Psychometric properties and initial validity of the Brief Observation of Social Communication Change (BOSCC), a measure of treatment-response for social-communication behaviors, are described. The BOSCC coding scheme is applied to 177 video observations of 56 young children with ASD and minimal language abilities. The BOSCC has high to excellent inter-rater and test–retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrates statistically significant amounts of change over time compared to a no change alternative while the ADOS CSS over the same period of time did not. This work is a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.

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Measuring Changes in Social Communication Behaviors: Preliminary Development of the Brief Observation of Social Communication Change (BOSCC)

Parent training (PT) has emerged as a promising treatment for disruptive behavior in children with autism spectrum disorder (ASD). This review summarizes the essential elements of PT for disruptive behavior in children with ASD and evaluates the available evidence for PT using both descriptive and meta-analytic procedures. We searched Medline, PsycINFO, and PubMed databases (1980–2016) in peer-reviewed journals for randomized controlled trials (RCTs) of PT for disruptive behavior in children with ASD. The systematic search of 2023 publications yielded eight RCTs involving a total of 653 participants. We calculated effect sizes using either raw post-treatment means and standard deviations for each treatment group (PT and control) or group mean differences with associated 95% confidence intervals (CIs). Differences in post-treatment means were converted to a standardized difference in means (SMD) for each primary outcome. Results support the efficacy of PT for disruptive behavior in children with ASD, with a SMD of −0.59 [95% CI (−0.88, −0.30); p < 0.001]. Across these eight studies, there was significant heterogeneity in the effect of PT on disruptive behavior. This variability is likely due to differences in sample size, number of treatment sessions, study duration, and control condition employed. Current findings provide solid support for the efficacy of PT for disruptive behavior in children with ASD. Future studies should focus on effectiveness trials to promote wider implementation of PT in clinical settings.

A Systematic Review and Meta-analysis of Parent Training for Disruptive Behavior in Children with Autism Spectrum Disorder.

Parent-child interaction therapy (PCIT), a program for young children and their families, is a strong evidence-based treatment that repeatedly receives the highest rankings possible in reviews of such treatments (e.g., California Evidence-Based Clearinghouse for Child Welfare, 2015; nrepp.samhsa.gov). PCIT was originally developed for use with young children (2–7 years of age) with disruptive behavior problems (McNeil and Hembree-Kigin 2010; Zisser and Eyberg 2010). As PCIT continued to show significant positive outcomes including improved child behaviors, reduced parenting stress, and improved parent-child relationships (Brinkmeyer and Eyberg 2003; Eyberg and Robinson 1982), the application of PCIT to children at risk or exposed to trauma seemed a logical step.

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Parent-Child Interaction Therapy:

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

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Characterizing Psychiatric Comorbidity in Children with Autism Spectrum Disorder Receiving Publicly Funded Mental Health Services.

Importance Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language. Objective To examine the association between parent training and language and communication outcomes in young children. Data Sources Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018. Study Selection Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included. Main Outcomes and Measures Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment. Results This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedgesg,−0.33 [0.06];P  Conclusions and Relevance The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.

Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis

This study examined the efficacy of the Child-Directed Interaction Training (CDIT) phase of Parent-Child Interaction Therapy for children with an Autism Spectrum Disorder (ASD). Thirty mother-child dyads with children ages 3-7 years with a diagnosis of ASD participated in this randomized controlled study. Following manualized CDIT, statistically significant and meaningful improvements in child disruptive behavior and social awareness as well as maternal distress associated with child disruptive behavior occurred. Across 8 sessions, mothers learned to provide positive attention to their children's appropriate social and play behaviors. Both child and parent changes were maintained at 6-week follow-up. A relatively brief, time-limited, and accessible intervention may be efficacious for improving child and parent behaviors in families of young children with ASD. By decreasing child disruptive behaviors, CDIT may also help to prepare children to benefit further from future interventions.

Child-Directed Interaction Training for Young Children With Autism Spectrum Disorders: Parent and Child Outcomes

This chapter briefly explores the research currently supporting Child-Directed Interaction (CDI) as a treatment modality both as part of broader Parent–Child Interaction Therapy (PCIT) framework and as a stand-alone intervention. It examines theoretical reasons why CDI is an effective and appropriate intervention that benefits children, parents, and the parent–child relationship as a whole as well as its unique value for children on the autism spectrum. The authors discuss effective CDI coaching strategies useful in both PCIT and CDI for children with autism spectrum disorder (ASD), including expanding play ideas, working with stereotyped interests, exploring the appropriateness of using labeled praises as reinforcers, and tailoring reflections for children with limited speech. The authors also suggest therapeutic guidelines for parents who rapidly reach mastery and address issues that commonly occur around the “Don’t” skills. Finally, the authors deliberate policy issues concerning the expansion of CDI as a stand-alone treatment to a broader base of health care providers.

Child-Directed Interaction Treatment for Children on the Autism Spectrum

An estimated 1 in 59 children in the USA is diagnosed with an autism spectrum disorder (ASD; CDC, Morbidity and Mortality Weekly Report. Surveillance Summaries 67(6):1–23, 2018). While all children diagnosed with ASD experience some level of difficulty with social communication and restricted, repetitive interests, many also exhibit problematic disruptive behaviors across settings. Parents and other adults in the children’s lives (e.g., family members, teachers, medical and mental health professionals, community members) are important in helping children with ASD meet their potential. Although several interventions exist that target children with ASD, their parents, and teachers, there are no widely available, evidence-based programs designed to help other adults who interact with children with ASD but who do not have a major caretaking role. Child-Adult Relationship Enhancement (CARE) is an intervention for all adults in provider roles based on evidence-based parenting programs (including Parent-Child Interaction Therapy; PCIT) designed to strengthen social relationships and improve child compliance for minor to moderate difficulties. Early findings related to CARE show that it is a promising intervention for improving relationships and behavior in several populations. Specifically, CARE Connections is an adaptation developed for all adults interacting with children with ASD. CARE Connections incorporates adult learning principles, live feedback, and ASD-specific examples to increase program uptake and implementation for care providers in a child’s life. CARE Connections may be an important step for all adults to learn more effective means of communicating with children with ASD with the goal of improving the child’s overall development (e.g., social development).

John Paul Abner

Papers

Child-Directed Interaction Training for Young Children With Autism Spectrum Disorders: Parent and Child Outcomes

Child-Directed Interaction Treatment for Children on the Autism Spectrum

Child-Adult Relationship Enhancement for Children with Autism Spectrum Disorders: CARE Connections