Using software that includes both on- and off-computer activities led to significant gains in the communication and social skills of students with autism, a Los Angeles Unified School District (LAUSD) study found.
The study, funded by the National Center for Technology Innovation (NCTI), included 47 LAUSD children with autism–22 in the treatment group and 25 in the control group. It took place in four schools and consisted of four pre-school classes and four kindergarten or first-grade classes.
Students took part in daily computer sessions for 20 minutes and daily off-computer activities, also for 20 minutes, for a three-month period. Off-computer activities consisted of one-on-one or small-group activities such as relationship building or expressive language.
Students used TeachTown Basics, a software program targeting a student’s receptive skills (the ability to understand) and expressive skills (the ability to verbalize thoughts and speak clearly).
TeachTown was developed as a solution for learning challenges faced by children with autism. It works via animated images that appear on the computer monitor and teach children words and expressions. The program’s interactive design enables it to customize content to each individual student.
Over the three-month test period, students using TeachTown saw up to 200-percent increases in performance scores on the software. In addition, TeachTown students gained two to five months more developmental growth than the control-group students using the Brigance Assessment and with less one-on-one instruction.
From November 2008 through February 2009, teachers were asked to use the program for 15 to 20 minutes per session, with a total of 50 to 60 sessions. All four teachers averaged between 50 and 58 sessions. One teacher averaged 15 minutes of student use per session, a second averaged 18 minutes, and the third and fourth teachers both averaged nine minutes per session.
"At this point, at least 2,000 or more students could potentially benefit from TeachTown in our district," said Debbie Moss, one of LAUSD’s two autism specialists. "The teachers are loving it now. They’re seeing progress in the children. Attention and focus have improved. [And] TeachTown ties into the pre-school curriculum and California standards, which is a big plus."
The findings included a significant increase in language, auditory processing, academics, and social skills compared with those of students who were not introduced to the software. "Even for students who don’t necessarily show great progress, we saw gains in attention span and focus, things we couldn’t measure with data," Moss said.
"I’m very leery of computer programs for children with autism," she said, but added that she felt encouraged by TeachTown’s off-computer activities.
"We’re looking for rapid growth, but also generalization–is it just on the computer, or do we see it in their everyday functions? And we did see it across the board. I think a lot of it has to do with the development of the off-computer activities," she said.
"The developmental progress far exceeds what would be expected. Some children had more than 30-month gains in specific learning areas like social understanding in just three months, with less than an hour a day of intervention, and a few children made so much progress that they have or are near to having age-appropriate skills," said Christina Whalen, co-founder, president, and chief science officer for TeachTown.
When compared with the control group halfway through the study, students in the treatment group showed notably larger increases in receptive and expressive language; auditory memory, general concepts, and social skills for pre-school students; and matching and auditory memory for kindergarten and first-grade students.
K-1 students in the treatment group showed slightly larger increases in general concepts and social skills, and pre-school treatment students demonstrated slightly larger increases in matching.
After three months using TeachTown, students in the treatment group showed significant gains from pre- to post-tests and learned, on average, 34 to 39 target concepts using the software, with the largest gains in receptive vocabulary.
Results from the first half of the study have been accepted for early 2010 publication in the peer-reviewed journal Autism. Whalen and Moss decided to continue with the second half after seeing the first part’s encouraging results. Researchers are currently analyzing data from the second part of the study, and Whalen estimates that the raw data will be available in early 2010. While it is too early to comment on data trends in the second part of the study, Whalen said the results "look promising."
The study used a Brigance assessment, which is a standardized developmental assessment used to identify deficits and track progress in developmental areas such as language, cognition, social skills, and motor skills.
In addition to helping students, Moss said teachers benefit from using TeachTown as well.
"It reinforced that we’re on the right track, it freed up teachers because it collects data for them, and it differentiates for the individual child," she said. "It also gives teachers the information they need to give to parents."
LAUSD just purchased 100 TeachTown licenses so more of its 8,600 students with autism can benefit from the program.
"Because our district is so large, other districts are looking to us for our experiences," Moss said.
"The advantage of using LAUSD is that it has the diversity that we wanted in terms of student population, both economic and ethnic," Whalen added.
The study was funded by a grant from NCTI and included the Special Education Graduate School Program at California State University, Los Angeles as a partner.
Early intervention with high-quality autism programs is key to helping children with autism develop valuable communication skills, Moss said.
A new study of 48 children evaluated at the University of Washington (UW) supports Moss’ assertion. The UW study found that two years of therapy in children as young as 18 months can vastly improve symptoms.
The results were so encouraging that the study has been expanded to several other sites, said Geraldine Dawson, chief science officer of the advocacy group Autism Speaks. Dawson, a former UW professor, led the research team.
Early autism treatment has been getting more attention, but it remains controversial because there is scant rigorous evidence showing it really works. The UW study is thus "a landmark of great import," said Tony Charman, an autism education specialist at the Institute of Education in London.
There’s also a growing emphasis on diagnosing autism at the earliest possible age, and the UW study shows that can pay off with early, effective treatment, said Laura Schreibman, an autism researcher at the University of California at San Diego.
The National Institute of Mental Health funded the study, which was published online on Nov. 30 by the journal Pediatrics.
Children ages 18 months to 30 months were randomly assigned to receive behavior treatment called the Early Start Denver model from therapists and parents, or they were referred to others for less comprehensive care.
The therapy is similar to other types of autism behavior treatment. It focused on social interaction and communication, which are both difficult for many autistic children. For example, therapists or parents would repeatedly hold a toy near a child’s face to encourage the child to have eye contact–a common problem in autism. Or, they’d reward children when they used words to ask for toys.
Children in the specialized group had four hours of therapist-led treatment five days a week, plus at least five hours weekly from parents.
After two years, IQ increased an average of almost 18 points in the specialized group, versus seven points in the others. Language skills also improved more in the specialized group. Almost 30 percent in the specialized group were re-diagnosed with a less severe form of autism after two years, versus 5 percent of the others. No children were considered "cured."
Ashton Faller of Everett, Wash., got specialized treatment, starting at age 2.
"He had no verbal speech whatsoever, no eye contact, he was very withdrawn," recalled his mother, Lisa Faller.
Within two years, Ashton had made "amazing" gains, she said. Now almost 6, he’s in a normal kindergarten class, and though he still has mild delays in social skills, people have a hard time believing he is autistic, Faller said.
The treatment used in the UW study is expensive; participants didn’t pay, but it can cost $50,000 a year, Dawson said. Some states require insurers to cover such costs, and Autism Speaks is working to expand those laws.
Material from the Associated Press was used in this report.