1 University of Washington, USA.
2 Loma Linda University, USA.
Autism. 2019 May;23(4):834-845. doi: 10.1177/1362361318787802. Epub 2018 Jul 12.
Several interventions have demonstrated efficacy in improving social outcomes for children with autism; however, few have been successfully implemented in schools. This study compared two implementation strategies to improve the use of a social engagement intervention for children with autism in public schools. In total, 31 children with autism in grades K-5 and 28 school personnel participated in a randomized controlled trial. Schools were randomized to (1) training in Remaking Recess, a social engagement intervention, or (2) training in Remaking Recess with implementation support. Linear regression with random effects was used to test the intervention effects on implementation fidelity and social outcomes (peer engagement, social network inclusion, and friendship nominations). In both groups, implementation fidelity improved after training but remained low. Children in the Remaking Recess with implementation support condition had significantly higher social network inclusion and received more friendship nominations than children in the Remaking Recess-only condition (p = 0.03). Children in both groups experienced reduced solitary engagement (p < 0.001) and increased joint engagement (p < 0.001). The results suggest that implementation supports may have an effect on outcomes above and beyond the intervention, and that further research is needed into the active intervention mechanisms.
几种干预措施已被证明能有效改善自闭症儿童的社交结果；然而，很少有措施能成功地在学校实施。本研究比较了两种实施策略，以提高自闭症儿童在公立学校使用社交参与干预的效果。共有 31 名 K-5 年级的自闭症儿童和 28 名学校人员参加了一项随机对照试验。学校被随机分配到（1）接受社交参与干预“重塑课间休息”的培训，或（2）接受“重塑课间休息”培训和实施支持。使用具有随机效应的线性回归检验干预对实施保真度和社交结果（同伴参与、社交网络包容和友谊提名）的影响。在这两组中，培训后实施保真度都有所提高，但仍然较低。在接受“重塑课间休息”实施支持的条件下的儿童，其社交网络包容度显著更高，并且获得了更多的友谊提名，比仅接受“重塑课间休息”的条件下的儿童（p=0.03）。两组儿童的独自参与都减少（p<0.001），联合参与增加（p<0.001）。结果表明，实施支持可能对干预效果产生超出干预本身的影响，并且需要进一步研究积极的干预机制。
