Enhancement of Social Communication Behaviors in Young Children With Autism Affects Maternal Stress.

Children with autism spectrum disorder (ASD) show difficulties in social communication behaviors, emotion regulation and daily living skills, and they frequently present with challenging behaviors. In parents of children with ASD, higher rates of stress and mental health problems have been reported than in parents of either typically developing children or children with other conditions. In this study, we tested whether maternal well-being changes with improved social communicative behaviors of children with ASD receiving early intervention. We examined developmental changes in 72 pre-schoolers and stress levels in their mothers (measured by the Parental Stress Inventory) before and after a 12-month community-based intervention program based on the Early Start Denver Model, a naturalistic developmental behavioral intervention targeting social communication. Multiple regression analyses showed that maternal child-related stress was predicted by changes in children's social communication behaviors (measured with the Pervasive Developmental Disorder Behavior Inventory). Gains in the early social communication behavior domain were the strongest predictor of post-intervention child-related maternal stress, surpassing adaptive behavior, language and non-verbal cognitive gains, and reduction in challenging behavior. These findings support the hypothesis that, in children with ASD, the acquisition of social communication behaviors contribute to improvements in maternal well-being.

Social-communicative gestures at baseline predict verbal and nonverbal gains for children with autism receiving the Early Start Denver Model.

LAY ABSTRACT: Although there is growing evidence of the effectiveness and importance of certain early intervention programs for children with autism spectrum disorders, little is known about predictive information before intervention to search for the most accurate therapeutic approach for the individual child and his family. In children with autism spectrum disorder, atypical gesture use is one core deficit with consequences for the development of social interaction and language, but there is little knowledge about the relevance of early gesture use in predicting developmental outcomes of children receiving early interventions targeting social-communicative behaviors such as the Early Start Denver Model. In this study, we found that the parent-rated "Gestural Approach Behavior" subscale of the Pervasive Developmental Disorder Behavior Inventory was predictively associated with clinically assessed developmental changes after 1 year of intervention. This subscale was as strong a predictor as nonverbal development before intervention. Our findings suggest that children who use more gestures in daily life might be better equipped to respond to learning opportunities offered by early interventions targeting social communication strategies such as the Early Start Denver Model. Furthermore, we conclude that the parent-rated questionnaire might be a valuable and economic set of questions with high relevance for clinical assessments.

Feasibility and Outcomes of the Early Start Denver Model Implemented with Low Intensity in a Community Setting in Austria.

OBJECTIVE: To investigate the feasibility and effectiveness of early autism intervention with the Early Start Denver Model (ESDM) implemented with low intensity in a community service in Europe. METHODS: Subjects were boys (n = 13, ages 34-54 months, mean age 43.3 months) consecutively diagnosed with autism spectrum disorder in a regional autism center in Austria. The subjects either received the ESDM intervention for 4.6 hours weekly over 12 months (n = 7) or intervention as usual (n = 6). Feasibility of the ESDM intervention was evaluated by parent and teacher questionnaires, ESDM fidelity measures, and therapists' feedback. Developmental status was assessed through standardized instruments (Mullen Scales of Early Learning [MSEL], Vineland Adaptive Behavior Scales Second Edition, Communicative Development Inventory, Pervasive Developmental Disorder Behavior Inventory [PDDBI], Parenting Sense of Competence Scale) at baseline and after intervention. RESULTS: The ESDM intervention was delivered with high fidelity (>80%) by a newly trained multiprofessional team. Acceptability by parents was rated as high. The ESDM was considered to be compatible with both family and preschool routines without any major adaptations. The ESDM group showed a trend toward improved receptive language (MSEL receptive language; p = 0.09, effect size [ES] = 0.72) and reduction in parent-reported core autism symptoms (PDDBI Autism Composite Score; p = 0.04; ES = 0.95). No such improvement was noted in the control group. CONCLUSION: Low-intensity implementation of the ESDM in a non-English-speaking community service context is feasible. Although outcomes from this small feasibility study should be interpreted with caution, our findings suggest a more favorable response to the ESDM intervention group compared with the control group.

Automatic chest compression devices--when do they make sense?

The current resuscitation guidelines of the European Resuscitation Council do not include automatic chest compression devices (ACDs) as standard equipment to support cardiopulmonary resuscitation attempts. One possible reason could be the lack of a list of indications and contraindications for the use of ACD systems. This review should give a summary of current studies and developments according to ACD systems and deliver a list of possible applications. Furthermore, we discuss some ethical problems with cardiopulmonary resuscitation attempts and, in particular, with ACD systems. The use of ACDs occurs instead of manual chest compression. Because of this, there is no reason for changing the current guidelines, especially termination recommendations while using ACD systems. From our point of view, ACDs are a very good supplement to the current standard of resuscitation according to the European Resuscitation Council guidelines.