American Speech-Language-Hearing Association

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:

The review addresses a clearly focused question No
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication No
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes

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

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