In one of the largest school-based clinical trials of its kind, researchers at the Institute for Autism Research (IAR) at Canisius College have found an innovative comprehensive school treatment (schoolMAX) yielded significant improvements for elementary school children with autism spectrum disorder (ASD). Specifically, children who received schoolMAX demonstrated significantly greater improvements in social-cognitive skills, social-communication skills, and ASD symptoms compared to children who received their typical educational programming.

High-functioning children with ASD (HFASD) have relative strengths in cognitive and language abilities, but struggle with social understanding, social interactions, and restricted and repetitive behaviors and interests. These core features significantly interfere with their daily functioning and addressing these in school settings has been a significant challenge.

According to Marcus L. Thomeer, PhD, one of the study’s lead authors, “the multiple symptoms of children with HFASD requires a comprehensive approach, yet developing effective interventions that address the range of symptoms while also being feasible in school settings has proven to be a major challenge due to a range of competing demands in that setting.” An additional challenge has been developing interventions that exploit the children’s cognitive and language strengths to improve their social understanding and skills and reduce their ASD symptoms. “schoolMAX is innovative and unique in that it utilizes cognitive and behavioral strategies to improve the children’s skills and symptoms; it is also delivered by members of the students’ school teams during the school day,” said Christopher Lopata, PsyD, the study’s lead author.

Findings from the clinical trial, just published in the Journal of Clinical Child and Adolescent Psychology, provided strong support for the effectiveness of schoolMAX for children with HFASD.

In this trial, 103 children, in grades 1-5 with HFASD were randomly assigned by school building to receive either schoolMAX or their typical educational program. In the schoolMAX buildings, each student’s educational team was trained to implement the intervention during the school year, which included weekly social skills groups, therapeutic activities to practice the skills, emotion recognition instruction, and a behavioral reinforcement system, as well as monthly parent training. Different members of each student’s school team were responsible for implementing separate intervention elements and the accuracy of their administration was tracked; the typical educational programming received by students in the non-schoolMAX schools was also monitored. Outcomes were assessed at the beginning and end of the school year.

Results revealed that students with HFASD in the schoolMAX intervention exhibited significantly greater improvements in their social understanding (emotion recognition testing) and on parent and teacher ratings of social-communication skills and ASD symptoms compared to students who received their typical school program.

James P. Donnelly, PhD, the statistician on the study noted that, “not only did the two groups differ, the magnitude of the differences were large, providing strong support for the superiority of schoolMAX on these measures.” Another positive finding was that the groups did not differ in terms of the children’s academic skills, which indicated that the time dedicated to the schoolMAX intervention did not negatively affect the children’s academic achievement; this is a common concern of school staff. The study also found that the schoolMAX school staff implemented the intervention components with a very high level of accuracy (greater than 92%).

According to Jonathan D. Rodgers, PhD, a coauthor on the study, “This was a very positive outcome as researchers have questioned whether multi-component interventions for children with HFASD are feasible in schools and whether school staff can accurately implement them—results suggest that schoolMAX works well within school settings.” Despite the significant improvements in core social impairments/skills and ASD symptoms, the children struggled to transfer these improvements to the recess setting where social interactions of the children did not differ across groups. “Researchers have noted that recess environments are complex social settings,” said Thomeer, “and specific instruction in those settings might be needed to help the children transfer their skills—we are currently looking at ways to do this.”

While this is one of the largest randomized trials of a comprehensive school-based intervention for children with HFASD and an important first step, most of the children in the study were Caucasian and the schools were primarily in suburban districts. “Because of this, schoolMAX needs to be tested in different settings and with more diverse children with HFASD,” noted Lopata. “And we are working to conduct those studies.”

—Newswise