Therapies for Children With Autism Spectrum Disorders

quotient (nonverbal mental age equivalent/chronological age X 100) took place in schools with
children videotaped and language outcomes codes by non-masked assessors. Videotaping took
place during snack sessions, selected because they are time limited and structured to include
requesting and other social communication.
The use of PECS in treatment classrooms was substantially increased immediately after
training, with children in the PECS training classrooms having 3.90 times (95 percent CI: 1.75–
8.68) the odds of being in a higher PECS use category than those whose teachers received no
PECS training. The effect, however, was not maintained, and by Time 3, the immediate
treatment group children were no more likely to be in a higher PECS rate category than untreated
children (OR 1.10; 95 percent CI: 0.46–2.62).
The third trial available on language intervention was also on PECS and was a
nonrandomized controlled trial, with selection into or out of treatment based on a geographical
limit. This study was reported in two papers. 262,265 Intervention was provided to 24 children
whose special education classrooms were within 50 miles of the researchers; while a comparison
group was selected from special education classrooms outside the 50-mile limit. Children were
between 3 and 7 years old, with a diagnosis of Autistic Disorder. Diagnosis was clinically based,
and not independently confirmed by the investigators. Children in the study were to have
received no PECS training prior to the research.
Children in the intervention group received a total of 15 hours of PECS teaching during
various classroom activities over 4 to 5 weeks. The research team designed the instrument by
which they assessed communicative interactions. They did not validate the instrument. The
investigators followed the Bondy and Frost guidance 82 for using PECS in the classroom, but at
Phase III randomly assigned children to either the approach specified in the PECS manual, or a
modified PECS teaching procedure. 265
Observation occurred 6 weeks prior to commencement of PECS intervention, 1 week prior to
intervention and during the week immediately following completion of the 15 hours of PECS.
The authors contended that the differences observed between the first and second observation
periods (during which no intervention took place) would provide a measure of rate of maturation
that could be used to differentiate maturation from treatment effects after the intervention phase;
however, no evidence that this approach is valid was provided in the paper.
No differences were observed on child-initiated communication either between the two preintervention
measurement periods or between the two groups immediately prior to intervention.
After intervention, however, the children in the PECS manual group had a significant increase in
initiations, while the children in the control group had no increase, and the frequency of child to
adult initiations was higher overall in the PECS manual group. Total adult-to-child initiations
with the opportunity for child response showed an opposite response, with no significant increase
in the PECS manual group, but a significant increase in the control group.
Because the study only measured outcomes immediately after intervention in the classroom
setting (at 6 weeks), it is impossible to determine whether the outcomes have any durability or to
assess the effects outside of the classroom. Furthermore, although reliability of the observations
was reported to be high (89.78 percent agreement), it was measured in only 56 percent of
observation sessions, and the observers were not blinded to intervention status.
Sensory- and Auditory-Focused Interventions
Sensory integration, a specialized occupational therapy model based on the premise that the
brain’s response to basic sensory input must be normalized before higher-order processes can be
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