Initial Outcomes of a RCT of a Comprehensive School-Based Intervention for Children with HFASD

Saturday, May 13, 2017: 12:00 PM-1:40 PM
Golden Gate Ballroom (Marriott Marquis Hotel)
J. D. Rodgers1, C. Lopata1, M. L. Thomeer1, J. P. Donnelly1, C. A. McDonald1, H. Wang2 and T. Smith3, (1)Canisius College, Institute for Autism Research, Buffalo, NY, (2)University of Rochester, Rochester, NY, (3)University of Rochester Medical Center, Rochester, NY

There are few evidence-based interventions for the social, social-communication, and behavioral deficits of children with ASD who have relative strengths in cognitive and language domains, i.e., high-functioning ASD (HFASD). School-based interventions for children with HFASD present an opportunity to address these deficits. Previous studies have supported the feasibility and initial efficacy of the current intervention protocol (Lopata et al., 2010; 2012).


This study reports the initial results (years one and two) of an ongoing four-year randomized controlled trial (RCT) of a comprehensive school-based intervention (schoolMAX) for children with HFASD.


Participants: The sample included 54 children, aged 6-12 with HFASD (28 children in the treatment condition and 26 children in a “business-as-usual” control condition). Random assignment was at the school level with 8 schools each in the treatment and control condition. Participants had a prior clinical diagnosis of ASD, a WISC-IV short-form full-scale IQ >70 (at least one composite, VCI or PRI >80), and a CASL expressive or receptive language score >75. All diagnoses were confirmed using the ADI-R.

Measures: Adapted Skillstreaming Checklist (ASC, completed by Parent and Teacher), Social Responsiveness Scale - Second edition (SRS-2, completed by Parent and Teacher), Cambridge - Mindreading Face-Voice Battery for Children (CAM-C, Faces and Voices), and the Social Interaction Observation Scale (SIOS).

Procedures: The 10-month schoolMAX intervention included social skills groups, therapeutic activities, computerized instruction in emotion recognition, an individualized behavioral plan, and parent training. The intervention was conducted by school staff with elements integrated into the school day. A manualized training and consultation model was used to monitor and ensure ongoing intervention fidelity in treatment condition schools (Thomeer et al., 2015). Control condition schools were monitored for the presence of elements of treatment fidelity using the same manualized forms. Ratings scales, CAM-C testing, and SIOS observations were completed pre- and post-treatment.


In treatment schools, intervention fidelity averaged 91% or higher for each intervention element. In control schools, elements of intervention fidelity averaged less than 8% across elements. Hierarchical models (adjusting for full-scale IQ and school socioeconomic status) were used to evaluate the impact of treatment condition on change scores. In this initial evaluation of RCT outcomes, four of the seven measures indicated significant treatment effects (p < .05). Specifically, parent-rated ASC indicated increased use of targeted social skills, teacher-rated SRS-2 indicated reduced ASD symptoms, and CAM-C Faces and Voices testing both showed increased emotion recognition skills for the treatment relative to control participants.


Initial results suggest efficacy for the schoolMAX intervention. Four of the seven outcome measures yielded statistically significant positive results. The training and consultation model utilized appears to have been successful at maintaining intervention fidelity. Finally, as these results present the first two of the four years of the overall study, the current analysis may be underpowered to detect effects in some of the other outcome measures.