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The purpose of this study was to identify evidenced-based, focused intervention practices for children and youth with autism spectrum disorder. This study was an extension and elaboration of a previous evidence-based practice review reported by Odom et al. (Prev Sch Fail 54:275–282, 2010b, doi:
 10.1080/10459881003785506
 ). In the current study, a computer search initially yielded 29,105 articles, and the subsequent screening and evaluation process found 456 studies to meet inclusion and methodological criteria. From this set of research studies, the authors found 27 focused intervention practices that met the criteria for evidence-based practice (EBP). Six new EBPs were identified in this review, and one EBP from the previous review was removed. The authors discuss implications for current practices and future research.

Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review.

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Handbook of the International Phonetic Association: A Guide to the Use of the International Phonetic Alphabet

Initially thought to be virtually free of negative effects, benzodiazepines are now known to carry risks of dependence, withdrawal, and negative side effects. Among the most controversial of these side effects are cognitive effects. Long-term treatment with benzodiazepines has been described as causing impairment in several cognitive domains, such as visuospatial ability, speed of processing, and verbal learning. Conversely, long-term benzodiazepine use has also been described as causing no chronic cognitive impairment, with any cognitive dysfunction in patients ascribed to sedation or inattention or considered temporary and associated with peak plasma levels. Complicating the issue are whether anxiety disorders themselves are associated with cognitive deficits and the extent to which patients are aware of their own cognitive problems. In an attempt to settle this debate, meta-analyses of peer-reviewed studies were conducted and found that cognitive dysfunction did in fact occur in patients treated long term with benzodiazepines, and although cognitive dysfunction improved after benzodiazepines were withdrawn, patients did not return to levels of functioning that matched benzodiazepine-free controls. Neuroimaging studies have found transient changes in the brain after benzodiazepine administration but no brain abnormalities in patients treated long term with benzodiazepines. Such findings suggest that patients should be advised of potential cognitive effects when treated long term with benzodiazepines, although they should also be informed that the impact of such effects may be insignificant in the daily functioning of most patients.

/pdf/the-effects-of-benzodiazepines-on-cognition-1vjy5hj3lf.pdf

The effects of benzodiazepines on cognition.

Evidence to support stimulus–stimulus pairing (SSP) in speech acquisition is less than robust, calling into question the ability of SSP to reliably establish automatically reinforcing properties of speech and limiting the procedure's clinical utility for increasing vocalizations. We evaluated the effects of a modified SSP procedure on low-frequency within-session vocalizations that were further strengthened through programmed reinforcement. Procedural modifications (e.g., interspersed paired and unpaired trials) were designed to increase stimulus salience during SSP. All 3 participants, preschoolers with autism, showed differential increases of target over nontarget vocal responses during SSP. Results suggested an automatic reinforcement effect of SSP, although alternative interpretations are discussed, and suggestions are made for future research to determine the utility of SSP as a clinical intervention for speech-delayed children.

/pdf/evaluation-of-an-enhanced-stimulus-stimulus-pairing-3relkz0tm0.pdf

Evaluation of an enhanced stimulus–stimulus pairing procedure to increase early vocalizations of children with autism

Many children with autism do not imitate adult vocalizations, an important skill in learning to talk. Pairing adult vocalizations with preferred stimuli has been shown to increase free-operant vocalizations but effects are temporary; thus, direct reinforcement may be necessary to establish durable vocal behaviors. In Experiment 1, directly reinforced echoic responses did not increase following stimulus-stimulus pairings in three children with autism. Similarly, pairings did not increase free-operant vocalizations in Experiment 2, a replication of Miguel et al. (2002). Experiment 3 demonstrated that shaping increased vowel frequency for one participant. Results suggest that variables are yet to be delineated that influence effectiveness of a stimulus-stimulus pairing procedure on vocalization frequency and acquisition of a verbal operant following such pairings.

/pdf/evaluating-stimulus-stimulus-pairing-and-direct-5f5v1a3lk8.pdf

Evaluating stimulus-stimulus pairing and direct reinforcement in the establishment of an echoic repertoire of children diagnosed with autism.

Secretin is used in the United States for diagnosis of pancreatic gastrointestinal (GI) dysfunction and disease. Repeated therapeutic use has not been approved. Widespread interest in secretin as a treatment for autism followed media reports of behavioral improvements in an autistic child who received the hormone during a GI diagnostic procedure. International demand for secretin soared in the absence of experimental evidence of its efficacy for autism. This review presents a brief history of secretin's rise to popularity and summarizes research on secretin as a treatment for autism. Seventeen studies are reviewed comparing the effects of secretin forms, dosage levels, and dosing intervals on outcome measures with approximately 600 children. Twelve of 13 placebo-controlled studies failed to demonstrate the differential efficacy of secretin. Implications for advocating treatment in the absence of empirical evidence are discussed.

Secretin as a treatment for autism: a review of the evidence.

Variability has been demonstrated to be an operant dimension of behavior (Neuringer, 2002; Page & Neuringer, 1985). Recently, lag schedules have been used to demonstrate operant variability of verbal behavior in persons with a diagnosis of autism (e.g., Lee, McComas, & Jawor, 2002). The current study evaluated the effects of a Lag 1 schedule on the vocal variability of 2 nonverbal children with a diagnosis of autism. Results showed systematic increases in variability during the Lag 1 schedule. Implications of lag schedules for speech and language training are discussed.

/pdf/increasing-vocal-variability-in-children-with-autism-using-a-532jakumek.pdf

Increasing vocal variability in children with autism using a lag schedule of reinforcement

Introduction As practitioners concerned with treating speech-language disorders, one of our primary goals is to accurately and efficiently determine which communication skills should be targeted for intervention. How do we know when something needs to be taught? What defines a skill deficit or a communication breakdown ? In everyday terms, a speech-language problem is signaled when a breakdown occurs in the interaction between a speaker and a listener. That is, we say that communication is successful when the outcome of an interaction is effective (i.e., functional), but when the interaction is weak and ineffective, we suspect a deficit in the repertoire of one of the communication partners. Thus, the critical aspect that defines communicative competence lies in the success of the dyad, a dynamic process comprised of functional units of discourse between a speaker and a listener, even when these roles are assumed within a single individual (e.g., Lodhi & Greer, 1989; Palmer, 1998; Skinner, 1957). Despite the fundamentally social nature of communication, assessment tools for speech-language deficits rarely take into account this requisite speaker-listener unit, nor is it routine to test for, describe, or analyze specific breakdowns in this unit. Most speech-language assessments in widespread use today evaluate response topographies (forms of responses) alone, without regard for a functional analysis of the causal variables that lead to the specific topographic features of responses. Indeed, much assessment time and energy is expended in classifying speech-language performance, not by its role within a unit of functional communication between a speaker and a listener (i.e., cause and effect), but instead only by its arbitrarily-labeled categories describing non-function based properties such as word structure (e.g., nouns, verbs, plurals), modality (expressive, receptive), relationship (e.g., antonyms/synonyms, agreement), or other inferred characteristics (e.g., ellipsis, nomination, phonological process). This focus is illustrated by ASHA's (1993) definition of language disorder as an impairment in "comprehension and/or use of spoken, written, and/or other symbol systems. The disorder may involve (1) the form of language (phonology, morphology, and syntax), (2) the content of language (semantics), and/or (3) the function of language in communication (pragmatics) in any combination." Although function is an element of this definition, this usage of the term refers to a linguistic feature of language (pragmatics) in contrast to Skinner's analysis of function in which environmental variables describe (and thus, define) the contingent relation that accounts for each particular instance of an utterance (i.e., language). As such, linguistic descriptions are less adequate for applied work (i.e., treatments) than is Skinner's model, which specifies the variables that evoke and strengthen verbal behavior. To be sure, a thorough topographic description of an individual's speech-language repertoire may be a necessary component to plan an appropriate therapy program, but it is insufficient to accomplish the task because a key element of the evaluation is missing. Our job during assessment is to document not merely occurrences of wrong responses to assessment items, but also the speaker-listener environment (antecedent and consequent variables) in which the topography occurs. If a functional analysis of the speaker-listener exchange is omitted from the assessment, a critical part of language learning is at risk of being excluded from an effective intervention plan (Damico, 1993; Frost & Bondy, 2006; LaRue, Weiss, & Cable, 2008; Rowland & Schweigert, 1993; Spradlin & Siegel, 1982; Sundberg, 2008). Meaning defined by environmental context. The meaning of verbal behaviors is a function of their controlling variables (Hegde, 2008; Skinner, 1957). Speakers and listeners do not "make mistakes," "use the wrong word," or "fail to generalize" in the ordinary sense. …

Speech and language assessment: A verbal behavior analysis.

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