EBP Compendium: Summary of Systematic Review

Communication Intervention for Children with Autism: A Review of Treatment Efficacy
Goldstein, H. (2002).
J Autism Dev Disord, 32(5), 373-396.

Indicators of Review Quality:

Description: This is a review and summary of empirical studies evaluating speech-language interventions involving children with autism.

Question(s) Addressed:

 Question not specifically stated.

Population: Children with autism

Intervention/Assessment: Interventions include sign language, discrete trial training, time delay/milieu/natural language teaching paradigms, functional communication training, modeling/scripted interactions and parent training.

Number of Studies Included: Approximately 60

Years Included: Not stated

Findings:

Conclusions:

• Treatment
  • Cognition/Language
    • General Findings - “Based on this review, one can conclude that substantial evidence exists to claim that effective interventions exist to teach communication skills to children with autism” (p. 393).
    • Alternative and Augmentative Communication (AAC)
      • Sign Language - “Although few studies explored the use of sign alone, it is contraindicated because the likelihood of children producing speech is diminished” (p. 385).
      • Total Communication
        • “Total communication appears to be a viable treatment strategy for teaching receptive and expressive vocabulary (i.e., language content) to individuals with autism” (p. 385).
        • For individuals with limited verbal imitation skills, speech alone approaches are less effective than total communication approaches. “…[T]otal communication often results in comprehension and production of both signs and speech” (pp. 385-386).
    • Applied Behavioral Analysis (ABA)/Discrete Trial
      • Findings for discrete-trial training suggested that treatment provides a foundation for the development of procedures needed to teach discriminative performances. Comparison studies between discrete-trial training and natural language paradigm have found mixed results in skill acquisition and generalization.
      • “…[T]here is no compelling evidence that milieu teaching procedures are clearly more effective than the procedures that have developed out of discrete-trial procedures” (p. 388).
    • Functional Communication Training - Functional communication training has been shown to be effective for remediating echolalia, noncompliance, and disruptive behavior.
    • Milieu
      • The author grouped interventions that were typically delivered in the natural milieu including time delay procedures, incidental teaching, Natural Language Paradigm, and mand-model procedures and concluded, “Research on milieu language teaching procedures has been extensive and seems to be applicable to teaching early language skills to a broad population of children" (p. 388).
      • “…[T]here is no compelling evidence that milieu teaching procedures are clearly more effective than the procedures that have developed out of discrete-trial procedures” (p. 388).
    • Natural Language Paradigm - Comparison studies between discrete-trial training and natural language paradigm have found mixed results in skill acquisition and generalization.
    • Parent-Mediated Interventions - Poor methodological quality of parent training studies limits the ability to meaningfully interpret the findings.
    • Pragmatics/Social Skills - The author presented evidence on peer facilitation, scripted interactions, and an intervention involving modeling, rehearsal, and token reinforcement and concluded: “Given that a problem relating to others is a core social deficit associated with autism, the effectiveness of these interventions in increasing social interaction with peers in particular is quite striking” (p. 390).
  • Speech
    • AAC
      • Sign Language - “Although few studies explored the use of sign alone, it is contraindicated because the likelihood of children producing speech is diminished” (p. 385).
• Service Delivery
  • Dosage
    • “No literature was found that directly sought to evaluate the effects of delivering treatments with varying frequency or intensity” (p. 391).
    • “The literature provides little direction in terms of service delivery models or the intensity of services that are more likely to maximize communication intervention efforts” (p. 393).
  • Provider
    • Poor methodological quality of parent training studies limits the ability to meaningfully interpret the findings. 

Keywords: Autism Spectrum Disorders, American Sign Language, Behavioral Treatments, Parent-Mediated Intervention, Social Skills, Total Communication, Functional Communication Training, Milieu, Natural Language Paradigm

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Added to Compendium: December 2011