Trajectories of Evidence Based Treatment for School Children with Autism: What's the Right Level for the Implementation?
Victor Lushin, David Mandell, Rinad Beidas and 6 others
PMID 31797182WHAT IT FOUND
Most children with autism received consistently low doses of discrete trial training and pivotal response training throughout the school year.
Teachers were more likely to increase treatment for children with more severe symptoms or greater sensory challenges, while children with better verbal and social skills were less likely to receive intensive intervention.
Key findings
01The majority of children followed a 'Low Stable' trajectory, receiving little to no intensive evidence-based treatment throughout the academic year.
02Children with higher verbal ability and better social approach skills were significantly less likely to be in the high-increasing DTT trajectory compared to those with lower skills.
03Roughly half of the variation in treatment trajectories was explained by teacher and classroom characteristics, rather than child characteristics alone.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Treatment intensity was measured by teacher self-report, which may be subject to bias, although it was cross-checked against coach observations. The study analyzed data at the child level rather than the teacher level, which may inflate statistical power since there were far fewer teachers than children. Teacher skills and intentions were measured only at baseline, so the analysis does not account for how these factors evolved throughout the year. The sample size was modest, which limited the ability to detect differences between some of the higher-intensity trajectory groups.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that children with less severe autism symptoms or better verbal skills need less evidence-based treatment. The study found these children were significantly less likely to receive intensive intervention, suggesting they may be inadvertently neglected rather than appropriately treated.