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Developmental Trajectories Indexing Change during Treatment for Toddlers with Autism Spectrum Disorder
Abstract: Early intervention for toddlers with autism spectrum disorder (ASD) is critical, given the potential for altering brain development and the increasing focus on early screening and diagnosis. Evidence is emerging for the efficacy of naturalistic, developmental behavioral interventions (NDBIs) for toddlers with ASD, which merge the behavioral learning and developmental science fields. Among these empirically-supported interventions is the Early Social Interaction Project, a parent-implemented intervention designed to achieve the necessary intensity for toddlers with ASD within natural environments. A randomized controlled trial (RCT) was conducted using a complete crossover design, allowing for examination of both treatment format/intensity and timing of treatment (Wetherby et al., 2014). In this RCT, children were randomized to receive nine months of either Individual-ESI, which consisted of three individual sessions per week, or Group-ESI, which consisted of one group session per week. Following completion of the first condition, children received the other condition for nine months, for a total of 18 months of intervention. Findings regarding format/intensity of ESI treatment revealed that children receiving Individual-ESI showed greater gains in social communication skills and receptive language than children receiving Group-ESI. Despite these promising findings, results from this RCT and other studies of NDBIs suggest that not all children benefit similarly from any treatment, indicating the need to better understand patterns of change during early intervention programs. The present study aimed to contribute to gaps in knowledge of individual patterns and predictors of change during treatment by identifying developmental trajectories during the 18-month ESI intervention and examining child characteristics that predict these trajectories. Participants were 82 children who were diagnosed with ASD between 16 and 20 months of age and subsequently enrolled in the treatment efficacy RCT (Wetherby et al., 2014). Children received measures of early social communication (Communication and Symbolic Behavior Scales [CSBS]) and autism symptoms in the social communication/interaction domain (Autism Diagnostic Observation Schedule [ADOS]) bimonthly, yielding nine to ten time points for each child. Piecewise growth mixture models (GMMs) were conducted in order to identify trajectories of change during intervention. Results were similar for CSBS Speech and Symbolic GMMs, as three-class solutions fit the data best. Classes were characterized by (1) steep, early improvement, (2) moderate improvement, and (3) little or no change. Membership in these classes was predicted by several child characteristics measured before the start of treatment, including speech, social, symbolic, and nonverbal developmental skills. GMMs also revealed three trajectories for CSBS Social analyses. Classes were characterized by (1) plateauing improvement, (2) variable improvement, and (3) no change. GMMs revealed just two trajectories for ADOS analyses: (1) first condition improvement and (2) second condition improvement. Only pretreatment symbolic skills predicted trajectory class membership for these variables measuring early social skills. These findings represent the first attempt to demonstrate the presence of distinct trajectories of change during a large parent-implemented intervention for toddlers with ASD. The observed trajectories represent diverse patterns of improvement, as well as very limited improvement in some children despite receiving efficacious intervention. Presence of these trajectories suggests that a group-level approach is likely to obscure individual variability in response to treatment, as a single developmental trajectory did not accurately characterize change during treatment. Findings regarding pretreatment predictors of these trajectories of change during treatment were consistent with previous longitudinal and treatment studies. The present study demonstrated a reciprocal relationship between development of social and symbolic skills, such that higher skills in one domain predicted a better trajectory in the other domain. An effect of these skills on language acquisition in treatment for young children with ASD was also demonstrated. Understanding developmental trajectories during early intervention has important research and clinical implications. Future research should focus on replicating the presence of specific developmental trajectories associated with treatment response and replicating important predictors of these trajectories (i.e., symbolic and social skills). The subset of children that did not show significant response requires further study, as specific profiles associated with limited response to treatment may help clinicians identify children who require greater intensity and/or duration of treatment, or who require a different approach. Alternatively, understanding which children are most likely to benefit from specific treatment approaches aids in understanding of which treatments work for whom. This line of research may ultimately contribute to treatment individualization for toddlers with ASD as trajectories of response to treatment are identified and associated with specific profiles. Findings may help clinicians predict response to treatment and ultimately tailor treatments for individual children. ; A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. ; Summer Semester 2015. ; June 18, 2015. ; autism spectrum disorder, developmental trajectory, growth mixture model, intervention ; Includes bibliographical references. ; Amy M. Wetherby, Professor Directing Dissertation; Juliann Woods, University Representative; Christopher Schatschneider, Committee Member; Janet Kistner, Committee Member; Kimberly Driscoll, Committee Member.
Keyword: Clinical psychology
URL: http://diginole.lib.fsu.edu/islandora/object/fsu%3A366441/datastream/TN/view/Developmental%20Trajectories%20Indexing%20Change%20during%20Treatment%20for%20Toddlers%20with%20Autism%20Spectrum%20Disorder.jpg
http://purl.flvc.org/fsu/fd/FSU_2016SU_Guthrie_fsu_0071E_12690
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2
Common Genetic and Environmental Influences on Reading, Spelling, and Writing for Older Children and Adolescents
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3
Relations Among Elementary Students' Use of Dialect and Concurrent and Subsequent Reading Outcomes
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4
Predictors of Reading Comprehension: A Model-Based Meta-analytic Review
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5
Parallel Word Processing during Reading &the Influence of Context
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Young English Language Learners' Cognate Sensitivity on Picture-Word Recognition and Production
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7
Assessing the Importance of Metalinguistic Skills to the Word Reading and Reading Comprehension Abilities of Adult Basic Education Students
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8
Developing Emergent Literacy Skills: The Impact of Alphabet Instruction
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9
Lexical Characteristics of Words and Phonological Awareness Skills of Preschool Children
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10
Development of Writing: Key Components of Written Language
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11
The Role of Parafoveal Information in Rapid Letter Naming
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12
Reading Comprehension in Grade Three as a Function of Child, Item, and Passage Characteristics
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13
Factors Affecting the Development of Second Grade Spelling at the Teacher, Student, and Word Level
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14
The Linguistic Profiles of Spelling Errors in Fourth, Fifth, and Seventh Grade Students
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15
Monitoring Growth in Early Reading Skills: Validation of a Computer Adaptive Test
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16
Preschool Externalizing Behavior Mediates the Relation Between Temperament and Emergent Literacy
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17
Early Literacy Professional Development: Exploring the Effects of Mentoring for Preschool Teachers
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18
The Nature of Morphological Knowledge
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19
Relationships Betweeen Measures of Word Knowledge and Reading Comprehension in Third-Grade Children
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20
A Latent Variable Modeling Approach to the Simple View of Reading
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