The breadth of available non-pharmacological interventions for autistic children, with varying ev... more The breadth of available non-pharmacological interventions for autistic children, with varying evidence for efficacy summarised in multiple systematic reviews, creates challenges for parents, practitioners, and policymakers in navigating the research evidence. In this article, we report the findings of an umbrella review of 58 systematic reviews of non-pharmacological interventions for autistic children (aged 0–12 years). Positive therapeutic effects were identified for Behavioural interventions, Developmental interventions, Naturalistic Developmental Behavioural Interventions, Technology-based interventions, and Cognitive Behaviour Therapy across several child and family outcomes. Positive effects for certain practices within Sensory-based interventions and ‘other’ interventions were limited to select child and family outcomes. Both inconsistent and null intervention effects were found for Treatment and Education of Autistic and related Communication-handicapped Children, and Anima...
Both the amount and responsiveness of adult language input contribute to the language development... more Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent–child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers’ language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.
Parents from individualist cultures (those focused on autonomy of individuals; that is, Australia... more Parents from individualist cultures (those focused on autonomy of individuals; that is, Australian) may view their autistic children differently compared to parents from collectivist cultures (where community needs are valued over an individual’s, that is, South-East Asian cultures). As most research on autism and parenting has been undertaken in Western individualist cultures, knowledge of parenting beliefs and mental health within collectivist cultures is lacking. We compared the mental health, quality of life, well-being and parenting sense of competency between families raising an autistic child from two groups: 97 Australian parents and 58 parents from South-East Asian backgrounds. Children from both groups were receiving the same community-based early intervention. No group differences were found on the measures of mental health but, when compared to Australian parents, parents from South-East Asian backgrounds reported higher well-being and less impact on their quality of lif...
Supplemental material, sj-pdf-1-aut-10.1177_1362361320984315 for Differential predictors of well-... more Supplemental material, sj-pdf-1-aut-10.1177_1362361320984315 for Differential predictors of well-being versus mental health among parents of pre-schoolers with autism by Cherie C Green, Jodie Smith, Catherine A Bent, Lacey Chetcuti, Rhylee Sulek, Mirko Uljarević and Kristelle Hudry in Autism
The transition into formal schooling environments is a difficult period of change for many childr... more The transition into formal schooling environments is a difficult period of change for many children. For some children with autism spectrum disorder, hereon referred to as autism, delays in their development of school readiness skills (e.g., following directions, attending to tasks) may exacerbate these difficulties. With a large proportion of children with autism educated in mainstream settings, it is critical that teachers in these settings are well equipped to support their transitions. For many children, this includes continuing to support their development of these school readiness skills, into the first year of formal schooling. Reviews of the autism treatment literature have resulted in the identification of empirically supported treatments (ESTs), a number of which specifically target school readiness skills. Whereas previous researchers have examined the extent to which ESTs are used by early intervention providers and special education teachers, this project was designed t...
Research and practice in intellectual and developmental disabilities, 2020
Increasing social-communication skills and peer interaction are high priority intervention target... more Increasing social-communication skills and peer interaction are high priority intervention targets for parents of children with autism (McConachie et al., 2018), including for 5-year-old Jimmy feat...
The provision of timely, effective, and socially valid non-pharmacological intervention is at the... more The provision of timely, effective, and socially valid non-pharmacological intervention is at the core of efforts to support the development of young autistic children. These efforts are intended to support children to develop skills, empower their caregivers, and lay the foundation for optimal choice, independence, and quality of life into adulthood. But what is the optimal amount of intervention? In this Viewpoint, we review current guidelines and consider evidence from an umbrella review of non-pharmacological interventions for autistic children aged up to 12 years. We show the lack of consensus on the issue, identify factors that might be relevant to consider, and present an evidence-based framework for determining the optimal amount of intervention for each child, along with recommendations for future research.
While timely early intervention is considered central to supporting children on the autism spectr... more While timely early intervention is considered central to supporting children on the autism spectrum, clinicians often face challenges in selecting the most appropriate interventions. These decisions are often complicated by several factors including the number of available interventions, with varying evidence for their efficacy, a lack of clear guidance around the most appropriate intervention dosage, and limited evidence to support what interventions work best for which children and why. There is a need to support clinicians to make effective decisions when selecting interventions for children on the autism spectrum, with Clinical Decision Support Systems (CDSS) offering a potential, novel, solution. The purpose of this scoping review is to examine the application of CDSS within the field of autism and related neurodevelopmental conditions to summarise their use to date and identify areas for future research.
Many autistic children have co-occurring behavioural problems influencing core autism symptomolog... more Many autistic children have co-occurring behavioural problems influencing core autism symptomology potentially relevant for intervention planning. Parental Expressed Emotion – reflecting critical, hostile and overprotective comments – contributes to understanding and predicting behaviour in autistic school-aged children, adolescents and adults and is typically measured using the Five-Minute Speech Sample. However, limitations exist for its use with parents of younger autistic children and so the Autism-Specific Five-Minute Speech Sample was adapted with the goal of better measuring parent Expressed Emotion in the context of childhood autism. The Autism-Specific Five-Minute Speech Sample has not yet been used to explore Expressed Emotion in parents of autistic preschoolers, nor has the relative predictive utility of the Autism-Specific Five-Minute Speech Sample and Five-Minute Speech Sample been evaluated in the same sample. We compared the two measures from speech samples provided b...
Extensive research has shown elevated mental health difficulties among parents of children with a... more Extensive research has shown elevated mental health difficulties among parents of children with autism compared to other parents. Although several studies have explored factors related to mental health among parents of children with autism, the factors that influence and promote well-being remain poorly characterised. Parents of young, newly diagnosed autistic children may also be particularly vulnerable to stressors that impact mental health and well-being. We examined child-, parent-, and family/socioeconomic factors associated with concurrent mental health and well-being among 136 parents of young children with autism, aged 13–48 months. Parental mental health was predicted by both trait negative emotionality and reported child autism symptoms, while well-being was predicted by parent factors alone, including trait extraversion and mindfulness. Broader child characteristics and family/socioeconomic contextual factors made no significant contribution in regression models. While th...
IntroductionResearch highlights the importance of early intervention for children with autism spe... more IntroductionResearch highlights the importance of early intervention for children with autism spectrum disorder with better outcomes associated with earlier access to early intensive intervention (EII) programmes. However, there is significant variability in response to EII despite children receiving the same programmes.Methods and analysisA prospective, multisite cohort study using a pre–post design assesses the predictors of early intervention outcomes for children who receive EII through six early intervention services (Autism Specific Early Learning and Care Centres, ASELCCs) across Australia. Child and family characteristics at entry to and exit from ASELCCs are ascertained using measures of autism symptoms (Autism Diagnostic Observation Schedule-2; Social Communication Questionnaire); cognitive, language and developmental skills (Mullen Scale of Early Learning); adaptive function (Vineland Adaptive Behaviour Scale—second Edition); behaviours (Child Behaviour Checklist—1.5 to 5...
Autism Spectrum Disorder attracts a range of practices, interventions, and treatments ranging fro... more Autism Spectrum Disorder attracts a range of practices, interventions, and treatments ranging from those with empirical support of positively influencing outcomes, through to those with implausible theoretical bases, evidence of ineffectiveness, or indeed harm. In this chapter, we overview, why evidence based practices (EBPs) are important in the field of autism. This includes defining evidence based practice including both the broader framework and the specific classification of practices as EBPs, and summarising recent reviews that have classified practices as EBPs. We highlight that EBPs are important in the context of the ongoing use of unsupported practices by parents, in early intervention, by teachers, and by allied health professionals. We discuss the harms associated with non-use of EBPs and use of unsupported practices including direct harm, false hope, and financial and opportunity cost. We argue that using EBPs is the ethical approach which supports human rights, but ack...
The breadth of available non-pharmacological interventions for autistic children, with varying ev... more The breadth of available non-pharmacological interventions for autistic children, with varying evidence for efficacy summarised in multiple systematic reviews, creates challenges for parents, practitioners, and policymakers in navigating the research evidence. In this article, we report the findings of an umbrella review of 58 systematic reviews of non-pharmacological interventions for autistic children (aged 0–12 years). Positive therapeutic effects were identified for Behavioural interventions, Developmental interventions, Naturalistic Developmental Behavioural Interventions, Technology-based interventions, and Cognitive Behaviour Therapy across several child and family outcomes. Positive effects for certain practices within Sensory-based interventions and ‘other’ interventions were limited to select child and family outcomes. Both inconsistent and null intervention effects were found for Treatment and Education of Autistic and related Communication-handicapped Children, and Anima...
Both the amount and responsiveness of adult language input contribute to the language development... more Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent–child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers’ language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.
Parents from individualist cultures (those focused on autonomy of individuals; that is, Australia... more Parents from individualist cultures (those focused on autonomy of individuals; that is, Australian) may view their autistic children differently compared to parents from collectivist cultures (where community needs are valued over an individual’s, that is, South-East Asian cultures). As most research on autism and parenting has been undertaken in Western individualist cultures, knowledge of parenting beliefs and mental health within collectivist cultures is lacking. We compared the mental health, quality of life, well-being and parenting sense of competency between families raising an autistic child from two groups: 97 Australian parents and 58 parents from South-East Asian backgrounds. Children from both groups were receiving the same community-based early intervention. No group differences were found on the measures of mental health but, when compared to Australian parents, parents from South-East Asian backgrounds reported higher well-being and less impact on their quality of lif...
Supplemental material, sj-pdf-1-aut-10.1177_1362361320984315 for Differential predictors of well-... more Supplemental material, sj-pdf-1-aut-10.1177_1362361320984315 for Differential predictors of well-being versus mental health among parents of pre-schoolers with autism by Cherie C Green, Jodie Smith, Catherine A Bent, Lacey Chetcuti, Rhylee Sulek, Mirko Uljarević and Kristelle Hudry in Autism
The transition into formal schooling environments is a difficult period of change for many childr... more The transition into formal schooling environments is a difficult period of change for many children. For some children with autism spectrum disorder, hereon referred to as autism, delays in their development of school readiness skills (e.g., following directions, attending to tasks) may exacerbate these difficulties. With a large proportion of children with autism educated in mainstream settings, it is critical that teachers in these settings are well equipped to support their transitions. For many children, this includes continuing to support their development of these school readiness skills, into the first year of formal schooling. Reviews of the autism treatment literature have resulted in the identification of empirically supported treatments (ESTs), a number of which specifically target school readiness skills. Whereas previous researchers have examined the extent to which ESTs are used by early intervention providers and special education teachers, this project was designed t...
Research and practice in intellectual and developmental disabilities, 2020
Increasing social-communication skills and peer interaction are high priority intervention target... more Increasing social-communication skills and peer interaction are high priority intervention targets for parents of children with autism (McConachie et al., 2018), including for 5-year-old Jimmy feat...
The provision of timely, effective, and socially valid non-pharmacological intervention is at the... more The provision of timely, effective, and socially valid non-pharmacological intervention is at the core of efforts to support the development of young autistic children. These efforts are intended to support children to develop skills, empower their caregivers, and lay the foundation for optimal choice, independence, and quality of life into adulthood. But what is the optimal amount of intervention? In this Viewpoint, we review current guidelines and consider evidence from an umbrella review of non-pharmacological interventions for autistic children aged up to 12 years. We show the lack of consensus on the issue, identify factors that might be relevant to consider, and present an evidence-based framework for determining the optimal amount of intervention for each child, along with recommendations for future research.
While timely early intervention is considered central to supporting children on the autism spectr... more While timely early intervention is considered central to supporting children on the autism spectrum, clinicians often face challenges in selecting the most appropriate interventions. These decisions are often complicated by several factors including the number of available interventions, with varying evidence for their efficacy, a lack of clear guidance around the most appropriate intervention dosage, and limited evidence to support what interventions work best for which children and why. There is a need to support clinicians to make effective decisions when selecting interventions for children on the autism spectrum, with Clinical Decision Support Systems (CDSS) offering a potential, novel, solution. The purpose of this scoping review is to examine the application of CDSS within the field of autism and related neurodevelopmental conditions to summarise their use to date and identify areas for future research.
Many autistic children have co-occurring behavioural problems influencing core autism symptomolog... more Many autistic children have co-occurring behavioural problems influencing core autism symptomology potentially relevant for intervention planning. Parental Expressed Emotion – reflecting critical, hostile and overprotective comments – contributes to understanding and predicting behaviour in autistic school-aged children, adolescents and adults and is typically measured using the Five-Minute Speech Sample. However, limitations exist for its use with parents of younger autistic children and so the Autism-Specific Five-Minute Speech Sample was adapted with the goal of better measuring parent Expressed Emotion in the context of childhood autism. The Autism-Specific Five-Minute Speech Sample has not yet been used to explore Expressed Emotion in parents of autistic preschoolers, nor has the relative predictive utility of the Autism-Specific Five-Minute Speech Sample and Five-Minute Speech Sample been evaluated in the same sample. We compared the two measures from speech samples provided b...
Extensive research has shown elevated mental health difficulties among parents of children with a... more Extensive research has shown elevated mental health difficulties among parents of children with autism compared to other parents. Although several studies have explored factors related to mental health among parents of children with autism, the factors that influence and promote well-being remain poorly characterised. Parents of young, newly diagnosed autistic children may also be particularly vulnerable to stressors that impact mental health and well-being. We examined child-, parent-, and family/socioeconomic factors associated with concurrent mental health and well-being among 136 parents of young children with autism, aged 13–48 months. Parental mental health was predicted by both trait negative emotionality and reported child autism symptoms, while well-being was predicted by parent factors alone, including trait extraversion and mindfulness. Broader child characteristics and family/socioeconomic contextual factors made no significant contribution in regression models. While th...
IntroductionResearch highlights the importance of early intervention for children with autism spe... more IntroductionResearch highlights the importance of early intervention for children with autism spectrum disorder with better outcomes associated with earlier access to early intensive intervention (EII) programmes. However, there is significant variability in response to EII despite children receiving the same programmes.Methods and analysisA prospective, multisite cohort study using a pre–post design assesses the predictors of early intervention outcomes for children who receive EII through six early intervention services (Autism Specific Early Learning and Care Centres, ASELCCs) across Australia. Child and family characteristics at entry to and exit from ASELCCs are ascertained using measures of autism symptoms (Autism Diagnostic Observation Schedule-2; Social Communication Questionnaire); cognitive, language and developmental skills (Mullen Scale of Early Learning); adaptive function (Vineland Adaptive Behaviour Scale—second Edition); behaviours (Child Behaviour Checklist—1.5 to 5...
Autism Spectrum Disorder attracts a range of practices, interventions, and treatments ranging fro... more Autism Spectrum Disorder attracts a range of practices, interventions, and treatments ranging from those with empirical support of positively influencing outcomes, through to those with implausible theoretical bases, evidence of ineffectiveness, or indeed harm. In this chapter, we overview, why evidence based practices (EBPs) are important in the field of autism. This includes defining evidence based practice including both the broader framework and the specific classification of practices as EBPs, and summarising recent reviews that have classified practices as EBPs. We highlight that EBPs are important in the context of the ongoing use of unsupported practices by parents, in early intervention, by teachers, and by allied health professionals. We discuss the harms associated with non-use of EBPs and use of unsupported practices including direct harm, false hope, and financial and opportunity cost. We argue that using EBPs is the ethical approach which supports human rights, but ack...
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