We propose that the crucial difference between human cognition and that of other species is the ability to participate with others in collaborative activities with shared goals and intentions: shared intentionality. Participation in such activities requires not only especially powerful forms of intention reading and cultural learning, but also a unique motivation to share psychological states with oth- ers and unique forms of cognitive representation for doing so. The result of participating in these activities is species-unique forms of cultural cognition and evolution, enabling everything from the creation and use of linguistic symbols to the construction of social norms and individual beliefs to the establishment of social institutions. In support of this proposal we argue and present evidence that great apes (and some children with autism) understand the basics of intentional action, but they still do not participate in activities involving joint intentions and attention (shared intentionality). Human children's skills of shared intentionality develop gradually during the first 14 months of life as two ontogenetic pathways intertwine: (1) the general ape line of understanding others as animate, goal-directed, and intentional agents; and (2) a species-unique motivation to share emotions, experience, and activities with other persons. The develop- mental outcome is children's ability to construct dialogic cognitive representations, which enable them to participate in earnest in the collectivity that is human cognition.

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Understanding and sharing intentions: The origins of cultural cognition

(1998). Human cognitive abilities: A survey of factor analytic studies. Gifted and Talented International: Vol. 13, No. 2, pp. 97-98.

Human cognitive abilities: A survey of factor analytic studies

Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs? Issues: Selection, maturation, history, mortality, testing, regression towrd the mean, selection by maturation, treatment by mortality, treatment by testing, measured treatment variables Increase: Eliminate the threats, above all do experimental manipulations, random assignment, and counterbalancing.

Reliability and validity

OBJECTIVE: To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). METHODS: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. RESULTS: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. CONCLUSIONS: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.

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Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model

Background: Information on long-term prognosis in autism is limited. Outcome is known to be poor for those with an IQ below 50, but there have been few systematic studies of individuals with an IQ above this.

Method:  Sixty-eight individuals meeting criteria for autism and with a performance IQ of 50 or above in childhood were followed up as adults. Their mean age when first seen was 7 years (range 3–15 years); at follow-up the average age was 29 years (range 21–48 years). Outcome measures included standardised cognitive, language and attainment tests. Information on social, communication and behavioural problems was obtained from the Autism Diagnostic Interview (ADI).

Results:  Although a minority of adults had achieved relatively high levels of independence, most remained very dependent on their families or other support services. Few lived alone, had close friends, or permanent employment. Communication generally was impaired, and reading and spelling abilities were poor. Stereotyped behaviours or interests frequently persisted into adulthood. Ten individuals had developed epilepsy. Overall, only 12% were rated as having a ‘Very Good’ outcome; 10% were rated as ‘Good’ and 19% as ‘Fair’. The majority was rated as having a ‘Poor’ (46%) or ‘Very Poor’ (12%) outcome. Individuals with a childhood performance IQ of at least 70 had a significantly better outcome than those with an IQ below this. However, within the normal IQ range outcome was very variable and, on an individual level, neither verbal nor performance IQ proved to be consistent prognostic indicators.

Conclusions:  Although outcome for adults with autism has improved over recent years, many remain highly dependent on others for support. This study provides some information on prognostic indicators, but more fine-grained research is needed into the childhood variables that are associated with good or poor outcome.

Adult outcome for children with autism

After a very intensive behavioral intervention, an experimental group of 19 preschool-age children with autism achieved less restrictive school placements and higher IQs than did a control group of 19 similar children by age (Lovaas, 1987). The present study followed-up this finding by assessing subjects at a mean age of 11.5 years. Results showed that the experimental group preserved its gains over the control group. The 9 experimental subjects who had achieved the best outcomes at age 7 received particularly extensive evaluations indicating that 8 of them were indistinguishable from average children on tests of intelligence and adaptive behavior. Thus, behavioral treatment may produce long-lasting and significant gains for many young children with autism.

Long-term outcome for children with autism who received early intensive behavioral treatment.

Young children with pervasive developmental disorder were randomly assigned to intensive treatment or parent training. The intensive treatment group (7 with autism, 8 with pervasive developmental disorder not otherwise specified—NOS) averaged 24.52 hours per week of individual treatment for one year, gradually reducing hours over the next 1 to 2 years. The parent training group (7 with autism, 6 with pervasive developmental disorder NOS) received 3 to 9 months of parent training. The groups appeared similar at intake on all measures; however, at follow-up the intensive treatment group outperformed the parent training group on measures of intelligence, visual-spatial skills, language, and academics, though not adaptive functioning or behavior problems. Children with pervasive developmental disorder NOS may have gained more than those with autism.

Randomized trial of intensive early intervention for children with pervasive developmental disorder.

Discrete trial training (DTT) is a method for individualizing and simplifying instruction to enhance children's learning. For children with autism, DTT is especially useful for teaching new forms o...

Discrete Trial Training in the Treatment of Autism

This study was designed to evaluate 1 year of intensive treatment for 4- to 7-year-old children with autism.An independent clinician assigned children to either behavioral treatment ( n = 13) or eclectic treatment (n = 12).Assignment was based on availability of personnel to supervise treatment and was not influenced by child characteristics or family preference.The two treat ment groups received similar amounts of treatment (M = 28.52 hours per week at the child’s school).Children in the behavioral treatment group made significantly larger gains on standard ized tests than did children in the eclectic treatment group.Results suggest that some 4- to 7-year-olds may make large gains with intensive behavioral treatment, that such treatment can be successfully implemented in school settings, and that specific aspects of behavioral treatment (not just its intensity) may account for favorable outcomes.

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Intensive Behavioral Treatment at School for 4- to 7-Year-Old Children with Autism: A 1-Year Comparison Controlled Study

Although previous studies have shown favorable results with early intensive behavioral treatment (EIBT) for children with autism, it remains important to replicate these findings, particularly in community settings. The authors conducted a 3-year prospective outcome study that compared 2 groups: (1) 21 children who received 35 to 40 hours per week of EIBT from a community agency that replicated Lovaas' model of EIBT and (2) 21 age- and IQ-matched children in special education classes at local public schools. A quasi-experimental design was used, with assignment to groups based on parental preference. Assessments were conducted by independent examiners for IQ (Bayley Scales of Infant Development or Wechsler Preschool and Primary Scales of Intelligence), language (Reynell Developmental Language Scales), nonverbal skill (Merrill-Palmer Scale of Mental Tests), and adaptive behavior (Vineland Adaptive Behavior Scales). Analyses of covariance, with baseline scores as covariates and Year 1-3 assessments as repeated measures, revealed that, with treatment, the EIBT group obtained significantly higher IQ (F = 5.21, p = .03) and adaptive behavior scores (F = 7.84, p = .01) than did the comparison group. No difference between groups was found in either language comprehension (F = 3.82, p = .06) or nonverbal skill. Six of the 21 EIBT children were fully included into regular education without assistance at Year 3, and 11 others were included with support; in contrast, only 1 comparison child was placed primarily in regular education. Although the study was limited by the nonrandom assignment to groups, it does provide evidence that EIBT can be successfully implemented in a community setting. J Dev Behav Pediatr 27:145Y155, 2006. Index terms: autism, early intervention, applied behavior analysis, behavioral treatment.

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Tristram Smith

Papers

Long-term outcome for children with autism who received early intensive behavioral treatment.

Randomized trial of intensive early intervention for children with pervasive developmental disorder.

Discrete Trial Training in the Treatment of Autism

Intensive Behavioral Treatment at School for 4- to 7-Year-Old Children with Autism: A 1-Year Comparison Controlled Study

Early intensive behavioral treatment: replication of the UCLA model in a community setting.