Tuesday, March 24, 2015

Comparing Early Intervention Outcomes

We know very little about which preschool intervention placements produce the best outcomes for which children with Autism Spectrum Disorder (ASD). A team from the University of Pennsylvania examined the effectiveness of three early intervention preschool placements: inclusive, mixed disability, and autism-only.

Children in this study had completed early intervention and were now enrolled in elementary school autism support classes. The researchers assessed each child’s current cognitive skills and reviewed their preschool early intervention educational records.

The three early intervention placements were categorized as follows:

  • Inclusive placements took place in a variety of settings, including center-based programs run by a special education teacher for typically developing children that included children with ASD, Head Start preschools, community-based typical preschools, and day-care settings.
  • Mixed disability placements included children with developmental or other disabilities as well as children with ASD.  
  • Autism-only placements took place in center-based autism support preschool programs.

Children who attended inclusive early intervention placements scored higher on cognitive measures when they started elementary school than the children who were in mixed disability and autism-only placements. This was particularly true for children with at least minimal communication skills, lower adaptive behavior skills, and lower social skills. 

These findings suggest that having more opportunities to interact with, and learn from, typically developing peers may be particularly important for the cognitive outcomes of some children with ASD. However children with ASD with other strengths and weaknesses may benefit from other types of intervention settings.

Based on the findings from this project, the University of Pennsylvania has begun a new study that is following children currently enrolled in the preschool early intervention system in Philadelphia. The researchers plan to follow the children over the course of nine months and observe whether children with different strengths and weaknesses benefit more or less in certain types of settings (inclusive, mixed-disability, or autism-only).

Source: Nahmias, A.S., Kase, C., Mandell, D.S. (2014). “Comparing cognitive outcomes among children with autism spectrum disorders receiving community-based early intervention in one of three placements.” Autism, 18(3), 311-320. PMID: 23188885

Tuesday, March 10, 2015

Sleep Behaviors and Sleep Quality

Getting a good night of sleep is crucial to a child’s development in the areas of attention, learning, memory, mood regulation, and behavior. Poor sleep quality in children also affects parents’ sleep quality. If a child isn’t sleeping well, chances are his/her parents aren’t sleeping well either.

Many children with Autism Spectrum Disorder (ASD) have difficulty falling asleep or staying asleep, but research into this has been limited. A study conducted by a team at the University of Pennsylvania (UPenn) School of Nursing and CHOP aimed to answer two critical questions: how many children with ASD have sleep problems, and what types of sleep problems are most common in ASD.

For the study, families were asked to answer sleep questionnaires and keep a sleep diary over a 17-day period. Parents noted the time the child went to bed, night wakings, morning wake time, naps, and health status during this period.

The children also wore a device that measures motion, called an actigraph, for 10 nights. An actigraph is a miniaturized wristwatch-like computer, and it is now a part of many fitness wristbands and cell phones. The actigraph measures how much children move at night and provides a measure of how much time children spend in different sleep phases. There were concerns about the children’s ability to fall asleep with something on their wrist, so the researchers created a special pocket for the actigraph that could be sewn into the upper sleeve of a pajama top.

When the researchers analyzed the sleep diaries, actigraphy, and sleep questionnaires, they found that 66.7% of children with ASD had some form of insomnia. The children with ASD took longer to fall asleep and had longer waking episodes during the night.

The most prevalent sleep disorders in this group were behavioral insomnia and required intensive strategies to be implemented by the parents to help their children fall asleep. Strategies included repeated reassurance about fears, rocking, patting, and frequently returning them back to bed. Of note, about a third of the children with ASD that had insomnia had strong bedtime routines, fell asleep by themselves, and did not have any medical conditions that might disrupt sleep. Insomnia in these children with ASD may be due to intrinsic causes. Research suggests that a fairly high state of hyperarousal or anxiety may be causing insomnia in these individuals. Ongoing treatment studies are testing whether alleviating the anxiety will also alleviate sleep difficulties.

Greater understanding of insomnia in the ASD population is critical because good sleep is strongly tied to the ability to attend, learn, and self-regulate. The UPenn School of Nursing and CHOP are presently conducting a Pilot Randomized Control study for sleep impairments in ASD. This study is funded by the Department of Defense to develop and refine a tailored behavioral intervention for children with ASD and insomnia that includes a calming module that addresses arousal dysregulation and anxiety.

Source: Souders, M.C., Mason, T.B., Valladares, O., Bucan, M., Levy, S.E., Mandell, D.S., Weaver, T.E., Pinto-Martin, J. (2009). “Sleep Behaviors and Sleep Quality in Children with Autism Spectrum Disorders.” Sleep, 32(12), 1566-1578. PMID: 20041592