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BACKGROUND: Autism is a complex neurodevelopmental disability with global prevalence of one in 100 individuals. Poor access to interventions in both under-resourced regions of high-income countries and low- and middle-income countries has deleterious effects on the health and wellbeing of individuals with autism and their families. Our objective was to utilize a reciprocal innovation framework and participatory methods to adapt and co-develop a culturally grounded group-based wellbeing and naturalistic developmental behavioural intervention (NDBI) training program for caregivers of young children with autism to be implemented in Kenya and rural Indiana. METHODS: This study was conducted within the Academic Model Providing Access to Healthcare (AMPATH) program. An evidence-informed Naturalistic Developmental Behavioral Intervention (NDBI) previously utilized in Indiana was adapted and iteratively refined using the Ecological Validity Framework (EVF) by a team of US and Kenyan disability experts. Key adaptations to the program were made across the EVF domains of language, persons, metaphors/content, concepts, goals, methods, and context. RESULTS: Substantial cultural adaptations were made to the NDBI following the EVF model, including the addition of traditional Kenyan cultural practices, use of narrative principles, and focus on daily routines over play. Pepea, the adapted program, involves 10 group sessions covering content in basic education on autism, positive caregiver coping strategies, and behavioural skills training to promote child communication and reduce challenging behaviour. Key adaptations for Pepea were integrated back into a US NDBI caregiver training program. CONCLUSIONS: This study fills a critical gap by detailing the adaptation process of a caregiver wellbeing and naturalistic developmental behavioural training program for caregivers of children with autism in low-resource settings. Our next steps are to report on mixed-methods outcomes from pilot implementation. Our long-term goal is to apply these insights to advance sustainable and scalable autism intervention services across the globe.
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Cuidadores , Humanos , Kenia , Cuidadores/educación , Cuidadores/psicología , Preescolar , Estados Unidos , Masculino , Femenino , Trastorno Autístico/rehabilitación , Trastorno Autístico/terapia , Trastorno Autístico/psicología , Terapia Conductista/métodos , Países en Desarrollo , Indiana , Asistencia Sanitaria Culturalmente Competente , Desarrollo de Programa , NiñoRESUMEN
Angelman syndrome (AS) is a rare genetic developmental disability that presents with high rates of co-occurring sleep difficulties. Most existing research has focused on the pathophysiology of sleep problems in people with AS, and suggests that sleep problems are the result of genetic and neurobiological factors. However, little is known about the role of the social environment and learning in sleep problems in children with AS. This descriptive study used survey data from 139 parents of children with AS to investigate: 1) the type, topography and severity of children's sleep problems; 2) the collateral child, parent and family impacts of the sleep problems; 3) treatment selection practices and the perceived effectiveness of these treatments; and 4) sources of support and treatment advice received. Parents reported that the majority of children experienced sleep problems, resulting in numerous deleterious effects on child and family functioning. They also reported high levels of concern about these sleep problems, but low levels of perceived support. Study findings highlight the need to establish a disability-specific profile of the type and impact of sleep problems experienced by children with AS, and have further implications for the delivery of clinical services and support provided to parents of children with AS.
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Introduction: Service dogs are an increasingly popular complementary intervention for children with autism spectrum disorder. However, despite increasing demand, there remains a lack of empirical research on their potential benefits. The purpose of this study was to evaluate the effects of service dogs on children with autism and their caregivers. Methods: A total of N = 75 families of children with autism were recruited from a non-profit service dog provider in the US, including n = 39 families previously placed with a service dog and n = 36 families engaging in usual care while on the waitlist. Caregivers completed an online survey containing both self- and proxy-report standardized measures of child, caregiver, and family functioning. Linear regressions modeled the relationship between service dog presence and survey outcomes, controlling for relevant child and caregiver covariates. Results: Results indicated that having a service dog was associated with significantly better child sleep behaviors, including better sleep initiation and duration and less sleep anxiety/co-sleeping with medium effect sizes. However, service dog presence was not significantly related to child withdrawal, negative emotionality, emotional self-control, hyperactivity, irritability, and lethargy with small effect sizes. For caregivers, having a service dog was not significantly related to standardized measures of caregiver strain, sleep disturbance, depression, or the impact of the child's condition on family functioning with small effect sizes. Supplemental matched case-control analyses confirmed these findings. Discussion: In conclusion, service dogs were found to positively impact sleep behaviors among children with autism, but may not uniformly relate to other areas of child and caregiver wellbeing. Prospective longitudinal designs, larger sample sizes able to detect small effects, and studies that measure sleep using objective methods are needed to build on these findings.
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The purpose of this study was to examine the effects of using adapted science eBooks within shared reading on comprehension and task engagement of high school students with autism spectrum disorder (ASD). A grade-level science textbook was selected and converted into an eBook format, incorporating various visual and auditory features (e.g., text-to-speech, summarized sentences, highlighted keywords) and presented on an iPad. The shared reading intervention included before, during, and after reading strategies (i.e., pre-teaching target vocabulary words, sharing information, retelling), with direct instruction on locating literal information. The intervention effects on reading comprehension and task engagement were evaluated using a single-case multiple probe design. The results of this study indicated that all participants demonstrated improvements in reading comprehension. Despite the longer intervention sessions compared to the baseline, all participants exhibited similar or enhanced levels of task engagement during the intervention sessions. The findings of this study provide empirical evidence supporting the use of adapted eBooks within shared reading as a means to increase access to grade-level science texts for high school students with ASD while maintaining a high level of task engagement. This intervention holds promise for improving the learning outcomes for students with ASD in science content area.
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There is a growing research literature on the potential benefits of augmentative and alternative communication (AAC) for individuals with autism; however few studies have investigated implementation of AAC within real-life contexts. Thus, the purpose of this study was to investigate the impact of training for practitioners in implementation of aided AAC, and to examine implementation of Picture Exchange Communication System (PECS) in real-life contexts. In particular, this study involved the implementation of instructional coaching to increase opportunities offered by behavioral therapists for their preschool-aged clients to use PECS to make requests. Results indicated increases in therapist implementation of AAC and client use of AAC in trained contexts, with limited generalization to untrained contexts.
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Trastorno Autístico/rehabilitación , Terapia Conductista/métodos , Equipos de Comunicación para Personas con Discapacidad , Educación Especial/métodos , Relaciones Profesional-Paciente , Psicología Educacional/métodos , Adulto , Trastorno Autístico/psicología , Terapia Conductista/educación , Terapia Conductista/estadística & datos numéricos , Trastornos Generalizados del Desarrollo Infantil/psicología , Trastornos Generalizados del Desarrollo Infantil/rehabilitación , Preescolar , Comunicación , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Psicología Educacional/educaciónRESUMEN
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.
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INTRODUCTION: Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being. METHODS AND ANALYSIS: The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up. ETHICS AND DISSEMINATION: The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).
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Terapia de Aceptación y Compromiso , Trastorno Autístico , Telemedicina , Adulto , Humanos , Preescolar , Cuidadores/psicología , Trastorno Autístico/terapia , Método Simple Ciego , Australia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
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.
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Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders. Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes. Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders. Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.
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Personal de Salud/educación , Trastornos del Neurodesarrollo/psicología , Adulto , Actitud , Niño , Educación Médica , Humanos , Grupo de Atención al Paciente , Calidad de la Atención de SaludRESUMEN
The first purpose of this study was to attempt to replicate previous findings that video-based preference assessments without access to selected stimuli may accurately predict relative reinforcing efficacy of stimuli. To do this, we conducted a concurrent operant reinforcer assessment in which we evaluated the relative reinforcing value of highly preferred and less preferred items identified in a video-based preference assessment. The second purpose of this study was to begin to evaluate the potential behavioral mechanisms responsible for the validity of this assessment. To conduct this analysis, we evaluated the relative reinforcing value of those same stimuli depicted in video format and then compared results to results obtained during the reinforcer assessment for tangible stimuli. For all five participants, stimuli identified as highly preferred functioned as reinforcers, and four of five participants, responding during the reinforcer assessment was similar in the presence of tangible stimuli and videos depicting those stimuli.
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Trastorno del Espectro Autista/psicología , Terapia Conductista/métodos , Conducta de Elección , Refuerzo en Psicología , Niño , Preescolar , Femenino , Humanos , Masculino , Juego e Implementos de JuegoRESUMEN
OBJECTIVE: This study examined the efficacy of an inhibitory stimulus control procedure (ISCP) for the management of vocal stereotypy in three children with autism. METHOD: During discrimination training, implemented within a changing criterion design, participants were taught that there were no consequences for vocal stereotypy in the absence of an inhibitory stimulus but that differential reinforcement procedures were in effect in the presence of the stimulus. Functional control of the inhibitory stimulus was subsequently assessed within a reversal design. RESULTS: Inhibitory stimulus control was established during discrimination training, with participants inhibiting vocal stereotypy for 30 min periods in the presence of the inhibitory stimulus. Reductions in vocal stereotypy were maintained in the presence of the inhibitory stimulus and in the absence of further programmed consequences. DISCUSSION: This study extends current knowledge by demonstrating the efficacy of ISCPs paired with reinforcement only, and illustrating the functional control of the inhibitory stimulus.
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Trastorno Autístico/terapia , Terapia Conductista/métodos , Refuerzo en Psicología , Conducta Estereotipada , Trastorno Autístico/rehabilitación , Niño , Humanos , Masculino , VozRESUMEN
By engaging with family members through video-chat technology, children with autism spectrum disorder (ASD) may access additional opportunities to develop social connections to build familial cohesion and access emotional support. The purpose of this study was to evaluate a behavioral intervention package in teaching social conversation via video-chat. Using a non-concurrent multiple-baseline across participants with an embedded alternating treatments design, three seven-year-old males with ASD were taught two variations of a social conversation. Their conversation skills generalized to unfamiliar adults, some of whom had no prior experience with children with ASD. When visual supports were removed, participants appropriately varied their social conversations. Social conversations continued to occur 2 weeks following the completion of the study. Results and implications are discussed.
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Trastorno del Espectro Autista/rehabilitación , Terapia Conductista/métodos , Comunicación , Instrucción por Computador/métodos , Adulto , Trastorno del Espectro Autista/psicología , Niño , Femenino , Humanos , Masculino , Proyectos Piloto , Grabación en VideoRESUMEN
We investigated the effects of a telehealth pyramidal training package on participants' implementation of incidental teaching. A total of eight adults worked with eight children with autism. Coaches were first taught to implement incidental teaching and then taught subsequent interventionists. The training package consisted of an online module and delayed video-based feedback provided via videoconferencing. Following the telehealth training program, coaches and interventionists reached the preset performance criteria and implemented incidental teaching with high fidelity. All of the child participants increased mands above baseline levels. Results suggest that interventionists can be trained via telehealth in behavior analytic interventions.
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Terapia Conductista/educación , Educación/métodos , Enseñanza , Telemedicina/métodos , Adulto , Trastorno Autístico/terapia , Niño , Preescolar , Retroalimentación , Femenino , Humanos , Masculino , Comunicación por Videoconferencia , Adulto JovenRESUMEN
We examined the behavior-altering effect of the motivating operation on challenging behavior during leisure activities for three individuals with severe disabilities. Prior functional analyses indicated that challenging behavior was maintained by positive reinforcement in the form of attention or tangible items for all participants. During leisure sessions, each participant played preferred games (cards, jigsaws) with two individuals without disabilities. The discriminative stimuli for challenging behavior were present during leisure sessions but challenging behavior was never reinforced. Immediately prior to leisure sessions, the participants received either access to the reinforcers that maintained challenging behavior or no access. Access versus no access to reinforcers for challenging behavior prior to leisure sessions was alternated in a multi-element design. Results demonstrated higher levels of challenging behavior during leisure sessions when the participants did not have access to the reinforcers prior to the sessions. Little challenging behavior occurred during leisure sessions when the participants had prior access to the reinforcers. Arguments for further examining the behavior-altering effects of the motivating operation in future applied research are presented.
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Terapia Conductista/métodos , Discapacidades del Desarrollo/psicología , Discapacidades del Desarrollo/terapia , Actividades Recreativas , Motivación , Adolescente , Adulto , Trastornos de la Conducta Infantil/psicología , Trastornos de la Conducta Infantil/terapia , Humanos , Discapacidad Intelectual/psicología , Discapacidad Intelectual/terapia , Masculino , Juego e Implementos de Juego , Refuerzo en Psicología , Índice de Severidad de la EnfermedadRESUMEN
A preliminary evaluation of the correspondence between functional analysis outcomes across settings was conducted with 2 children who had been diagnosed with autism and who engaged in challenging behavior. Differences across settings (a therapy room and a classroom) were demonstrated in ABAB reversal designs. Three potential patterns of results that may occur when comparing functional analyses across environments are described, and one possible explanation for the occurrence of discrepancies between environments (differing learning histories within separate environments) is offered.
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Trastorno Autístico/epidemiología , Trastorno Autístico/psicología , Conducta Autodestructiva/epidemiología , Medio Social , Niño , Femenino , HumanosRESUMEN
The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.
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Trastorno del Espectro Autista/rehabilitación , Problema de Conducta , Terapia Conductista , HumanosRESUMEN
The prevalence of autism spectrum disorder (ASD) is on the rise. In addition to the social communication skill deficits and restrictive repetitive behaviors and interests, many individuals with ASD engage in challenging behavior. Challenging behavior is associated with a multitude of negative outcomes. Challenging behavior may cause harm to the individual with ASD as well as limit opportunities for educational, vocational, and social participation and development. In addition, caregivers experience high stress and low quality of mental health. As a result, challenging behavior warrants intervention that is specifically tailored to the unique characteristics of individuals with ASD. The purpose of this Special Issue is to showcase recent research in the treatment of challenging behavior for individuals with ASD. This two-part Special Issue contains 12 studies that range from systematic and quality reviews of the intervention literature, to innovative treatment approaches, to studies that develop and evaluate treatments for restrictive and repetitive behaviors and interests.
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Research on trial-based functional analysis has primarily focused on socially maintained challenging behaviors. However, procedural modifications may be necessary to clarify ambiguous assessment results. The purposes of this study were to evaluate the utility of iterative modifications to trial-based functional analysis on the identification of putative reinforcement and subsequent treatment for vocal scripting. For all participants, modifications to the trial-based functional analysis identified a primary function of automatic reinforcement. The structure of the trial-based format led to identification of social attention as an abolishing operation for vocal scripting. A noncontingent attention treatment was evaluated using withdrawal designs for each participant. This noncontingent attention treatment resulted in near zero levels of vocal scripting for all participants. Implications for research and practice are presented.
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Atención/fisiología , Trastorno del Espectro Autista/rehabilitación , Problema de Conducta , Refuerzo en Psicología , Conducta Verbal/fisiología , Trastorno del Espectro Autista/fisiopatología , Niño , Humanos , MasculinoRESUMEN
The purpose of this study was to evaluate a procedure to transfer stimulus control from picture exchange requests to receptive identification. Three children with autism spectrum disorder (ASD) and absent receptive identification repertoires participated. An adapted alternating treatment design was used. During intervention, two high-preferred and two low-preferred targets were available during picture exchange requesting sessions. Participants requested primarily for one or both high-preferred targets. During receptive identification instructional sessions, one participant acquired one high-preferred target, one participant acquired all targets, and one participant demonstrated no improvements. Generalization to novel examples of targets was assessed pre- and post-intervention and programmed if necessary. One participant generalized his acquired high-preferred target without programming. Another participant generalized a high-preferred and a low-preferred target without programming, and acquired a high-preferred target with programming. Potential benefits of this intervention and suggestions for future research are presented.
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Trastorno del Espectro Autista/rehabilitación , Rehabilitación Psiquiátrica/métodos , Psicoterapia/métodos , Trastorno del Espectro Autista/psicología , Niño , Femenino , Humanos , Masculino , Percepción , Conducta SocialRESUMEN
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.