Researchers at the Institute for Autism Research at Canisius College have found that reducing the intensity of their comprehensive summer treatment (summerMAX) yielded improvements for high-functioning children with autism spectrum disorder (HFASD) that were comparable to the original high-intensity program. Specifically, significant improvements on social-communication tests and parent and clinician ratings of social/behavioral performance and ASD-related symptoms did not differ between the children who received the lower-intensity version of the program or the high-intensity version.
Addressing the social-communicative impairments and restricted and repetitive interests and behaviors of children with HFASD requires a comprehensive treatment that is sufficiently intensive, as well as feasible. Prior studies have repeatedly and consistently shown the intensive summer treatment, summerMAX, to be highly effective in improving the social-communicative skills and ASD symptoms of children with HFASD. Once the effectiveness of the original high-intensity program was established, the research team questioned whether summerMAX might be equally effective in a lower-intensity version. According to Christopher Lopata, PsyD, the study's lead author, "almost nothing is known about how treatment intensity effects program effectiveness and feasibility for summerMAX, as well as other psychosocial treatments for this population, and researchers have called for studies examining the impact of treatment intensity." In order to begin to answer this complex question, the research team compared the feasibility and effectiveness of a lower-intensity (LI) version of summerMAX to the original high-intensity (HI) version.
Findings from the clinical trial, just published in the journal Research in Autism Spectrum Disorders, provide strong support for the effectiveness and feasibility of the LI version of summerMAX.
In this trial, a total of 47 children, ages 7-12 years with HFASD were randomly assigned to receive either the LI or HI version of summerMAX. All of the children received the same 5-week summerMAX program, 5 full days per week targeting social/social-communication skills, face-emotion recognition skills, interpretation of non-literal language skills, and interest expansion. The only difference between the treatment conditions involved the intensity of the treatment. The HI groups consisted of 6 children with HFASD and 3 staff clinicians (2:1 child-to-staff ratio) and the LI condition was created by approximately doubling the number of children with HFASD per group (11 or 12 per group) while maintaining the staffing at 3 staff clinicians per group (approximately 4:1 child-to-staff ratio). "Doubling the group size reduced treatment intensity as the children had fewer opportunities for practice trials and feedback, factors considered important for skills development in children with HFASD," said Marcus L. Thomeer, PhD, one of the lead investigators.
Following the 5-week treatment, results indicated that children in the LI and HI conditions did not differ in their outcomes, with both groups making comparable improvements. Specifically, children in the LI and HI groups both made significant gains on non-literal language and facial-emotion recognition testing, as well as on parent and clinician ratings of social-communication skills, ASD symptoms, and behavior problems. Beyond child outcomes, the effect of intensity level on program feasibility was also evaluated, with results indicating no difference in accuracy of treatment implementation or in parent, child, or staff satisfaction with the program between the LI and HI conditions.
This study constitutes an important step in understanding how treatment intensity affects outcomes and feasibility of the summerMAX program. "High intensity programs that are effective and feasible in university and research settings may be cost-prohibitive for many community clinical providers. This study suggests that summerMAX can be equally effective when delivered at a lower intensity," said Thomeer. While this study in an important first step and suggests that a lower-intensity version of the program is effective, there is a need for further studies to determine the optimal treatment dosage. According to James P. Donnelly, PhD, one of the study investigators, "examining dosage in terms of both treatment intensity and duration (e.g., number of treatment days) is a critical next step for us, as well as for other treatment researchers. Identifying the optimal dosage will help ensure that psychosocial treatments are adequately intensive and effective, and also delivered in the most efficient way." Studies of dosage also have significant public health and financial implications. "Determining the lowest dosage (intensity and duration) needed to produce significant gains will help make summerMAX, and other psychosocial treatments, more affordable and accessible to the greatest number of children with HFASD," said Thomeer and Lopata.
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