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Social Communication Disorders in School-Age Children
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External Scientific Evidence

Evidence-Based Practice Guidelines
Royal College of Speech & Language Therapists; Department of Health; National Institute for Clinical Excellence (United Kingdom)

Royal College of Speech and Language Therapists Clinical Guidelines: 5.4 Autistic Spectrum Disorders
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
Added: October 2012

Description
This guideline provides recommendations for assessment and treatment of preschool and school-age children with autism spectrum disorder (ASD). This guideline is intended for speech-language pathologists. Each recommendation is graded:

  • A - requires at least one randomized controlled trial,

  • B - requires at least one well-conducted clinical study, or

  • C - requires evidence from expert committee reports.

Recommendations
"It is essential to make a qualitative assessment of the [child with ASD's] social interaction skills. This should be carried out in a variety of social settings such as a school, nursery or day centre" (Level B Evidence) (p. 36).

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Royal College of Speech & Language Therapists; Department of Health (UK); National Institute for Clinical Excellence (NICE)

Royal College of Speech and Language Therapists Clinical Guidelines: 5.8 Disorders of Feeding, Eating, Drinking & Swallowing (Dysphagia)
Taylor-Goh, S., ed. (2005).
RCSLT Clinical Guidelines. Bicester, Speechmark Publishing Ltd.
Added: October 2012

Description
This guideline provides recommendations for the assessment and management of swallowing disorders in children and adults. This guideline is intended for speech-language pathologists. Populations included, but were not limited to, stroke, traumatic brain injury, autism spectrum disorder, cerebral palsy, Parkinson’s disease and head and neck cancer. Each recommendation is graded:

  • A - requires at least one randomized controlled trial,

  • B - requires at least one well-conducted clinical study, or

  • C - requires evidence from expert committee reports.

Recommendations
“The Speech & Language Therapist will optimize the individual’s environment in order to provide the most pleasurable, safe and positive mealtime experience.  This can be achieved [in a few ways such as the adjustment of factors facilitating/enabling social interaction] (Level B Evidence) (p. 69).

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American Speech-Language-Hearing Association

Guidelines for Speech-Language Pathologists in Diagnosis, Assessment, and Treatment of Autism Spectrum Disorders across the Life Span
Wetherby, A., Diehl, S., et al. (2006).
Rockville (MD): American Speech-Language-Hearing Association, 46 pages.
Added: October 2012

Description
This guideline provides recommendations for screening, diagnosis, assessment and treatment of children and adults with autism spectrum disorder (ASD). The target audience of this guideline is speech-language pathologists.

Recommendations

  • "Determining an individual’s social and communication competence [...] necessitates evaluation across a range of social settings and not just one-on-one structured formal testing sessions" (p. 14).

  • SLPs should provide services in natural environments "for individuals with ASD [as] exclusive provision of services through pull-out services does not address the underlying challenge of social communication inherent in the disorder, the issues of generalization, functional outcomes, or the importance of collaborating with significant communication partners" (p. 32).

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Scottish Intercollegiate Guidelines Network; NHS Quality Improvement Scotland (United Kingdom)

Assessment, Diagnosis and Clinical Interventions for Children and Young People with Autism Spectrum Disorders: A National Clinical Guideline
Scottish Intercollegiate Guidelines Network. (2007).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN publication No. 98, 65 pages.
Added: October 2012

Description
This guideline provides recommendations for assessment and intervention for children with autism spectrum disorders (ASD). The target audience includes a wide range of professionals involved in the management and care of children with ASD. Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence.

  • Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population.

  • Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence.

  • Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence.

  • Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence.

  • Good Practice Points are recommendations based on the clinical experience of the guideline development group.

Recommendations
"Adapting the communicative, social and physical environments of children and young people with ASD may be of benefit (options include providing visual prompts, reducing requirements for complex social interactions, using routine, timetabling and prompting and minimising sensory irritations) (Good Practice Point) (p. 17).

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Ministries of Health and Education (New Zealand)

New Zealand Autism Spectrum Disorder Guideline
Ministries of Health and Education. (2008).
Ministry of Health and Education (New Zealand), 312 pages.
Added: October 2012

Description
This guideline provides recommendations for identification, diagnosis, ongoing assessment, and access to interventions and services for children, adolescents and adults with autism spectrum disorders (ASD) in New Zealand. The target audience of this guideline is primary care practitioners, education professionals, policy makers, funders, parents, carers, specialists and any others who make provisions for individuals with ASD.

  • Level A recommendations are supported by good evidence.

  • Level B recommendations are supported by fair evidence.

  • Level C recommendations are supported by expert opinion.

  • Level I indicates that there was insufficient evidence to make a recommendation.

  • Good practice point recommendations are made by the guideline developers in the absence of evidence.

Recommendations

  • "Social assessment should be carried out in a variety of natural settings with both adults and peers as social partners" (Grade C Evidence) (p. 102).

  • "Social interventions should take place in natural settings and within natural activities as much as possible" (Grade A Evidence) (p. 102).

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Scottish Intercollegiate Guidelines Network

Management of Attention Deficit and Hyperkinetic Disorders in Children and Young People
Scottish Intercollegiate Guidelines Network. (2009).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN Publication No. 112, 52 pages.
Added: October 2012

Description
This guideline provides recommendations for the management of children with attention deficit hyperactivity disorder (ADHD). The target audience of this guideline are all healthcare professionals involved in the assessment and intervention of children with ADHD, including speech-language pathologists.

Recommendations
"Information about performance in the school/nursery setting, including details of academic achievement as well as social functioning in relation to other children and staff" should be gathered when parents/carers are asked details of the history of the child's current problems, nature of the symptoms, and any associated behaviors (p. 7).

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Evidence-Based Systematic Reviews
Social Skills Development in Children with Autism Spectrum Disorders: A Review of the Intervention Research
Williams White, S., Keonig, K., et al. (2007).
Journal of Autism and Developmental Disorders, 37(10), 1858-1868.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of published studies and unpublished dissertations exploring the state of the evidence for social skills training interventions for school-age children with autism spectrum disorders (ASD) in order to determine future research directions.

Conclusions
Although empirical support for this approach is incomplete, group-based social skills training may be a useful intervention for children with ASD. Promising teaching strategies for social skills training include teaching social scripts, modeling and role-play, differential reinforcement, peer involvement, multiple trainers, parent involvement, practice in natural environments, fostering self-awareness, errorless teaching, and defining concrete social rules.

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Practitioner Review: Psychosocial Interventions for Children with Selective Mutism: A Critical Evaluation of the Literature from 1990-2005
Cohan, S. L., Chavira, D. A., et al. (2006).
Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47(11), 1085-1097.
Added: October 2012

Description
This is a review of peer-reviewed studies that investigated psychosocial interventions for children with selective mutism (SM) who "consistently fail to speak in one or more social settings (e.g., school) despite speaking normally in other settings (e.g., home)" (p. 1085).

Conclusions
"A potentially effective treatment approach for a typical SM child who experiences significant social anxiety and is mute at school would include individual psychotherapy focusing on communication skills and anxiety management, in addition to a behavioral program implemented concurrently in the school setting to shape appropriate verbal communication" (p. 1094).

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The Impact of Population Inclusivity in Schools on Student Outcomes
Kalambouka, A., Farrell, P., et al. (2005).
EPPI-Centre, University of London.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of empirical research that investigated the effect of inclusivity in schools on students with and without educational needs.

Conclusions
"The majority of studies (N = 24) reported the results of including pupils with difficulties in the area of cognition and learning, although studies, more often than not, refer to groups of pupils with a variety of [special education needs] SEN. Therefore, it is difficult to provide direct conclusions regarding the impact of including pupils with a specific type of SEN on the academic and/or social or other outcomes of all school pupils" (p. 4).

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The Interaction Between Behavior and Speech and Language Difficulties: Does Intervention for One Affect Outcomes in the Other? Technical Report
Law, J., & Plunkett, C. (2009).
Research Evidence in Education Library. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: October 2012

Description
This is a review of studies that investigated "the relationship between speech, language, and communication difficulties and emotional and behavioral difficulties in children of primary school age" (p. 3).

Conclusions
Within the group of studies pertaining to hybrid interventions, positive effects on language, social skills, and behaviour were associated with a classroom wide implemented intervention (p. 44).

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Picture Exchange Communication System With Individuals With Developmental Disabilities: A Meta-Analysis of Single Subject Studies
Hart, S. L., & Banda, D. R. (2009).
Remedial & Special Education, 1-13.
Added: October 2012

Description
This is a meta-analysis of single-subject research design investigations that examined the effectiveness of the Picture Exchange Communication System (PECS) in children and adults with developmental disabilities including autism.

Conclusions
"PECS may increase manding, social communicative behavior, and speech and decrease problem behaviors. More research is needed to determine if the use of PECS is feasible in inclusive settings and with varied age groups, particularly with adolescents" (p. 12).

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Social Story Interventions for Students with Autism Spectrum Disorders: A Meta-Analysis
Kokina, A., & Kern, L. (2010).
Journal of Autism and Developmental Disorders, 40(7), 812-826.
Added: October 2012

Description
This is a meta-analysis of single-subject research that investigated the use of Social Stories™ and the impact of a set of moderator variables on intervention outcomes, including social  and communication skills, in participants with autism spectrum disorder (ASD). 

Conclusions
"Social Stories™ implemented in the general education settings produced substantially larger effects on students' behaviors than those implemented in the self-contained settings" (p. 823).

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A Meta-Analysis of Peer-Mediated Interventions for Young Children with Autism Spectrum Disorders
Zhang, J., & Wheeler, J. J. (2011).
Education and Training in Autism and Developmental Disabilities, 46(1), 62-77.
Added: October 2012

Description
This is a meta-analysis of single-subject design studies that investigated peer-mediated interventions for promoting social interactions in young children with autism spectrum disorder (ASD).

Conclusions
"Further categorical comparisons suggest that these interventions were more effective in enhancing social responses in younger boys, when older male siblings served as interventionists, when the interventions took place in the home, when peer modeling was used, and when consideration was given to maintenance and generalization across participants, behaviors and activities, and in involving collaboration among all researchers, peers/siblings, school staff, and parents/families" (p. 71).

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Social Skills Interventions for Children with High-Functioning Autism Spectrum Disorders
Schreiber, C. (2011).
Journal of Positive Behavior Interventions, 13(1), 49-62.
Added: October 2012

Description
This is a review of studies that investigated social skills interventions used with children with high-functioning autism spectrum disorders (HFASD).

Conclusions
"Cognitive behavioral therapy or social skills instruction in a group setting for individuals with HFASD is a potentially effective way to teach social skills, and the group setting may foster friendships. However, in order for the skills to be maintained and generalized, they must be practiced in a naturalistic environment" (p. 59).

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Use of School Recess Time in the Education and Treatment of Children with Autism Spectrum Disorders: A Systematic Review
Lang, R., Kuriakose, S., et al. (2011).
Research in Autism Spectrum Disorders, 5(4), 1296-1305.
Added: October 2012

Description
This is a review of studies that investigated the "use of school recess time in the education and treatment of children with autism spectrum disorders [ASD]" (p. 1296).

Conclusions
"All 15 studies reported improvement in dependent variables...; thirteen studies focused primarily on improving social skills and/or communication" (p. 1302).

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A Meta-Analysis of Classroom-Wide Interventions to Build Social Skills: Do They Work?
January, A. M., Casey, R. J., et al. (2011).
School Psychology Review, 40(2), 242-256.
Added: October 2012

Description
This is a meta-analysis of empirical control or comparison group studies that investigated the effectiveness of classroom-wide interventions designed to improve social skills of school-age children.

Conclusions
"In general, the results of this meta-analysis suggest that school-based social skills interventions are minimally effective for implementation in a classroom-wide setting" (p. 250).

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Is Video-Based Instruction Effective in the Rehabilitation of Children with Autism Spectrum Disorders?
Kagohara, D. M. (2010).
Developmental Neurorehabilitation, 13(2), 129-140.
Added: October 2012

Description
This is a review of peer-reviewed studies that investigated the effectiveness of video-based instruction in the rehabilitation of children with autism spectrum disorder (ASD).

Conclusions
Most [video-modeling] interventions were conducted in school and home settings; community-based interventions were the minority" (p. 138).

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Clinical Expertise/Expert Opinion

Consensus Guidelines
State of New Hampshire, Department of Health and Human Services

The New Hampshire Task Force on Autism: Part I Assessment and Interventions
New Hampshire Task Force on Autism. (2001).
(NH): Department of Health and Human Services, 69 pages.
Added: October 2012

Description
This guideline provides recommendations for screening, assessment and treatment of children and adults with autism spectrum disorder (ASD). The target audience of this guideline includes speech-language pathologists, audiologists and other professionals.

Recommendations
For children with ASD, instruction priorities should include "social instruction in a variety of natural settings" (p. 24).

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National Research Council; National Academy of Sciences; U.S. Department of Education

Educating Children with Autism
Lord, C., & McGee, J. P., eds. (2001).
Washington (DC): National Academy Press, National Research Council: Division of Behavioral and Social Sciences, 323 pages.
Added: October 2012

Description
This guideline provides recommendations for assessment and treatment of children with autism spectrum disorders (ASD). This report also addresses the needs of families of these children. The target audience of this guideline is professionals involved in the diagnosis and management of children with ASD, including speech-language pathologists. A detailed review precedes the recommendations, which describes the current evidence base for specific treatment approaches.

Recommendations
"Social [skills] instruction should be delivered throughout the day in various settings, using specific activities and interventions planned to meet age-appropriate, individualized social goals" (p. 221).

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Client/Patient/Caregiver Perspectives

Using Telepractice in Parent Training in Early Autism
Baharav, E., & Reiser, C. (2010).
Telemedicine and e-Health, 16(6), 727-31.
Added: October 2012

Description
This study compares traditional speech therapy administered twice a week to an alternative service delivery model in which speech therapy is delivered once a week in a traditional clinical setting and once a week by parents at home and remotely supervised by a speech-language pathologist for children with autism spectrum disorder.

Conclusions
"Parent questionnaires indicated mostly positive findings regarding the level of comfort using the technology and the perceived benefits of this approach [on their child's communication and interaction skills], with some reservations regarding preference for telepractice sessions at home versus clinical sessions" (p. 731). They also indicated that the telepractice sessions were as valuable as sessions delivered by the clinician directly, and that they would recommend the telepractice model to other parents.

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Parental Perspectives of the Quality of Life in School Environments for Children with Asperger Syndrome
Brewin, B. J., Renwick, R., et al. (2008).
Focus on Autism and Other Developmental Disabilities 23(4), 242-252.
Added: October 2012

Description
This report describes a semi-structured interview of parents of children with Asperger syndrome regarding their impression of quality of life impacts at school.

Conclusions
“Parents described a need for ongoing social skills training at school, where children can practice these skills with their peers in the environment where these skills are most often needed” (p. 248).

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