The effectiveness of a behavioral intervention was evaluated in an adult with intellectual disability, epilepsy, and challenging behavior who had ceased oral intake of liquids and medications. The intervention consisted of fading, designed to gradually increase the volume of water accepted; backward chaining, involving bringing a cup to the lips, introducing liquid into the mouth, and ultimately swallowing; and differential reinforcement. A descriptive functional assessment revealed that the most common consequences of intake refusal were access to preferred conversation topics from parents and hospital staff and escape. Baseline measures showed little or no acceptance of liquids or medications. Following fading and differential reinforcement, swallowing was established and increased to 90 ml of water, while medication intake reached 100% success. Treatment gains were maintained in both clinic and home settings. The study replicated the findings of Hagopian et al. (1996) and extended their generality to an adult client and the oral intake of medication. Social validity scores were favorable for both parents.

Early Intensive Behavioral Intervention (EIBI) is widely recommended for children with Autism Spectrum Disorder (ASD). However, the treatment intensity and effectiveness have been debated. We conducted a meta-analysis and examined individual participant data to evaluate the effectiveness and clinical significance of the outcomes on adaptive behavior, intellectual functioning, and autism severity. We included studies of children with ASD aged 2-6 years who received EIBI for at least 12 months. The final literature search was conducted on September 26, 2024. The GRADE tool was used to assess the risk of bias. Across the 17 identified studies, we obtained participant data from 15 studies: 341 children received EIBI and 280 were in comparison-groups. All studies had a serious risk of bias due to the lack of random assignment. Our meta-analysis yielded effect sizes of 0.66 for improvement in adaptive behavior, 0.87 for improvement in intellectual functioning and 1.36 for reductions in ASD severity. A significantly higher percentage of children in the EIBI-group met the criteria for statistically reliable change and scored in the non-clinical range post-intervention with a Number Needed to Treat between 4.1 and 6.9. We found that treatment intensity significantly contributed to changes across all outcome measures. Based on our analyses we propose benchmarks for evaluating interventions for children with ASD. Although EIBI demonstrates broad, substantial effects, some uncertainty remains due to the lack of random assignment in the reviewed studies. Nonetheless, EIBI should currently be considered as the preferred treatment for children with ASD.

Effective staff training and supervision are vital in human care services, influencing staff performance and the quality of care. This study explores the effectiveness of an 8 h training program for Board Certified Behavior Analysts (BCBA) in providing performance feedback, specifically in the context of a Paired Stimulus (PS) preference assessment. The training consisted of 5 h of instruction, exercises, and discussions, followed by 3 h of Behavioral Skills Training (BST), emphasizing performance feedback as a pivotal component. Using a concurrent multiple probe design across four supervisors, the results demonstrated substantial improvement in supervisors' ability to provide performance feedback, which in turn enhanced supervisees PS preference assessment skills. Furthermore, two of the four supervisees demonstrated mastery of feedback-giving skills after receiving performance feedback and observing their supervisors being given feedback. The remaining two supervisees required direct instruction in feedback delivery in order to meet the mastery criteria. The study contributes to the limited literature on training supervisors to provide effective feedback and the importance of incorporating specific feedback-giving skills in supervision training programs.

This study investigated parental stress in 270 parents of 167 autistic children before and after 18 months of community based Early Intensive Behavioral Intervention (EIBI). Parental stress was measured by Swedish Parental Stress Questionnaire (SPSQ). The study examined associations between parental stress and child behaviors, as well as the influence of parental roles on stress levels. Compared to parents of typically developing children, both mothers and fathers reported elevated stress with mothers consistently experiencing higher levels. Mothers’ stress at intake was associated with child externalizing behaviors and fathers’ level of stress. Fathers’ stress at intake was solely predicted by mothers’ level of stress. During the intervention mothers’ stress related to role restriction and health problems reduced, while fathers’ stress remained relatively stable, except for increased feelings of incompetence in parenting, which increased. The study underscores the need for tailored support strategies for mothers and fathers and emphasizes the intricate dynamics of parental stress, suggesting interventions that will consider factors like parent training, parental involvement, coping styles, and social support to enhance overall family well-being.

Ensuring high-quality general and special education in preschools is crucial for the positive development of at-risk children and children with special needs. However, recent reports suggest inconsistencies in general education quality and challenges in implementing special education support and early intensive behavioral intervention (EIBI). These results indicate that further training is needed to improve the quality of services for preschool children with special needs. The current study employed a delayed multiple probe design to evaluate a staff training program’s influence on the quality of general education, EIBI, and evocative situations in three inclusive preschool units. The intervention lasted 17 weeks, consisting of a 4-h post-baseline workshop and biweekly coaching with the entire staff group. The quality of the teaching and learning environment, measured by the Autism Program Environment Rating Scale (APERS-P-SE), improved in two preschools. We observed improvement in the quality of evocative situations with a large effect size, increased children’s response rate during lunch, improved EIBI quality, and good social validity. This indicates that using APERS-P-SE to establish objectives for inclusive practices and training the entire staff group with a focus on evocative situations may be one way to improve the implementation of EIBI and the quality of preschools’ teaching and learning environment.

Contextual events are recognized to affect seizure-like behaviors, yet there is limited research on procedures assessing contextual control. This study aimed to examine the utilization of a brief experimental precursor functional analysis within a clinical team assessment. Furthermore, the study explored if telehealth supervision could guide a parent administered replication of the functional analysis. The participants were a young female with Rett syndrome and a history of epilepsy as well as non-epileptic seizures and her mother. The functional analysis procedures consisted of the systematic alternations of contextual conditions that were hypothesized to either prevent or evoke seizure-like behaviors. The primary outcome measure was the occurrence of behavioral precursors that were identified to consequently signal subsequent seizure-like behaviors. In addition, procedure fidelity and interobserver agreement data were obtained alongside parent rating of the procedure’s social validity. The clinical functional analysis clearly suggested that the seizure-like behaviors served the function of access to attention and preferred activities. A parent administered functional analysis replicated clinical functional analysis findings. The parent’s fidelity to procedures was high and scores in social validity were excellent. The results show that functional analysis procedures could provide essential information in assessment of non-epileptic seizures. Strengths and limitations are discussed.

Research on attention towards non-social stimuli in preschoolers with autism spectrum disorder (ASD) has increased over the past decade; however, findings have been inconsistent. It has been suggested that stimuli relating to common circumscribed interests (CIs) elicit more attention than non-CI related stimuli. This meta-analysis synthesizes results from 31 studies that compared attention towards non-social stimuli in children with ASD under the age of five with typically developing (TD) controls using eye-tracking. Additional subgroup analysis comparing studies that employed non-social stimuli related to CIs frequently reported in adults with ASD to studies using non-CI related stimuli were conducted. Meta-regressions with age, sex, stimulus dimension, nonverbal DQ, and symptom severity were conducted. Results show small (g = 0.39) but significantly higher attention towards non-social stimuli for the ASD group. However, when studies were split based on stimulus type no significant differences for non-CI related stimuli was found. Meanwhile studies employing CI related stimuli reported significant large effects on attention allocation (g = 0.69). None of the conducted regressions reached significance. The findings show increased non-social attention in children with ASD is driven by CI related content rather than a general non-social attentional bias. The findings and future research directions are discussed.

This study evaluated the effects of a center-based Intensive Behavioral Intervention (IBI) model for preschool aged children with autism. Outcomes of 25 children receiving IBI was compared to the outcomes of 14 children receiving autism specific, eclectic, special education. Both provisions were described as appropriate treatment options by the professional agency who diagnosed the children, and the decision of where to enroll the child was made by the parents after consultations with the specialists. After 14 months of treatment, children from the IBI group improved significantly on standard scores in intellectual functioning and adaptive behavior and had a significant reduction in autism severity compared to the children in the autism specific, eclectic, special education group. Results suggest that preschool aged children with autism may make large gains in intellectual and adaptive functioning and improvement in autism severity with IBI, and that effects of IBI may be similar to that of EIBI. These findings must be interpreted with caution due to the limitations inherent in the present comparison-controlled design.

Behavioral intervention manuals for children with autism spectrum disorder (ASD) commonly recommend that praise should be delivered in an enthusiastic tone of voice. Only a few studies, however, have explicitly tested this assumption, and results have been mixed. This study therefore compared the effects of enthusiastic and non-enthusiastic tone of voice in praise on the behavior of children with ASD. We also examined how typically developing (TD) children responded to enthusiastic and non-enthusiastic praise. Participants were 21 children with ASD matched on developmental age with the chronological age of 20 TD children. The effects of enthusiastic and non-enthusiastic praise were assessed using an application on a tablet computer designed to isolate tone of voice as a variable in vocally delivered praise. Two buttons produced the same six praise statements, one with an enthusiastic tone of voice and one with a neutral tone of voice. Results showed that the children with ASD, on average, allocated more responding to the square on the tablet computer producing enthusiastic praise as compared to the square producing non-enthusiastic praise. In addition, higher rates of responding to non-enthusiastic praise correlated positively with higher IQ, suggesting that non-enthusiastic praise was more effective for children with ASD with higher cognitive scores. The TD children, in contrast, did not allocate more responding to either the squares, suggesting that tone of voice in praise was not an important variable for the behavior of TD children.

The Social Referencing Observation Scale (SoROS) was developed to assess social referencing behaviors and as a screening instrument to identify children at risk of autism spectrum disorder. It is quick and easy for preschool teachers to administer. The instrument assesses social referencing behaviors in three different scenarios, where the administrator expresses fear, pain, and joy. The participants were 56 children with autism and 204 typically developing children aged between 2.6 and 5 years. The inter-rater agreement was high, and we found significant differences in scores between the autism spectrum disorder group and the group of typically developing children. The SoROS predicted an autism spectrum disorder diagnosis with excellent sensitivity and specificity. More research is needed with a larger and more diverse group of children.

We evaluated whether intraverbal and reverse intraverbal behavior emerged following listener training in children with autism spectrum disorder (ASD). Six participants were each taught three sets of three "when?" questions in listener training. A multiple baseline design across behaviors (stimulus sets) was used to assess the effects of listener training. Results showed that intraverbal behavior emerged following listener training for five out of six participants. One participant received additional listener training and intraverbal training before intraverbal behavior emerged. Furthermore, reverse intraverbal responding occurred across all three sets of questions for three of the six participants. Establishing listener behavior may be a pathway for emergent intraverbal and reverse intraverbal responding in children with ASD. Future research could examine what skill repertoire may facilitate such transfer.

This systematic replication was designed to teach nonvocal children with autism to mand for missing items using an Augmentative Alternative Communication (AAC) system. Consistent with Rodriguez et al. (2017) and Wojcik et al. (2020), we used the interrupted chain procedure with EO-present and EO-absent trials. Consistent with Wojcik et al., 2020, we used sufficient exemplar training and activity schedules to establish manding for missing items. Participants were three children with autism, and the design was a nonconcurrent multiple-baseline design across participants. Following training, all participants requested the missing items during EO-present trials correctly and refrained from making requests during EO-absent trials, suggesting that requesting using the AAC system was established as a verbal operant controlled by the appropriate EO, hence, was established as a mand. Correct requesting behavior transferred to new tasks, across skill domains, across people, to new settings, and across time.

Deficits in social referencing have been associated with autism spectrum disorder. It may lead to deficits in language, symbolic abilities, and other social-cognitive behaviors. When deficits in social referencing are detected, teaching such behaviors should be a priority, but effective teaching procedures are lacking. We consider social referencing as a behavior chain and suggest teaching each component in the chain in sequence. We introduce a program to teach the initial component of social referencing, reacting to new and missing objects in the environment through initiating interaction with another present person. Six children with autism spectrum disorder participated. All children acquired the skill within six months and generalized it to new people and materials. Future research could aim to replicate these findings and to develop effective procedures to teach other component skills of social referencing.

We examined whether an interrupting chain procedure with establishing operation (EO)-absent and EO-present trials and sufficient exemplar training was effective in teaching three preschool-aged children with autism to request missing items. Children were taught to request missing items across three different skill domains (play, self-help, and academic tasks), and audio scripts were used as prompts. We employed a non-concurrent multiple-baseline design across participants. All three participants learned to request missing items during EO-present trials and to refrain from doing so during EO-absent trials. The behavior transferred to untrained tasks, generalized to new people, and was maintained at follow-up 3 months after the intervention.

This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis–based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis–based interventions improved more on the Vineland adaptive behaviour scale (MD = 7.00; 95% confidence interval = 1.95–12.06) and cognitive ability (intelligence quotient) (MD = 14.13; 95% confidence interval = 9.16–19.10) relative to comparators at 2 years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence of modest, albeit short term, effects of a range of pre-school autism interventions and the limitations of the quality of evaluation studies to date, future research should investigate which supports and interventions are most effective for children and families prioritising outcomes measures that are meaningful for the autism community and longer-term follow-up. Further systematic reviews of the existing evidence are unlikely to add to the findings presented here. Lay abstract Early intensive applied behaviour analysis–based interventions are designed to support young autistic children’s learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis–based interventions might lead to some changes in children’s cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.

ABSTRACT Methods to enhance the quality of delivered Early Intensive Behavioral Intervention (EIBI) for children with autism spectrum disorder (ASD) have received surprisingly little attention in previous research. In a pragmatic randomized controlled pilot study, we studied the feasibility and effects of enriched supervision (using detailed video feedback) on EIBI quality compared to regular supervision only, over a period of 4–6 months. EIBI was conducted in 30 children with ASD by preschool staff, where 18 received enriched, and 12 regular supervisions. EIBI quality was evaluated using the York Measure of Quality of Intensive Behavioural Intervention. The enriched supervision was deemed feasible and compared to staff receiving regular supervision. Preschool staff who received enriched supervision improved on overall quality of EIBI delivery, as well as specifically regarding goal-directedness, organization and efficiency of the EIBI. Findings support the significance of adequate education and supervision of EIBI providers for intervention quality assurance.

Interventions for preschool children with autism typically require professionals and parents to identify which social and language skills the individual child shows deficits in. Many assessment tools aimed at identifying such deficits exist, but they often require extensive training to use. The present study investigated the potential usefulness for said assessment purposes of the Norwegian assessment tool, TRAS - "Tidig Registrering Av Språkutveckling" (i.e. Nordic acronym for assessment of early language development), which can be used by preschool teachers without any specific training. Participants were 54 children with ASD, aged 2-5 years, enrolled in a behavioral intervention program. Participants were scored using TRAS at three time points during treatment to investigate TRAS' sensitivity for detecting change. Only participants who had TRAS scores registered at all three time points were used for this analysis (n = 27). At intake, children were also scored using the Vineland Adaptive Behavior Scales, the results of which was then compared to TRAS scores. Results showed that TRAS scores increased significantly across time points, indicating that the tool is sensitive to treatment effects. TRAS scores also correlated significantly with Vineland communication subscale (n = 50), indicating that the measure can be used to measure language abilities in children with ASD. We conclude that TRAS is a potential alternative to more comprehensive language assessment tools for children with ASD.

This study reports outcome in adolescents with autism who in their childhood received Early and Intensive Behavioral Intervention (EIBI). Nineteen children (16 boys) who had received two years of EIBI starting at a mean age of 2-years-and-11-months were followed up, on average, 12 years later. Results showed the participants significantly increased their cognitive and adaptive standard scores during the two years of EIBI, and that these gains were maintained at follow-up, 10 years after the EIBI had ended. Participants also showed a significant reduction in autism symptoms between intake and follow-up. At follow-up, none of the participants had received any additional psychiatric diagnoses, and none were taking any psychotropic medication. Results indicate that treatment gains achieved in EIBI are maintained into adolescence.