Randomized controlled trial of propranolol on social communication and anxiety in children and young adults with autism spectrum disorder.

RATIONALE: Autism spectrum disorder (ASD) is characterized by impaired social communication and is also frequently characterized by co-occurring anxiety. Propranolol is widely utilized to treat performance and public speaking anxiety. Single-dose psychopharmacological challenge studies suggested benefits using propranolol for verbal tasks and social interaction. OBJECTIVE: We conducted a double-blinded, placebo-controlled trial of the ß-adrenergic antagonist propranolol in ASD for social interaction, anxiety, and language. METHODS: Seventy-four participants with ASD, age 7-24 years, were enrolled and randomized to a 12-week course of propranolol or placebo, with blinded assessments at baseline, 6 weeks, and 12 weeks. The primary outcome was the General Social Outcome Measure-2 (GSOM-2) for social interaction, and secondary outcomes were the Clinician Global Clinical Impression-Improvement (CGI-I) ratings independently conducted for social interaction, anxiety, and language at 6 weeks and 12 weeks. RESULTS: Sixty-nine participants completed the 12-week visit. No significant effect of drug was found for the GSOM-2 or the CGI-I for social interaction or language. CGI-I for anxiety showed greater improvement with propranolol at the 12-week time point (p = 0.045, odds ratio = 2.58 (95% CI = 1.02-6.52). Expected decreases in heart rate and blood pressure were observed with propranolol, and side effects were uncommon. CONCLUSIONS: Propranolol did not impact social interaction measures or language, but there were indications of a beneficial effect for anxiety. This will need confirmation in a larger multicenter trial, monitoring markers or characteristics to identify those participants most likely to respond to propranolol for anxiety, and determine whether there is a subset of participants that are responsive for other previously reported outcomes.

A Pilot Feasibility Study Assessing the Combined Effects of Early Behavioral Intervention and Propranolol on Autism Spectrum Disorder (ASD).

Autism spectrum disorder (ASD), a neurodevelopmental disorder typified by differences in social communication as well as restricted and repetitive behaviors, is often responsive to early behavioral intervention. However, there is limited information on whether such intervention can be augmented with pharmacological approaches. We conducted a double-blinded, placebo-controlled feasibility trial to examine the effects of the ß-adrenergic antagonist propranolol combined with early intensive behavioral intervention (EIBI) for children with ASD. Nine participants with ASD, ages three to ten, undergoing EIBI were enrolled and randomized to a 12-week course of propranolol or placebo. Blinded assessments were conducted at baseline, 6 weeks, and 12 weeks. The primary outcome measures focusing on social interaction were the General Social Outcome Measure-2 (GSOM-2) and Social Responsiveness Scale-Second Edition (SRS-2). Five participants completed the 12-week visit. The sample size was insufficient to evaluate the treatment efficacy. However, side effects were infrequent, and participants were largely able to fully participate in the procedures. Conducting a larger clinical trial to investigate propranolol's effects on core ASD features within the context of behavioral therapy will be beneficial, as this will advance and individualize combined therapeutic approaches to ASD intervention. This initial study helps to understand feasibility constraints on performing such a study.

An Initial Development and Evaluation of a Culturally Responsive Police Interactions Training for Black Adolescents with Autism Spectrum Disorder.

The purpose of the current study was to conduct a qualitative and experimental analysis of a culturally informed police safety skills training for adolescents with autism spectrum disorder (ASD). The current study focused primarily on meeting the unique training needs of Black adolescents with autism spectrum disorder (ASD). A single case design was used to evaluate the initial efficacy and acceptability of a culturally responsive training method. Preliminary evidence about the physiological ramifications of police contact were also collected to begin to examine the broader behavioral and psychophysiological nature of youth's experiences. The current experimental design included in-person simulated contexts that youth, and caregivers, endorsed as relevant to their normal lives, which greatly strengthened the ecological validity of the approach.

Educational and Diagnostic Classification of Autism Spectrum Disorder and Associated Characteristics.

Research continues to highlight discrepancies between clinical diagnoses of Autism Spectrum Disorder (ASD) and determination of special education eligibility for services within school settings. However, limited research has been conducted on the impact of those discrepancies for the identification of appropriate services within schools. The aim of the current study is to examine students' characteristics (e.g., language, social emotional) associated with educational eligibility and clinical diagnoses. More specifically, the study examines characteristics differentially associated with ASD diagnoses to inform targeted evidence-based interventions. The study accessed data from a four-year cluster-randomized trial of 283 students with and without reported ASD diagnosis. The results of the study demonstrate that the educational eligibility of Autism did not differentiate between students with and without autism on any of the measured characteristics including language, peer and social competence, academics, and aggressive behaviors. However, the Autism Diagnostic Observation Schedule, second edition (ADOS-2; Lord et al. in Autism diagnostic observation schedule. Western Psychological Services, Torrance, CA, 2012) classification was a more sensitive diagnostic measure for characteristics associated with autism. Implications for research, practitioners, and schools are discussed.

Influence of homogeneity of student characteristics in a group-based social competence intervention.

Although some literature reviews cited mixed results for group-based social competence interventions in schools, existing descriptions of intervention efficacy often lack attention on important factors that may moderate differential response. Some studies suggest that individual characteristics such as diagnosis (i.e., specific deficit clusters) or behavioral profiles may be important social outcome moderators. Given the interactive nature of group-based interventions, understanding how individual characteristics combine to influence outcomes for the group as a whole is an important next step. By using a multisite cluster randomized control trial (n = 274), the current study explores the impact that varying student characteristics have on outcomes of the Social Competence Intervention for Adolescents (SCI-A; Stichter, Herzog, Owens, & Malugen, 2016; Stichter et al., 2010) compared to outcomes of business-as-usual (BAU) practices. Researchers hypothesized that (a) SCI-A would be more effective than BAU in improving ratings of students' social functioning when students within groups were more similar to each other on relevant diagnostic and behavioral indicators, and (b) that within SCI-A only, more versus less homogenous groups would demonstrate greater social outcome gains. Results offer some support for these hypotheses: SCI-A was more effective in improving social communication and motivation when groups were diagnostically similar (ds > 0.55). Considering changes in social awareness and communication, SCI-A was more effective when groups were heterogeneous on socially competent behavior (ds > 1.32) and less effective when groups were heterogeneous on antisocial behavior (ds > 1.00). The authors discuss the implications and importance of research exploring factors such as group composition that may moderate intervention response in applied settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Brief Report: Flanker Visual Filtering Ability in Older Adolescents with Autism Spectrum Disorder.

Recent research has documented impaired ability to resist interference from visual distractors in individuals with autism spectrum disorder (ASD) and suggests that this phenomenon may be more pronounced in young versus older children (Christ et al., Neuropsychology 25(6):690-701, 2011). The present study extends previous findings by examining visual filtering inhibitory ability within an older adolescent population. A flanker visual filtering task was administered to 36 adolescents with ASD and 44 adolescents without ASD (age: 11-20 years). Analysis revealed no evidence of group differences in visual filtering performance. Taken together with previous research, these results suggest that during early adolescence the previously observed impairment may resolve or compensatory strategies develop, allowing individuals with ASD to perform as well as their neurotypical peers.

Exploring the Moderating Effects of Cognitive Abilities on Social Competence Intervention Outcomes.

Many populations served by special education, including those identified with autism, emotional impairments, or students identified as not ready to learn, experience social competence deficits. The Social Competence Intervention-Adolescents' (SCI-A) methods, content, and materials were designed to be maximally pertinent and applicable to the social competence needs of early adolescents (i.e., age 11-14 years) identified as having scholastic potential but experiencing significant social competence deficits. Given the importance of establishing intervention efficacy, the current paper highlights the results from a four-year cluster randomized trial (CRT) to examine the efficacy of SCI-A (n = 146 students) relative to Business As Usual (n = 123 students) school-based programming. Educational personnel delivered all programming including both intervention and BAU conditions. Student functioning was assessed across multiple time points, including pre-, mid-, and post-intervention. Outcomes of interest included social competence behaviors, which were assessed via both systematic direct observation and teacher behavior rating scales. Data were analyzed using multilevel models, with students nested within schools. Results suggested after controlling for baseline behavior and student IQ, BAU and SCI students differed to a statistically significant degree across multiple indicators of social performance. Further consideration of standardized mean difference effect sizes revealed these between-group differences to be representative of medium effects (d > .50). Such outcomes pertained to student (a) awareness of social cues and information, and (b) capacity to appropriately interact with teachers and peers. The need for additional power and the investigation of potential moderators and mediators of social competence effectiveness are explored.

Social Skills Intervention Participation and Associated Improvements in Executive Function Performance.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication. It has been postulated that such difficulties are related to disruptions in underlying cognitive processes such as executive function. The present study examined potential changes in executive function performance associated with participation in the Social Competence Intervention (SCI) program, a short-term intervention designed to improve social competence in adolescents with ASD. Laboratory behavioral performance measures were used to separately evaluate potential intervention-related changes in individual executive function component processes (i.e., working memory, inhibitory control, and cognitive flexibility) in a sample of 22 adolescents with ASD both before and after intervention. For comparison purposes, a demographically matched sample of 14 individuals without ASD was assessed at identical time intervals. Intervention-related improvements were observed on the working memory task, with gains evident in spatial working memory and, to a slightly lesser degree, verbal working memory. Significant improvements were also found for a working memory-related aspect of the task switching test (i.e., mixing costs). Taken together, these findings provide preliminary support for the hypothesis that participation in the SCI program is accompanied by changes in underlying neurocognitive processes such as working memory.

Assessing, understanding, and supporting students with autism at school: Contemporary science, practice, and policy.

Over the past 3 decades, there has been an unprecedented increase in students identified as eligible for special education as a result of students meeting criteria for autism spectrum disorder (ASD). The increasing number of students with ASD in the schools presents significant challenges to teachers, school psychologists, and other school professionals working with this population. Although there is considerable research addressing assessment, identification, and support services for children with ASD, there is a need for further research focused on these topics within the school context. Employing a diverse array of methodologies, the articles in this special topic section address several gaps in the literature, including (a) the application of evidence-based programs within the school context, (b) the social validity of well-established evidence-based practices with both parents and educators, (c) the assessment of social communication, (d) intervention and assessment of spatial and body awareness for children with ASD, (e) the use of peer-mediated discreet trial training, and (f) discrepancies across informants for both externalizing and internalizing symptoms associated with ASD. The results of these studies provide school psychologists and other education professionals with specific directions for advocacy and service delivery that aim to enhance school outcomes for students with ASD. (PsycINFO Database Record

Effects of propranolol on conversational reciprocity in autism spectrum disorder: a pilot, double-blind, single-dose psychopharmacological challenge study.

RATIONALE: Pharmacological intervention for autism spectrum disorder (ASD) is an important addition to treatment, yet currently available agents target co-morbid psychiatric concerns, such as aggression and irritability. Propranolol, a beta-adrenergic antagonist with anxiolytic effects, has been shown to improve verbal fluency and working memory in adults and adolescents with ASD in single-dose challenges. OBJECTIVES: The present pilot study explores the acute effects of propranolol on a measure of conversational reciprocity in this population. We also examined whether autonomic activity and anxiety moderate or mediate response to the drug, given relationships between these variables and ASD, as well as the drug's effects. METHODS: In a within-subject crossover design, 20 individuals with ASD received a single dose of propranolol or placebo during two sessions in a double-blinded, counterbalanced manner. After drug administration, participants performed a conversational reciprocity task by engaging in a short conversation with the researcher. Measurements of autonomic activity and anxiety were obtained before and after drug administration. RESULTS: Propranolol significantly improved performance on the conversational reciprocity task total [d = 0.40] and nonverbal communication domain scores when compared to the placebo condition. However, neither autonomic activity nor anxiety was significantly associated with drug response. CONCLUSIONS: Acute propranolol administration improved conversational reciprocity in ASD. Further exploration of these preliminary findings, as well as other potential treatment response predictors, with serial doses is warranted.

Reliability of Direct Behavior Ratings - Social Competence (DBR-SC) data: How many ratings are necessary?

The purpose of this investigation was to evaluate the reliability of Direct Behavior Ratings-Social Competence (DBR-SC) ratings. Participants included 60 students identified as possessing deficits in social competence, as well as their 23 classroom teachers. Teachers used DBR-SC to complete ratings of 5 student behaviors within the general education setting on a daily basis across approximately 5 months. During this time, each student was assigned to 1 of 2 intervention conditions, including the Social Competence Intervention-Adolescent (SCI-A) and a business-as-usual (BAU) intervention. Ratings were collected across 3 intervention phases, including pre-, mid-, and postintervention. Results suggested DBR-SC ratings were highly consistent across time within each student, with reliability coefficients predominantly falling in the .80 and .90 ranges. Findings further indicated such levels of reliability could be achieved with only a small number of ratings, with estimates varying between 2 and 10 data points. Group comparison analyses further suggested the reliability of DBR-SC ratings increased over time, such that student behavior became more consistent throughout the intervention period. Furthermore, analyses revealed that for 2 of the 5 DBR-SC behavior targets, the increase in reliability over time was moderated by intervention grouping, with students receiving SCI-A demonstrating greater increases in reliability relative to those in the BAU group. Limitations of the investigation as well as directions for future research are discussed herein. (PsycINFO Database Record

iSocial: delivering the Social Competence Intervention for Adolescents (SCI-A) in a 3D virtual learning environment for youth with high functioning autism.

One consistent area of need for students with autism spectrum disorders is in the area of social competence. However, the increasing need to provide qualified teachers to deliver evidence-based practices in areas like social competence leave schools, such as those found in rural areas, in need of support. Distance education and in particular, 3D Virtual Learning, holds great promise for supporting schools and youth to gain social competence through knowledge and social practice in context. iSocial, a distance education, 3D virtual learning environment implemented the 31-lesson social competence intervention for adolescents across three small cohorts totaling 11 students over a period of 4 months. Results demonstrated that the social competence curriculum was delivered with fidelity in the 3D virtual learning environment. Moreover, learning outcomes suggest that the iSocial approach shows promise for social competence benefits for youth.

Social Competence Intervention for Parents (SCI-P): Comparing Outcomes for a Parent Education Program Targeting Adolescents with ASD.

Research has shown that parent education programs can address some of the distinct challenges that parents of youth with autism spectrum disorders (ASDs) encounter. This study examined the effectiveness of the Social Competence Intervention for Parents (SCI-P), a parent education program, administered in conjunction with a social competence intervention that targeted youth with ASD ages 11-14 (SCI-A). Using a quasi-experimental pre-post design, parents were assigned to either the SCI-P group (n = 16) or to the waitlist comparison group (n = 10). Analyses of covariance (ANCOVAs) revealed a significant effect for parent education participation such that SCI-P participants experienced significantly greater reductions in levels of stress and a trend for increases in parenting sense of competence from pre- to post-intervention. Moreover, parents in the SCI-P group reported high satisfaction with the program. These findings suggest that parent education can result in positive outcomes for parents' well being.

Social competence intervention for elementary students with Aspergers syndrome and high functioning autism.

Despite frequent reports of academic success, individuals with high functioning autism or Aspergers Syndrome (HFA/AS) often manifest deficits in social abilities. These deficits can lead to daily difficulties, and negative long-term outcomes. Deficits in social competency are evident in this population from an early age, as children with HFA/AS present unique challenges relating to peers, interpreting complex contextual cues, and transitioning across settings. A paucity of social interventions exist that target elementary-age children with HFA/AS and their combination of core social competence deficit areas: theory of mind (ToM), emotional recognition, and executive functioning. The current study expanded on the Social Competence Intervention (for adolescents; SCI-A), as detailed in Stichter et al. (J Autism Dev Disorders 40:1067-1079, 2010), by adjusting the curriculum to meet the needs of an elementary population. Results indicate significant improvements on direct assessments measuring theory of mind and problem solving, and parent perceptions of overall social abilities and executive functioning for 20 students, aged 6-10, with HFA/AS. The elementary SCI program appears promising, however, additional replications are necessary including expansion to school settings.

An initial investigation of the generalization of a school-based social competence intervention for youth with high-functioning autism.

This study evaluated the impact of generalization of the Social Competence Intervention-Adolescent (SCI-A) curriculum in a school setting for individuals with high-functioning autism or Asperger's Syndrome (N = 6). This study examined to what degree the generalization of the SCI-A curriculum could be measured when delivered in a school setting. Across the six participants preliminary results suggest improvement on teacher reports of social skills and executive functioning. Some improvements were also evident in direct measures of facial-expression recognition. Data collected in the nonintervention settings indicated that some generalization of social interaction skills may have occurred for all six participants. Future research directions are discussed.

Social competence intervention for youth with Asperger Syndrome and high-functioning autism: an initial investigation.

Individuals with high functioning autism (HFA) or Asperger Syndrome (AS) exhibit difficulties in the knowledge or correct performance of social skills. This subgroup's social difficulties appear to be associated with deficits in three social cognition processes: theory of mind, emotion recognition and executive functioning. The current study outlines the development and initial administration of the group-based Social Competence Intervention (SCI), which targeted these deficits using cognitive behavioral principles. Across 27 students age 11-14 with a HFA/AS diagnosis, results indicated significant improvement on parent reports of social skills and executive functioning. Participants evidenced significant growth on direct assessments measuring facial expression recognition, theory of mind and problem solving. SCI appears promising, however, larger samples and application in naturalistic settings are warranted.

The use of structural analysis to develop antecedent-based interventions for students with autism.

Evidence continues to maintain that the use of antecedent variables (i.e., instructional practices, and environmental characteristics) increase prosocial and adaptive behaviors of students with disabilities (e.g., Kern et al. in J Appl Behav Anal 27(1):7-19, 1994; Stichter et al. in Behav Disord 30:401-418, 2005). This study extends the literature by systematically utilizing practitioner-implemented structural analyzes within school settings to determine antecedent variables affecting the prosocial behavior of students with autism. Optimal antecedents were combined into intervention packages and assessed utilizing a multiple baseline design across settings. All three students demonstrated improvement across all three settings. Rates of engagement and social interaction were obtained from classroom peers to serve as benchmark data. Findings indicate that practitioners can implement structural analyzes and design corresponding interventions for students with ASD within educational settings.

A descriptive analysis of intervention research in emotional and behavioral disorders from 1980 through 1999.

The current study was conducted to examine the trends involved with experimental intervention research designed to modify behaviors of children and youth with emotional and/or behavioral disorders (EBD). Trends are summarized and compared to the intervention research that has been conducted in developmental disabilities (DD). The contents of 10 journals published between 1980 and 1999 were analyzed. Descriptive dimensions of the research including participant demographics, settings, research designs, dependent and independent variables, intervention agents, and measures of ecological validity were investigated. In addition, the databases were examined to determine whether interventions were based on individualized processes of assessment. The results showed strikingly similar trends across interventions with EBD and DD participants. The discussion addresses the general status of intervention research across both populations, as well as the importance of extending the current research to examine additional variables and measures with various populations.