Engagement with Activity Monitoring During a Behavioral Activation Intervention: A Randomized Test of Monitoring Format and Qualitative Evaluation of Participant Experiences.

Behavioural activation (BA) is an efficacious treatment approach. Activity monitoring is a key component of brief BA treatments; however, no studies have examined the most efficacious format for monitoring. The present pilot study tested brief versus intensive activity monitoring approaches during a BA intervention administered in a college orientation course. Outcomes characterised (1) engagement with the treatment protocol via activity monitoring and (2) participant qualitative experiences with monitoring and the intervention as reported during focus group interviews. Four course sections were randomly assigned to receive monitoring forms that were brief (assessed activities three times daily) or intensive (assessed activities hourly). Forms were provided electronically to students via a web-based platform which tracked completion. There were no significant differences in monitoring frequency (38.0 vs. 23.0 days; p = .154) or the duration of monitoring engagement (62.0 vs. 36.0 days; p = .054) between the brief and intensive conditions. Qualitative findings suggested that participants in both conditions found utility in activity monitoring, particularly during the first month as they transitioned to college. Overall, findings indicated that participants may find utility in monitoring during the first month of a BA intervention using either brief or intensive monitoring forms.

Rationale and design of integrating a parents first obesity intervention with a pediatric weight management intervention for rural families - Evaluating the ripple effect.

Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment tailored for rural participants. Outcomes of this study include participant weight loss from baseline to 9-months, device-measured physical activity, and dietary intake. This project will additionally compare reach between clinic and school settings and evaluate the impact of nurse engagement. This study will include 240 participants from eight rural communities who will be randomized to either a Parent +Family-based group or a Newsletter +Family-based group. Parents in the Parent +Family-based group will receive a 3-month adult obesity treatment designed for adult behavior change as a first step. Then, parents and children together will enter the family-based program (iAmHealthy), allowing for potential enhancement of a theorized ripple effect. Parents in the Newsletter +Family-based group will receive 3 monthly newsletters and then participate in the 6-month family-based intervention designed for child behavior change. This study is the first RCT to examine the effectiveness of an integrated adult- and child-focused obesity treatment program. Registered with ClinicalTrials.gov NCT ID NCT05612971.

iKanEat: protocol for a randomized controlled trial of megestrol as a component of a pediatric tube weaning protocol.

BACKGROUND: Although tube feeding routinely saves the lives of children who do not eat by mouth, chronic tube feeding can be a burden to patients, caregivers, and families. Very few randomized trials exist regarding the best methods for weaning children from their feeding tubes. METHODS: The current paper describes a randomized controlled trial of an empirically supported outpatient treatment protocol for moving children from tube to oral eating called iKanEat. Specifically, we describe the methods of randomized double-blind, placebo-controlled trial which includes a 4-week course of megestrol, the only medication used in the iKanEat protocol, to determine whether the addition of megestrol results in improved child outcomes. The primary and secondary aims are to assess the safety and efficacy of megestrol as part of the iKanEat protocol. The third aim is to provide critical information about the impact of the transition from tube to oral feeding on parent stress and parent and child quality of life. DISCUSSION: This trial will provide data regarding whether megestrol is a safe and effective component of the iKanEat tube weaning protocol, as well as important data on how the tube weaning process impacts parent stress and parent and child quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT#03815019 . Registered on January 17, 2019.

The Impact of Dose and Dose Frequency on Word Learning by Kindergarten Children With Developmental Language Disorder During Interactive Book Reading.

Purpose The goal was to determine whether interactive book reading outcomes for children with developmental language disorder (DLD) were affected by manipulation of dose (i.e., the number of exposures to the target word during a book reading session) and dose frequency (i.e., the number of repeated book reading sessions) and whether pretreatment factors predicted treatment response variation. Method Thirty-four kindergarten children with DLD (aged 5;0-6;2 [years;months]) were taught 1 set of words using the Dose 6 and Dose Frequency 6 format from a prior study (Storkel, Voelmle, et al., 2017) and taught a different set of words using an alternative format, either Dose 4 × Dose Frequency 9 or Dose 9 × Dose Frequency 4, determined through random assignment. Word learning was tracked for each treatment via a definition task prior to, during, and after treatment. Results Results showed that children with DLD learned a significant number of words during treatment regardless of the dose and dose frequency format but that significant forgetting of newly learned words occurred in all formats once treatment was withdrawn. Individual differences in word learning were related to Clinical Evaluation of Language Fundamentals Core Language and Understanding Spoken Paragraphs scores. Conclusion When administered at an adequate intensity, variation in the dose and dose frequency of interactive book reading does not appear to influence word learning by children with DLD. Although interactive book reading continues to show promise as an effective word learning intervention for children with DLD, further development is needed to enhance the effectiveness of this treatment approach. Supplemental Material https://doi.org/10.23641/asha.9745181.

Concurrent Validity and Reliability for the Communication Complexity Scale.

Purpose: The Communication Complexity Scale (CCS; Brady et al., 2012) was created to fill a void in measures of expressive communication skills in individuals who communicate primarily with presymbolic or early symbolic means. CCS scores reflect expressive communication observed during interactive communication contexts. Method: Two studies were completed to examine the reliability and validity of the revised CCS scores. Participants in both studies had minimal verbal skills (i.e., produced less than 20 functional words). Study 1 examined interobserver agreement, test-retest reliability, and concurrent validity for 239 participants with intellectual disabilities between the ages of 3-66 years, assessed with the protocol developed at the University of Kansas (KU CCS). CCS scores were compared with scores from the Vineland Adaptive Behavior Scales-Second Edition (Sparrow, Cicchetti, & Balla, 2005) and the Communication Matrix (Rowland & Fried-Oken, 2010). Study 2 examined the reliability and concurrent validity for CCS scores derived from 110 children (chronological age = 3-9) with autism from diverse backgrounds. These children were assessed with the Early Social Communication Scale (Mundy et al., 2003). CCS scores were compared with rates of communication derived from the Early Social Communication Scale. Results: CCS scores were moderately correlated with scores from existing measures of early communication. In addition, CCS scores from different raters were reliable, and test-retest scores were highly similar. Conclusions: These findings support the validity and reliability of the CCS when used with individuals across a wide range of ages and with various types of disabilities. The CCS can be used in research and clinical practice to describe extant communication levels in individuals with minimal verbal skills.

CLASS-WIDE FUNCTION-RELATED INTERVENTION TEAMS (CW-FIT): Student and Teacher Outcomes from a Multisite Randomized Replication Trial.

The purpose of the study was to conduct a randomized controlled trial (RCT) to demonstrate efficacy of the Classwide Function-Related Intervention Teams (CW-FIT) program. The study was designed to replicate an initial RCT conducted by the CW-FIT developers in 1 site, with 2 additional research groups not involved in its development. The study was conducted across 3 states, in 21 culturally diverse schools, and with 83 teachers (classrooms) assigned to CW-FIT and 74 teachers (classrooms) assigned to the comparison group. The CW-FIT intervention included teaching prosocial skills and use of differential attention (teacher praise and points) for appropriate behaviors using a group contingency, class teams, goal setting, points, and rewards. Class-wide student on-task behavior improved, teacher praise and attention to appropriate behaviors increased, and reprimands decreased in the CWFIT classes with significantly fewer changes over time for the comparison group.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying Adequate Progress and Successful Learning Patterns.

Purpose: The goal of this study was to provide guidance to clinicians on early benchmarks of successful word learning in an interactive book reading treatment and to examine how encoding and memory evolution during treatment contribute to word learning outcomes by kindergarten children with specific language impairment (SLI). Method: Twenty-seven kindergarten children with SLI participated in a preliminary clinical trial using interactive book reading to teach 30 new words. Word learning was assessed at 4 points during treatment through a picture naming test. Results: The results indicate that the following performance during treatment was cause for concern, indicating a need to modify the treatment: naming 0-1 treated words correctly at Naming Test 1; naming 0-2 treated words correctly at Naming Test 2; naming 0-3 treated words correctly at Naming Test 3. In addition, the results showed that encoding was the primary limiting factor in word learning, but rmemory evolution also contributed (albeit to a lesser degree) to word learning success. Conclusion: Case illustrations demonstrate how a clinician's understanding of a child's word learning strengths and weaknesses develop over the course of treatment, substantiating the importance of regular data collection and clinical decision-making to ensure the best possible outcomes for each individual child.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying an Adequate Intensity and Variation in Treatment Response.

PURPOSE: This study sought to identify an adequate intensity of interactive book reading for new word learning by children with specific language impairment (SLI) and to examine variability in treatment response. METHOD: An escalation design adapted from nontoxic drug trials (Hunsberger, Rubinstein, Dancey, & Korn, 2005) was used in this Phase I/II preliminary clinical trial. A total of 27 kindergarten children with SLI were randomized to 1 of 4 intensities of interactive book reading: 12, 24, 36, or 48 exposures. Word learning was monitored through a definition task and a naming task. An intensity response curve was examined to identify the adequate intensity. Correlations and classification accuracy were used to examine variation in response to treatment relative to pretreatment and early treatment measures. RESULTS: Response to treatment improved as intensity increased from 12 to 24 to 36 exposures, and then no further improvements were observed as intensity increased to 48 exposures. There was variability in treatment response: Children with poor phonological awareness, low vocabulary, and/or poor nonword repetition were less likely to respond to treatment. CONCLUSION: The adequate intensity for this version of interactive book reading was 36 exposures, but further development of the treatment is needed to increase the benefit for children with SLI.

Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex With Men.

INTRODUCTION: Hypersexuality has been conceptualized as sexual addiction, compulsivity, and impulsivity, among others, in the absence of strong empirical data in support of any specific conceptualization. AIM: To investigate personality factors and behavioral mechanisms that are relevant to hypersexuality in men who have sex with men. METHODS: A sample of 242 men who have sex with men was recruited from various sites in a moderate-size mid-western city. Participants were assigned to a hypersexuality group or a control group using an interview similar to the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition. Self-report inventories were administered that measured the broad personality constructs of positive emotionality, negative emotionality, and constraint and more narrow constructs related to sexual behavioral control, behavioral activation, behavioral inhibition, sexual excitation, sexual inhibition, impulsivity, attention-deficit/hyperactivity disorder, and sexual behavior. MAIN OUTCOME MEASURES: Hierarchical logistic regression was used to determine the relation between these personality and behavioral variables and group membership. RESULTS: A hierarchical logistic regression controlling for age showed a significant positive relation between hypersexuality and negative emotionality and a negative relation with constraint. None of the behavioral mechanism variables entered this equation. However, a hierarchical multiple regression analysis predicting sexual behavioral control indicated that lack of such control was positively related to sexual excitation and sexual inhibition owing to the threat of performance failure and negatively related to sexual inhibition owing to the threat of performance consequences and general behavioral inhibition CONCLUSION: Hypersexuality was found to be related to two broad personality factors that are characterized by emotional reactivity, risk taking, and impulsivity. The associated lack of sexual behavior control is influenced by sexual excitatory and inhibitory mechanisms, but not by general behavioral activation and inhibitory mechanisms.

HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample.

To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.

Conducting Internet Research With the Transgender Population: Reaching Broad Samples and Collecting Valid Data.

Health research on transgender people has been hampered by the challenges inherent in studying a hard-to-reach, relatively small, and geographically dispersed population. The Internet has the potential to facilitate access to transgender samples large enough to permit examination of the diversity and syndemic health disparities found among this population. In this article, we describe the experiences of a team of investigators using the Internet to study HIV risk behaviors of transgender people in the United States. We developed an online instrument, recruited participants exclusively via websites frequented by members of the target population, and collected data using online quantitative survey and qualitative synchronous and asynchronous interview methods. Our experiences indicate that the Internet environment presents the investigator with some unique challenges and that commonly expressed criticisms about Internet research (e.g., lack of generalizable samples, invalid study participants, and multiple participation by the same subject) can be overcome with careful method design, usability testing, and pilot testing. The importance of both usability and pilot testing are described with respect to participant engagement and retention and the quality of data obtained online.

Understanding sexual perpetration against children: effects of attachment style, interpersonal involvement, and hypersexuality.

This study explores in an adolescent sample hypotheses about child sexual abuse perpetration drawn from contemporary theories that implicate insecure attachment and adolescent social development. Specifically, three 13- to 18-year-old adolescent male samples (sex offenders with child victims, sex offenders with peer/adult victims, and nonsex delinquent youth) were compared in a cross-sectional design. Participants completed a computer-administered self-report questionnaire and a semistructured attachment style interview. Attachment style was coded by two independent raters blind to study hypotheses and group membership. The results indicated an indirect effect for attachment style. Attachment anxiety affected involvement with peers and interpersonal adequacy. Feelings of interpersonal inadequacy, combined with oversexualization and positive attitudes toward others distinguished sex offenders with child victims from nonsex delinquents and from sex offenders with peer/adult victims. These data provide a preliminary model of sexual abuse perpetration consistent with contemporary theories. Attachment anxiety with a lack of misanthropic attitudes toward others appears to lead to isolation from peers and feelings of interpersonal inadequacy. Individuals with this constellation of factors may turn to children to meet their intimacy and sexual needs, both of which seem to be exaggerated compared with other troubled youth.