behaviors (e.g. self control); and to restrict or diminish conditions under which interfering behaviors (e.g. self injury) occur (Maurice et al., 1996). The purpose of this research study is to determine the impact of ABA as an early intervention in primary-aged boys with autism.
 * Introduction:**

Is there a statistically significant reduction in behavioral problems in primary-aged boys with autism receiving the early intervention of applied behavioral analysis (ABA), as compared with those that do not?
 * Research Question:**

R OXO OCO
 * Experimental Design:**

X= treatment - applied behavior analysis (ABA) C= control group - does not receive treatment O= Vineland Adaptive Behavior Scales R= participants were randomly assigned to one of the two equivalent groups

There will be no statistically significant difference in behavior problems between the two groups.
 * Null Hypothesis:**

Behavioral problems in primary-aged boys with autism will decrease as compared to those who did not receive intervention.
 * Directional Hypothesis:**

There will be a statistically significant difference in behavioral problems in primary-aged boys who receive the ABA intervention compared to those who do not receive the ABA intervention.
 * Non-Directional Hypothesis:**

Applied Behavioral Analysis (ABA), as a systematic behavioral intervention for primary aged boys with autism
 * Independent Variable:**

Behavioral Problems, as measured by the Vineland Adaptive Behavior Scales
 * Dependent Variable:**

Autism is a devastating neurological disorder. And while its causes are unclear, it has a strong genetic component and is marked by rapid brain growth during early childhood. This condition works on a spectrum in which affected people differ from the rest of us only by degrees (Cowley et al., 2003). Certain aggressive behaviors may be symptoms associated with autism. There may be many reasons why certain children with autism sometimes demonstrate disruptive or aggressive behaviors (such as confusion due to language deficits, high anxiety, or low tolerance for change, to name a few) however, these behaviors are generally not "chosen" by the child (Clinical Practice Guideline: Report of the Recommendations, 1999).
 * Literature Review:**

Not surprisingly, autism affects boys more than girls. Males account for more than 80 percent of the million-plus Americans with autisitic disorders (Cowley et al., 2003). According to the NICHD (National Institute of Child Health and Human Development), there are three groups at a higher-than-normal risk for autism: siblings of those with autism, people with certain other developmental disorders, and boys. Statistics show that boys are four times more likely to be affected by autism than are girls (2005).

To date, there is no cure for autism, but sometimes, children with autism make so much progress that they no longer show the full syndrome of autism when they are older. Research shows that early diagnosis and interventions delivered early in life, such as in the preschool period, are more likely to result in major positive effects on later skills and symptoms. The sooner a child begins to get the help, the more opportunity for learning. Because a young child's brain is still forming, early intervention gives children the best start possible and the best chance of developing their full potential. Even so, no matter when a person is diagnosed with autism, it's never too late to benefit from treatment. People of all ages with autism at all levels of ability generally respond positively to well designed interventions (NICHD, 2005).

Experts agree that early intervention is the key to success. The earlier you can get into a treatment program, the better the prognosis (Cowley et al., 2003) In a policy statement by the American Academy of Pediatrics, early diagnosis resulting in early, appropriate, and consistent intervention has been shown to be associated with improved long-term outcomes. There is a growing body of evidence that intensive early intervention services for children in whom autism is diagnosed before 5 years of age may lead to better overall outcomes. Currently accepted strategies are to improve the overall functional status of the child by enrolling the child in an appropriate and intensive early intervention program that promotes development of communication, social, adaptive, behavioral, and academic skills. Behavioral training, including communication development, has been shown to be effective in reducing problem behaviors and improving adaptation ((2001).

Intervention programs go by several different names - applied behavioral analysis (ABA), discreet trial training, or pivotal response treatment. Most of these interventions use simple conditioning exercises to open lines of communication (Cowley et al., 2003). The focus of this study will be on applied behavioral analysis (ABA). In general, behavior management therapy, which is based on applied behavioral analysis (ABA), works to reinforce wanted behaviors and reduce unwanted behaviors. Different applications of ABA commonly used for people with autism include: Positive Behavioral Interventions (PBS), Pivotal Response Training (PRT), Incidental Teaching, Milieu Therapy, Verbal Behavior, and Discrete-Trial Teaching (DTT), among others (NICHD, 2005). Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior (The United States Surgeon General, 1998). Several studies have determined that applied behavior analysis (ABA) is effective in teaching new skills and in increasing behaviors (Goldstein, 2002; Odum et al.; 2003; McConnell, 2002). In addition, studies demonstrate that ABA is an effective intervention in reducing problem behavior (Horner et al.; 2002).

We will be using the Vineland Adaptive Behavior Scales as the primary measurement tool. The benefits of using the Vineland Adaptive Behavior Scales include a comprehensive content that allows the user to use the Vineland in a variety of settings, interview and questionnaire formats make it easy to assess those who find test taking situations difficult, and the three different versions provide flexibility.This assessment provides critical data for the diagnosis or evaluation of a wide range of disabilities, including mental retardation, developmental delays, functional skills impairment, and speech/language impairment. Vineland has also been proven to be an accurate resource for predicting autism and Asperger syndrome, among other differential diagnoses (Pearson Assessments, 2007).

Twenty primary-aged boys with autism will be participating in the study. These boys are students at the Trudeau Center. Permission was granted by both the Trudeau Center and the legal guardians of the boys. Students will be randomly assigned to two equivalent groups. One group (n=10), will receive the ABA intervention. The control group (n=10) will not receive the ABA intervention.
 * Sample:**

This quantitative study will measure the behaviors of 20 primary-aged boys. Behaviors will be measured by using the Vineland Adaptive Behavior Scales (VABS). This scale assigns numerical values to the frequency, or lack thereof, that a behavior occurs**.** Each item is rated 2 (behavior is usually or habitually performed), 1 (sometimes or partly performed), or 0 (never performed). The VABS will be used to measure whether there is a statistically significant difference between the group who received the ABA intervention and the control group.
 * Data Collection:**

The mean scores of both groups will be compared using a t-test to determine whether there is a statistically significant difference (p<.05). There is a 5% chance that we are going to assume that the ABA intervention caused the significant difference when in actuality, it was chance.
 * Data Analysis:**

Is the Vineland Adaptive Behavior Scales a valid measure of early intervention of applied behavioral analysis?
 * Validity and Reliablility:**

__Threats to internal validity:__ The threat of //history// in this study is affected by the degree of parental follow through at home. The threat of //mortality// in this study is considered by individuals who may withdraw or move out of the community. Since this may be a factor, we will address this weakness by increasing our sample.The threat of //maturation// has been controlled by having an experimental group and a control group formed at random. The threat of //testing// has been controlled by using the appropriate Childhood Autism Rating Scale (CARS), which is part of the instrument for the Vineland Adaptive Behavior Scales.

__Threat to external validity:__ The threat of //reactivity// in this study is affected by parents wanting their child in the control group. We addressed this by having the parents whose children are in the control group, as well as the teachers, to refrain from discussing confidential information.

__Strengths__ Use of a control group shields/reduces various threats to validity. The control group reduces the threat of //history// because the control group is also subject to events that occur prior to the evaluative process. Use of a control group should reduce the threat of //regression// as the same level of //regression// would be noted in both groups. Also, the use of an equivalent control group will protect against the threat of //maturation.// Our research project is a quantitative study that can be studied further and the findings can be generalized to similar groups of autistic children.
 * Strength of Design:**

__Weaknesses__ Our study will be limited to students in Rhode Island at the Trudeau Center, and therefore the results may not be considered the population of the entire United States. The population of students in Rhode Island is not the same as the population of students throughout the United States. Although, in Rhode Island, there are a few schools that have similar ABA programs, so our sample could possibly be increased in size.

A qualitative study would be an effective way to follow up this study. Once we determine if there is a difference in the reduction in behavioral problems by implementing early intervention of applied behavioral analysis (ABA), we would like to do a qualitative study to find out why. We would conduct this with in-depth interviews with the parents and teachers of the students to see if there is a significant difference as the students continue through their schooling. Considering the length of time, the sensitive issues and knowing our resources were limited conducting a quantitative study was in our best interest.

1. How do child and family characteristics correlate with intervention methods? 2. What are the different intervention techniques that affect child outcomes? 3. Why is parent training so important in an early intervention program for children with autism?
 * Examples of questions that might guide the qualitative study are:**

(2001) //American Academy of Pediatrics//. Policy Statement: The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children (RE060018) Pediatrics, 107, 1221-1226.
 * References:**

(2007). Assessments for Specialized Education Needs. Pearson Assessments.

(2005). Autism Overview: What We Know. //National Institute of Child Health and Human Development//. NIH Pub. No. 05-5592

(1999). **Clinical Practice Guideline: Report of the Recommendations**. Autism/Pervasive Developmental Disorders, Assessment and Intervention for Young Children (Age 0-3 years). Publication No. 4215. Chapter 2.

Cowley, Geoffrey, Underwood, Anne, Murr, Andrew, Springen, Karen, Sennott, & Sarah. (2003). Girls, Boys and Autism. //Newsweek//. Vol. 142, Issue 10.

Goldstein, H. (2002). Communication intervention for children with autism: A review of treatment efficacy. //Journal of Autism and Developmental Disorders,// 32, 373-396.

Guralnick, M. (1996). **The Effectiveness of Early Intervention**. Baltimore: Paul H. Brookes. Chapter 14.

Horner, R., Carr, E.G., Strain, P.S., Todd, A.W., & Reed, H.K. (2002). Problem behavior interventions for young children with autism: A research synthesis. //Journal of Autism and Developmental Disorders,// 32, 423-446.

Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T, Dawson, G., Durand, M., Grossman, L., Guthrie, D., Harris, S., Kasari, C., Marcus, L., Murphy, S., Odom, S., Pickles, A., Scahill, L., Shaw, E., Siegel, B., Sigman, M., Stone, W., Smith, T., & Yoder, P. (2006). Challenges in Evaluating Psychosocial Interventions for Autistic Spectrum Disorers. //Journal of Autism and Developmental Disorders//.

Maurice, C., Green, G. & Luce, S. (1996). //Behavioral intervention for young children with autism.// Austin, TX: Pro-Ed.

McConnell, S. (2002). Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. //Journal of Autism and Developmental Disorders,// 32, 351-372.

Odum, S.C., Brown, W.H., Frey, T., Karasu, N., Smith-Carter, L.L., & Strain, P.S. (2003). Evidence-based practices for young children with autism: Contributions from single-subject design research. //Focus on Autism and Other Developmental Disabilities,// 18, 166-175.

Smith, T. (1999). Outcome of early intervention for children with autism. //Clinical Psychology: Science and Practice,// 6, 33-49.

United States Surgeon General (1998). **Mental health: A report of the Surgeon General.** Washington, D.C.

Werner, E., Dawson, G., Munson, J., & Osterling, J. (2005). Variation in Early Developmental Course in Autism and its Relation with Behavioral Outcome at 3-4 Years of Age. //Journal of Autism and Developmental Disorders//. Vol. 35. No.3.

This research team collaborated on all fronts. We found our group dynamics to be in the best interest of the research project presented on this page. We are extremely happy to report that each one of us put in 33% of the work. LeeAnn was responsible for a large portion of the research and validity sections. Kim was responsible for narrowing the contents of the research down to the minute details and getting the ball rolling, while Jen did the majority of the analyzing for the literature review and continuous editing. Editing of the final project was a collaborative effort.
 * Distribution of Duties:**

Proposal grade = A (Pete Adamy)**
 * 6/25/07: An excellent proposal - thorough and accurate. Well done!