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Abstract | Summary | Original Article
The Scottish Centre for Autism preschool treatment programme. II.
The results of a controlled treatment outcome study.
Salt J, Shemilt J, Sellars V, Boyd S, Coulson T, McCool S.
Autism. 6(1): 33-46. 2002.
Question: Was the Scottish Centre
for Autism preschool programme, a developmentally based intervention,
effective in the treatment of preschool children with autism?
Background: Applied behavioural
analysis is the most common treatment for autistic disorders.
However, there are other therapies that are less widely used
and less studied. One example is the social-communication
program. It relies on teaching that is tailored to the individual
child’s developmental stage in all domains of learning,
comparing each to age-appropriate skills levels, and providing
remediation to bring the child up to that level. Rather than
using discrete trial techniques, it relies on more "naturalistic"
processes.
Design: Non-randomized two group
pre/post trial using a waiting list control group.
Setting: The Scottish Centre for
Autism in Glasgow, Scotland.
Participants: Twenty children
with a mean age of 42.36 months took part, 14 in the treatment
group and 6 on the waiting list who served as controls.
Intervention: A social-developmental
model of treatment of autism.
Main Outcome Measures: Bayley
Scales of Infant Development (2nd Edition), the British Picture
Vocabulary Scale, The Vineland Adaptive Behaviour Scales,
Pre-Verbal Communication Schedule, MacArthur Communication
Development, Symbolic Play Test, Early Social Communication
Scales, and the Parenting Stress Index (3rd Edition).
Main Results: Children in the
control group had higher IQs at study entry compared to the
treatment group. Treatment group children showed greater improvement
on the socialization, skills of daily living, motor, and adaptive
behaviour composite scores than did the children in the control
group. On the Pre-Verbal Communication Schedule (PVCS) the
treatment group showed greater improvement on the imitation
scales. Both groups showed improvement on the MacArthur Communication
Development Inventories and the Symbolic Play Test. For the
Early Social Communication Scales test, data for only 9 of
the treatment group and 5 of the control group were available.
The treatment group children showed significantly greater
improvement on tests of joint attention and social interaction.
Test of requesting behaviour improved in the treatment group,
but did not reach statistical significance.
The Stress Index for parents was reduced for the treatment
group, and increased, but not significantly so, for the parents
of control group children.
Conclusion: Despite having lower
mean IQ scores than the comparison group, the treatment group
showed greater improvement in a variety of areas compared
to the control group. The treatment group children improved
scores in both joint attention and imitation skills, which
has implications for further improvements in other areas.
If children can attend to another person and imitate them,
it likely means that their ability to learn will be enhanced.
Treatment group children also showed improvements in social-emotional
functioning. Both groups showed improvements in the realm
of language skills, so it was not the program that had an
effect in this area. However, in the control group, 3 of the
5 families instituted the Hanen program, a form of parent
training designed to enhance language acquisition in small
children. It may be important to compare the Hanen program
to other types of treatment to determine its place in standard
treatment regimens. Long-term studies may be needed to determine
what helps reduce stress for parents of children with ASDs.
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Commentary
The SCA program is designed to increase the child’s
motivation to communicate and does this by working to
improve their non-verbal communication skills, their
language use, imitation, and social interaction abilities.
These skills are viewed as important to engaging in
play and developing social skills, and to improving
behavioural flexibility.
In the SCA program, the staff assess the individual
child’s social and communication deficits and then
develop a remedial program to address them. The program
uses a developmental approach; that is, staff look at
each child’s developmental level and then set learning
goals based on what skills the child needs to attain
skills and abilities usually seen in the next developmental
stage. Teachers take their lead from the child and always
use his/her interests and preferences to set lessons.
The child’s vocalizations and movements are imitated
as a way of entering their world. Other studies have
found that imitation can lead to better eye contact,
gesturing, touching, and play (see, for example, Escalona
et al. 2002). The child’s motivation to take part
in activities and the ability to switch from one activity
to another are also emphasized.
This study of the SCA was based on findings from a
small group of children, so the numbers would have to
be increased to get a better sense of whether the treatment
actually works. It would be better, as well, if a randomized
controlled trial design were used. It is difficult to
ensure that wait list children are not exposed to other
treatments, thus making the differences noted between
the two groups unreliable.
The authors don’t view this treatment as a cure
for autism, but as a way to help children with autism
develop skills needed to make use of their educational
opportunities. I can be viewed as complementary to other
educational or treatment methods such as ABA.
Patricia Colton, M.A., M.Ed.,
CAIRN Project Coordinator
Escalona A, Field T, Nadel J, Lundy B. Brief report:
Imitation effects on children with autism
Journal of Autism and Developmental Disabilities 2002.
32(2): 141-4.
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