Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis.

While recent studies suggest a converging role for genetic factors towards risk for nosologically distinct disorders including autism, intellectual disability (ID), and epilepsy, current estimates of autism prevalence fail to take into account the impact of comorbidity of these disorders on autism diagnosis. We aimed to assess the effect of comorbidity on the diagnosis and prevalence of autism by analyzing 11 years (2000-2010) of special education enrollment data on approximately 6.2 million children per year. We found a 331% increase in the prevalence of autism from 2000 to 2010 within special education, potentially due to a diagnostic recategorization from frequently comorbid features such as ID. The decrease in ID prevalence equaled an average of 64.2% of the increase of autism prevalence for children aged 3-18 years. The proportion of ID cases potentially undergoing recategorization to autism was higher (P = 0.007) among older children (75%) than younger children (48%). Some US states showed significant negative correlations between the prevalence of autism compared to that of ID while others did not, suggesting state-specific health policy to be a major factor in categorizing autism. Further, a high frequency of autistic features was observed when individuals with classically defined genetic syndromes were evaluated for autism using standardized instruments. Our results suggest that current ascertainment practices are based on a single facet of autism-specific clinical features and do not consider associated comorbidities that may confound diagnosis. Longitudinal studies with detailed phenotyping and deep molecular genetic analyses are necessary to completely understand the cause of this complex disorder.

Effect of Repeated Reading on Reading Fluency for Adults with Specific Learning Disabilities.

The current study implemented an alternating-treatments design with Standard Celeration Charting. The applied experiment occurred via telecommunication and assessed the effectiveness of repeated reading (RR) on reading fluency for two adults with specific learning disabilities using high-level and low-level reading passages. Participants reread each passage until they met a predetermined fluency criterion. We measured participants reading fluency using correct words per 1 min (CWPM) and assessed for retention at 1 week, 2 weeks, and 1 month. Both participants reached their fluency aims and maintained their progress postintervention. • RR can improve reading fluency for children and adults with reading deficits. • RR practice sessions require minutes to implement, which offers great flexibility for scheduling. • Telecommunication represents an effective modality for implementing RR procedures for adults with reading disabilities. • Participants in the study retained their fluency gains post-intervention, supporting that time spent on RR may represent a good investment for clinicians.

Slope Identification and Decision Making: A Comparison of Linear and Ratio Graphs.

Applied behavior analysts have traditionally relied on visual analysis of graphic data displays to determine the extent of functional relations between variables and guide treatment implementation. The present study assessed the influence of graph type on behavior analysts' (n = 51) ratings of trend magnitude, treatment decisions based on changes in trend, and their confidence in decision making. Participants examined simulated data presented on linear graphs featuring equal-interval scales as well as graphs with ratio scales (i.e., multiply/divide or logarithmic vertical axis) and numeric indicators of celeration. Standard rules for interpreting trends using each display accompanied the assessment items. Results suggested participants maintained significantly higher levels of agreement on evaluations of trend magnitude and treatment decisions and reported higher levels of confidence in making decisions when using ratio graphs. Furthermore, decision making occurred most efficiently with ratio charts and a celeration value. The findings have implications for research and practice.

Increasing Confident Thoughts in an Adolescent With Autism: A Pilot Study.

Private events such as thoughts and feelings occur within the individual and are inaccessible to outside observers. Creating interventions for troublesome private events, therefore, is challenging. Precision teaching has a number of studies where participants self-count targeted private events and intervene by engaging in 1-min timings of positive thoughts. The present pilot study extended the 1-min timing procedure to a 15-year-old girl with autism spectrum disorder. After the intervention, the participant's level of despondent thoughts dropped by ÷4.55 in level, with lower levels of anxiety and depression as measured by the Beck Anxiety Inventory and the Beck Depression Inventory.

Qualitative Methodology for Planning and Executing In-Person and Virtual Neurosurgery Educational Opportunities for Medical Students: Lessons Learned from Five Years of Medical Student Neurosurgery Training Center Initiatives.

INTRODUCTION: There is a growing need for collaborative and broad-scale medical student neurosurgery educational initiatives. Here, we propose a comprehensive methodology and structure for hosting both in-person and virtual learning opportunities for early trainees interested in clinical neurosciences. METHODS: We conducted an internal review of educational courses hosted by Medical Student Neurosurgery Training Center from 2017 to 2022. Inspired by the lessons learned from these activities, we examine the elements vital to the planning, production, funding, and execution of future programs. RESULTS: Six domains were deemed important for carrying out medical student neurosurgery educational opportunities: directorship, curriculum, logistics, faculty and instructor outreach, funding, and marketing. Each of these elements is discussed in detail for both in-person and web-based programs, as well as an examination of the advantages and disadvantages of various implementation strategies. CONCLUSIONS: Based on the Medical Student Neurosurgery Training Center experience, successful production and hosting of both in-person and virtual educational endeavors seems to be contingent on a collaborative effort by medical students, resident physicians, and neurosurgery faculty. Including medical students throughout the planning phase adds to the overall educational value of each experience and promotes program longevity and consumer engagement. Curricula should be guided by clear learning objectives and a variety of teaching modalities available to the organization. Finally, methods for assessing course outcomes are important, including institutional review board-approved data curation and analysis. Further investigation of neurosurgical learning outcome measurement is needed and has the potential to shape the future of medical student education and neurosurgery career preparation.

Precision Teaching and Behavior Dynamics.

Precision teaching (PT) comprises a sophisticated measurement and decision-making system aimed at helping its users foster superior outcomes for the clients or students they serve. The longevity of PT has led to many discoveries surrounding measurement, performance, learning, and behavior change. The contributions to knowledge derive from a range of studies. Some of the research uses single-case experimental designs, whereas the majority employs an approach called behavior dynamics. The use of behavior dynamics distinguishes PT from behavior analysis. Behavior dynamics does not seek to uncover functional relations. Nevertheless, behavior dynamics represents a sound approach to conduct research, generate reliable information, and engender knowledge.

Building Prealgebra Fluency Through a Self-Managed Practice Intervention: Order of Operations.

Behavioral fluency refers to a combination of accuracy and speed that enables students to function proficiently in the learning environment. The present study investigated the effects of a self-managed frequency-building intervention on the behavioral fluency of a critical prealgebra skill in four 6th-grade students. The intervention involved students having access to the PEMDAS (parentheses, exponents, multiplication, division, addition, and subtraction) mnemonic during frequency building. Using an alternating-treatments design, the first experimental condition presented the intervention as three 1-min practice trials with 30 s of feedback delivered immediately after each frequency-building trial ended. The second condition offered one 3-min practice trial with 90 s of feedback once the trial ended. A baseline condition (no practice) had the students engage in a 1-min timed trial with no feedback. The alternating-treatments design demonstrated that three of the four students produced a superior performance within the two intervention conditions when compared to baseline. However, the results did not conclusively show that one frequency-building intervention was superior to the other.

Quantifying Function with the Functional Analysis Celeration Chart.

The present brief practice examined 6 randomly selected studies from the Journal of Applied Behavior Analysis that included functional analysis data replotted on the functional analysis celeration chart (FACC). The FACC showcases the practicality of a standard celeration chart- derived visual display. The research question asked, what level values occurred related to the original authors' determination of function? Results indicated all functions had a ×2 level multiplier or higher when placed on the FACC.

An initial survey of fractional graph and table area in behavioral journals.

This study examined the fractional graph area (FGA), the proportion of page space used to display statistical graphics, in 11 behavioral journals and places behavior analysis on a continuum with other natural, mathematical, and social science disciplines. The composite FGA of all 11 journals puts behavior analysis within the range of the social sciences, whereas the composite FGA of the most established and preeminent behavioral journals positions behavior analysis within the range of the natural sciences. In addition, fractional table area (FTA), the proportion of page space used to display tables, generally is higher in behavioral journals with lower degrees of FGA, a result that replicates previous research.

Endurance of multiplication fact fluency for students with attention deficit hyperactivity disorder.

This study examines the relationship between a critical learning outcome of behavioral fluency and endurance, by comparing the effects of two practice procedures on multiplication facts two through nine. The first procedure, called whole time practice trial, consisted of an uninterrupted 1 minute practice time. The second procedure, endurance building practice trials, had three 20 second practice trials. A total of 3 students with attention deficit hyperactivity disorder participated. Results indicated that multiplication facts with the endurance building practice trials produced more efficient learning when compared to the whole time practice trial procedure for all 3 participants. Additionally, results show that even with the amount of practice time being equal, 1 minute in both conditions, on average participants practiced 30% more problems with the endurance building practice trials procedure than they did with the whole time practice trial procedure.

General outcome measures for verbal operants.

A general outcome measure (GOM) can be used to show progress towards a long-term goal. GOMs should sample domains of behavior across ages, be sensitive to change over time, be inexpensive and easy to use, and facilitate decision making. Skinner's (1957) analysis of verbal behavior may benefit from the development of GOM. To develop GOM, we conducted a review of the literature on mands, tacts, echoics, and intraverbals. The four areas reviewed included (a) an examination of the participant's response form (i.e., vocal or nonvocal), (b) the type of prompt used, (c) types of materials used, and (d) timing of responses or sessions. Based on the review of the literature, we developed GOM for mands and tacts. This paper attempts to bridge the concept of GOMs with Skinner's analysis of verbal behavior.

Using transfer procedures to teach tacts to a child with autism.

This applied study attempted to evaluate a combination of transfer procedures commonly used to teach tacts to children with autism. A receptive to echoic to tact transfer and an echoic to tact transfer procedure were combined during 5-min instructional sessions to teach tacts to a seven-year-old vocal child with autism. A multiple baseline design across three sets of ten tacts was used. Without the teaching procedure, the child acquired no target tacts. With the 5-min teaching procedure implemented first with Set 1 then with Sets 2 and 3, respectively, the child acquired thirty new tacts over sixty teaching sessions. The results have wide application for children with and without autism who need instruction to learn tacts.