Using the Choiceboard Creator™ app on an iPad© to teach choice making to a student with severe disabilities.

This paper describes an intervention to teach the use of the Choiceboard Creator app on an iPad for choice making to a student with autism, severe intellectual disability, and challenging behavior. This app provides flexibility in the number of pictures and blank distractors displayed, produces voice output, shuffles the picture arrangement after each activation, and makes the selected picture more salient by enlarging it once it has been selected. The effectiveness of the intervention was explored using a multiple baseline across three settings. Pre- and post-assessments of the student's ability to select a picture given the spoken word or the object and to select the object given the spoken word or the picture explored the further development of picture skills. The student learned to use a display of three pictures in free play, a display of two pictures in morning circle, and a display of five pictures at morning tea.

A qualitative study of the transition to employment of former university students on the autism spectrum from Australia and New Zealand.

Many former university students on the autism spectrum have poor employment outcomes despite strengths, qualifications, and ability. This article presents findings from a qualitative study of 11 former university students on the spectrum (self-identified: 2 males, 7 females, 2 non-binary, 18-50+ years), and five significant others (2 mothers, 3 spouses), from Australia and New Zealand. We identified issues associated with better and poorer transition to employment experiences (poor mental health, lack of support, poor interview skills). The former students also indicated a belief that it was not the role of a university education to prepare students for employment. This belief may have influenced their discipline choices and attitude towards using career supports and university employability components. The participants who studied non-vocationally specific qualifications described more difficulty with conceptualising their transition to employment, developing an employment goal, and finding work. It was suggested that universities may need to provide comprehensive transition to employment programs that develop the 'soft skills' required for employment and offer work placements for both vocationally and non-vocationally oriented courses to help students build skills that increase their employability.

Adaptation of COMPASS for use in Autism-Specific Schools in Australia: A Cluster Randomized Trial.

Autistic students are educated in Australia across a variety of contexts and almost all educators use individualized goal-setting as a way of ensuring appropriate accommodations and curriculum modifications. Educators experience similar challenges when developing individualized goals for students, including lack of a standardized process for goal setting, inconsistent support networks, and challenges with data-driven goal-setting. The purpose of our research was to adapt and trial the Collaborative Model for Competence and Success (COMPASS), a research-based intervention aimed at improving the individualized goal-setting process for autistic students. Our primary hypothesis was that autistic students who participate in COMPASS would demonstrate more growth on their individualized outcomes relative to autistic students who receive services as usual (SAU). To answer our primary research question, we applied a single-blind cluster randomized trial. Participants were randomized into one of two groups: (a) a COMPASS intervention group and (b) a SAU group. Results indicate that students whose teachers received the intervention made more progress on their final individualized goals than those who received SAU, replicating previous findings regarding COMPASS in the US. Also, the adaptation of COMPASS for an Australian context showed high rates of satisfaction and fidelity. The success of this intervention in improving the progress that students make on their individualized goals demonstrates the benefits of a standardized intervention that supports teachers and families in this critical practice.

Factors and Perceptions Associated with Post-Pandemic Food Sourcing and Dietary Patterns among Urban Corner Store Customers in Baltimore, Maryland.

OBJECTIVE: Diet-related disease is rising, disproportionately affecting minority communities in which small food retail stores swamp supermarkets. Barriers to healthy food access were exacerbated by the pandemic. We examined the following: (1) individual- and household-level factors in a sample of Baltimore community members who regularly shop at corner stores and (2) how these factors are associated with indicators of dietary quality. DESIGN: Cross-sectional data were collected using an online survey to capture sociodemographics, anthropometrics, and food sourcing, spending, and consumption patterns. Concurrent quantitative and qualitative analyses were conducted in Stata 18 and ATLAS.ti. SETTING: This study was set in Baltimore, Maryland, USA. PARTICIPANTS: The participants included adults (n = 127) living or working in Baltimore who identified as regular customers of their neighborhood corner store. RESULTS: The respondents were majority Black and low-income, with a high prevalence of food insecurity (62.2%) and overweight/obesity (66.9%). Most (82.76%) shopped in their neighborhood corner store weekly. One-third (33.4%) of beverage calories were attributed to sugar-sweetened beverages, and few met the recommended servings for fruits and vegetables or fiber (27.2% and 10.4%, respectively). Being Black and not owning a home were associated with lower beverage and fiber intake, and not owning a home was also associated with lower fruit and vegetable intake. Food insecurity was associated with higher beverage intake, while WIC enrollment was associated with higher fruit and vegetable and fiber intakes. Open-ended responses contextualized post-pandemic food sourcing and consumption in this setting. CONCLUSIONS: This paper helps characterize the consumers of a complex urban food system. The findings will inform future strategies for consumer-engaged improvement of local food environments.

Health-related quality of life before and after pediatric epilepsy surgery: the influence of seizure outcome on changes in physical functioning and social functioning.

Health-related quality of life (HRQOL) is an important outcome in pediatric epilepsy surgery, but there are few studies that utilize presurgical ratings to assess the effect of surgery on HRQOL. We collected parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 28 children who participated in neuropsychological assessment before and after epilepsy surgery. Our results revealed significant improvements in overall HRQOL after surgery, especially in physical and social activities. These changes were apparent despite generally unchanged intellectual and psychological functioning. Children with better seizure outcome had more improvement in HRQOL; however, improvements were not statistically different among children with Engel class I, II, and III outcomes. Our results suggest that children can experience significant improvements in HRQOL following epilepsy surgery even when neuropsychological functioning remains unchanged. Moreover, improvements in HRQOL appear evident in children who experience any worthwhile improvement in seizure control (Engel class III or better).

Discharge rate modulation of trapezius motor units differs for voluntary contractions and instructed muscle rest.

This study examined discharge rate modulation at respiratory (0-0.5 Hz) and beta (16-32 Hz) frequencies in trapezius motor units active during voluntary contractions and during periods of instructed rest under conditions of low and high psychosocial stress. In separate sessions, single motor unit activity was recorded from the trapezius muscle of healthy women during low-intensity voluntary contractions and during periods of instructed muscle rest that followed voluntary contractions. The level of psychosocial stress during periods of instructed muscle rest was manipulated using a verbal math task combined with social evaluative threat which increased perceived anxiety, heart rate, and blood pressure (P ≤ 0.002). Discharge rate modulation was quantified by the mean power of motor unit discharge rate profiles within frequency bands of interest. Under low stress conditions, motor units active during instructed rest had greater power at 0-0.5 Hz (P = 0.002) and less power at 16-32 Hz (P = 0.009) compared to those active during voluntary contraction. Exposure to the stressor increased the amount of motor unit activity during instructed rest (P = 0.021) but did not alter the power of discharge rate modulation at 0-0.5 Hz (P = 0.391) or 16-32 Hz (P = 0.089). These results indicate that sustained motor unit activity during periods of instructed muscle rest has a lesser contribution from inputs at beta frequencies and a greater contribution from inputs at respiratory frequencies than present during low-intensity voluntary contractions. Furthermore, increases in motor unit activity when exposed to stressors during periods of instructed rest are not caused by changes in inputs at respiratory or beta frequencies.

An On-Line Survey of University Students with Autism Spectrum Disorder in Australia and New Zealand: Characteristics, Support Satisfaction, and Advocacy.

An on-line survey of 102 (51 females; undergraduate and graduate) university students with ASD across Australia and New Zealand examined student characteristics and satisfaction with academic and non-academic supports. A broad range of disciplines were studied, and the participants' reported strengths included a passion for learning, strong technology skills, and creative thoughts. The participants' greatest concerns were academic requirements and mental health, including high rates of self-harm and suicidal ideation. Despite support satisfaction ratings being high, support usage was low, possibly indicating a mismatch of supports and needs, lack of awareness of available supports, and/or poor advocacy skills.

Perspectives of Former Students with ASD from Australia and New Zealand on Their University Experience.

The university experience of students with ASD was explored through a qualitative study of 11 former university students and six significant others from Australia and New Zealand. A range of key issues were identified including difficulties encountered when studying, reasons for completion and non-completion, supports used, and coping strategies used by the participants. Many switched to part-time to manage their poor mental health and/or executive function and most had slow rates of progress. Also, some felt they had made poor discipline choices. The participants offered suggestions for future students and for making universities more autism friendly, and the possible need for transition and more structured study supports was identified.

Partner Perceptions of Conversations with Individuals with Autism Spectrum Disorder.

Pragmatic difficulties resulting in problems with reciprocal conversation are widely studied in individuals with autism spectrum disorder (ASD). There is some consensus on the conversation differences between individuals with autism compared to neurotypical groups and groups with other developmental delays. There is little information on whether conversation partners (neurotypical or with ASD) of individuals with ASD find these differences problematic. The results indicate that behaviors reported to be the most problematic were not necessarily behaviors commonly addressed in research. Further, some conversational capacities that have received less research focus were perceived as more problematic. Although conversation partners who had ASD themselves reported the frequency of behaviors similarly to the neurotypical group, they did not find the behaviors as problematic.

The use of weighted vests with children with autism spectrum disorders and other disabilities.

Therapists who use sensory integration therapy may recommend that children wear weighted vests as an intervention strategy that they claim may assist in remediating problems such as inattentiveness, hyperactivity, stereotypic behaviors and clumsiness. Seven studies examining weighted vests are reviewed. While there is only a limited body of research and a number of methodological weaknesses, on balance, indications are that weighted vests are ineffective. There may be an arguable case for continued research on this intervention but weighted vests cannot be recommended for clinical application at this point. Suggestions are offered for future research with regard to addressing methodological problems.

The coordination of upper and lower limb movements during gait in healthy and stroke individuals.

Human walking involves coordinated movements of all four limbs. The benefits of incorporating arm movements in gait rehabilitation are not known and difficult to investigate in patient populations with poor balance and reduced walking capacity. This study assessed the effect of supported (SUP) versus unsupported (UNSUP) arm movements on the coordination patterns present during walking in individuals with and without a stroke. Ten high functioning stroke subjects and 10 healthy subjects walked on a treadmill while swinging their arms naturally, and while holding onto handles that were either fixed in place or allowed to slide along horizontal handrails. Full-body kinematics were recorded, and arm-leg coordination was quantified using relative phase index, mean relative phase, and cross-correlation of hip and shoulder angle time series. No differences were observed in any measures of coordination between healthy and stroke subjects, indicating that the ability to coordinate arm and leg movements during walking remains preserved in high functioning stroke individuals. Coordination patterns were also unaffected by the use of sliding handrails, suggesting that this paradigm may be a suitable surrogate for natural arm movements if individuals are unable to walk without an external support. Stroke subjects were able to perform arm movements at a faster walking speed when using the handles than they were able to achieve without the handles, indicating that this paradigm may be useful in encouraging arm movements during gait rehabilitation.

Iconicity in the development of picture skills: typical development and implications for individuals with severe intellectual disabilities.

The iconicity of graphic symbols and the iconicity hypothesis are theoretical concepts that have had an impact on the use of augmentative and alternative communication strategies for people with severe intellectual disabilities. This article reviews some of the recent literature on the impact of iconicity on symbol recognition and use by typically developing children and relates those findings to people with severe disability. It seems that although iconicity may have some impact on symbol learning, there are other variables that are likely to be much more important. It is likely that iconicity is not helpful to those learning graphic symbols who have little or no comprehension of spoken language.

Picture-book reading as an intervention to teach the use of line drawings for communication with students with severe intellectual disabilities.

Picture-book reading provides an effective intervention context for young children learning spoken language and may also be appropriate for teaching the use of augmentative and alternative communication to children with severe intellectual disabilities. This study reports on a group intervention using a semiscripted book reading routine implemented by a teacher in a classroom for students with severe intellectual disabilities. Student use of line drawings was observed over the course of the intervention. Students' abilities to match words, line drawings, book illustrations, and real objects were assessed weekly. There were differences between baseline and intervention performances for all students, and these differences were particularly noticeable for one student.

Recognition and use of line drawings by children with severe intellectual disabilities: the effects of color and outline shape.

Communication symbols for students with severe intellectual disabilities often take the form of computer-generated line drawings. This study investigated the effects of the match between color and shape of line drawings and the objects they represented on drawing recognition and use. The match or non-match between color and shape of the objects and drawings did not have an effect on participants' ability to match drawings to objects, or to use drawings to make choices.

A Systematic Literature Review of Empirical Research on Postsecondary Students with Autism Spectrum Disorder.

The findings from a systematic literature review of 24 empirical studies of interventions for post-secondary students with autism spectrum disorder (ASD) are reported in this study. A diverse range of interventions were examined, many of which appeared feasible and high rates of participant satisfaction were also reported. Differing responses within and among interventions may point to the possible need for individualized supports. Few studies analyzed a specific academic support despite many students with ASD indicating they prefer these supports and that they find them useful. This may highlight the need for participant preferences to be given more consideration when designing supports. Most studies were of poor quality, however, so any conclusions are tentative. Directions for future research were discussed.

Instruments to Evaluate Nurse Residency Programs: A Review of the Literature.

The purpose of this literature review was to explore evaluation instruments used by nurse residency programs to evaluate outcomes. The 15 studies found yielded 26 instruments, and all instruments were subjective, dated, and varied in how they were used. Nursing professional development practitioners should use a combination of reliable, valid, and current evaluation methods to appraise their nurse residency programs in order to demonstrate program quality and effectiveness.

Perspectives of University Students with Autism Spectrum Disorder.

Students with autism spectrum disorder (ASD) are at heightened risk of post-secondary educational failure and account for approximately 1% of students in post-secondary education. Findings from an on-line survey of students with ASD attending university in Australian are reported in this study. Respondents indicated high rates of academic and non-academic difficulties but low usage of supports. Ratings for supports were idiosyncratic, and some students indicated discomfort from using supports or disclosing their disability. Those students who delayed their disclosure accessed fewer supports and reported a poorer overall university experience. Recommendations were made including the need for better transition support and alternative strengths based approaches that use more flexible and individualised curriculum designs.

Physiological evaluation of gait disturbances post stroke.

A large proportion of stroke survivors have to deal with problems in mobility. Proper evaluations must be undertaken to understand the sensorimotor impairments underlying locomotor disorders post stroke, so that evidence-based interventions can be developed. The current electrophysiological, biomechanical, and imagery evaluations that provide insight into locomotor dysfunction post stroke, as well as their advantages and limitations, are reviewed in this paper. In particular, electrophysiological evaluations focus on the contrast of electromyographic patterns and integrity of spinal reflex pathways during perturbed and unperturbed locomotion between persons with stroke and healthy individuals. At a behavioral level, biomechanical evaluations that include temporal distance factors, kinematic and kinetic analyses, as well as the mechanical energy and metabolic cost, are useful when combined with electrophysiological measures for the interpretation of gait disturbances that are related to the control of the central nervous system or secondary to biomechanical constraints. Finally, current methods in imaging and transcranial magnetic stimulation can provide further insight into cortical control of locomotion and the integrity of the corticospinal pathways.

The effect of color on the recognition and use of line drawings by children with severe intellectual disabilities.

Line drawings are commonly used as communication symbols for individuals with severe intellectual disabilities. This study investigated the effect of color on the recognition and use of line drawings by young children with severe intellectual disabilities and poor verbal comprehension who were beginning picture users. Drawings where the color of the picture matched the object and where the color of the drawing did not match the object were used, as well as black and white line drawings. Tentative findings suggest that some students with intellectual disabilities may find it more difficult to recognize and line drawings where the color does not match the object compared to line drawings where the color of the drawing does match the color of the object.

Friendship Satisfaction in Children with Autism Spectrum Disorder and Nominated Friends.

The current study examined the level of friendship satisfaction of children with autism spectrum disorder (ASD) and their nominated friends (with and without diagnosis of ASD). A total of 77 target children with ASD and friends from 49 nominated friendships participated in the study. Relatively high levels of friendship satisfaction were reported by both target children and their nominated friends with no overall difference between dyads involving typically developing friends and friends with ASD. Analysis at the individual dyad level showed a high level of agreement on the reported level of satisfaction across the target participants and their friends. Limitations and directions for future research are presented.