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Author(s): Stephen R. Anderson, Debra L. Avery, Ellette K. DiPietro, Glynnis L. Edwards and
Walter P. Christian
Source: Education and Treatment of Children, Vol. 10, No. 4, SPECIAL ISSUE: New Developments
in the Treatment of Persons Exhibiting Autism and Severe Behavior Disorders (NOVEMBER 1987
), pp. 352-366
Published by: West Virginia University Press
Stable URL: http://www.jstor.org/stable/42899040
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ANDTREATMENT
EDUCATION OF CHILDREN 1987
Vol.10,No.4,NOVEMBER,
ABSTRACT
Although severaldescriptionsofeducational
programs foryoung autistic
children inthe
exist
mosthavefocused
literature, ononemodel ofservice thepreschool
delivery, classroom.Un-
fortunately,thismodelfailstomeettheeducational needsofsomeautistic childrenbecause
oflimitationsintheamount ofdirect itcanprovide,
instruction thelackofgeneralizationof
treatment
effects,andtheabsence ofcomprehensiveparent Thecurrent
training. studydeveloped
andevaluated a home-based alternative
tothepreschool Essential
setting. features
ofthemodel
include: useofbehavioral
(a) systematic teaching
techniques andtreatment (b)in-
procedures;
tensive
training conductedineachchild's
naturalhome; and(c)extensive
parent Most
training.
ofthe14children whoparticipatedinthestudydemonstratedsignificant
gainsintheir
language,
social,andacademic
self-care, development,as evidenced bytheresults of standardized
assessmentsandindividual treatmentdata.Theresultsalsoindicated
a changeintheparents'
toteach
ability their
handicapped children.
Theseresults
arecomparedandcontrastedtoprevious
findings
reported intheliterature.
Thispaper
wassupported
bygrantsfrom theU.S.Department
ofEducation,
thePublic
Welfare
andtheMabelLouiseRiley
Foundation, Trust.Wegratefully
acknowledgethecontributions
ofNyemade Baker,Juliet
Burger,DeniseCallahan,Charlene
Foley,Janice
Geddes,Anne
Patricia
Williams, McCarthy, SusanRisi,RichardHook,Jeff SusanLynds,
Withstandley, and
theBoston
Children's
Hospital.
Requests forreprints
should
besenttoStephenR. Anderson,
TheMayCenter,188North BeaconStreet,Watertown,MA02172.
Pages 352-366
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HOME-BASEDEARLYINTERVENTION 353
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354 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
Method
Childrenand Setting
The primarysourcefortheidentification and diagnosisof participantsin
the study was the DevelopmentalEvaluation Clinic located at Boston
Children'sHospital.The clinicprovideda thoroughassessmentof each child,
includingpsychological, speechand hearing,and medicalevaluations,to help
determine programeligibility. Criteriaforacceptanceintotheprogramwere
based upon a diagnosisof autism(or autistic-like), age (lessthan72 months),
to and
parents'willingness participate, geographicproximity to theclinic(i.e.,
withina 35 mile radius).
Fourteenchildrenand theirfamiliesparticipatedin thestudy.Table 1 in-
dicatesthechronological-age(C.A.), mental-age(M.A.), social-age(S.A.),
and language-agescores forthe childrenat the timeof theirentryinto the
study.The mean age of thechildrenat thetimeof admissionwas 43 months
(range: 18 to 64 months).The childrenexhibitedbehaviorsrepresentative
of the definition of autismprovidedby the AmericanPsychiatricAssocia-
tion(1980), includingthefollowingprimaryand associatedfeatures:(a) lack
of responsivenessto otherpeople (93% exhibitedgaze aversion); (b) im-
pairmentsin communication(43% were nonverbal and 50% exhibited
echolalia); (c) bizarreresponsesto theenvironment (86% resistedchangeand
86% engagedin self-stimulation); (d) aggression(43%); (e) self-injury(50%);
(0 noncomplianceto instructions (93%); and (g) severetantrums(100%).
The childrenall lived at home withtheirnaturalparents.Eleven of the
childrenalso participated in preschoolprogramsprovidedbytheirlocal public
schools.
An analysisof the socioeconomiclevelof the familiessuggestedthatthe
major providerwas likelyto be engagedin a supervisory or professionaloc-
cupation, had at least a high school degree,and lived in an area in which
thepercapita incomewas averageor above. All butone of thechildrenwere
fromtwo parentfamilies.Motherswerethe primaryparticipantfor 11 of
the 14 familiesand fathersand mothersparticipatedequallyin the remain-
ing families.
Procedures
individualswith
. Therapistswerebachelor's-and master's-level
Therapists
trainingin psychology,specialeducation,speech,or earlychildhoodeduca-
tion.Priorto workingwiththechildren, thetherapists train-
receivedinservice
ing(approximately 30 hours)to aquaintthemwithbehavioralteachingtech-
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HOME-BASEDEARLYINTERVENTION 355
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356 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
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HOME-BASEDEARLYINTERVENTION 357
DependentMeasures
Child. Measureswerecollectedon a varietyof behaviorsexhibitedby the
children.One measureof child performancewas gain in standardizedtest
scoresyieldedbyannualpsychologicaland speechand languageassessments.
Formal evaluationswere completedby personsnot directlyinvolvedwith
the operationof the programnor the summaryof its researchfindings.
A school psychologistadministereda standardizedintelligencetest(i.e,
Stanford-Binet IntelligenceScale forChildren,FormL-M or BayleyMental
Scales of InfantDevelopment)and a test of adaptive development(i.e.,
VinelandSocial MaturityScale or VinelandAdaptiveBehaviorScales, In-
terview,SurveyForm). Language developmentscores were obtained by a
speechpathologistwho administered a combinationof instruments (i.e., Sym-
bolic Play Test; Peabody Picture Vocabulary Test, Form L; Preschool
Language Scale; Sequenced Inventoryof CommunicationDevelopment).
Anotherarea of potentialimprovement was progressmade bythechildren
on theirindividualizedsequenceof behavioralobjectives.The trainersand
parentsrecordedcorrectand incorrectresponsesof thechildrenacrosstrials
or stepsof each program,as well as frequency,duration,or timesampling
of maladaptivebehaviors.These data wereobtaineddailyand used to deter-
mine progresstowardthe achievementof individualizedobjectives.
A thirdmeasureof programeffectiveness was the children'sprogresson
theUniformPerformanceAssessmentSystem(UPAS) (White,Edgar, Har-
ing,Afflick, & Hayden, 1978),a norm-referenced assessmentinstrument that
lists skills (i.e., comunication, social/self-help,preacademic, motor,
behavioral)in a normaldevelopmentalsequence. Performancewas assessed
by determining wherein the sequence each child fell. The UPAS was ad-
ministeredby the trainerand parent. The resultsof the communication,
social/self-help, and preacademicsectionswereused to evaluatetreatment
effects.
Finally,school placementratingswere completedalong a 6-pointscale
based upon the amountof integrationwithnonhandicappedpeersand the
locationof theeducationplacement(publicschool versusprivateschool set-
ting).An integrated classroomsettingwithina regularpublicschoolbuilding
was consideredideologically mostdesirable(Bricker,1978),whilea segregated
placementin a privateschool settingwas consideredleast desirable.
Parentmeasures.The parents'abilityto use behavioralteachingtechniques
(Koegel, Russo, & Rincover,1977) was the primarymeasureof the effects
of the intervention on parentbehavior.Parentswereinstructed to conduct
a specifictrainingprogramfortheirchildren(e.g., brushingteeth)whilethe
trainingwas videotaped. Five-minutevideotaped samples of the parents'
behaviorwereobtainedat the timeof theirchildren'sentryinto the study,
after6 monthsof participation,and again after12 monthsof participation.
Observers(thesecond and thirdauthors)laterviewedthe5-minutesamples
and coded, in 30-secondintervals,whetherthe parentsprovidedclear and
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358 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
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HOME-BASEDEARLYINTERVENTION 359
Results
Child Behavior
A one-tailed,t-testof dependentmeans was performedon the resultsof
scores obtained fromstandardizedand age-referenced assessments(i.e.,
psychological, language,UPAS). Table 1 presents data forchangesin mental-
age, social-age, and language-age scores. Table 2 providesa summaryof
UPAS scores.
Each table displaysscores obtained at the timeof entryinto the study
(within3 months),afterone yearof training,and aftertwoyearsof training
whenapplicable.The data are presented byindividualsas wellas group.Note
thatthenumberof childrensummarizedin thegroupanalysesvarieswithin
and across tables (i.e., some childrenfailedto receivefollowup testingin
some areas or theyreceivedincompletescores).Onlythosedata forchildren
who completeda fullsecondyear(12 months)wereincludedin theanalyses
forYear 2. Numbersprovidedin parentheses indicatemeans,standarddevia-
tions, and group size (n) used to compare firstand second year scores.
The resultsshown in Table 1 indicatea statisticallysignificant change
(p< .0005) in thechildren'smental-ageafterone yearof participationin the
study.Significant changeswerealso observedbetweenfirstand secondyear
scoresforthefivechildrenwho completeda fullsecondyearand forwhom
testscoreswereavailable. A closerlook at the data forindividualchildren
showsthat 12 of the 13 childrentestedat theend of one yeardemonstrated
a positivechangein theirmental-agescores(Darrylwas theexception).Gains
rangedfrom2 to 23 monthschangein one yearwitha mean of nearly10
months.Forty-sixpercentof thechildrenexhibitedat leasta 13-monthgain
in theirmental-agescores withina singleyear.
Similarresultswereobtainedforsocial-agescoresas measuredbythead-
ministration of the VinelandSocial Maturityor AdaptiveBehaviorScales,
withtheparentas informant (see Table 1). Firstyearscoresweresignificant
<
(p .0005) for group means. Changes in social-agescores forindividuals
ranged from no change(Ben) 23 months(Elaine),witha meanof 9 months.
to
Four of the 13 children(31%) demonstrated12 or moremonthschangein
theirsocial-agedevelopment.Gains for5 childrenwho completeda second
yearof involvement weremoresignificant, rangingfrom4 to 17 monthswith
a mean of 10 months.
Results also indicate a statisticallysignificantchange in the children's
languageperformance forbothYear 1 and Year 2 (see Table 1). Pretest/post-
testdata wereavailable foronly 11 of 14 children.Afterone year,9 of the
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360 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
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HOME-BASEDEARLYINTERVENTION 361
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362 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
ratio
ofdevelopmental
1.A summary
Figure tests
forformal
scores ofmental, andlanguage
social,
ontheUPAS.Barsrepresent
aswellasforprogress
development, group forallchildren
scores
andafter
tointervention
prior oneandtwoyears inthestudy.
ofparticipation
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HOME-BASEDEARLYINTERVENTION 363
gramintervention. multiplebaselinedesignsweresuccessfully
Thirty-six com-
pleted(i.e., demonstrating controlacrossat leasttwoconsecutive
experimental
tiers).
The resultsof schoolplacementratingsindicatethatonlyone child(n = 11)
participatedin sociallyintegratedschool placementat the timeof her ad-
missionintotheprogram.At theend of one yearof participationin thepro-
gram,23% of thechildren(n = 13) wereintegrated at leasttwohoursa week.
This percentagehad increasedto 31% (n = 13) bythetimethestudyhad been
completed.Nevertheless,all childrencontinuedto requirespecializedser-
vicesand none weremainsteamedfull-time in a regularkindergartenor first
grade classroom.
Parent Behavior
The resultsindicatethatparentssignificantlyimprovedin theirabilityto
correctly use teachingtechniques.Duringbaselinesessions,parents
behavioral
averaged 17.5%, 21.8%, and 48.5% correctin theiruse of instructions,
prompts,and consequences,respectively. After6 monthsof participation
in the study,thesepercentagesincreasedto 91.7%, 81.9%, and 88.7%. A
t-testof dependentgroupmeansindicatedthatthesechangesweresignificant
(p < .01). Resultsalso indicatethatparentsmaintainedtheircorrectuse of
behavioralteachingtechniquesas evidencedby theresultsof an evaluation
after12 monthsof participation.Scores of 88.3%, 85.6%, and 82.7% were
obtained for the correctuse of instructions,prompts,and consequences,
respectively.
ConsumerSatisfaction
Eighteenparentsrepresenting 13 of 14 familiescompletedand returned
theConsumerSatisfactionSurvey.Ninety-nine percentof theresponseswere
ratedas eithercompletelysatisfiedor satisfiedwiththe programstaffand
servicesprovided.Identicalresultswereobtainedat theend of two yearsof
participation(n = 3).
Discussion
Home-based earlyintervention resultedin positivetreatmenteffectsfor
themajorityof autistic(autistic-like)childrenparticipating in thestudy.In-
dividualdifferencesin themagnitudeof thetreatment effectswereevident,
includingtwochildrenwhodemonstrated littleor no change(Darryland Ben)
as measuredbystandardizedinstruments. Bothchildrenexhibitedentrylevel
mental-age,social-age,and language-age scores below 12 monthsand neither
showed much change afterintervention.This findingis consistentwith
previousreportsindicatinga poor treatment prognosisforseverelydisabled
children(Lovaas, 1987; Rutter,1966).
Theseresultspartiallysupportthefindings of Lovaas (1987),demonstrating
positivetreatment effects for the children who participatedin home-based
Unlikethefindingsof Lovaas, however,none of thechildren
intervention.
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364 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
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HOME-BASEDEARLYINTERVENTION 365
References
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366 ANDERSON,AVERY,DIPIETRO,EDWARDS,AND CHRISTIAN
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