Design Elements During Development of Videogame Programs for Children with Autism Spectrum Disorder: Stakeholders' Viewpoints.

Introduction: Research has demonstrated that videogame programs can be an effective intervention targeting social challenges among children with autism spectrum disorder (ASD). Despite the rapid growth in developing videogame programs, incorporation of stakeholders' views has been limited. Objective: This project aimed to identify the design elements that should be considered during development of videogame programs for children with ASD, from the perspectives of stakeholders. Materials and Methods: We involved 26 stakeholders, including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Results: Thematic analysis yielded three themes: (1) addressing heterogeneity and diverse needs; (2) mirroring real world; and (3) teaching strategies. Conclusion: Incorporating these elements during development of videogame programs can help enhance the outcomes for children with ASD. By including stakeholders' voices, it is assumed that the developed videogame programs may serve as user-friendly and engaging tools to potentially complement traditional interventions when overcoming social difficulties in individuals with ASD.

Perceived Barriers and Existing Challenges in Participation of Children with Autism Spectrum Disorders: "He Did Not Understand and No One Else Seemed to Understand Him".

Social participation is one of the most important predictors of the children's physical and mental health. Although it is evidenced that children with autism spectrum disorder (ASD) have restricted social participation, it is unclear which factors play a significant role. This research aimed to uncover perceived barriers of social participation by involving 26 stakeholders including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Using thematic analysis yielded three themes including (a) difficulty understanding social situations; (b) maladaptive behaviours; and (c) conflicting priorities and restricted nature of training. This project was the first study to involve key stakeholders to highlight barriers of social participation among individuals with ASD.

Social Stories for Children with Autism Spectrum Disorder: Validating the Content of a Virtual Reality Program.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects socio-emotional skills and perspective-taking abilities. Although social stories in a form of virtual reality program can help children with ASD, developing them and identifying appropriate responses might be subjective and thus challenging. Using Delphi method, and guided by general case training, we involved 63 parents and clinicians of individuals with ASD, in two rounds of online iteration to refine the stories. Scenarios that reached a 75% agreement level were accepted. This project is the first study to develop and validate a library of 75 short socio-emotional stories that illustrate various types and intensities of emotion in three social contexts of home, school, and community as the content of a virtual reality program.

Autism Spectrum Disorder and the Experience of Traumatic Events: Review of the Current Literature to Inform Modifications to a Treatment Model for Children with Autism.

Children with autism incur trauma and have increased vulnerabilities for experiencing trauma. This paper summarizes the current literature in the study of trauma in typically developing children and those with autism. A treatment model for children with autism, drawing on components from cognitive behavior therapy (CBT), trauma-focused CBT, and CBT to teach emotion regulation and treat anxiety in children with autism is suggested. Components include: (a) Functional Behavior Assessment; (b) behavior plans and behavioral skills training; (c) teaching emotion regulation; (d) exposure therapy; (e) cognitive restructuring; (f) parent and child support between sessions; (g) safety plan; and (h) programming for generalization and maintenance. Future research should establish evidence-based treatment of trauma in this population by evaluating the modified treatment package.

Transforming Parent-Child Interaction in Family Routines: Longitudinal Analysis with Families of Children with Developmental Disabilities.

The efficacy and consequential validity of an ecological approach to behavioral intervention with families of children with developmental disabilities was examined. The approach aimed to transform coercive into constructive parent-child interaction in family routines. Ten families participated, including 10 mothers and fathers and 10 children 3-8 years old with developmental disabilities. Thirty-six family routines were selected (2 to 4 per family). Dependent measures included child problem behavior, routine steps completed, and coercive and constructive parent-child interaction. For each family, a single case, multiple baseline design was employed with three phases: baseline, intervention, and follow-up. Visual analysis evaluated the functional relation between intervention and improvements in child behavior and routine participation. Nonparametric tests across families evaluated the statistical significance of these improvements. Sequential analyses within families and univariate analyses across families examined changes from baseline to intervention in the percentage and odds ratio of coercive and constructive parent-child interaction. Multiple baseline results documented functional or basic effects for 8 of 10 families. Nonparametric tests showed these changes to be significant. Follow-up showed durability at 11 to 24 months postintervention. Sequential analyses documented the transformation of coercive into constructive processes for 9 of 10 families. Univariate analyses across families showed significant improvements in 2- and 4-step coercive and constructive processes but not in odds ratio. Results offer evidence of the efficacy of the approach and consequential validity of the ecological unit of analysis, parent-child interaction in family routines. Future studies should improve efficiency, and outcomes for families experiencing family systems challenges.

Effects of Pilates exercises on shoulder range of motion, pain, mood, and upper-extremity function in women living with breast cancer: a pilot study.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the effects of Pilates exercises on shoulder range of motion (ROM), pain, mood, and upper-extremity (UE) function in women who had been treated for breast cancer. PARTICIPANTS: The participants were 4 women who had undergone axillary dissection and radiation therapy for stage I to IV breast cancer. METHODS: A nonconcurrent, multiple-baseline, single-subject research design was used to examine the effects of Pilates exercises on the 4 outcomes. RESULTS: Visual analyses of the data suggest a modest effect of the Pilates exercise program in improving shoulder abduction and external rotation ROM. Statistically significant improvement in shoulder internal and external rotation in the affected UE was shown for the one participant with pre-existing metastatic disease. The improving baselines seen for pain, mood, and UE function data made it impossible to assess the effects of Pilates exercises on those outcomes. No adverse events were experienced. DISCUSSION AND CONCLUSION: Pilates exercises may be an effective and safe exercise option for women who are recovering from breast cancer treatments; however, further research is needed.

Validating the Construct of Coercion in Family Routines: Expanding the Unit of Analysis in Behavioral Assessment with Families of Children with Developmental Disabilities.

We conducted an observational study of parent-child interaction in home activity settings (routines) of families raising young children with developmental disabilities and problem behavior. Our aim was to empirically investigate the construct validity of coercion in typical but unsuccessful family routines. The long-term goal was to develop an expanded ecological unit of analysis that may contribute to sustainable behavioral family intervention. Ten children with autism and/or mental retardation and their families participated. Videotaped observations were conducted in typical but unsuccessful home routines. Parent-child interaction in routines was coded in real time and sequential analyses were conducted to test hypotheses about coercive processes. Following observation, families were interviewed about the social validity of the construct. Results confirmed the presence of statistically significant, attention-driven coercive processes in routines in which parents were occupied with non-child centered tasks. Results partially confirmed the presence of escape-driven coercive processes in routines in which parent demands are common. Additional analysis revealed an alternative pattern with greater magnitude. Family perspectives suggested the social validity of the construct. Results are discussed in terms of preliminary, partial evidence for coercive processes in routines of families of children with developmental disabilities. Implications for behavioral assessment and intervention design are discussed.