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      Investigating SOcial Competence and Isolation in children with Autism taking part in LEGO-based therapy clubs In School Environments (I-SOCIALISE): study protocol

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          Abstract

          Introduction

          Social skills training interventions for children with autism spectrum disorder (ASD) typically focus on a skills deficit model rather than building on existing skills or encouraging the child to seek their own solutions. LEGO-based therapy is a child-oriented intervention to help improve social interactional skills and reduce isolation. The therapy is designed for school-age children with ASD and uses group-based play in a school setting to encourage peer relationships and social learning. Despite the reported potential benefits of LEGO-based therapy in a prior randomised controlled trial (RCT) and its adoption by many schools, the evidence to support its effectiveness on the social and emotional well-being of children with ASD is limited and includes no assessment of cost-effectiveness.

          Methods and analysis

          This multicentre, pragmatic, cluster RCT will randomise 240 participants (aged 7–15 years) with a clinical diagnosis of ASD to receive usual care or LEGO-based therapy with usual care. Cluster randomisation will be conducted on a school level, randomising each school as opposed to each individual child within a school. All prospective participants will be screened for eligibility before assenting to the study (with parents giving informed consent on behalf of their child). All participants will be followed up at 20 and 52 weeks after randomisation to assess for social, emotional and behavioural changes. The primary outcome measure is the social skills subscale of the Social Skills Improvement System completed by a teacher or teaching assistant associated with participating children at the 20-week follow-up time point.

          Ethics and dissemination

          Ethics approval has been obtained via the University of York Research Ethics Committee. The results of the trial will be submitted for publication in a peer-reviewed journal and will be disseminated to participating families, education practitioners and the third sector including voluntary and community organisations.

          Trial registration number

          ISRCTN64852382; Pre-results.

          Related collections

          Most cited references17

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          Young adult outcome of autism spectrum disorders.

          To learn about the lives of young adults with ASD, families with children born 1974-1984, diagnosed as preschoolers and followed into adolescence were contacted by mail. Of 76 eligible, 48 (63%) participated in a telephone interview. Global outcome scores were assigned based on work, friendships and independence. At mean age 24, half had good to fair outcome and 46% poor. Co-morbid conditions, obesity and medication use were common. Families noted unmet needs particularly in social areas. Multilinear regression indicated a combination of IQ and CARS score at age 11 predicted outcome. Earlier studies reported more adults with ASD who had poor to very poor outcomes, however current young people had more opportunities, and thus better results were expected.
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            Adult outcome for children with autism.

            Information on long-term prognosis in autism is limited. Outcome is known to be poor for those with an IQ below 50, but there have been few systematic studies of individuals with an IQ above this. Sixty-eight individuals meeting criteria for autism and with a performance IQ of 50 or above in childhood were followed up as adults. Their mean age when first seen was 7 years (range 3-15 years); at follow-up the average age was 29 years (range 21-48 years). Outcome measures included standardised cognitive, language and attainment tests. Information on social, communication and behavioural problems was obtained from the Autism Diagnostic Interview (ADI). Although a minority of adults had achieved relatively high levels of independence, most remained very dependent on their families or other support services. Few lived alone, had close friends, or permanent employment. Communication generally was impaired, and reading and spelling abilities were poor. Stereotyped behaviours or interests frequently persisted into adulthood. Ten individuals had developed epilepsy. Overall, only 12% were rated as having a 'Very Good' outcome; 10% were rated as 'Good' and 19% as 'Fair'. The majority was rated as having a 'Poor' (46%) or 'Very Poor' (12%) outcome. Individuals with a childhood performance IQ of at least 70 had a significantly better outcome than those with an IQ below this. However, within the normal IQ range outcome was very variable and, on an individual level, neither verbal nor performance IQ proved to be consistent prognostic indicators. Although outcome for adults with autism has improved over recent years, many remain highly dependent on others for support. This study provides some information on prognostic indicators, but more fine-grained research is needed into the childhood variables that are associated with good or poor outcome.
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              Involvement or isolation? The social networks of children with autism in regular classrooms.

              Including children with autism in regular classrooms has become prevalent; yet some evidence suggests such placements could increase the risk of isolation and rejection. In this study, we used social network methods to explore the involvement of children with autism in typical classrooms. Participants were 398 children (196 boys) in regular 2nd through 5th grade classes, including 17 children (14 boys) with high functioning autism or Asperger's syndrome. Children reported on friendship qualities, peer acceptance, loneliness, and classroom social networks. Despite involvement in networks, children with autism experienced lower centrality, acceptance, companionship, and reciprocity; yet they did not report greater loneliness. Future research is needed to help children with autism move from the periphery to more effective engagement with peers.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                1 June 2019
                : 9
                : 5
                : e030471
                Affiliations
                [1 ] departmentCOMIC , Leeds and York Partnership NHS Foundation Trust , York, UK
                [2 ] departmentDepartment of Health Sciences , University of York , York, UK
                [3 ] departmentHull York Medical School , University of York , York, England
                [4 ] departmentScHARR , University of Sheffield , Sheffield, UK
                [5 ] departmentClinical Trials Research Unit , University of Sheffield , Sheffield, UK
                [6 ] departmentDepartment of Epidemiology and Biostatistics , Western University , London, Ontario, Canada
                [7 ] departmentSchool of Health and Related Research , University of Sheffield , Sheffield, UK
                [8 ] Cambridgeshire Community Services NHS Trust , Cambridge, UK
                [9 ] Leeds and York Partnership NHS Foundation Trust , York, UK
                [10 ] departmentInstitute of Health and Society , Newcastle University , Newcastle upon Tyne, UK
                [11 ] City of York Council , York, UK
                Author notes
                [Correspondence to ] Professor Barry Wright; barry.wright1@ 123456nhs.net
                Article
                bmjopen-2019-030471
                10.1136/bmjopen-2019-030471
                6549632
                31154316
                3cf73c78-4915-41c1-b23b-b9ba7ca5803f
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 18 March 2019
                : 08 April 2019
                : 10 April 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001921, Public Health Research Programme;
                Categories
                Mental Health
                Protocol
                1506
                1712
                Custom metadata
                unlocked

                Medicine
                paediatrics,mental health,autism spectrum disorder,public health
                Medicine
                paediatrics, mental health, autism spectrum disorder, public health

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