R&R Autism Intervention Research
The past two decades of research in the field of developmental psychology have led to significant advances in our understanding of typical child development, and have provided important insights on the core deficits in autism spectrum disorder (ASD). Reference and Regulate has been developed to provide an innovative approach to autism intervention based on the most current understanding of typical development, and deficits in ASD. A key finding of recent research in the area of typical child development has been the identification of the pivotal role of social referencing skills in the development of language, play, and emotional regulation ( Bloom, 2000 ; Morales, Mundy, Crowson et al, 2005 ; Mundy, Sigman, & Kasari, 1993 ; Rollins & Snow, 1998 ; Rutherford, Young, Hepburn & Rogers, 2007 ). Indeed, social referencing and joint attention have been called "the foundation for all further communication and cultural learning" ( Carpenter et al,1998 ). Importantly, these social referencing skills have also been identified in a large number of studies as a core deficit in ASD ( Baron-Cohen et al, 1996 ; Charman, 2003 ). Despite these numerous and well-replicated research findings, rarely, if ever, do the conventional approaches to the treatment of autism address the development of social referencing as a primary goal in a structured, developmentally sound manner ( Kasari, 2006 ). R&R bridges the gap between research and practice by providing a systematic, step-by-step approach to the development of social referencing for children with ASD. While R&R is based on a strong foundation of research, outcome studies are necessary to determine whether the program is truly effective in remediating the deficits in children with ASD, and improving their quality of life. To this end, we have initiated several projects designed to document children's progress and test the effectiveness of R&R. In addition to company-based research initiatives, we are also undertaking projects in partnership with the academic community with the goal of developing a rigorous, ongoing program of research. In the following update we outline some of the highlights of our three pilot projects.
The three pilot projects described briefly here have provided early confirmation of our clinical observations that children in the R&R program are acquiring the social referencing skills targeted in therapy, and that they are additionally making significant gains in language, play, and behaviour.
- Early joint social referencing skills can be taught relatively quickly, with core skills such as visual referencing and point and gaze following almost always mastered within the first year of therapy.
- Case study data suggest that many children participating in the R&R program make particularly large gains in the areas of communication and socialization, traditionally the weakest areas for children with ASD and the most difficult to treat.
- Third party data supports the evidence provided by clinical data, showing that changes in joint attention, language, and play can be observed within the first 15 weeks of therapy.
We are encouraged by the positive findings emerging from our research program. We believe that the increasing consensus on the importance of social referencing skills in ASD is vital to the future of children with ASD, and are constantly working to improve the R&R program to reflect new knowledge from development and intervention research.
Projects currently underway include:
Understanding of Other's Perspectives:
A clinical data review investigating the progress of R&R participants in "Stage 3: Recognizing, Responding, and Adapting to Other's Perspectives".
Communicative use of language after treatment with R&R:
Using Language Communicatively: Using the Canadian-developed Language Use Inventory (LUI: www.languageuseinventory.ca
), we are investigating changes in children's functional use of language in the first months of therapy. The LUI has recently been identified as a recommended instrument for measuring progress in the use of spoken language.
R&R Research Opportunities
We are actively seeking research partners to join us in our work to test the effectiveness of R&R, and to improve the understanding of the role of social referencing in ASD. Our program offers exceptional possibilities for several reasons:
- Active collaboration and support from Dr. Kate Chase, our director of research, who has recently been recommended by the UBC School of Audiology and Speech Science for appointment as a Clinical Assistant Professor at the University of British Columbia.
- A specific, defined curriculum with regular data collection that is developmentally sound and play-based.
- Highly trained and closely supervised intervention staff.
- A large pool of potential participants, with over 50 clients on our current caseload.
- A strong network of community partnerships with child development centres, health units, private speech-language pathologists and occupational therapists, and the early childhood education community.
- Collaboration with a program gaining provincial and national recognition, including invited lectures and workshops in school boards, hospitals, health units, child development centres, provincial professional associations, and in 2010, at the conference of the Canadian Association of Speech-Language Pathologists.
There are many possibilities for future research projects, including single and multiple subject case studies, cross-sectional comparison studies, and randomized control trials. We welcome interested partners and are delighted to work with graduate and post-doctoral students at all levels.
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