Review of the Research to Identify the Most Effective Models of Practice in Early Intervention for Children with Autism Spectrum Disorders


Appendix E: Scientific merit rating scale and outcome data



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Appendix E: Scientific merit rating scale and outcome data

The following tables present the raw data providing analysis of the scientific merit of the studies included in the review. Scores can fall between 0 and 5, with scores of 3, 4 or 5 indicating that sufficient scientific rigour has been applied to the study and that we can draw conclusions about the treatment effects. The following data are presented alphabetically.

Please refer to the Reference list for further details of the information presented in the tables.



Study: Carter, A.S., Messinger, D.S., Stone, W.L. & Celimli, S., Nahmias, A.S. & Yoder, P. (2011)

Intervention type: Hanen (RCT)


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV (Direct Behavioural Observation)

Type of measurement

Reliability

%age of sessions

Conditions


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)

Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 4 = 4.75

5; 5; 3; 4 = 4.25

5; 5; 5 = 5

3; 3 = 3

5; 3 = 4

Weighted Score

4.75 x 0.3 = 1.425

4.25 x 0.25 =1.0625

5 x 0.2 =1

3 x 0.15 = 0.45

4 x 0.1 = 0.4

Total Score

4.3375












Comment: No main effect on parent responsiveness or child outcome, however improved outcomes for children with initially lower object interest (played with fewer toys). Children were all under 2 years of age.

Study: Gulsrud, A.C., Kasari, C., Freeman, S. & Paparella, T. (2007)

Intervention type: ‘Joint attention intervention’ vs. ‘Symbolic play intervention’

Criteria


Research Design

No, of Groups

Design

No. of Participants



Data Loss

Measurement Of DV (Direct Behavioural Observation)

Type of Measurement

Reliability

%Age Of Sessions

Conditions


Measurement Of IV

Implementation Accuracy

Implementation Accuracy Data Collection

IOA For Treatment Fidelity




Participant Ascertainment

Who Diagnosed (Professional; Independent; Blind)

How Diagnosed (Instrument; Dsm Icd)


Generalisation

Objective

Maintenance Data &/Or Across Settings / Stimuli / Responses / Persons


Score Per Criteria

5; 5; 5; 4 = 4.75

5; 5; 5; 5 = 5

1; 1; 1 = 1

3; 3 = 3

5; 2 = 3.5

Weighted Score

4.75 X 0.3 = 1.425

5 X 0.25 = 1.25

1 X 0.2 = 0.2

3 X 0.15 = 0.45

3.5 X 0.1 = 0.35

Total Score

3.675












Comment: Compared two interventions, no control group. Joint attention>symbolic play for shared interactions, and proportion of time spent sharing coordinated joint looks.

Study: Klayva, E. & Avramidis, E. (2005) Intervention type: ‘Circle of Friends’


Criteria

Research Design

No of groups

Design

No of participants



Data loss

Measurement of DV (Direct behavioural observation)

Type of measurement

Reliability

%age of sessions

Conditions


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 4; 3; 4 = 4

4; 5; 3; 3 = 3.75

1; 1; 1 = 1

1; 1 = 1


2; 2 = 2

Weighted Score

4 x 0.3 = 1.2

3.75 x 0.25 = 0.938

1 x 0.2 = 0.2

1 x 0.15 = 0.15

2 x 0.1 = 0.2

Total Score

2.688












Comment: Outcomes for communication (response and initiation rates). NB: N=5 and SMRS rating low. Interpret with caution

Study: Keen, D., Couzens, D., Muspratt, S. & Rodger, S. (2010)

Intervention type: Professionally supported parent focused intervention vs. Self-directed video based parent focused intervention


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators

Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity



Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 4 = 4.75

5; 5; 5; 4 = 4.75

1; 1; 1 = 1

3; 5 = 4

5; 1 = 3

Weighted Score

4.75 x 0.3 = 1.43

4.75 x 0.25 = 1.19

1 x 0.2 = 0.2

4 x 0.15 = 0.6

3 x 0.1 = 0.3

Total Score

3.72












Comment: No control group. Professionally supported significantly better outcomes than parent directed in children’s’ social communication, adaptive behaviour; parents’ stress, self-efficacy

Study: Landa , R.J., Holman K.C., O’Neill, A.H. & Stuart, E.A. (2011)

Intervention type: Interpersonal Synchrony (IS) vs. Non-interpersonal synchrony (Non-IS) - both school and home based interventions, but IS provided supplementary curriculum targeting socially engaged imitation, joint attention, and affect sharing.



Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 4 = 4.75

5; 5; 5; 4 = 4.75

3; 3; 5 = 3.7

5; 5 = 5

5; 4 = 4.5

Weighted Score

4.75 x 0.3 = 1.43

4.75 x 0.25 = 1.19

3.7 x 0.2 = 0.74

5 x 0.15 = 0.75

4.5 x 0.1 = 0.45


Total Score

4.57












Comment: No control group. IS > Non-IS (see ‘Intervention Type’ above). Significant Outcomes (endpoint and follow up): socially engaged imitation. Similar gains for joint attention and affect sharing, but figures did not reach significance.

Study: Lim, H. (2010).

Intervention type: Music Training vs. Speech Training vs. controls


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV (Direct Behavioural Observation)

Type of measurement

Reliability

%age of sessions

Conditions


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 4 = 4.75

5; 5; 5; 5 = 5


1; 1; 1 = 1

5; 5 = 5

5; 2 = 3.5

Weighted Score

4.75 x 0.3 = 1.425

5 x 0.25 = 1.25

1 x 0.2 = 0.2

5 x 0.15 = 0.75

3.5 x 0.1 = 0.35

Total Score

3.975












Comment: Music Training, Speech Training both had better outcomes than controls. Outcomes: Verbal production (semantics, phonology, pragmatics, prosody). Music Training had greater outcomes than Speech Training for low functioning ASD children.

Study: Lydon, H., Healy, O. & Leader, G. (2011).

Intervention type: Pivotal Response Training (PRT) vs. Video Modelling (VM)


Criteria

Research Design

No of groups

Design

No of participants



Data loss

Measurement of DV (Direct Behavioural Observation)

Type of measurement

Reliability

%age of sessions

Conditions



Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 4; 2; 4 = 3.75

5; 5; 5; 5 = 5

1; 1; 1 = 1

5; 5 = 5

5; 2 = 3.5

Weighted Score

3.75 x 0.3 = 1.125

5 x 0.25 = 1.25

1 x 0.2 = 0.2

5 x 0.15 = 0.75

3.5 x 0.1 = 0.35

Total Score

3.675












Comment: No control group, PRT greater numbers of play actions than VM

Study: McConkey, R. Truesdale-Kennedy, M., Crawford, H., McGreevy, E., Reavey, M., Cassidy, A. (2011)


Intervention type: Keyhole (TEACCH + PECS + Hanen)


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 3; 5; 3 = 4

4; 4; 3; 2 = 3.25

1; 1; 1 = 1

1; 1 = 1

4; 1 = 2.5

Weighted Score

4 x 0.3 = 1.2

3.25 x 0.25 = 0.81

1 x 0.2 = 0.2

1 x 0.15 = 0.15


2.5 x 0.1 = 0.25

Total Score

2.61












Comment: Treatment vs. control (home visits with parental psycho-education and educational toys and equipment). Significant outcomes: child communication, parental health. Low total score due to several design limitations, need to be cautious in interpreting results.

Study: Oosterling, I. Visser, J., Swinkels, S., Rommelse, N., Donders, R., Woudenberg, T., Roos, S., van der Gaag, R., Buitelaar, J. (2010)

Intervention type: Focus Parent Training (for Toddlers)


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)

Generalisation

Objective

Maintenance data &/or across settings / stimuli / responses / persons



Score Per Criteria

5; 4; 5; 4 = 4.5

5; 5; 4; 3 = 4.25

1; 1; 1 = 1

5; 5 = 5

4; 4 = 4

Weighted Score

4.5 x 0.3 = 1.35

4.25 x 0.25 = 1.06

1 x 0.2 = 0.2

5 x 0.15 = 0.75

4 x 0.1 = 0.4

Total Score

3.76












Comment: No greater outcomes reported when compared with ‘treatment as usual’. Both intervention and control participants were enrolled in comprehensive interventions.

Study: Peters-Scheffer, N., Didden, R., Mulders, M., & Korzilius, H. (2010)

Intervention type: ‘low intensity behavioural treatment’ – group & on-on-one; elements of TEACCH, elements of Lovaas’ discrete trial format

Criteria


Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 4; 5; 4 = 4.5

5; 3; 4; 3 = 3.75

1; 1; 1 = 1

5; 5 = 5

5;1 = 3

Weighted Score

4.5 x 0.3 = 1.35

3.75 x 0.25 = 0.94

1 x 0.2 = 0.2

5 x 0.15 = 0.75

3 x 0.1 = 0.3

Total Score

3.54











Comment: Intervention and control (control group poorly defined, no treatment). Significant outcomes: developmental age; adaptive skills, Non-Significant outcomes: autistic symptom severity; emotional and behavioural problems.
Study: Pillay, M., Alderson-Day, B., Wright, B., Williams, C., & Urwin, B. (2011) Intervention type: ASCEND


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

2; 2; 2; 2 = 2

2; 2; 3; 2 =2.25

1; 1;1 = 1

5; 5 = 5


2; 1 = 1.5

Weighted Score

2 x 0.3 = 0.6

2.25 x 0.25 = 0.563

1 x 0.2 = 0.2

5 x 0.15 = 0.75

1.5 x 0.1 = 0.15

Total Score

2.263












Comment: Study has no control group. All data is self-report from parents, pre and post 11 session programme.
Study: Russo, N.M., Hornickel, J., Nicol, T., Zecker, S. & Kraus, N. (2010)

Intervention type: Fast ForWord


Criteria

Research Design

No of groups

Design

No of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity



Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)



Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

2; 5; 1; 2 = 2.5

5; 1; 1; 3 =2.5

0; 0; 0

2; 2 = 2

0; 0 = 0

Weighted Score

2.5 x 0.3 = .75

2.5 x.25 = 0.625

0 x 0.2 = 0

2 x 0.15=0.3

0

Total Score

1.675












Comment: non-RCT, 5 participants, mixed group of diagnoses (ASD, autism, Asperger’s), biological markers only measured.

Study: Smith, I. M., Koegel, R. L., Koegel, L. K., Openden, D. A., Fossum, K. L., & Bryson, S. E. (2010)

Intervention type: NS EIBI (Nova-Scotia early intensive behaviour intervention model) – includes Pivotal Response Treatment

Criteria


Research Design

No of groups

Design

No of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 4; 5; 4 = 4.5

5; 4; 4; 4 = 4.25

5; 1; 5 = 3.67

5; 5 = 5

5;1 = 3

Weighted Score

4.5 x 0.3 = 1.35

4.25 x 0.25 = 1.06

3.67 x 0.2 = 0.73

5 x 0.15 = 0.75

3 x 0.1 = 0.3

Total Score

4.19

NB: No Control Group













Comment: no control group. Improved outcomes: Expressive and receptive language; behaviour problems; autism symptoms
Study: Tonge, B., Brereton, A., Kiomall, M., McKinnon, A., King, N. & Rinehart, N. (2006)

Intervention type: Parent training


Criteria

Research Design

No of groups

Design

No of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 5 = 5

5; 5; 5; 5 = 5

5; 5; 2 = 4

5; 5 = 5

3; 1 = 2


Weighted Score

5 x 0.3=1.5

5 x 0.25= 1

4 x 0.2=0.8

5 x 0.15 = 0.75

2 x 0.1= 0.2

Total Score

4.25












Comment: Measured parent outcomes only, beneficial outcomes reported compared with controls and alternative treatment group.
Study: Whalen C, M. D., Ilan, A.B., Vaupel, M., Fielding, P., Macdonald, K., Cernich, S.& Symon J. (2010).

Intervention type: Teachtown Basics (Computer Assisted Instruction)


Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity



Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)



Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 4; 5; 4 = 4.5

5; 3; 4 ;3 =3.75

1;1;1 = 1

2;2 = 2

5;1 = 3

Weighted Score

4.5 x 0.3 = 1.35

3.75 x 0.25 = 0.94

1 x 0.2 = 0.2

2.5 x 0.15 = 0.3

3 x0.1 = 0.3

Total Score

3.09












Comment: Beneficial outcomes compared with control group (i.e. regular school curriculum) in receptive language for younger children only, no change in expressive language or developmental assessment.

Study: Zachor, D. A., Ben-Itzchak, E., Rabinovich, A.-L., & Lahat, E. (2007)

Intervention type: Eclectic-Developmental (ED) vs. Applied Behavioural Analysis (ABA)

Criteria


Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 5 = 5

5; 5; 5; 3 = 4.5

1; 1; 1 = 1

5; 5 = 5

5; 1 = 3

Weighted Score

5 x 0.3 = 1.5

4.5 x 0.25 = 1.13

1 x 0.2 = 0.2

5 x 0.15 = 0.75

3 x 0.1 = 0.3

Total Score

3.88











Comment: No control group, ABA group greater outcomes than ED group in communication, social interaction and changes to diagnostic classification

Study: Zachor, D. A., & Itzchak, E. B. (2010)

Intervention type: Eclectic-Developmental (ED) vs. Applied Behavioural Analysis (ABA)

Criteria

Research Design

No. of groups

Design

No. of participants



Data loss

Measurement of DV

Type of measurement

Protocol

Psychometric properties

Evaluators


Measurement of IV

Implementation accuracy

Implementation accuracy data collection

IOA for treatment fidelity




Participant Ascertainment

Who diagnosed (professional; independent; blind)

How diagnosed (instrument; DSM ICD)


Generalisation

Objective

Maintenance data &/or Across settings / stimuli / responses / persons


Score Per Criteria

5; 5; 5; 5 = 5

5; 5; 5; 4 = 4.75

0 (no description)

5; 4 = 4.5

0 (not measured)

Weighted Score


5 x 0.3 = 1.5

4.5 x 0.25 = 1.13

0

4.5 x 0.15 = 0.675

0

Total Score

3.30













Comment: Outcomes included high diagnostic stability with both groups showed similar stability and change (ABA – 6.7% improved, 4.4% deteriorated; EC – 6% improved). Both groups improved, no difference between groups.




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