effective interventions for children and adolescents with autism spectrum disorders and other ...

327 Pages·2016·2.61 MB·English

by  Natasha Anne Elliott

EFFECTIVE INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH AUTISM SPECTRUM
DISORDERS AND OTHER SPECIAL EDUCATIONAL NEEDS

by
NATASHA ANNE ELLIOTT

A thesis submitted to the University of Birmingham for the degree of DOCTOR OF
PHILOSOPHY

School of Psychology
College of Life and Environmental Sciences
University of Birmingham
October 2015
University of Birmingham Research Archive

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ABSTRACT

The need for cost-effective interventions for individuals with Autism Spectrum Disorders
(ASD) and related conditions is growing rapidly. Recent research suggests that only a
limited number of individuals who are eligible for intervention are actually receiving such
services. This thesis first discusses the current evidence-base for interventions aimed at
young children with ASD. It then outlines a frequent oversight in the literature regarding
motor development and resonance difficulties in this population, which forms the basis for
developing motor-based interventions for these individuals. Two large-scale experimental
school-based studies are then presented which examine the effects of an ABA-based high-
intensity physical exercise as an effective intervention for children with ASD and other
Special Educational Needs (SEN). In one study, this intervention is compared with a low-
intensity exercise program. Results indicate that high-intensity physical exercise results in
significant short-term (0-to-90 minute), but not long-term (24 hours+), improvements in
cognitive/behavioral flexibility (executive functions) in students with ASD and students
with SEN. Furthermore, both high-intensity and low-intensity exercise resulted in
significant reductions in stress, in both the short-term and long-term in students with ASD
and students with SEN. These findings provide direct evidence for the effectiveness of
physical exercise as a school-based intervention.
To my Grandpa and Dad who we lost during this process, and to my Mum who has
supported me through everything: this is for you.
ACKNOWLEDGMENTS

I would first like to express to my sincere gratitude to my supervisor, Dr. Joe McCleery, whose trust,
enthusiasm and guidance encouraged me throughout this process. For taking me on straight from
my Undergraduate and for helping me achieve so much along the way, I am forever grateful. Thank
you to Dr. Sarah Beck for her valued supervision, to Dr. Jackie Blissett for her input when these
projects were beginning, and to Dr. Colin Ard and Dr. Emma Gowen for their appreciated advice in
the final stages of this journey.
I’d also like to thank Dr. Rosy Matos and Dr. Lynn Koegel, who have been my inspirations in this
field since I was fortunate enough to join them as an Intern. I would not be where I am today if it
wasn’t for you. Thank you for believing in me when I was just getting started in this field.
To Dani, Hannah, Mitchel, Zoe, Chloe and Molly: I could not have asked for better research
assistants. Thank you for all of your hard work, and for being brilliant with the children.
To my fellow office and lab buddies who made this experience great. Special thanks to Catherine
Darnell for keeping me sane during the writing process, and to Kelly Leyden for making my
transition into PhD life one of the most fun years ever.
Thank you to the school, the children and the teachers who participated in this research. Allowing
us to work alongside you is the reason this has been a success.
Finally, words cannot express how eternally thankful I am to Jasper and my family. Thank you to
James for putting up with me; to my Grandma, Karen and Graham for their encouragement; to my
Grandpa for inspiring me to become a researcher; to my Dad for always telling me how proud he
is, and to my Mum for her endless support in everything I do – you are the reason I got through it
all and I appreciate you more than you know. Finally, thank you to my husband Jasper, for his
understanding, support, and staying by me through everything. Here’s to the next adventure.
TABLE OF CONTENTS

CHAPTER 1: THESIS INTRODUCTION ................................................................................ .1
CHAPTER 2: A SYSTEMATIC REVIEW OF EVIDENCE SUPPORTING EARLY INTERVENTION
FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS .................................................... 5
2.1. Introduction ............................................................................................................... 6
2.1.1. Evidence-Base for Early Intervention for Autism Spectrum Disorders .................. 7
2.1.1.1. Behavioural Interventions ............................................................................. 9
2.1.1.2. Developmental Interventions ..................................................................... 15
2.1.1.3. Developmental-Behavioural Interventions .................................................. 21
2.2. Limitations of the Current Autism Early Intervention Literature ............................... 25
Randomization of Participants to Treatment Conditions ............................................. 26
2.3. Parent-Mediated Versus Therapist-Mediated Intervention ...................................... 29
2.4. Real-World Translation ............................................................................................. 31
2.6. Summary .................................................................................................................. 33
CHAPTER 3: MOTOR DEVELOPMENT AND MOTOR RESONANCE DIFFICULTIES IN
AUTISM: IMPLICATIONS FOR EARLY INTERVENTION FOR LANGUAGE AND
COMMUNICATION SKILLS……. ........................................................................................ 68
3.1. Introduction ............................................................................................................. 69
3.2. Early Motor Development in Autism ........................................................................ 71
3.3. Motor Resonance Deficits in Individuals with Autism ............................................... 77
3.4. Interventions ............................................................................................................ 82
3.4.1. Augmentative and Alternative Communication (AAC) Interventions .................. 86
3.4.1.1. Sign language training ................................................................................. 86
3.4.1.2. Picture exchange communication system (PECS) ........................................ 89
3.4.2. Motor-Based Behavioural Interventions ........................................................... 94
3.4.2.1. Prompts for restructuring oral muscular phonetic targets (PROMPT).......... 94
3.4.2.2. Auditory motor mapping training ............................................................... 97
3.4.3. Electromagnetic Brain Stimulation Interventions ............................................... 98
3.4.3.1. Transcranial direct current stimulation and transcranial magnetic stimulation
................................................................................................................................ 98
3.4.4. Interventions Targeting Synchronous Motor Activities .................................... 101
3.4.4.1. Early Start Denver Model (ESDM) ............................................................. 102
3.4.4.2. Reciprocal imitation training (RIT) ............................................................. 103
3.5. Discussion and Future Directions............................................................................ 106
3.6. Conclusion.............................................................................................................. 110
CHAPTER 4: THE EFFECT OF STRUCTURED EXERCISE INTERVENTIONS ON THE REPORTED
STRESS OF SCHOOL-AGED CHILDREN WITH AUTISM SPECTRUM DISORDERS AND OTHER
SPECIAL EDUCATIONAL NEEDS ..................................................................................... 112
4.0.1. Introduction ........................................................................................................ 113
4.0.1.1. Behavioural Evidence ................................................................................... 115
4.0.1.2. Physiological Explanations ............................................................................ 120
4.0.1.3. Temporal properties ..................................................................................... 123
4.0.1.4. Intensity ....................................................................................................... 124
4.0.1.5. Summary ...................................................................................................... 124
CHAPTER 4A: STUDY 1 - THE EFFECTS OF AN ACUTE EXERCISE INTERVENTION ON SELF-
REPORTED STRESS IN SCHOOL-AGED CHILDREN WITH ASD AND OTHER SEN .............. 126
4.1.1. Introduction ........................................................................................................ 126
4.1.1.1. Study aims and hypothesis ........................................................................... 130
4.1.2. Methods .............................................................................................................. 131
4.1.2.1. Participants .................................................................................................. 131
4.1.2.2. Design .......................................................................................................... 132
4.1.2.3. Measures ...................................................................................................... 133
4.1.2.4. Procedure ..................................................................................................... 137
4.1.3. Results ................................................................................................................ 140
4.1.3.1. Session Order ............................................................................................... 140
4.1.3.2. Heart Rate .................................................................................................... 140
4.1.3.3. Stress ............................................................................................................ 141
4.1.3.4. Exercise Enjoyment Survey ........................................................................... 142
4.1.4. Discussion ........................................................................................................... 144
CHAPTER 4B: STUDY 2 - THE EFFECTS OF A CHRONIC EXERCISE INTERVENTION ON SELF-
REPORTED STRESS IN SCHOOL-AGED CHILDREN WITH ASD AND OTHER SEN .............. 151
4.2.1. Introduction ........................................................................................................ 151
4.2.1.1. Behavioural Evidence ................................................................................... 151
4.2.1.2. Exercise Intensity: Does it matter?................................................................ 153
4.2.1.3. Study aims and hypothesis ........................................................................... 155
4.2.2. Methods .............................................................................................................. 156
4.2.2.1. Participants .................................................................................................. 156
4.2.2.2. Design .......................................................................................................... 158
4.2.2.3. Measures ...................................................................................................... 160
4.2.2.4. Procedure ..................................................................................................... 160
4.2.3. Results ................................................................................................................ 161
4.2.3.1. Session Order ............................................................................................... 161
4.2.3.2. Heart Rate .................................................................................................... 161
4.2.3.3. Stress ............................................................................................................ 162
4.2.3.4. Exercise Enjoyment Survey ........................................................................... 164
4.2.4. Discussion ........................................................................................................... 165
CHAPTER 5: THE EFFECT OF A STRUCTURED EXERCISE INTERVENTION ON THE
EXECUTIVE FUNCTION PERFORMANCE OF SCHOOL-AGED CHILDREN WITH AUTISM
SPECTRUM DISORDERS AND OTHER SPECIAL EDUCATIONAL NEEDS .......................... 170
5.0.1. Introduction ........................................................................................................ 171
5.0.1.1. Behavioural Evidence: Acute Physical Exercise.............................................. 173
5.0.1.2. Behavioural Evidence: Chronic Physical Exercise ........................................... 176
5.0.1.3. Mechanisms Underpinning EF and Physical Exercise ..................................... 179
5.0.1.3.1. Physiological explanations ..................................................................... 179
5.0.1.3.2. Psychological Explanations..................................................................... 184
5.0.1.3.3. Complex motor movements .................................................................. 186
5.0.1.4. Temporal Properties ..................................................................................... 187
5.0.1.5. Summary ...................................................................................................... 189
CHAPTER 5A: STUDY 1 - THE EFFECTS OF AN ACUTE EXERCISE INTERVENTION ON EF
PERFORMANCE IN SCHOOL-AGED CHILDREN WITH ASD AND OTHER SEN ................... 191
5.1.1. Introduction ........................................................................................................ 191
5.1.1.1. Study aims and hypothesis ........................................................................... 194
5.1.2. Methods .............................................................................................................. 194
5.1.2.1. Participants .................................................................................................. 194
5.1.2.2. Measures ...................................................................................................... 195
5.1.2.3. Procedure ..................................................................................................... 198
5.1.3. Results ................................................................................................................ 199
5.1.3.1. Statistical Analysis ........................................................................................ 199
5.1.3.2. Pictures Task................................................................................................. 200
5.1.3.3. Arrows Task .................................................................................................. 202
5.1.3.4. Eyes Task ...................................................................................................... 204
5.1.4. Discussion ........................................................................................................... 208
CHAPTER 5B: STUDY 2 - THE EFFECTS OF A CHRONIC EXERCISE INTERVENTION IN
SCHOOL-AGED CHILDREN WITH ASD AND OTHER SEN…… ........................................... 215
5.2.1. Introduction ........................................................................................................ 215
5.2.1.2. Study aims and hypothesis ........................................................................... 219
5.2.2. Methods .............................................................................................................. 219
5.2.2.1. Participants .................................................................................................. 219
5.2.2.2. Measures ...................................................................................................... 220
5.2.2.3. Procedure ..................................................................................................... 220
5.2.3. Results ................................................................................................................ 220
5.2.3.1. Statistical Analysis ........................................................................................ 220
5.2.3.2. Pictures Task................................................................................................. 220
5.2.3.3. Arrows Task .................................................................................................. 222
5.2.3.4. Eyes Task ...................................................................................................... 224
5.2.4. Discussion ........................................................................................................... 228
CHAPTER 6: GENERAL DISCUSSION .............................................................................. 233
6.1. Introduction ........................................................................................................... 235
6.2. Stress ..................................................................................................................... 237
6.3. Executive Functioning ............................................................................................ 240
6.4. Strengths and Limitations ....................................................................................... 246
6.5. Future Directions.................................................................................................... 252
6.6. Summary ................................................................................................................ 253
TABLES

Chapter 2
Table 1. Intervention Ingredients for Behavioural, Developmental-Behavioural, and
Developmental Interventions .......................................................................................... 36
Table 2. Evidence-base for ASD-targeted interventions .................................................. 45
Table 3. Evidence-base for ASD-targeted interventions - additional information ............ 56
Chapter 3
Table 4. Brain regions and mechanisms associated with motor aspects of language
development .................................................................................................................. 78
Table 5. Levels of evidence for each intervention ........................................................... 83
Chapter 4
Table 6. Exercise session framework ............................................................................. 303
Table 7. Participant demographics: Study 1 .................................................................. 131
Table 8. Scores on the SSS at education as usual and post-intervention ........................ 141
Table 9. Scores on the PPEQ at education as usual and intervention............................. 142
Table 10. Responses to “Do you enjoy physical exercise classes in school?” ................. 142
Table 11. Frequency of responses given for exercise class enjoyment or non-enjoyment
segregated by response category .................................................................................. 144
Table 12. Participant demographics: Study 2 ................................................................ 156
Table 13. Scores on the SSS at education as usual and intervention .............................. 162
Table 14. Scores on the PPEQ at education as usual and intervention........................... 163
Table 15. Responses to “Do you enjoy physical exercise classes in school?” in the AE
group ............................................................................................................................ 164