Technology delivered self-monitoring application to promote successful inclusion of an elementary student with autism.

The ever-increasing prevalence of children diagnosed with autism spectrum disorder (ASD) is paralleled in public educational settings, including general education classrooms. Challenges with social/behavioral functioning, including limited self-management and behavior inhibition, can lead to off-task and disruptive behaviors that interfere with acquisition of academic and social skills. Without effective and efficient interventions, opportunities to participate in inclusive settings will likely be reduced. Self-monitoring (SM) is an intervention with strong evidence for increasing prosocial behaviors and decreasing challenging behaviors for students with ASD in educational settings, although the cuing mechanisms (e.g., timers, stopwatch) and tracking materials (e.g., paper, pencil) can be cumbersome and obtrusive. I-Connect is an SM application that allows for customizable prompts, recording, and data monitoring. The purpose of this study was to evaluate, utilizing an ABAB design, the functional relationship between implementation of I-Connect SM intervention and increases in on-task behavior with concurrent decreases in disruptive behavior for an elementary student with ASD in a general education classroom. Results indicate an immediate increase in on-task behavior as well as a decrease in disruptive behaviors with each introduction of I-Connect. Implications for practice and future research are discussed.

Exploring Subtypes of Repetitive Behavior in Children with Autism Through Functional Analysis and Wearable Technology: a Pilot Biobehavioral Assessment.

Objectives: Prior research has established assessment methodologies, such as functional analysis to identify specific contexts in which restricted and repetitive behavior (RRB) occurs, and measures of heart rate variability (HRV) to index the level of autonomic arousal in individuals with autism spectrum disorder (ASD). Yet, a gap remains in integrating multiple assessment methodologies to examine the complex underlying mechanisms of RRB. This study piloted a multi-disciplinary approach to assess both the functional behavioral and neurophysiological factors that may underlie occurrences of RRB. The study (a) evaluated the effect of a modified functional analysis protocol on delineating functional subtypes of RRB and (b) explored the effect of using a wearable technology within a functional analysis on identifying the relationship between RRB and HRV. Method: A single-case alternating treatment design was used to randomly alternate noncontingent low-stimulation and high-stimulation conditions in a modified functional analysis protocol. Simultaneous measurement of RRB and HRV was obtained through direct behavioral observations and a wristband that collects blood volume pulse, respectively. Visual analysis of time series data was used to determine the functional subtypes of RRB, and nonparametric correlational analyses were conducted to determine the association between HRV and RRB. Results: Findings from a sample of six participants suggest preliminary effectiveness of the assessment protocol in identifying subtypes of RRB and a significant correlation between HRV and RRB. Conclusions: This study demonstrates the potential effect and usability of a wearable technology-aided biobehavioral approach to assess RRB and HRV in individuals with ASD.

Crohn's disease activity: quantitative contrast-enhanced ultrasound assessment.

OBJECTIVES: To determine whether quantitative parameters from contrast-enhanced ultrasound examination (CE-US) of the bowel wall correlate with endoscopic inflammatory activity in Crohn's disease and to assess its utility in the follow-up of patients on treatment. METHODS: This was a prospective study of 30 patients with Crohn's disease requiring colonoscopy or flexible sigmoidoscopy. The Crohn's disease activity index (CDAI), serum C-reactive protein (CRP) and Crohn's disease endoscopic index of severity (CDEIS) were calculated. CE-US was performed within 7 days of endoscopy using intravenous perflutren lipid microsphere and repeated a median of 45.5 days following treatment. Time-intensity curves of bowel wall enhancement were generated to derive the area under the curve (AUC), time to peak intensity (TTP) and peak intensity (PI). RESULTS: In separate multivariate regression models, the AUC, TTP and PI showed no significant association with endoscopic activity whilst controlling for CDAI and CRP. However, the reductions in CDAI and CRP following treatment were mirrored by significant reductions in TTP (P = 0.05). CONCLUSIONS: CE-US does not appear to predict for Crohn's disease endoscopic activity independent of simple parameters such as CDAI and CRP. However, it may be useful in the serial assessment of patients on treatment.

"Setting Them Up for Success": Including Youth on the Autism Spectrum in 4-H.

Youth on the autism spectrum often face challenges accessing services in rural communities compared to those who live in higher resource areas. There is a particular need for services that support skills that will help youth transition to adulthood and future employment. 4-H is a national youth development program that is well-positioned to address the needs of youth on the autism spectrum; however, minimal empirical evidence exists about the implementation and effectiveness of inclusive practices in 4-H programs. The goal of this study was to better understand barriers to enrollment and to identify gaps in support for youth on the autism spectrum participating in 4-H. Twenty Extension Educators in Indiana participated in two focus groups. Thematic analysis of focus group transcripts identified barriers to enrollment including awareness of 4-H as an inclusive program and difficulties navigating 4-H culture. Our analysis identified themes related to new training content and delivery including a resource portfolio, communication, individualized accommodations, and working within the existing leadership training structure. Findings support the benefits of 4-H as a program that can promote life skills and personal development for youth on the autism spectrum but also highlight a significant need for additional training opportunities and resources to increase uptake and improve the implementation of inclusive practices.

Telehealth Training in Naturalistic Communication Intervention for Mothers of Children with Angelman Syndrome.

Objectives : Young children with Angelman syndrome have significant delays in expressive communication. Parents of children with Angelman syndrome require training to support their child's communication development. Unfortunately, parent training focused on the needs of families of children with rare genetic syndromes is unavailable to many families. The purpose of this study was to evaluate a telehealth parent training program on naturalistic communication intervention for young children with Angelman syndrome. Methods: Using two single-case multiple baseline designs across a total of six parent-child dyads, we evaluated the effects of a telehealth parent training program on parent implementation fidelity of a naturalistic communication intervention, child communication, and child engagement. Results: With the telehealth parent training program, parent implementation fidelity of naturalistic communication intervention improved, maintained and generalized to untrained home routines. Small effects on child communication and engagement were observed during the program. Conclusions: Parents of children with Angelman syndrome were successfully taught via telehealth to implement a naturalistic communication intervention with their child at home. Additional research is needed to promote positive child communication outcomes through parent-mediated intervention.

A Meta-Analysis of Video Modeling Interventions to Enhance Job Skills of Autistic Adolescents and Adults.

Background: Autistic transition-aged youth and young adults face many societal barriers to competitive integrated employment (CIE). Existing evidence-based practices (EBPs) for autistic individuals, such as video modeling (VM), may be a viable on-the-job training method to enhance employment experiences and outcomes for this population. Methods: The purpose of this meta-analysis was to synthesize VM studies to teach job skills for autistic individuals. We applied the Council for Exceptional Children's (CEC) Standards for Evidence-Based Practices in Special Education to evaluate the methodological rigor of included studies using a weighted coding scheme. We further evaluated methodologically sound studies by calculating an omnibus Tau-U effect size. Results: Twenty articles met our inclusion criteria, and 11 of those studies were classified as methodologically sound according to the CEC's criteria. Results indicate that VM is an EBP to improve job skills of autistic individuals. The overall effect size for methodologically sound studies was strong (0.91), but most studies occurred in contrived or school-based employment settings rather than CIE settings in the local labor market. Conclusions: Employers, transition professionals, and related service providers can consider VM a viable method to teach job skills to autistic employees. However, additional research conducted in CIE settings is needed to better understand the effects of VM in contexts where autistic employees earn regular wages. Lay summary: Why was this study done?: Autistic adolescents and adults often experience barriers obtaining employment in their local communities. They may also benefit from on-the-job supports for successful employment. Video modeling is one intervention technique that has been used to teach a variety of skills to autistic individuals. Video modeling involves creating short video clips that show the person how to do specific skills or tasks. We wanted to learn about how video modeling has been used to teach job skills to autistic employees.What was the purpose of this study?: The purpose of this study was to evaluate the quality of research studies that used video modeling to teach job skills to autistic employees. Understanding how video modeling interventions can be used in employment settings may help autistic employees have more positive work experiences.What did the researchers do?: The researchers analyzed the video modeling research studies with autistic participants aged 14 years or older. We evaluated the quality of each study, type of employment setting, type of job skill, and how much the job skills improved. We used a criteria established by a professional organization, the Council for Exceptional Children, to evaluate the quality of the research studies.What were the results of the study?: We analyzed 20 research studies and found that video modeling was an overall effective intervention to teach job skills to autistic adolescents and adults. However, most of the studies focused on general job tasks rather than employment-related social skills. In addition, most of the studies were conducted in employment settings where the autistic employees did not earn regular wages, such as school settings or internships. We encourage future researchers to study how video modeling can be used to promote competitive integrated employment in community settings.What do these findings add to what was already known?: Prior research studies have used video modeling to teach skills such as academic, play, and social skills to autistic children and youth. This study showed us that video modeling is an effective intervention to teach job skills to autistic adolescents and adults.What are the potential weaknesses of the study?: There are disagreements about how to evaluate the quality of research studies in the field of special education. We used a popular criterion by the Council for Exceptional Children organization, but our results may be different from other researchers. We also did not find a large number of studies, so some of our findings should be considered with caution.How will these findings help autistic adults now or in the future?: These findings demonstrate that video modeling is an effective on-the-job training method for autistic employees. Autistic adults can use video modeling at work to learn new job skills. Employers, job coaches, and secondary transition professionals could use brief videos to support autistic employees.

A Meta-analysis of Challenging Behavior Interventions for Students with Developmental Disabilities in Inclusive School Settings.

Challenging behavior is a significant barrier in accessing the general education curriculum for students with developmental disabilities. This necessitates the identification of evidence-based practices for addressing challenging behavior in inclusive settings. The purpose of our meta-analysis is to (a) quantify the magnitude of effect of interventions targeting the reduction of challenging behavior in students with developmental disabilities in inclusive educational settings and (b) determine if participant and intervention characteristics moderate intervention effects. A systematic search of academic databases was conducted to identify studies, which were evaluated for methodological rigor and analyzed for effects using Tau-U. Results indicate a strong overall effect of .94 (95% CI [.87, 1]) and moderating variables associated with behavior topography, interventionist, and intervention components were identified.

The Effects of a Technology-Based Self-monitoring Intervention on On-Task, Disruptive, and Task-Completion Behaviors for Adolescents with Autism.

Individuals with autism spectrum disorders (ASD) often present with difficulty in sustaining engagement, attention, and have disruptive behavior in classroom settings. Without appropriate intervention, these challenging behaviors often persist and negatively impact educational outcomes. Self-monitoring is a well-supported evidence-based practice for addressing challenging behaviors and improving pro-social behaviors for individuals with ASD. Self-monitoring procedures utilizing a handheld computer-based technology is an unobtrusive and innovative way of implementing the intervention. A withdrawal design was employed to assess the effectiveness of a technologically-delivered self-monitoring intervention (I-Connect) in improving on-task and task completion behaviors and decreasing disruptive behavior with four adolescents with ASD. Results demonstrated improvements in on-task and task completion behaviors across all four participants and disruptive behavior improved for two participants.

Exploring paraprofessional and classroom factors affecting teacher supervision.

BACKGROUND: Paraprofessionals serve a primary role in supporting students with disabilities in the classroom, which necessitates teachers' supervision as a means to improve their practice. Yet, little is known regarding what factors affect teacher supervision. AIMS: We sought to identify how paraprofessional competence and classroom type affected the levels of teacher direction. METHODS AND PROCEDURES: We administered an adapted version of the Paraprofessional Needs, Knowledge & Tasks Survey and the Survey for Teachers Supervising Paraprofessionals to teachers supervising paraprofessionals in elementary schools. Structural Equation Modeling was used to examine the link between paraprofessional competence and classroom factors affecting the level of teacher supervision. OUTCOMES AND RESULTS: Our results indicated that when teachers perceived paraprofessionals as being more skilled, they provided more supervision, and when more supervision was provided the less they thought paraprofessionals should be doing their assigned tasks. Additionally, paraprofessionals working in classrooms with more students with mild disabilities received less supervision than paraprofessionals working in classrooms with more students with moderate-to-severe disabilities. Those paraprofessionals in classrooms serving mostly children with mild disabilities were also perceived as having lower levels of skill competence than those serving in classrooms with students with more moderate-to-severe disabilities. CONCLUSION AND IMPLICATIONS: By understanding the factors that affect teacher supervision, policy and professional development opportunities can be refined/developed to better support both supervising teachers and paraprofessionals and, in turn, improve the outcomes of children with disabilities.

A Systematic Review of Parent-Implemented Functional Communication Training for Children With ASD.

Supporting parents in reducing challenging behavior of children with autism spectrum disorder (ASD) requires the identification of effective, feasible, and sustainable interventions. Functional communication training (FCT) is one of the most well-established interventions in the behavioral literature and is used increasingly by parents. However, there is a need for additional evaluation of the literature related to parent-implemented FCT. In the present review, we identified 26 peer-reviewed studies on parent-implemented FCT. We conducted systematic descriptive and social validity analyses to summarize the extant literature. Across studies, parent-implemented FCT was effective in reducing child challenging behavior, and in some cases, intervention outcomes maintained and generalized to novel settings and implementers. However, few studies reported fidelity data on parent implementation of FCT, and data regarding sustained use of FCT by parents were limited. Results of the social validity analysis indicate that while FCT is often implemented by natural change agents in typical settings, parent training is often provided by professionals not typically accessible to parents. These findings suggest that future research is warranted in the areas of parent training and long-term sustainability of parent-implemented FCT.

Impact of a Teacher-as-Coach Model: Improving Paraprofessionals Fidelity of Implementation of Discrete Trial Training for Students with Moderate-to-Severe Developmental Disabilities.

Ensuring educational progress for students with moderate-to-severe developmental disabilities requires exposure to well executed evidence-based practices. This necessitates that the special education workforce, including paraprofessionals, be well-trained. Yet evidence regarding effective training mechanisms for paraprofessionals is limited. A multiple baseline design across five teachers was used to evaluate the impact of online instructional modules and a Practice-Based Coaching (PBC) model with teacher-as-coach on their paraprofessionals' fidelity of discrete trial training (DTT). Implementation of the instructional modules yielded little to no change in paraprofessionals' DTT fidelity, however, a clear functional relation between PBC and improvement in paraprofessionals' fidelity of implementation of DTT was demonstrated. Implications for future research and practice are discussed.

The effects of video modeling in teaching functional living skills to persons with ASD: A meta-analysis of single-case studies.

BACKGROUND: Many individuals with autism spectrum disorders (ASD) show deficits in functional living skills, leading to low independence, limited community involvement, and poor quality of life. With development of mobile devices, utilizing video modeling has become more feasible for educators to promote functional living skills of individuals with ASD. AIMS: This article aims to review the single-case experimental literature and aggregate results across studies involving the use of video modeling to improve functional living skills of individuals with ASD. METHODS AND PROCEDURES: The authors extracted data from single-case experimental studies and evaluated them using the Tau-U effect size measure. Effects were also differentiated by categories of potential moderators and other variables, including age of participants, concomitant diagnoses, types of video modeling, and outcome measures. OUTCOMES AND RESULTS: Results indicate that video modeling interventions are overall moderately effective with this population and dependent measures. While significant differences were not found between categories of moderators and other variables, effects were found to be at least moderate for most of them. CONCLUSIONS AND IMPLICATIONS: It is apparent that more single-case experiments are needed in this area, particularly with preschool and secondary-school aged participants, participants with ASD-only and those with high-functioning ASD, and for video modeling interventions addressing community access skills.

Use of a Self-monitoring Application to Reduce Stereotypic Behavior in Adolescents with Autism: A Preliminary Investigation of I-Connect.

Many students with autism engage in a variety of complex stereotypic behaviors, impacting task completion and interfering with social opportunities. Self-monitoring is an intervention with empirical support for individuals with ASD to increase behavioral repertoires and decrease behaviors that are incompatible with successful outcomes. However, there is limited evidence for its utility for decreasing stereotypy, particularly for adolescents in school settings. This study evaluated the functional relationship between I-Connect, a technology-delivered self-monitoring program, and decreases in the level of stereotypy for two students with ASD in the school setting utilizing a withdrawal design with an embedded multiple baseline across participants. Both students demonstrated a marked decrease in stereotypy with the introduction of the self-monitoring application. Results and implications for practice and future research will be discussed.

A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: a randomized trial in kindergarten and first grade.

The purpose of this randomized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First-grade children with autism spectrum disorders. Trained school staff members provided direct instruction for 56 children in the intervention group, and 39 children participated in a comparison group. Results showed children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment social probes and generalization probes. Treatment session data showed significant growth for total communications over baseline levels. Children in treatment also showed more growth in language and adaptive communication. Finally, teachers' ratings of prosocial skills revealed significantly greater improvements for the intervention group.

Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: an aggregate study of single-case research with individuals with ASD.

OBJECTIVE: The purpose of this meta-analysis was to evaluate the potential moderating effects of intervention setting and type of aided augmentative and alternative communication (AAC) on outcome variables for students with autism spectrum disorders. METHODS: Improvement rate difference, an effect size measure, was used to calculate aggregate effects across 35 single-case research studies. RESULTS: Results indicated that the largest effects for aided AAC were observed in general education settings. With respect to communication outcomes, both speech generating devices (SGDs) and the Picture Exchange Communication System (PECS) were associated with larger effects than other picture-based systems. With respect to challenging behaviour outcomes, SGDs produced larger effects than PECS. CONCLUSION: This aggregate study highlights the importance of considering intervention setting, choice of AAC system and target outcomes when designing and planning an aided AAC intervention.

Peer Mediation to Increase Communication and Interaction at Recess for Students with Autism Spectrum Disorders.

Recess plays an integral role in the social and emotional development of children given the time provided to engage in interactions with others and practice important social skills. Students with ASD, however, typically fail to achieve even minimal benefit from recess due to social and communication impairments as well as a tendency to withdraw. Implementation of evidence-based interventions such as peer-mediated social skills groups, are necessary to ensure recess is an advantageous learning environment for students with ASD. A multiple-baseline design across participants was used to determine if a functional relationship exists between a social skills instructional program combined with peer networks with school staff as implementers and increases in level of communicative acts for participants with ASD at recess. Results indicate all participants demonstrated an immediate increase in the number of communicative acts with the introduction of the intervention. Implications for practice are discussed.

A review of the quality of behaviorally-based intervention research to improve social interaction skills of children with ASD in inclusive settings.

Students with autism spectrum disorders (ASDs) often have difficulties in social interaction skills, which may prevent their successful inclusion in general education placements. Behaviorally-based social skills interventions have been shown to be effective in attenuating such difficulties in these environments. In light of the increasing number of children with ASD being educated in inclusive settings and requirements for the use of research-based interventions in schools, this paper (1) analyzes the quality of single-case research using behaviorally-based interventions to improve social interaction skills of children with ASD in inclusive settings and (2) evaluates whether such interventions can be considered an evidence-based practice. Characteristics and components of the interventions are summarized, and their implications for practice and future research are discussed.

Interaction of participant characteristics and type of AAC with individuals with ASD: a meta-analysis.

Individuals with autism spectrum disorders (ASD) and complex communication needs often rely on augmentative and alternative communication (AAC) as a means of functional communication. This meta-analysis investigated how individual characteristics moderate effectiveness of three types of aided AAC: the Picture Exchange Communication System (PECS), speech-generating devices (SGDs), and other picture-based AAC. Effectiveness was measured via the Improvement Rate Difference. Results indicated that AAC has small to moderate effects on speech outcomes, and that SGDs appear to be most effective when considering any outcome measure with individuals with ASD without comorbid intellectual/developmental disorders (IDD). PECS appears to be most effective when considering any outcome measure with individuals with ASD and IDD. SGDs and PECS were the most effective type of AAC for preschoolers, when aggregating across outcome measures. No difference was found between systems for elementary-aged and older individuals.

Effects of video modeling on communicative social skills of college students with Asperger syndrome.

INTRODUCTION: Empirical support regarding effective interventions for individuals with autism spectrum disorder (ASD) within a postsecondary community is limited. Video modeling, an empirically supported intervention for children and adolescents with ASD, may prove effective in addressing the needs of individuals with ASD in higher education. OBJECTIVE: This study evaluated the effects of video modeling without additional treatment components to improve social-communicative skills, specifically, eye contact, facial expression, and conversational turntaking in college students with ASD. METHOD: This study utilized a multiple baseline single-case design across behaviors for two post-secondary students with ASD to evaluate the effects of the video modeling intervention. RESULTS: Large effect sizes and statistically significant change across all targeted skills for one participant and eye contact and turntaking for the other participant were obtained. CONCLUSION: The use of video modeling without additional intervention may increase the social skills of post-secondary students with ASD. Implications for future research are discussed.

Moderating factors of video-modeling with other as model: a meta-analysis of single-case studies.

Video modeling with other as model (VMO) is a more practical method for implementing video-based modeling techniques, such as video self-modeling, which requires significantly more editing. Despite this, identification of contextual factors such as participant characteristics and targeted outcomes that moderate the effectiveness of VMO has not previously been explored. The purpose of this study was to meta-analytically evaluate the evidence base of VMO with individuals with disabilities to determine if participant characteristics and targeted outcomes moderate the effectiveness of the intervention. Findings indicate that VMO is highly effective for participants with autism spectrum disorder (IRD=.83) and moderately effective for participants with developmental disabilities (IRD=.68). However, differential effects are indicated across levels of moderators for diagnoses and targeted outcomes. Implications for practice and future research are discussed.