Modernizing behavioral parent training program for ADHD with mHealth strategies, telehealth groups, and health behavior curriculum: a randomized pilot trial.

OBJECTIVE: Parent behavior management training (BMT) is an evidence-based yet underutilized tool to treat children with ADHD and address related health disparities. This pilot study investigated the acceptability and feasibility of a novel, health behavior-, and technology-adapted BMT (LEAP) vs. standard BMT. METHODS: The weekly 9-session LEAP telemedicine group program is based on a standard BMT curriculum enhanced with strategies for supporting optimal child sleep, problematic media use (PMU), and physical activity, including wrist-worn activity trackers. Children ages 6-10 years with ADHD and their caregivers were randomized to LEAP or standard BMT. Acceptability and feasibility were tracked. Caregivers completed standardized measures, and children wore hip-worn accelerometers for 1 week at baseline, postintervention (10 weeks), and follow-up (20 weeks). RESULTS: 84 parent/child dyads were randomized to LEAP or standard BMT, with high and comparable acceptability and feasibility. Both treatment groups demonstrated decreased ADHD symptoms and improved executive functions postintervention (p < .0001), maintained at follow-up. Average accelerometer-measured MVPA decreased and sleep duration remained unchanged, while PMU and bedtime resistance improved for both groups. CONCLUSIONS: LEAP is highly feasible and acceptable, and yielded similar initial clinical and health behavior improvements to standard BMT. Innovative and targeted supports are needed to promote healthy behaviors in children with ADHD.

Visual bodily signals and conversational context benefit the anticipation of turn ends.

The typical pattern of alternating turns in conversation seems trivial at first sight. But a closer look quickly reveals the cognitive challenges involved, with much of it resulting from the fast-paced nature of conversation. One core ingredient to turn coordination is the anticipation of upcoming turn ends so as to be able to ready oneself for providing the next contribution. Across two experiments, we investigated two variables inherent to face-to-face conversation, the presence of visual bodily signals and preceding discourse context, in terms of their contribution to turn end anticipation. In a reaction time paradigm, participants anticipated conversational turn ends better when seeing the speaker and their visual bodily signals than when they did not, especially so for longer turns. Likewise, participants were better able to anticipate turn ends when they had access to the preceding discourse context than when they did not, and especially so for longer turns. Critically, the two variables did not interact, showing that visual bodily signals retain their influence even in the context of preceding discourse. In a pre-registered follow-up experiment, we manipulated the visibility of the speaker's head, eyes and upper body (i.e. torso + arms). Participants were better able to anticipate turn ends when the speaker's upper body was visible, suggesting a role for manual gestures in turn end anticipation. Together, these findings show that seeing the speaker during conversation may critically facilitate turn coordination in interaction.

Parent Behavior Management Training for Child ADHD Enhanced to Address Health Behaviors: Comparison of Telemedicine "Telegroup" Versus In-Person Delivery.

OBJECTIVE: ADHD is associated with suboptimal health behaviors including physical activity (PA). LEAP is a parent BMT group program enhanced to focus on health behaviors, integrated with mHealth technology. Little is known about implementing BMT via telemedicine "telegroups." METHODS: Children ages 5 to 10 with ADHD and their caregiver wore activity trackers and participated in an 8 to 9 week parent BMT and social media group emphasizing PA, sleep, and screen use. A 7-day child accelerometer-wear and parent and teacher measures were completed pre- and post-group. Groups were in-person prior to the COVID-19 pandemic and in telegroup format during the pandemic. RESULTS: Thirty-three families participated in person and 23 participated via virtual telegroup. Group attendance was superior for telegroup with equivalent satisfaction and skill use. Changes in health behavior and clinical outcomes were equivalent. CONCLUSIONS: LEAP is a feasible and novel BMT intervention that can be delivered in an accessible telegroup format with high participation and acceptability.

Evaluating the Feasibility and Acceptability of the Lifestyle Enhancement for ADHD Program.

OBJECTIVE: To evaluate the feasibility and acceptability of the Lifestyle Enhancement for Attention Deficit Hyperactivity Disorder (ADHD) Program (LEAP), a novel parent behavior management training program that promotes physical activity (PA) and positive health behaviors and is enhanced with mobile health technology (Garmin) and a social media (Facebook) curriculum for parents of children with ADHD. METHODS: The study included parents of children ages 5-10 years diagnosed with ADHD who did not engage in the recommended >60 min/day of moderate to vigorous PA based on parent report at baseline. Parents participated in the 8-week LEAP group and joined a private Facebook group. Children and one parent wore wrist-worn Garmin activity trackers daily. Parents completed the Treatment Adherence Inventory, Client Satisfaction Questionnaire, and participated in a structured focus group about their experiences with various aspects of the program. RESULTS: Of 31 children enrolled, 51.5% had ADHD combined presentation, 36.3% with ADHD, predominately inattentive presentation, and 12.1% had unspecified ADHD (age 5-10; M = 7.6; 48.4% female). Parents attended an average of 86% of group sessions. On average, parents wore their Garmins for 5.1 days/week (average step count 7,092 steps/day) and children for 6.0 days/week (average step count 9,823 steps/day). Overall, parents and children were adherent to intervention components and acceptability of the program was high. CONCLUSIONS: Findings indicate that the LEAP program is an acceptable and feasible intervention model for promoting PA among parents and their children with ADHD. Implications for improving ADHD symptoms and enhancing evidence-based parent training programs are discussed.

An interest-based intervention package to increase peer social interaction in young children with autism spectrum disorder.

The literature suggests that children with autism spectrum disorder (ASD) educated in inclusive settings generally do not interact with typically developing classmates during social activities. This study assessed whether an intervention package consisting of interest-based structured play activities involving adult instruction, modeling, and response to child questions would result in an increase in social interaction with typically developing peers. A multiple baseline design across four participants with an embedded reversal was used to demonstrate the effects of the intervention on social interaction during structured play sessions. Initiations, responses, and interactive play increased for all participants. Generalization to novel peers was observed, and treatment gains were maintained during 6-week follow-up sessions. Recommendations for practitioners working with children with ASD in inclusive settings and potential areas of future research are discussed.

Physiological Self-Regulation Buffers the Relationship between Impulsivity and Externalizing Behaviors among Nonclinical Adolescents.

Trait impulsivity is a risk factor for rule breaking and aggressive (externalizing) behaviors among nonclinical youth. Buffers of trait-based risk are of practical interest to preventing externalizing behaviors. One such buffer may be the capacity and efforts of a child to self-regulate their physiology. Youth who possess baseline physiological self-regulatory capacities are more likely to maintain adaptive engagement with their environment and may be less prone to impulsively rule break or be aggressive. Similarly, youth who are able to use self-regulatory skills to calm their physiology in times of stress may be less likely to externalize distress. This study examined self-regulatory capacity and efforts as a moderator of the relationship between trait impulsivity and externalizing behaviors, cross-sectionally and prospectively. We hypothesized that the effect of trait impulsivity on externalizing behaviors would depend on the presence of baseline self-regulatory capacity and/or self-regulatory efforts during stress. Participants were 134 nonclinical adolescents (Mage = 12.59, SD = 1.20 51.9% female, 71% Caucasian). Trait impulsivity was measured using a parental report questionnaire. Physiological self-regulatory capacity and efforts were measured through collection of electrocardiogram data during a resting baseline and a stressful, unsolvable anagram task, respectively. Physiological self-regulation was quantified by calculating respiratory sinus arrhythmia scores across baseline and stress tasks. Respiratory sinus arrhythmia is the change in heart rate across the breathing cycle, and is hypothesized to index physiological self-regulation capacity and efforts under specific conditions. The results indicated that physiological self-regulation capacity, but not efforts, moderated the effect of trait impulsivity on externalizing behaviors prospectively. Stronger physiological self-regulatory capacity buffered the effect of greater trait impulsivity. Implications of these findings among typically developing youth are discussed.

Assessing the acquisition of requesting a variety of preferred items using different speech generating device formats for children with autism spectrum disorder.

Five children with autism spectrum disorder (ASD) were taught to request preferred items using four different augmentative and alternative communication (AAC) displays on an iPad®-based speech-generating device (SGD). Acquisition was compared using multi-element designs. Displays included a symbol-based grid, a photo image with embedded hotspots, a hybrid (photo image with embedded hotspots and symbols), and a pop-up symbol grid. Three participants mastered requesting items from a field of four with at least three displays, and one mastered requesting items in a field of two. The fifth participant did not acquire requests in a field of preferred items. Individualized display effects were present, and the photo image appeared to have provided the most consistent advantages for three participants. Some errors were more or less common with specific displays and/or participants. The results have important implications for AAC assessment and implementation protocols.

Evidence-Based Social Communication Interventions for Children with Autism Spectrum Disorder.

Impairments in social communication skills are a core feature of autism spectrum disorder (ASD) and include deficits in social-emotional reciprocity, non-verbal communicative behaviors used for social interaction, and developing, maintaining, and understanding relationships. In order to improve outcomes for children with ASD, much research has been focused on developing effective interventions to treat these social communication deficits. The purpose of this paper is to highlight the evidence-based practices found within the intervention literature that specifically targets social communication impairments and provide an overview of these strategies. Four relevant themes regarding evidence-based social communication interventions are considered and discussed: (a) social communication outcomes and practices relevant to different stages of development, (b) practices that both reduce interfering behaviors and improve social communication skills,

Research involving anxiety in non-human primates has potential implications for the assessment and treatment of anxiety in autism spectrum disorder: A translational literature review.

OBJECTIVE: The purpose of this translational review (i.e. moving from basic primate research toward possible human applications) was to summarize non-human primate literature on anxiety to inform the development of future assessments of anxiety in non-verbal individuals with autism spectrum disorder (ASD). METHODS: Systematic searches of databases identified 67 studies that met inclusion criteria. Each study was analysed and summarised in terms of (a) strategies used to evoke anxiety, (b) non-verbal behavioural indicators of anxiety and (c) physiological indicators of anxiety. RESULTS: Eighteen strategies were used to evoke anxiety, 48 non-verbal behavioural indicators and 17 physiological indicators of anxiety were measured. CONCLUSIONS: A number of the strategies used with non-human primates, if modified carefully, could be considered in the ongoing effort to study anxiety in individuals with ASD. Potential applications to the assessment of anxiety in humans with ASD are discussed.

Increasing the vocalizations of individuals with autism during intervention with a speech-generating device.

This study aimed to teach individuals with autism spectrum disorder (ASD) and limited vocal speech to emit target vocalizations while using a speech-generating device (SGD). Of the 4 participants, 3 began emitting vocal word approximations with SGD responses after vocal instructional methods (delays, differential reinforcement, prompting) were introduced. Two participants met mastery criterion with a reinforcer delay and differential reinforcement, and 1 met criterion after fading an echoic model and prompt delay. For these participants, vocalizations initiated before speech outputs were shown to increase, and vocalizations generalized to a context in which the SGD was absent. The 4th participant showed high vocalization rates only when prompted. The results suggest that adding vocal instruction to an SGD-based intervention can increase vocalizations emitted along with SGD responses for some individuals with ASD.

A review of peer-mediated social interaction interventions for students with autism in inclusive settings.

This review addresses the use of peer-mediated interventions (PMI) to improve the social interaction skills of students with autism spectrum disorder (ASD) in inclusive settings. The purpose of this review is to (a) identify the characteristics and components of peer-mediated social interaction interventions, (b) evaluate the effectiveness of PMI by offering an analysis of intervention results and research design, and (c) suggest directions for future research. Overall, results suggest that PMI is a promising treatment for increasing social interaction in children, adolescents, and young adults with ASD in inclusive settings, with positive generalization, maintenance, and social validity outcomes. Findings also suggest that participant characteristics and the type of social deficit an individual exhibits are important considerations when choosing the optimal configuration of PMI strategies.

Rhodium(III)-catalyzed arene and alkene C-H bond functionalization leading to indoles and pyrroles.

Recently, the rhodium(III)-complex [Cp*RhCl(2)](2) 1 has provided exciting opportunities for the efficient synthesis of aromatic heterocycles based on a rhodium-catalyzed C-H bond functionalization event. In the present report, the use of complexes 1 and its dicationic analogue [Cp*Rh(MeCN)(3)][SbF(6)](2) 2 have been employed in the formation of indoles via the oxidative annulation of acetanilides with internal alkynes. The optimized reaction conditions allow for molecular oxygen to be used as the terminal oxidant in this process, and the reaction may be carried out under mild temperatures (60 °C). These conditions have resulted in an expanded compatibility of the reaction to include a range of new internal alkynes bearing synthetically useful functional groups in moderate to excellent yields. The applicability of the method is exemplified in an efficient synthesis of paullone 3, a tetracyclic indole derivative with established biological activity. A mechanistic investigation of the reaction, employing deuterium labeling experiments and kinetic analysis, has provided insight into issues of reactivity for both coupling partners as well as aided in the development of conditions for improved regioselectivity with respect to meta-substituted acetanilides. This reaction class has also been extended to include the synthesis of pyrroles. Catalyst 2 efficiently couples substituted enamides with internal alkynes at room temperature to form trisubstituted pyrroles in good to excellent yields. The high functional group compatibility of this reaction enables the elaboration of the pyrrole products into a variety of differentially substituted pyrroles.