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Adolescents with autism spectrum disorder (ASD) without an intellectual disability have daily living skills (DLS) impairments. An initial feasibility pilot of Surviving and Thriving in the Real World (STRW), a group intervention that targets DLS, demonstrated significant improvements. A pilot RCT of STRW was conducted to extend these findings. Twelve adolescents with ASD were randomized to the treatment or waitlist groups. The treatment group had significant DLS improvements on the Vineland Adaptive Behavior Scales, 3(rd) Edition and the DLS goal attainment scale. Four adolescents from the waitlist crossed over and completed STRW. Entire sample analyses with 10 participants demonstrated large DLS gains. Results provide further evidence of the efficacy of STRW for closing the gap between DLS and chronological age.

Increasing scientific productivity in the field of autism research requires citation evaluations that may produce multiple benefits. One of the most recent citation evaluations is the delayed recognition of scientific productions, known as "Sleeping Beauties", which in this study referred to research articles that were neglected (rarely cited) in the first ten years of publication (ten-year sleep/sleep depth) but suddenly cited in later years (at least ten years later/ten years opportunity to wake up). Based on the standard and comprehensive selection criteria, out of a total of 8,865 papers found in WoS and Medline databases between 1946 and 2000, a total of 197 SB papers were identified, and in the Scopus out of 8,550 papers, which published between 1946 and 2000, 232 papers were identified as SB. Gillberg (1983) received the highest SB score in all citation databases, and Vilensky et al. (1981) received the highest SB score among the most cited papers. The innovative nature of the SB papers and the special attention paid to autism in recent years were discussed and concluded as possible reasons for the findings.

BACKGROUND. Students with ASD have some of the worst postsecondary outcomes when compared to other students with disabilities indicating transition planning may not be working effectively. One source of support for postsecondary planning is development of the transition Individualized Education Program (IEP). However, little research is available to describe the current contents of transition IEPs for students with ASD. This study aimed to describe IEP and postsecondary planning quality for students with autism in their final year of high school. METHOD. IEPs for 20 students with autism (Mage = 18.2 years; SD = 1.1) from two mid-southern states were analyzed. Descriptive analyses were used to identify strengths and weaknesses of IEPs and postsecondary goals based on federal law requirements and best practice recommendations. RESULTS. IEPs contained an average of 3.1 IEP goals and 1.6 postsecondary goals. IEP goals were most frequently related to academic, learning/work, or communication skills. All IEPs contained an employment postsecondary goal while less than half of the IEPs included an independent living postsecondary goal. Key findings include lack of goals related to social skills and the lack of alignment between present levels of performance, IEP goals, and postsecondary goals. CONCLUSIONS. IEPs for students with ASD in their final year of school do not consistently meet standards outlined by federal law or best practice recommendations necessary for successful transition from high school.

Although teachers reporting high teaching self-efficacy demonstrate positive teaching behaviors, minimal stress, and superior classroom management techniques, surprisingly few studies have demonstrated a relationship between teacher self-efficacy and student outcomes. This study explored self-efficacy specific to teaching students with autism spectrum disorder (ASD), and examined relationships with stress, teacher engagement, and student individualized education program (IEP) outcomes. Special education teachers ( N = 44) were recruited as part of a larger study examining a consultation intervention. Results indicated that self-efficacy for teaching students with ASD was significantly and positively correlated with teacher engagement and student outcomes, and negatively correlated with teacher stress. Furthermore, teachers who received the consultation intervention reported higher levels of self-efficacy for teaching students with ASD. This is the first study to report a direct association between teacher self-efficacy and student IEP outcomes and the potential positive impact of a teacher consultation intervention on the teacher intrapersonal factor of self-efficacy.

The school, student and family factors underlying poor postsecondary outcomes of students with autism spectrum disorder (ASD) are not well understood. The potential impact of school [e.g., transition planning quality (TPQ)], family (e.g., parent activation), and student factors (e.g., adaptive functioning) and their interaction (e.g., parent-teacher alliance) on student outcomes were examined. Student IQ and adaptive behavior, TPQ, and alliance correlated with IEP progress, with postsecondary goal attainment generally and with student participation in training/education, specifically. However, only parent activation and student externalizing behavior correlated with employment. Families and students, rather than school personnel, were the primary persons in charge and in control of the implementation of postsecondary plans and required help across multiple coaching sessions to implement plans fully.

Young students with ASD have instructional needs in social, communication, and learning skills that should be reflected in their Individualized Education Program (IEP). Research suggests that many of these goal areas present a challenge for special educators because of problems with measurability. The current study utilized an idiographic approach called Goal attainment scaling (GAS) for measuring IEP progress of individualized skills. Cross-sectional analysis of the associations between GAS ratings from an independent observer were correlated against teacher and parent ratings of IEP progress at the end of the school year and with standardized measures of the Behavior Assessment System for Children and Vineland Adaptive Behavior Scales (VABS). GAS scores were associated with parent and teacher ratings, including the VABS.

Autism spectrum disorder (ASD) is a developmental disorder that impairs the development of social and communication skills. There is evidence that children with ASD prefer images of self over others [1] . These studies may explain the effectiveness of video self-modeling (VSM), an evidence-based ASD intervention in which one learns by watching oneself on video performing a target behavior. VSM content is difficult to create as target behaviors are sporadic. In this paper, we propose the MEBook system which uses a Kinect sensor to inject self-images into a gesture-based social narrative to teach children with ASD proper greeting behaviors. MEBook consists of two components. The first component is a social narrative. A social narrative is an animated story about the main character meeting and greeting different cartoon characters in a particular setting. Self-modeling is achieved by first replacing the main characters face with an image of the learner, and then animating the learner's body and voice to match the narration. The second component is a positive reinforcement practice session in which the subject is prompted to greet different cartoon characters. Through depth-based body posture tracking, proper greeting behaviors are recognized and immediately reinforced with praise and visual confetti. Novel computational multimedia tools are proposed to turn video recordings of successful attempts into VSM content, thereby alleviating the tedious production process. A multiple-baseline single subject pilot study has been conducted and the preliminary results show that MEBook is potentially effective in teaching greeting behaviors to children with ASD.

Consultation is essential to the daily practice of school psychologists (National Association of School Psychologist, 2010). Successful consultation requires fidelity at both the consultant (implementation) and consultee (intervention) levels. We applied a multidimensional, multilevel conception of fidelity (Dunst, Trivette, & Raab, 2013) to a consultative intervention called the Collaborative Model for Promoting Competence and Success (COMPASS) for students with autism. The study provided 3 main findings. First, multidimensional, multilevel fidelity is a stable construct and increases over time with consultation support. Second, mediation analyses revealed that implementation-level fidelity components had distant, indirect effects on student Individualized Education Program (IEP) outcomes. Third, 3 fidelity components correlated with IEP outcomes: teacher coaching responsiveness at the implementation level, and teacher quality of delivery and student responsiveness at the intervention levels. Implications and future directions are discussed. (PsycINFO Database Record

The postsecondary outcomes of individuals with autism spectrum disorder (ASD) are significantly worse than peers with other disabilities. One problem is the lack of empirically-supported transition planning interventions to guide services and help produce better outcomes. We applied an implementation science approach to adapt and modify an evidence-based consultation intervention originally tested with young children called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble et al., The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) and evaluate it for efficacy in a randomized controlled trial for transition-age youth. Results replicated findings with younger students with ASD that IEP outcomes were higher for COMPASS compared to the placebo control group (d = 2.1). Consultant fidelity was high and teacher adherence improved over time, replicating the importance of ongoing teacher coaching.

Although data-based decision making is an evidence-based practice, many special educators have difficulty applying the practice within daily routines. We applied the theory of planned behavior (TPB) to understand the influences that promote or hinder early childhood special educators’ intentions to collect data. We assessed three influences on behavioral intention to collect data derived from the TPB: (a) attitude toward collecting data, (b) social norms for collecting data, and (c) perceived behavioral control for collecting data. All three influences correlated positively with teachers’ reported intention to collect data; however, only perceived behavioral control of barriers correlated positively with actual data collection. Additional measures of teacher self-efficacy and administrative support correlated positively with intention to collect data, but not with actual data collection behaviors. Perceived behavior control accounted for the most variance in actual data collection behavior. Implications of the findings for data collection practices in educational settings are discussed.

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.

Despite the growing number of studies that demonstrate the importance of empowering parents with knowledge and skills to act as intervention agents for their children with autism spectrum disorder (ASD), there are limited examples of parent-mediated interventions that focus on problem behaviors. Additionally, access to ASD-trained clinicians and research supported delivery options for families in rural areas is severely limited. COMPASS for Hope (C-HOPE) is an 8-week parent intervention program that was developed with the option of telehealth or face-to-face delivery. Parents who received C-HOPE intervention reported a reduction in parenting stress and an increase in competence. Parents also reported significant reductions in child behavior problems, both when compared to pre-intervention levels and to a waitlist control condition.

Teacher stress and burnout have a detrimental effect on the stability of the teaching workforce. However, the possible consequences of teacher burnout on teaching quality and on student learning outcomes are less clear, especially in special education settings. We applied Maslach and Leiter’s (1999) model to understand the direct effects of burnout on teaching in general and stress arising from interaction with a specific student on the individualized education program (IEP) outcomes of young children with autism spectrum disorder. We also examined indirect effects through teaching quality and student engagement. The results indicated that one of the three components of burnout—teacher personal accomplishment—was directly related to IEP outcomes, a distal effect, whereas stress was directly related to teaching quality and student engagement, which were more proximal effects. In addition, teacher stress, emotional exhaustion, and depersonalization had indirect effects on IEP outcomes through teaching quality and student engagement.

The transition outcomes for individuals with autism spectrum disorder (ASD) and their families are less than desirable. A survey of parent stressors, resources, coping/appraisals, and adaptation to transition was completed by 226 parents. The mediating mechanisms between stressors and parent outcomes were identified. At the indicator level, three stressors (i.e., autism severity, mental health crisis/challenging behaviors, and filial obligation), four resources (i.e., general social support, transition planning quality, parent-teacher alliance, and parenting efficacy), and three coping styles (i.e., problem-focused coping, avoidance-focused coping, and optimism) predicted parents' outcomes (i.e., burden, transition experience, subjective health, and quality of life). At the structural level, optimism, emotion-coping strategies, and resources mediated the relationships between stressors and parental outcomes. Research and practical applications are discussed.

Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by the Exploration, Preparation, Implementation, and Sustainment implementation science framework, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was characterized by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services stipulated in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder. Lay abstract Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by an implementation science framework that takes into account the multiple factors that influence transition outcomes, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth with autism spectrum disorder access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was described by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services specified in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.

Background Evidence-based educational instruction includes teaching elements common across different approaches as well as specific elements of the chosen evidence-based practice. We were interested in evaluating the use and impact of common elements of teaching. Specifically, we adopted a model of elements of high quality teaching sequences and developed and tested an instructional quality index to capture evidence-based features within teaching sequences ( Grisham-Brown & Ruble, 2014 ). Method The current investigation examined 29 special education teachers who received a consultation intervention called the Collaborative Model for Promoting Competence and Success ( Ruble, Dalrymple, & McGrew, 2012 ; Ruble, McGrew, & Toland, 2012 ) that results in personalized teaching plans for young students with ASD and embeds elements of evidence-based teacher coaching of self-reflection and performance-based feedback. We analyzed the teaching plans to understand which of the common elements were present, and if teachers demonstrated improved performance after coaching. Results Analysis of the use of common elements during the first and fourth coaching session demonstrated that all teachers showed improvement. Most importantly, the use of common elements correlated with student goal attainment outcomes. Conclusions These results suggest that common elements of teaching sequences which we view as core features of teaching quality, can be improved as a result of coaching, and most importantly, are associated with students’ educational outcomes.

This study aimed to better understand predictors of evidence-based assessment practices for autism spectrum disorder (ASD). Nationwide, 402 school psychologists were surveyed for their knowledge of and training and experience with ASD on assessment practices, including reported areas of training needs. The majority of school psychologists reported that they did not engage in comprehensive assessment of ASD, which was defined as assessments that consider all areas of development in addition to the use of ASD-specific instruments. Results from logistic regression revealed that experience and training, working with young children with ASD, and geographic location predicted use of evidence-based assessment practices. Experience and training with ASD was the strongest predictor of evidence-based assessment. No differences in training needs were indicated by school psychologists whose practices were consistent with evidence-based assessment and those whose practices were not. Overall, the results identi...

The article discusses current empirical evidence, also identifying gaps and areas for future research, for the three critical elements of evidence-based practice in psychology (EBPP) (evidence-based practice; client characteristics, preferences, and culture; and clinical expertise) as applied to autism spectrum disorder (ASD). We contrast EBPP to a pure EBP approach, outline issues in specifying criteria and sources for defining EBP, and identify gaps in the evidence base (e.g., treatments for adults with ASD). We review the impact on treatment of specific client characteristics (client age, ASD severity, intellectual and language ability, diagnostic comorbidity, cultural/family factors) and outline critical issues affecting clinical expertise and decision making when choosing and adapting treatments. Implications for policy, training, and research are discussed.

This qualitative study aimed to understand the stressors, external and internal support, coping strategies, and family adaptation outcomes during transition, from a parent’s perspective, using the ABCX model (McCubbin & McCubbin, 1993). Thirteen parents of adolescents and young adults with ASD were interviewed. These parents reported a continually high level of stress due to normative strains and ASD-related demands. They described the tangible, emotional, informational, and internal resources received and needed. Parents, as active agents in their children’s lives, have their own views towards transition, philosophy, and ways of coping. Even though many of them reported negative experiences, these parents also found new meanings and happiness in their lives. This study detailed the adaptation process during transition.

Implementation science provides guidance on adapting existing evidence based practices (EBP) by incorporating implementation concerns from the start. Focus group methodology was used to understand barriers and facilitators of transition planning and implementation for students with autism spectrum disorder (ASD). Results were used to modify an evidence-based consultation intervention originally applied to young students with ASD called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple, & McGrew, 2012). Because consultation is a multilevel EBP, two existing implementation science frameworks were used to guide adaptation: the Framework for Evidence Based Implementation and Intervention Practices (FEBIIP; Dunst & Trivette, 2012) and the Consolidated Framework for Implementation Research (Damschroder et al., 2009). The purpose of this paper is to describe a process of adaptation that may be useful for other implementation science studies of consultation interventions, teacher acceptability, feasibility, and burden, and parent/student satisfaction with the adapted intervention. The study advances implementation science approaches for adapting evidence-based interventions. Offered is a hybrid model to guide researchers in the study of adapting consultation interventions. Teachers found the adaptations acceptable and feasible; parents and students reported high satisfaction.

Changes to the diagnosis of autism spectrum disorder (ASD) within the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013) have important implications for school psychologists responsible for evaluating children with ASD, interpreting results to caregivers, and informing policy makers of needed revisions to eligibility criteria based on empirical understanding. The primary purpose of this review is to describe changes to the DSM-5 and the empirical evidence behind the modifications. A secondary goal is to describe implications for best practices in school evaluations for ASD. Given the concerns about the DSM-5 expressed by caregivers and individuals with ASD during the revision process, school psychologists who are aware of the rationale for and implications of the changes will be better positioned to assist local policy makers regarding diagnostic evaluations for ASD and address parental concerns regarding the evaluation process and service im...

Individuals with Autism Spectrum Disorder (ASD) and their relatives process faces differently from typically developed (TD) individuals. In an fMRI face-viewing task, TD and undiagnosed sibling (SIB) children (5–18 years) showed face specialization in the right amygdala and ventromedial prefrontal cortex (vmPFC), with left fusiform and right amygdala face specialization increasing with age in TD subjects. SIBs showed extensive antero-medial temporal lobe activation for faces that was not present in any other group, suggesting a potential compensatory mechanism. In ASD, face specialization was minimal but increased with age in the right fusiform and decreased with age in the left amygdala, suggesting atypical development of a frontal-amygdala-fusiform system which is strongly linked to detecting salience and processing facial information.

More than a decade has passed since the National Research Council described the common elements of effective educational programs for young children with autism. Since that time, few studies have attempted to understand the mechanisms of change and factors affecting the effectiveness of research supported interventions implemented in community settings. Using Dunst’s (2013) framework of implementation science, we examined the relationships between the fidelity of an implementation practice (i.e., a parent–teacher consultation called the Collaborative Model for Promoting Competence and Success; COMPASS), the fidelity of the intervention practice (i.e., teachers’ adherence to the intervention plans generated as a result of COMPASS), and child goal attainment outcomes using data from a randomized controlled trial. Results confirmed the predicted relationships between implementation fidelity, intervention practice fidelity, and child outcomes. Specifically, we replicated findings that two hypothesized mechanisms of change, individual education program (IEP) quality and teacher adherence, positively affected intervention practices directly and child outcomes indirectly.

The purpose of the current study was to evaluate a new measure, the Autism Self-Efficacy Scale for Teachers (ASSET) for its dimensionality, internal consistency, and construct validity derived in a sample of special education teachers (N = 44) of students with autism. Results indicate that all items reflect one dominant factor, teachers’ responses to items were internally consistent within the sample, and compared to a 100-point scale, a 6-point response scale is adequate. ASSET scores were found to be negatively correlated with scores on two subscale measures of teacher stress (i.e., self-doubt/need for support and disruption of the teaching process) but uncorrelated with teacher burnout scores. The ASSET is a promising tool that requires replication with larger samples.

It is encouraging that children with autism show a strong response to early intervention, yet more research is needed for understanding the variability in responsiveness to specialized programs. Treatment predictor variables from 47 teachers and children who were randomized to receive the COMPASS intervention (Ruble et al. in The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) were analyzed. Predictors evaluated against child IEP goal attainment included child, teacher, intervention practice, and implementation practice variables based on an implementation science framework (Dunst and Trivette in J Soc Sci 8:143–148, 2012). Findings revealed one child (engagement), one teacher (exhaustion), two intervention quality (IEP quality for targeted and not targeted elements), and no implementation quality variables accounted for variance in child outcomes when analyzed separately. When the four significant variables were compared against each other in a single regression analysis, IEP quality accounted for one quarter of the variance in child outcomes.

The Response to Intervention (RTI) framework, a preventive model of universal screening, tiered interventions, and ongoing progress monitoring, poses an interesting consideration for identification and service delivery for children with autism spectrum disorders (ASD). Upon examination of the existing literature, paucity exists regarding how RTI might guide identification and service delivery for students with ASD; however, the authors consider core tenets of RTI and how they are relevant for students with ASD given what is known about this unique population. Due to the importance of early identification and interventions for individuals with ASD, the RTI framework could be problematic if used to delay education eligibility. Thus, two routes of identification are outlined by the authors, one of which expedites evaluation based on pervasive symptomatology, while the other route uses a form of universal screening to assist in moving toward evaluation for those suspected of ASD. The use of tiered interventio...

Little is known about services for children with autism spectrum disorders (ASD) living in rural areas. The purpose of this study was to examine parent report of access to and satisfaction with services for children with ASD in rural areas and compare results to parents from urban areas. Parents in both groups reported children were diagnosed after the age of 3 and experienced challenges accessing services, trained professionals, and educators. Parents from rural areas reported significantly more difficulty accessing trained physicians and professionals in their areas. The implications of this study and needed future research are discussed.

The significant increase in the numbers of students with autism combined with the need for better trained teachers (National Research Council, 2001) call for research on the effectiveness of alternative methods, such as consultation, that have the potential to improve service delivery. Data from 2 randomized controlled single-blind trials indicate that an autism-specific consultation planning framework known as the collaborative model for promoting competence and success (COMPASS) is effective in increasing child Individual Education Programs (IEP) outcomes (Ruble, Dal-rymple, & McGrew, 2010; Ruble, McGrew, & Toland, 2011). In this study, we describe the verbal interactions, defined as speech acts and speech act exchanges that take place during COMPASS consultation, and examine the associations between speech exchanges and child outcomes. We applied the Psychosocial Processes Coding Scheme (Leaper, 1991) to code speech acts. Speech act exchanges were overwhelmingly affiliative, failed to show statistically significant relationships with child IEP outcomes and teacher adherence, but did correlate positively with IEP quality.

The purpose of this study was to develop an Individual Education Program (IEP) evaluation tool based on Individuals with Disabilities Education Act (IDEA) requirements and National Research Council recommendations for children with autism; determine the tool’s reliability; test the tool on a pilot sample of IEPs of young children; and examine associations between IEP quality and school, teacher, and child characteristics. IEPs for 35 students with autism (Mage = 6.1 years; SD = 1.6) from 35 different classrooms were examined. The IEP tool had adequate interrater reliability (ICC = .70). Results identified no statistically significant association between demographics and IEP quality, and IEPs contained relatively clear descriptions of present levels of performance. Weaknesses of IEPs were described and recommendations provided.

Very little research has been conducted on insurance type (private vs. public funded) and costs, accessibility, and use of services of children with autism. Analysis of five parent reported outcomes: (a) out-of-pocket expenditures, (b) variety of services used, (c) access to services, (d) child and family service outcomes, and (e) satisfaction with payer of services against private and public insurance was completed. Parents/caregivers completed a survey regarding recent usage of nine specific services—inpatient care, medication management, counseling or training, individual therapy, in-home behavior therapy, speech and language therapy, occupational therapy, case management, and respite care. Across all respondents (n = 107), 73.5% were privately insured; 21.2% were publicly insured. Based on insurance type, no statistically significant differences in outcome variables were found, findings that were not consistent with previous research. However, an indirect association was found between out-of-pocket expense and parent satisfaction with the payer of services, access to care, and family outcomes. Further, a significantly higher percentage of total out-of-pocket expenditures were allocated to speech language therapy among publicly insured children than among privately insured children (p = .03) and parent stress was a moderating variable between access to care and variety of services used.

Purpose The purpose of this study was to examine the agreement between parent and teacher perceptions of specific social behaviors in children with autism spectrum disorders (ASD). Method Informant ratings were generated concerning 45 children with ASD between the ages of 5 and 14 years who were enrolled in social skills groups at 2 Midwestern outpatient autism treatment centers. Results Moderate agreement was observed between parents and teachers for the overall social skills rating scores ( r = 0.34; p < 0.05), but there was little agreement on specific social items. Distinct patterns of skill profiles emerged. Parents consistently provided relatively higher ratings on items that pertained to initiating interactions. Teachers, on the other hand, consistently provided higher ratings on items related to responding to and maintaining interactions. Parents and teachers agreed most often on items of affective understanding and perspective taking. Conclusion These findings suggest that specific social behaviors may be context dependent, indicating the need for a multi-informant approach to provide a more complete profile of a child’s social abilities, which is necessary for generating a more effective treatment plan.

Although it is documented that parent interaction influences children's development, few studies have focused on methods for reliably assessing molar-level caregiver-child interactions that are used regularly in treatment evaluations in community-based settings, and none have targeted children with autism spectrum disorders. Thirty-five children and their caregivers participated in an outpatient evaluation for therapeutic treatment planning for children with autism spectrum disorders. Parent-child interactions (part of the routine evaluation) were coded immediately after a 10-minute free-play activity. Analyses indicated that molar-level caregiver interaction behaviors could be evaluated with good reliability. Correlational analysis of parent and child demographics with the quality of interactions revealed no significant relationships, consistent with previous research. However, an expected and significant concurrent association was observed between parent responsiveness, measured using the observational rating scale, and parents' reports of children's ability to initiate interactions with adults. Research on reliable, ecologically feasible methods of parent-child interaction assessment conducted in community-based settings may help translate evidence-based practices into real-world settings.

More examples for clinicians are needed on the implementation of data-driven intervention approaches for autism spectrum disorders (ASDs). The purpose of this case study is to present a feasible data-driven approach using a pre- and postdesign of an outpatient social skills group for children with ASD who were clinically referred rather than research recruited for services. Measurement tools with ecological validity are described, as are the treatment outcomes. Challenges included the generation of meaningful and obtainable outcomes with social validity and the development of feasible methods to evaluate clinical outcomes. Practical issues related to implementation are described that can increase researchers' understanding of the practitioner environment, and suggestions are made for data-driven methods for service delivery monitoring, accountability, and scalability.

In an era in which evidence based practices are becoming the standard of care, there is little evidence that the current array of services commonly delivered for those with autism is helpful. This study describes community-based service utilization and caregiver-rated outcomes of services on symptoms of 113 children with autism spectrum disorders and their families. Parents/caregivers reported on nine types of services, received in the prior 6 months, which were evaluated against child and family outcomes. Caregivers rated in-home behavior therapy as providing the best outcomes overall for the child and respite care as providing the best outcomes for the family. Younger children were reported to have better outcomes than older children. Polytherapy was the rule, rather than the exception, as children used a mean of 3.5 different services. The frequency of services and the number of different types of services utilized correlated with family but not child outcomes. Examination of the potentiating effect of medication on outcomes of psychosocial interventions was not significant.

Autism spectrum disorder (ASD) is a chronic developmental disorder that impairs the development of social and communication skills. Multiple studies have shown that children with ASD prefer images of self over others. These studies explain the effectiveness of video self-modeling (VSM), an evidence-based autism intervention in which one learns by watching oneself performing a target behavior in video. VSM content is difficult to create as target behaviors are sporadic, but advances in sensing and graphics enable synthesis of such behaviors. In this paper, we propose the MEBook system which uses Kinect sensor to inject self-images into a social narrative game to teach students with ASD proper greeting behaviors. The social narrative is an animated story about the main character meeting and greeting different cartoon characters in a clinic. Self-modeling is achieved by first replacing the main characters face with an image of the subject, and then animating the subject to match the narration. The second component is a positive reinforcement game in which the subject is prompted to greet different cartoon characters. Through depth-based body posture tracking, proper greeting behaviors are recognized and immediately rewarded with praises and visual confetti. A multiple-baseline single-subject study has been conducted and the preliminary results show that MEBook is effective in teaching greeting behaviors to children with ASD.

Engagement is a core component of effective educational programs for children with autism. Analysis of 711 naturalistic goal-directed classroom behaviors of four school-age children with autism and four comparable children with Down syndrome (DS) was conducted. The definition of engagement was expanded to include child compliance and congruence. A main finding was both child and environmental factors influenced type of engagement. Children with DS produced 20% more goal-directed behaviors that were both congruent and compliant compared to children with autism. Large group instruction was associated with less congruent engagement but more compliant engagement for children with autism. These findings suggest specific types of engagement which may lead to advances in developing evidence-based practices for specific developmental disorders.

Although Medicaid is the largest public payer of behavioral health services, information on access and utilization of services is lacking, and no data on the frequency of service use or types of services provided for children with autism spectrum disorders (ASDs) are available. As states move toward managed care approaches for their Medicaid program, services information is critical. Behavioral health service data for children with autism spectrum disorders were collected from a state Medicaid Managed Care (MMC) program and analyzed from fiscal years 1995 through 2000. Findings revealed that the number of children who received services over time increased significantly; however, the rate of service use was only one tenth of what should be expected based on prevalence rates. The mean number of service days provided per child decreased significantly, about 40%, and the most prevalent forms of treatment changed. Day treatment vanished and medication and case management increased disproportionately to the number of children served. Explanations and implications of the findings are presented as well as recommendations for future research.

In our prior chapters, we described what we have learned about our implementation practice and intervention practice in terms of quality and internal and external factors and investigated the potential impact of these variables in explaining variability in COMPASS outcomes. In this chapter we cover what we learned about child factors. Most autism research has focused on evidence-based practices with less attention to understanding the child internal and external factors that help explain treatment outcome. To date, the most robust results identify autism severity, IQ, and language as important treatment outcome predictors. Although when we analyzed these variables against other child and teacher variables in COMPASS, they were correlated directly with child outcomes bivariately, they were not unique predictors of treatment outcome multivariately within a regression analysis. That is, the impact of these traditional child variables was better explained by other malleable elements of the teacher-child interaction. Specifically, child engagement or how well the teacher was able to instruct the child was the only child variable that accounted for variance in treatment outcome. Moreover child differences based on IQ, language, adaptive behaver, and autism severity were uncorrelated with teacher adherence or ability to implement teaching plans. Finally, we had some indication that COMPASS may be particularly helpful for students with severe autism. Teachers of those with higher autism severity reported the highest satisfaction with COMPASS.

One critical challenge to educators and to researchers is how to assess progress for group comparison designs when children have different goals, different stating baseline levels, and different intervention plans and, therefore, different milestones for what constitutes success. Evaluation of Individual Education Program (IEP) outcomes at the student level requires an idiographic measure of change. Idiographic assessment approaches are ideal for evaluating special education outcomes as IEPs require strict individualization of student goals. In this chapter we describe our approach for measuring COMPASS outcomes. We chose Goal Attainment Scaling as our answer for a sensitive, idiographic approach for measuring individual student outcomes. Because we also needed to ensure psychometric equivalence for group comparisons, we developed templates to help create equivalent goals as well as tools to evaluate the comparability of different goals by rating the (a) measurability of the goal; (b) level of difficulty of the goal; and (c) equidistance of goal. We then report our findings that we could develop templates with reliability and that scores from teacher-made videotapes that were used to score child progress during the coaching sessions were similar to tapes collected by researchers. Overall, our data suggests that GAS can be a valid and sensitive idiographic approach for use in group design experimental studies.

In this chapter we report results from our two randomized controlled trials (RCTs) of COMPASS. The goal of our first RCT was to conduct a proof of concept study. We wanted to demonstrate the efficacy of COMPASS using goal attainment scaling as our outcome measure. The goal of our second RCT was both to replicate our initial results and test a second type of experimental condition, web-based videoconferencing for the coaching sessions against face-to-face coaching. The first RCT demonstrated a very high effect size that was confirmed with the second RCT. More importantly, coaching using web-based videoconferencing was equally effective to face-to-face coaching. Thus, our first RCT provided proof of concept, and the second RCT upheld our findings that COMPASS is effective in helping children with ASD achieve high educational outcomes. We also learned that we could implement COMPASS reliably at multiple sites with multiple teachers in multiple schools and multiple districts, and teachers could be coached to successfully implement interventions reliably and accurately. COMPASS was received with high satisfaction from parents and teachers, despite the extra work COMPASS required from teachers.

Our last chapter reviewed critical teacher behaviors that are observable. In contrast, this chapter explores less understood but equally important teacher behaviors that are internal and not observable. Internal factors evaluated included self-efficacy, stress, and burnout as well as teachers’ attitudes toward data collection. Our analysis of self-efficacy revealed a significant correlation with burnout in our first study and with stress in our second study where we used a different autism-specific self-efficacy questionnaire. Most importantly, self-efficacy obtained at the end of the school year was associated with child goal attainment scores and with IEP quality. We also examined a larger number of internal factors to see which ones were independent predictors of outcomes: stress, burnout, years teaching, experience with ASD, and external factors (administrator support). Only one variable, teacher emotional exhaustion, correlated with student outcomes. Lastly our study of data collection attitudes identified facilitators or supports for data collection. Teachers who reported higher personal accomplishments, self-efficacy that one could collect data successfully, and administrator support reported greater intention to collect data. In fact, self-efficacy was the strongest predictor of behavioral intention of any of the assessed variables. Altogether, our findings identify new variables that should be included in the study of internal and external factors and practice outcomes.

The chapter provides an overview, brief critique, and description of how COMPASS fits within the Evidence Based Practices in Psychology (EBPP) framework. We also describe the models that guided the development and testing of COMPASS. Specifically, we describe the Ladder of Evidence, Dunst and Trivette’s (2012) implementation science framework and introduce and describe our Integrated Model. The Integrated Model starts with the consultant, teacher and student as primary actors, includes measures of the quality of the interaction between actors and incorporates internal and external resource factors impacting each actor. The Integrated Model was the primary guide for our research into understanding and testing the effectiveness, as well as exploring potential mechanisms of action and factors that underlie COMPASS effectiveness.