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Social Communication Disorders in School-Age Children
Cognition/Language Treatment

Parent-Mediated/Implemented

 


 

External Scientific Evidence

Evidence-Based Practice Guidelines
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
"Support and training should be provided to families (including siblings) to develop social skills interventions in the home" (Grade C Evidence) (p. 102).

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National Institute for Health and Clinical Excellence

Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults
National Institute for Health and Clinical Excellence. (2009).
London (UK): The British Psychological Society and The Royal College of Psychiatrists, No. CG72.
Added: October 2012

Description
This guideline provides recommendations for the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults. The guideline is intended for clinicians and service commissioners.

Recommendations

  • "If the [school-aged] child or young person with ADHD has moderate levels of impairment, the parents or carers should be offered referral to a group parent training/education programme, either on its own or together with a group treatment programme ([cognitive behavioral therapy] CBT and/or social skills training) for the child or young person” (p. 205). 

  • “When using group treatment (CBT and/or social skills training) for the [school-aged] child or young person in conjunction with a parent-training/education programme, particular emphasis should be given to targeting a range of areas, including social skills with peers, problem solving, self-control, listening skills and dealing with and expressing feelings. Active learning strategies should be used, and rewards given for achieving key elements of learning” (p. 205). 

  • “For older adolescents with ADHD and moderate impairment, individual psychological interventions (such as CBT or social skills training) may be considered as they may be more effective and acceptable than group parent training/education programmes or group CBT and/or social skills training” (p. 205).

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Evidence-Based Systematic Reviews
Parent Implemented Early Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review
McConachie, H., & Diggle, T. (2007).
Journal of Evaluation in Clinical Practice, 13(1), 120-129.

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

Description
This is a review of comparative studies pertaining to parent-mediated or parent-implemented interventions for young children with autism spectrum disorders (ASD).

Conclusions
Findings suggest that parent-implemented training can improve social communication skills in children with autism. However, the authors state that results should be reviewed with caution due to methodological concerns with included studies and limited amount of evidence found (p. 120).

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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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Social Skills Interventions for Individuals with Autism: Evaluation for Evidence-based Practices within a Best Evidence Synthesis Framework
Reichow, B., & Volkmar, F. R. (2010).
Journal of Autism and Developmental Disorders, 40, 149-166.

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

Description
This is a review of experimental and quasi-experimental studies investigating social skills interventions for individuals with autism spectrum disorder.

Conclusions
“The accumulating evidence with young children for the support of parent training permits the recommendation of parent training as an effective method for increasing social skills of young children. However, the scarcity of research involving older participants does not permit the same” (pp. 159-160).

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A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders
Warren, Z., McPheeters, M. L., et al. (2011).
Pediatrics, 127(5), e1303-11.
Added: October 2012

Description
This is a review of research studies (excluding case reports) examining the evidence for the use of early intensive intervention for children with autism spectrum disorder (ASD).

Conclusions
“Less-intensive interventions that provide parent training also may be useful for younger children with ASDs, particularly for improving social communication, language use, and, potentially, symptom severity and family functioning, but the current evidence base for such treatment remains insufficient” (p. e1309).

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The Effectiveness of Parent-Implemented Language Interventions: A Meta-Analysis
Roberts, M. Y., & Kaiser, A. P. (2011).
American Journal of Speech-Language Pathology, 20, 180-199.

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

Description
This is a meta-analysis of studies of parent-implemented language interventions of young children with primary and secondary language impairments.

Conclusions
"In addition to providing empirical support for the practice of parent-implemented language interventions, several specific implications for practices related to parent-implemented language interventions may be drawn from this review, [including the following]: interventions should focus on socially communicative interactions between parents and children" (p. 31).

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Training Parents to Implement Communication Interventions for Children with Autism Spectrum Disorders (ASD): A Systematic Review
Lang, R., Machalicek, W., et al. (2009).
Evidence-Based Communication Assessment & Intervention, 3(3), 174 - 190.
Added: October 2012

Description
This is a systematic review of peer-reviewed studies investigating parent-implemented communication interventions for children with autism spectrum disorders (ASD). Interventions taught to parents included expectant waiting with imitating/animating, enhanced milieu teaching, pivotal response training, Natural Language Paradigm, and Early Start Denver Model.

Conclusions

  • "Every study [...] reported improvement in some aspect of child communication.  Specific child target behaviors included: increased spontaneous verbalizations or vocalization, joint attention, picture card use, appropriate interactions, imitation, attentiveness, and overall expressive and receptive language" (p. 186).

  • "Each of the studies reported parents' ability to implement communication interventions with fidelity following training, and the resultant interventions improved communication for children with ASD" (p. 187).

  • The overall literature base for this topic is considered limited and additional research is warranted.

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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
"Parent, family, and peer training may be the essential component in ensuring a holistic skill application" (p. 59).

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Attention-Deficit Hyperactivity Disorder: Critical Appraisal of Extended Treatment Studies
Schachar, R., Jadad, A. R., et al. (2002).
The Canadian Journal of Psychiatry, 47(4), 337-348.

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

Description
This is a review of randomized controlled trials that investigated long-term treatments for individuals with attention-deficit hyperactivity disorder (ADHD).

Conclusions
"Of the nine studies that assessed the effect of treatment on conduct and oppositional and social behavior, all but three showed a treatment effect.  In each case, the beneficial effects could be attributed to either MPH or DEX [i.e., stimulant medications], rather than to the addition of other treatments such as parent training, thioridazine, or behaviour therapy" (p. 343).

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A Meta-Analytic Review of Components Associated with Parent Training Program Effectiveness
Kaminski, J. W., Valle, L. A., et al. (2008).
Journal of Abnormal Child Psychology, 36(4), 567-589.
Added: October 2012

Description
This is a meta-analysis of articles, books, and book chapters that investigated program components (i.e., content covered, delivery methods used) "associated with more successful outcomes of parent training programs that targeted the prevention and/or remediation of early childhood behavior problems, [including those that fall in the social skills domain]" (p. 568).

Conclusions
"Parenting interventions targeting social skills only through a family-based approach may be less effective, as the child might have limited opportunities to practice the skills with peers and others outside the immediate family" (p. 581).

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Evaluation of Comprehensive Treatment Models for Individuals with Autism Spectrum Disorders
Odom, S. L., Boyd, B. A., et al. (2010).
Journal of Autism and Developmental Disorders, 40(4), 425-436.
Added: October 2012

Description
This is a review of empirical studies, book chapters, and literature reviews that investigated the use of comprehensive treatment models (CTMs) for individuals with autism spectrum disorder (ASD). Specifically, the authors sought to "determine the quality of multiple dimensions of CTMs that have been developed for learners with ASD and their families" (p. 432).

Conclusions
Low evaluation ratings were applied to the following models: Hanen, Higashi, Eden, Summit, Lancaster, and Son Rise (p. 432).

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Promoting the Social and Communicative Behavior of Young Children with Autism Spectrum Disorders: A Review of Parent-Implemented Intervention Studies
Meadan, H., Ostrosky, M. M., et al. (2009).
Topics in Early Childhood Special Education, 29(2), 90-104.
Added: October 2012

Description
This is a review of experimental studies that investigated parent-implemented interventions designed to promote and enhance social and communicative behavior in young children with autism spectrum disorders.

Conclusions

  • The data from the studies is consistent with previous findings that show that "parents can learn new strategies and use them with their children in natural environments to realize positive changes in children's social and communication skills" (p. 102).

  • Future research should examine other parent-implemented interventions that have limited, but positive, support; evaluate the impact of other services or therapies administered to children while they receive parent-implemented interventions; conduct large-scale parent-implemented intervention studies; and assess the effectiveness of parent-implemented interventions across culturally- and linguistically-diverse groups.

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Clinical Expertise/Expert Opinion

Consensus Guidelines
National Initiative for Autism: Screening and Assessment; National Autistic Society; Royal College of Psychiatrists; Royal College of Paediatrics and Child Health; All Party Parliamentary Group on Autism (United Kingdom)

National Autism Plan for Children (NAPC): Plan for the Identification, Assessment, Diagnosis and Access to Early Interventions for Pre-School to Primary School Aged Children with Autism Spectrum Disorders (ASD)
Le Couteur, A., Baird, G., et al. (2003).
London (United Kingdom): The National Autistic Society, 57 pages.
Added: October 2012

Description
This guideline provides good practice recommendations for the identification, assessment, diagnosis and intervention for preschool and elementary school-aged children with autism spectrum disorder (ASD). The target audience of this guideline includes speech-language pathologists and other professionals providing services to this population.

Recommendations
Families should be assisted with ways to foster social-communicative interactions with their child; treatment programs that have proven effective for parents and professionals include offering small group social opportunities for children and their families (p. 43).

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Client/Patient/Caregiver Perspectives

In-Home Communication Intervention Training for Parents of Multiply Handicapped Children... Including Commentary by Neff Ej
Elder, J. H. (1995).
Scholarly Inquiry for Nursing Practice, 9(1), 71-95.
Added: October 2012

Description
This is a study investigating the effects of an in-home parent communication training program on the acquisition of child-training skills in parents and communication behaviors in children with multiple handicaps.  All of the children demonstrated “autistic features.”

Conclusions
"Parental Consumer Satisfaction Questionnaire results indicated that the intervention was positively perceived by the parents” (p. 71). In addition "behavioral occurrences of imitating/animating, expectant waiting, vocal utterances, social initiating, and social responding increased in each of the parent and child subjects during treatment" (p. 79).

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Promoting Social Skill Development in Children with Pervasive Developmental Disorders: A Feasibility and Efficacy Study
Koenig, K., White, S. W., et al. (2010).
Journal of Autism & Developmental Disorders, 40(10), 1209-1218.
Added: October 2012

Description
This randomized-controlled trial investigates the acceptability and efficacy of a social skills intervention for children with autism. The intervention involved a behavioral approach to group intervention with the use of peer mentors.

Conclusions
Thirty-one out of 44 families returned a parent satisfaction survey. Most indicated that the baseline assessment was informative and over 90% indicated that their child enjoyed the group intervention. Most parents felt there was adequate communication with the research team. Parents that did not feel that communication was adequate desired additional information regarding the content of the group or additional instruction for home follow-up.

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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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Pilot Study of a Parent Training Program for Young Children with Autism: The PLAY Project Home Consultation Program
Solomon, R., Necheles, J., et al. (2007).
Autism: The International Journal of Research & Practice, 11(3), 205-224.
Added: October 2012

Description
This study investigated a training program for parents of children with autism spectrum disorder that follows a DIR/Floortime model. This program is called The PLAY Project.

Conclusions
Of the families that completed the satisfaction survey, most were very satisfied with The PLAY Project, a social-pragmatic intervention.  Parents who responded that they were “somewhat satisfied” with the program commonly suggested that The PLAY Project did not provide enough services.

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Putting the Pieces Together: Preliminary Efficacy of a Web-Based Family Intervention for Children with Traumatic Brain Injury
Wade, S. L., Wolfe, C., et al. (2005).
Journal of Pediatric Psychology, 30(5), 437-442.
Added: October 2012

Description
This is an intervention study of eight parents and their six children with moderate to severe traumatic brain injury (TBI).  This study examined the impact of a preliminary Web-based family problem-solving intervention designed to improve parent and child adaptation, including social competence.

Conclusions
"Parents...reported a significant reduction in antisocial behaviors on the Home and Community Social Behavior Scale-Antisocial Behavior (HCBS-AB).  Although improvements were also noted on the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), the difference did not achieve statistical signfiicance in the small sample" (p. 440).

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Exploring Parents' Use of Strategies to Promote Social Participation of School-Age Children with Acquired Brain Injuries
Bedell, G. M., Cohn, E. S., et al. (2005).
American Journal of Occupational Therapy, 59(3), 273-284.
Added: October 2012

Description
This is a qualitative study of 16 mothers and three fathers of school-aged children with acquired brain injury (ABI) associated with traumatic brain injury, stroke, anoxia, encephalitis, or encephalopathy.  This study examined the parents' perspectives on the impact of strategies they used to promote social participation of their children in home, school, and community life.

Conclusions
Strategies identified by parents to promote social participation were creating opportunities (e.g., selecting peers to visit or play or do schoolwork with the child), teaching skills (e.g., talking through social situations before, as, or after they arise), and regulating cognitive and behavioral function (e.g., using key words or cues to slow or calm down, pay attention, or ask for help) (p. 279).

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Parental Influence on Children with Attention-Deficit/Hyperactivity Disorder: II. Results of a Pilot Intervention Training Parents as Friendship Coaches for Children
Mikami, A. Y., Lerner, M. D., et al. (2010).
Journal of Abnormal Child Psychology, 38(6), 737-749.
Added: October 2012

Description
This is a randomized controlled trial of families of 62 children with attention deficit hyperactivity disorder.  This study examined the impact of Parental Friendship Coaching on parents' ability "to create social opportunities for their children to encourage peer relationships and to instruct their children in social skills" (p. 3).

Conclusions

  • "Parents reported increases in the child's social skills and reduced conflict and disengagement that occurred during playdates, and teachers reported increases in classroom peers that accept the child and decreases in peers that reject the child" (p. 12). 

  • "Significant main effects were not found on parent report of playdates hosted or teacher reports of the child's social skills" (p. 12).

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Parent-Assisted Social Skills Training to Improve Friendships in Teens with Autism Spectrum Disorders
Laugeson, E. A., Frankel, F., et al. (2009).
Journal of Autism and Developmental Disorders, 39(4), 596-606
Added: October 2012

Description
This is a randomized controlled trial of 33 teens between 13 and 17 years of age with autism spectrum disorderand their parents.  This study examined the short-term outcome of a parent-assisted, outpatient social skills program.

Conclusions
"Teens in the Treatment Group demonstrated improved knowledge of rules of social etiquette relevant to making and keeping friends.  They reported a significant increase in the frequency of hosted get-togethers and significantly better quality of friendships at the end of treatment in comparison to the Delayed Treatment Group.  Parents of teens in the Treatment Group reported significant improvement in their teen's overall level of social skills in comparison with parents of teens in the Delayed Treatment Control Group" (p. 603).

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Supporting Parents to Facilitate Communication and Joint Attention in Their Young Children with Autism Spectrum Disorders: Two Pilot Studies
Prelock, P. A., Calhoun, J., et al. (2011).
Topics in Language Disorders, 31(3), 210-234.
Added: October 2012

Description
This is a pilot study of four children with autism spectrum disorder (ASD) and their parents.  The study examined parents' ability to enhance communication and joint attention in their children with ASD using More than Words, a Hanen program.

Conclusions
"Results indicated that...three children [i.e., P1, P2, and P3] increased their use of social and symbolic communicative acts from pre- to post-training.  Notably, caregiver ratings and examiners' observational assessments of change were similar for all children" (p. 222).

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Parents Plus Programme 1: Evaluation of Its Effectiveness for Pre-School Children with Developmental Disabilities and Behavioural Problems
Quinn, M., Carr, A., et al. (2007).
Journal of Applied Research in Intellectual Disabilities, 20(4), 345-359.
Added: October 2012

Description
This is a comparative treatment outcome study of “42 parents of children aged 4-7 years with developmental disabilities and clinically significant behavioural problems” (p. 349).

Conclusions
Use of the Parents Plus program, a group-based parent training package that includes video modeling, was associated with 34% of parents reporting they should “use praise and encouragement and active listening to promote prosocial behavior” (p. 356).

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