Literature and clinical research suggest that improvements in communicative initiations are associated with widespread improvements in communication and in related core symptoms of autism (communicative, social, and behavioral domains), as well as in generalized improvements in the condition of autism as a whole. However, there are three major limitations to the current research in this area. Before important large scale randomized clinical trials can be conducted, it is first necessary to conduct preliminary research to show that: (1) improvements in communicative initiations can be measured in generalized socially significant contexts;(2) measureable collateral gains in related core symptoms of autism will occur;and (3) growth curves can be calculated to assess the rate of change. This study will use a manualized language intervention using motivational procedures of child choice and direct response-reinforcer relationships, which is built upon previous NIH research and recognized by the National Research Council (2000) as effective for language intervention for children with autism. To assess the effectiveness of intervention for communicative initiations, the proposed study will use a wide range of assessments, including objective measures such as the Autism Diagnostic Observation Schedule-Generic (ADOS-G;Lord, Risi, Lambrecht, Cook, Leventhal, DiLavore, et al., 2000;Gotham, Risi, Pickles, &Lord, 2007) and the Autism Diagnostic Interview- Revised (ADI-R;Lord, Rutter, and LeCouteur,1994;LeCouteur, Lord, &Rutter, 2003), language samples in children's natural environments to specifically and carefully assess speech acts (e.g., Dore's primitive speech acts;Dore, 1974), semantic intent, and syntax that should appear in primitive question forms during Stage I and early Stage II and be quite sophisticated by early Stage IV. In addition, standardized parent measures such as the Vineland Adaptive Behavior Scales II (VABS-II;Sparrow et al., 2005) and behavioral rating scales of normalcy of communicative interactions during videotaped language samples with a parent or clinician will be utilized. The effect sizes for changes from pre to post intervention will be calculated on all measures and a growth curve analysis will be conducted by collecting measures every two months. Additionally, the results from the experimental group will be compared with a comparison group of children who receive treatment as usual, focusing on communicative responsiveness rather than on communicative initiations. Fidelity of implementation measures will be taken for all clinicians in both conditions across time. Results will be written up and published in journals focusing on research on the widespread significance of communication improvements for children with autism.
The Center for Disease Control has declared autism as an epidemic affecting 1 in 150 children, and is an NIH priority area. The proposed project will examine specific intervention components during language intervention and social communication. The study will assess improvements on the condition of autism.
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