Effects of Intensive Behavioural Treatment and a focused Imitation Intervention for young Children with Autism Spectrum Disorder - One plus One means More

摘要

AbstractSpjut Janson, B. (2017). Effects of IBT and a focused Imitation Intervention for youngChildren with ASD. One plus One means More. Department of Psychology, University ofGothenburg, Sweden.The general aim of this thesis was to investigate the effectiveness of interventions offered tochildren with autism attending the Habilitation services. Another aim was to investigate theefficacy of a new intervention within the setting of Swedish Habilitation services, namelyImitation Responding.In Study I the aim was to investigate if habilitation services, after early screening,showed a positive outcome. The interventions were Intensive Behavior Treatment (IBT),and Eclectic Interventions encompassing a selection of methods based on TEACCH orcommunication methods such as ComeAlong.In study II the aim was to explore if an intervention based on imitation, ImitationResponding (IR), could function as a complement to a comprehensive IL/IBT, which istreatment as usual at the Habilitation services.In Study III the aim was to examine if generalized joint attention had been developedin the group of children with autism that received IR followed by IL/IBT and the group ofchildren with autism that received IL/IBT only.Study I investigated the impact of intelligence on outcome of interventions fromHabilitation service in a naturalistic study. The actual comprehensive program is IntensiveLearning for young children with autism, an IBT intervention (acronym: IL/IBT) offeredas regular or modified version. The Modified IL/IBT had only parents as trainers and lowweekly intensity. The Regular IL/IBT had both parents and preschools staff as trainers andwith planned training of 25 hrs/weekly. The third group encompassed Eclectic interventions.Child variables at initial assessment (IQ in particular) accounted for most of the outcomevariance regardless of intervention group. Although the mean adaptive composite score didnot change significantly between start of intervention and follow-up, the variance increasedsignificantly. This underscores the need for regular monitoring of the child´s functioningand developmental gain/loss during the intervention period and the necessity to consider achange or modification of the program in use.Study II comprised of 40 children with Autism Spectrum Disorder (ASD), afterreceiving diagnosis they were randomized to either IL/IBT, which is standard treatment inchild habilitation service, or the new treatment Imitation Responding (IR). IR is a focusedprogram directed to increase the child´s ability to respond to other´s communication andto learn from others by utilizing a Being Imitated strategy, where the therapist imitates thechild. All children got their first intervention during 12 weeks.ivThe IR group, mean age 41.6 months at start of intervention received treatment onaverage 2.2 hours/week while the IL/IBT group, mean age 40.1 months at start of intervention,received 14.4 hours/week. Before and after treatment all children were assessed with ThePsycho Educational Profile - revised edition (PEP-R), and Vineland Behavior AdaptiveScales, second edition (VABS- II). Seven measures from the PEP-R and VABS-II, coveringlanguage, play, interpersonal relations, and visuo-motor imitation, were used as outcomemeasures. Results showed a significant increase in 6 out of 7 subscales for both interventiongroups but no significant difference was noted in any of the subscales when comparing thegroups. Only the IR group had a significant gain on the measure of interpersonal relations.We interpret the findings as support for IR to be used as a complementary interventionstrategy alongside comprehensive programs such as IL/IBT.Study III examined if the intervention IR or if IL/IBT could have an effect on thedevelopment of IJA in children with autism. One group received IR for three monthsfollowed by IL/IBT for 12 months, whereas the second group received only IL/IBT forthe whole 15 months period. Two measures of IJA were used: A gaze shift score and a sumscore of pointing and showing.IJA did not change during the first three months of treatment, nor were any significantdifferences between the interventions groups noted. However, at the end of the 15-monthlongintervention period the gaze shift score had increased significantly for the IR groupfollowed by IL/IBT training in contrast to the IL/IBT only group. No significant changewas noted for pointing and showing. Our results indicate that IR with the Being Imitatedstrategy might be useful if implemented early as a “start-up” – intervention, which isfollowed by an IL/IBT treatment.