A Comprehensive Secondary Education Program for Students with ASD

Background: The combination of autism spectrum disorder (ASD), adolescence, and the tumultuous nature of high school settings makes providing an appropriate education program for adolescents with ASD one of the most challenging tasks for public education in the US. The Center on Secondary Education for Students with Autism Spectrum Disorder (CSESA) created a comprehensive treatment program to address the variety of educational and learning needs for adolescents with ASD. The CSESA program consists of four features that focused on literacy, independence, social competence, and transition/families, with these features implemented over at two-year period.

Objectives: To determine the efficacy of the CSESA program, investigators conducted a cluster randomized control trial.

Methods: Sixty high schools located in three regional locations in the US (CA, NC, WI) were randomly assigned to CSESA and services as usual (SAU) conditions and 545 high school students with educational diagnoses of autism and their families participated in the study. The mean age of the students at the beginning of the study was 16 years; 86% of the student participants were male; 45% of the students had race/ethnicity other than white, nonHispanic; 39% of the student were from low income families; and the students spanned the range of autism severity. An assessment of program quality was collected at the beginning and end of the study in all schools. During the course of the study, multiple measures of implementation were collected and assembled as an “implementation index.” A battery of standardized measures collected at the beginning of the study and again at the end of the study included two Woodcock-Johnson literacy measures, Vineland Adaptive Behavior Scale-3, Social Responsiveness Scale, AIR Self-Determination Scale, the Support Intensity Scale, the Family Empowerment Scale, and the Zarit Burden Inventory. Also, Goal Attainment Scales (GAS) were collected for individual student goals related to literacy, social competence, independence, and transition.

Results: A standard ANCOVA, controlling for site and pretest scores, revealed significant differences in program quality favoring CSESA. Implementation index scores found significant difference between CSESA and SAU schools’ implementation of CSESA program features and also a range of “levels” of implementation within the CSESA group. A multilevel analysis with students nested within schools and regional sites as a control was conducted for all standardized and GAS measures. The CSESA families scored significantly higher on the Family Empowerment Scale than SAU group families, and CSESA students scored significantly higher on the mean GAS scores than students in the SAU condition. However, significant difference were not found on the standardized student measures.

Conclusions:

This study demonstrated that this multicomponent comprehensive treatment model implemented at the school level can significantly impact program quality, families’ perceptions of empowerment, and accomplishments of student goals (which are the most proximal assessment of intervention effects), although the more distal student measures did not detect treatment effects. In addition, the range of levels of implementation across schools in the CSESA sample reflect the challenge of conducting large scale RCTs in authentic public school settings.