A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder.

BACKGROUND: Technology-based interventions for Autism Spectrum Disorder (ASD) have proliferated, but few have been evaluated within the context of a randomised controlled trial (RCT). This RCT evaluated the efficacy of one technology-based early intervention programme (Therapy Outcomes By You; TOBY) in young children with ASD. METHODS: TOBY is an app-based learning curriculum designed for children and parents as a complement to early behavioural intervention. Eighty children (16 female) were recruited to this RCT within 12 months of receiving a diagnosis of ASD (M age = 3.38; SD = 0.69) and randomised to receive either treatment-as-usual (community-based intervention, n = 39) or the TOBY therapy (at least 20 min/day) plus treatment-as-usual (n = 41) for a period of 6 months. Outcomes were assessed at 3 and 6 months postbaseline. (Australian New Zealand Clinical Trials Registry: ACTRN12614000738628; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365463). RESULTS: Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months, but only 2 min/day during the second 3 months. There was no group difference in scores on the primary outcome, the Autism Treatment Evaluation Checklist, at either the 3- or 6-month follow-up. However, significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes: the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index. Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function, although these decreased in magnitude from the 3- to 6-month follow-up. CONCLUSIONS: This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD. However, sustained use of the app over the full 6-month period was a challenge for most families.

Randomised controlled trial of an iPad based early intervention for autism: TOBY playpad study protocol.

BACKGROUND: Evidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use. METHODS AND DESIGN: Children aged less than 4;3 years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group 'TOBY therapy + therapy as usual' or, the control group 'therapy as usual' for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad - Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2). DISCUSSION: This trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents' self-efficacy and empowerment in an effort to reduce children's ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents. TRIAL REGISTRATION: ACTRN12614000738628 retrospectively registered on 1st of July, 2014. UTN: U1111-1158-6423.

Father participation with mothers in the Signposts program: an initial investigation.

BACKGROUND: The Signposts program is an evidence-based intervention system for parents of children with intellectual disability and problem behaviours. This study provided an initial investigation of the outcomes for mothers associated with father participation in Signposts, using data collected from the Signposts Statewide project, conducted in Victoria, Australia. METHOD: Data from Signposts Statewide were analysed, with the effect size Cohen's d and 95% confidence interval around d calculated for pre- to post-program changes for 134 mothers who participated in Signposts with fathers and 483 mothers who participated without fathers. RESULTS: Although mothers in both groups benefitted from the program, as evidenced by pre- to post-program improvements across all measures, the mean effect size was notably larger for mothers who participated in Signposts with fathers. CONCLUSIONS: These results highlight possible further program benefits for mothers who participate in Signposts with fathers, and are of particular significance in light of research describing the increased stress experienced by mothers of children with a disability.

Barriers and Facilitators of Access to Psychological Services for Indigenous Populations: A Scoping Review and Thematic Analysis.

Background: The extent to which behavior-analytic interventions are offered to Indigenous populations across CANZUS in accessible and culturally appropriate ways is unknown. We conducted a scoping review with a thematic analysis of the extant literature to find: (1) what are the barriers and facilitators for providing effective and equitable delivery of psychological services (with a behavioral component) to Indigenous populations; and (2) what tools and practices exist for an effective and equitable service delivery. Methods: We systematically reviewed Medline, CINAHL, PubMed, PsycInfo, Web of science, Ovid and INNZ databases between 1990 and 2020. For the scoping review, we adhered to the JBI methodological approach (2015) and the PRISMA strategy for the identification, selection, and appraisal of the reviewed articles. A total of 1265 unique articles met the criteria for the screening by title; 238 by abstract; 57 were included for full text assessment; and 37 were included in the final analysis. Results: Three themes were revealed to account for the barriers and facilitators of culturally friendly practices: (1) connecting practices are about interactions shaping the relationship between service provider and service client; (2) innovative practices test new approaches and innovations that could facilitate access to psychological services and overcome barriers, and (3) reflective practices are about critically examining the processes and actions undertaken toward effective cultural adaptation of services. Conclusions: Our analysis suggests that the level of success in bringing together services and the recipients of treatment (connection), showing flexibility and persistence in finding solutions (innovation) and examining the role of our behaviors in reaching our goals (reflection) is determined by the providers' action in the aforementioned three dimensions of practice.

Maintenance and generalization of skills acquired through picture exchange communication system (PECS) training: a long-term follow-up.

Purpose: To conduct a follow-up assessment of the maintenance of communication skills of a 7-year-old child with autism spectrum disorder, 3 years 7 months post PECS training; and investigate the effects of environmental adaptations on the child's PECS and vocal communications. Methods: An alternating-treatments design enabled comparison of the effects of two treatment conditions (an environmental adaptation to increase need and opportunities for communication, versus a continuation of baseline procedures) on the child's PECS and vocal communications in the child's home. Results: Baseline data demonstrated decreased levels of PECS and vocal communication at follow-up, compared to post PECS training 3 years 7 months prior. The environmental adaptation had no observable effect on the participant's use of PECS, but vocal manding increased in this condition. Conclusion: These results suggest ongoing need for motivating environments with ample opportunities to practice post PECS training. Implications and directions for future research are discussed.

Behavior Change Techniques Incorporated in Fitness Trackers: Content Analysis.

BACKGROUND: The use of fitness trackers as tools of self-management to promote physical activity is increasing. However, the content of fitness trackers remains unexplored. OBJECTIVE: The aim of this study was to use the Behavior Change Technique Taxonomy v1 (BCTTv1) to examine if swim-proof fitness trackers below Aus $150 (US$ 105) incorporate behavior change techniques (BCTs) that relate to self-management strategies to increase physical activity and reduce sedentary behavior and to determine if content of the fitness trackers correspond to physical activity guidelines. METHODS: A total of two raters used the BCTTv1 to code 6 fitness trackers that met the inclusion criteria. The inclusion criteria were the ability to track activity, be swim proof, be compatible with Android and Apple operating systems, and cost below Aus $150. RESULTS: All fitness trackers contained BCTs known to promote physical activity, with the most frequently used BCTs overlapping with self-management strategies, including goal setting, self-monitoring, and feedback on behavior. Fitbit Flex 2 (Fitbit Inc) contained the most BCTs at 20. Huawei Band 2 Pro (Huawei Technologies) and Misfit Shine 2 (Fossil Group) contained the least BCTs at 11. CONCLUSIONS: Fitness trackers contain evidence-based BCTs that overlap with self-management strategies, which have been shown to increase physical activity and reduce sedentary behavior. Fitness trackers offer the prospect for physical activity interventions that are cost-effective and easily accessed by a wide population.

Innovation and effectiveness: changing the scope of school nurses in New Zealand secondary schools.

OBJECTIVE: To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio-economic areas with high Pacific Island and Maori rolls. METHODS: An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland, NZ (2002-05). Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken. RESULTS: Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses. CONCLUSIONS AND IMPLICATIONS: School nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. Co-ordination of school nurses either at a regional or national level is required.

A parent-focused early intervention program for autism: who gets access?

BACKGROUND: The EarlyBird program is a psycho-educational early intervention program for parents of children with autistic spectrum disorder (ASD). It aims to provide parents with skills to increase their child's communication and manage challenging behaviour using behavioural techniques. METHOD: Two interlinked studies examined access to the EarlyBird program and barriers which may affect uptake. Study 1 investigated who accessed the EarlyBird program, and what factors influenced this choice. Study 2 was a qualitative investigation which focused on barriers to uptake for ethnic minority groups in New Zealand. RESULTS: Findings indicated that approximately 85% of families eligible for the program do not participate. Non-membership of Autism New Zealand (the agency responsible for administering the program), ethnicity, and length of wait time were significant factors in non-participation. CONCLUSIONS: A model of factors which may influence uptake of interventions targeting the families of children with a disability is proposed.

Comparing the effectiveness of virtual reality and video modelling as an intervention strategy for individuals with Autism Spectrum Disorder: Brief report.

The increasing numbers of individuals diagnosed with Autism Spectrum Disorder (ASD) has foreshadowed a greater need for effective intervention procedures to aid learning. PURPOSE: This study compared the effectiveness of video modelling (VM) and virtual reality (VR) for teaching adults with ASD. METHODS: Using an alternating treatments design without baseline two participants completed paper folding projects of varying difficulty following exposure to either VM or VR task modelling. The rate of learning (ROL) determined treatment effectiveness. RESULTS: One participant reached mastery criterion for the intermediate project on the 5th trial with both VR and VM (i.e. equal ROL). The other achieved mastery by the 6th trial of VM, but did not attain mastery in VR. Both participants reported enjoying both procedures. CONCLUSIONS: The results suggest that VM was more effective than VR in facilitating learning. Implications for future research are discussed.

Teaching Reading Comprehension Skills to a Child with Autism Using Behaviour Skills Training.

A multiple probe design across skills was used to examine the effects of behaviour skills training (BST) on teaching four reading comprehension skills (predicting, questioning, clarifying, and summarizing) to a 7th grade student with autism. Following baseline, the student received 12 sessions of BST during which each skill was taught to criterion. At each session, data was also collected on the accuracy of oral responses to 10 comprehension questions. BST was associated with clear gains in the participant's performance on each comprehension skill, along with concomitant gains in reading comprehension both on the daily probes and a standardized measure. Skills maintained at follow-up support the conclusion that BST was effective in improving the comprehension skills of a child with autism.

Effects of video modeling with video feedback on vocational skills of adults with autism spectrum disorder.

OBJECTIVE: To examine the effectiveness of a video modeling (VM) with video feedback (VFB) intervention to teach vocational gardening skills to three adults with autism spectrum disorder (ASD). METHOD: A multiple probe design across skills was used to assess the effects of the intervention on the three participants' ability to perform skills accurately. RESULTS: The use of VM with VFB led to improvements across skills for two of the participants. The third participant required video prompting (VP) for successful skill acquisition. Skill performance generalized across personnel and settings for two of the participants, but it was not assessed for the third. Skill performance maintained at follow-up for all three participants. Social validity data gathered from participants, parents, and co-workers were positive. CONCLUSION: These findings suggest that VM with VFB and VP with VFB were effective and socially acceptable interventions for teaching vocational gardening skills to young adults with ASD.

Use of video modelling to teach complex and meaningful job skills to an adult with autism spectrum disorder.

OBJECTIVE: To examine the effectiveness of a video modelling (VM) intervention to teach job-related telephone skills to an adult with Autism Spectrum Disorder (ASD). METHODS: A multiple baseline design across four telephone-relevant behaviours was used to assess the effects of the intervention on the participant's ability to respond to telephone calls. RESULTS: Use of the VM intervention led to immediate improvements in listening and responding to both orders and complaints; more gradual improvements were also observed in the participant's professional speech. All skill increases were maintained at follow-up. CONCLUSION: VM may be an effective method of teaching complex vocational skills to adults with ASD, although a stronger focus on social skills may be warranted in the future.

TOBY play-pad application to teach children with ASD - A pilot trial.

PURPOSE: To investigate use patterns and learning outcomes associated with the use of Therapy Outcomes By You (TOBY. Playpad, an early intervention iPad application. METHODS: Participants were 33 families with a child with an autism spectrum disorder (ASD) aged 16 years or less, and with a diagnosis of autism or pervasive developmental disorder - not otherwise specified, and no secondary diagnoses. Families were provided with TOBY and asked to use it for 4-6 weeks, without further prompting or coaching. Dependent variables included participant use patterns and initial indicators of child progress. RESULTS: Twenty-three participants engaged extensively with TOBY, being exposed to at least 100 complete learn units and completing between 17% and 100% of the curriculum. CONCLUSIONS: TOBY may make a useful contribution to early intervention programming for children with ASD delivering high rates of appropriate learning opportunities. Further research evaluating the efficacy of TOBY in relation to independent indicators of functioning is warranted.

Social skills assessment of children with autism in free-play situations.

Poor social functioning and limited play are characteristic of children with autism. Increasingly, education for children with autism is provided within mainstream settings, but given their particular difficulties, the adequate provision of educational services in such settings is challenging. This study presents observational data of the play behaviour and social interaction patterns of 10 children with autism in mainstream kindergartens and primary school playgrounds. The target children differed significantly in terms of their play and social interactions from typically developing children in the same settings. The adequacy of the provision of services for children with autism in mainstream provision is discussed.

Toilet training in individuals with Angelman syndrome: a case series.

OBJECTIVE: To assess if adapted versions of the response restriction toilet training protocol, based on the behavioral phenotype of Angelman syndrome (AS), were successful in fostering urinary continence in seven individuals with AS. METHOD: Data were collected in AB-designs during baseline, training, generalization and follow-up. The response restriction protocol was adapted: individuals were trained in their natural environment, were prompted to void and along with improving continence, the interval between voids was prolonged and time-on-toilet decreased. RESULTS: During generalization five individuals had less than two accidents and one to six correct voids per day; during baseline more accidents and/or less correct voids occurred. In two participants correct voids increased, but several accidents still occurred. Three participants maintained positive results after 3-18 months. CONCLUSION: Despite their intellectual and behavioral challenges, urinary continence can be acquired in AS. Several indications of voiding dysfunctions were found; further research is indicated.

Parent-implemented picture exchange communication system (PECS) training: an analysis of YouTube videos.

PURPOSE: To investigate the integrity with which parents and carers implement PECS in naturalistic settings, utilizing a sample of videos obtained from YouTube. METHODS: Twenty-one YouTube videos meeting selection criteria were identified. The videos were reviewed for instances of seven implementer errors and, where appropriate, presence of a physical prompter. RESULTS: Forty-three per cent of videos and 61% of PECS exchanges contained errors in parent implementation of specific teaching strategies of the PECS training protocol. Vocal prompts, incorrect error correction and the absence of timely reinforcement occurred most frequently, while gestural prompts, insistence on speech, incorrect use of the open hand prompt and not waiting for the learner to initiate occurred less frequently. CONCLUSIONS: Results suggest that parents engage in vocal prompting and incorrect use of the 4-step error correction strategy when using PECS with their children, errors likely to result in prompt dependence.

Using video self-modelled social stories to teach social skills to a young child with autism.

The present study investigated the effectiveness of combining Social Stories and Video Self-Modelling (VSM) to teach social skills to a three-year-old child with autism. A multiple-baseline across behaviors design revealed that video self-modelled Social Stories were effective at improving all three target behaviors: greeting, inviting to play, and contingent responding. In addition, these behaviors successfully generalized across settings, toys, and communication partners. Concomitant behavior changes, namely, increased levels of communicative behavior and levels of social engagement were also observed. These results support the effectiveness of video self-modelled Social Stories and illustrate the potential of combined intervention techniques for remedying the social deficits faced by this population.