Field Testing the Family Behavior Support Mobile Application (FBSApp) During a Global Pandemic.

We developed and tested an evidence-based mobile application designed to support families in using functional assessment-based intervention strategies with their young children with disabilities and challenging behaviors in home settings. Five families participated in the study. We utilized a multiple-probe across participants design to examine the effects of the FBSApp on parents' use of intervention strategies and childrens' use of challenging behaviors and replacement behaviors. We adapted our procedures to include individualized coaching to provide meaningful and effective support after the onset of the COVID-19 pandemic. A functional relation was not identified between access to FBSApp and caregiver use of strategies; however, the addition of coaching did lead to increased strategy use for two of four caregivers. A functional relation was identified between the use of the FBSApp plus coaching and CB. Families reported the app and coaching procedures favorably. We found that responsive, family-centered research CAN be conducted in spite of significant history events, and that mobile apps and virtual meeting platforms can be an accessible and efficient method for supporting families. The use of single case design allowed for flexible, yet methodologically sound procedures. More work is needed examining effective and efficient virtual supports for families.

Using Progressive Time Delay to Increase Levels of Peer Imitation During Sculpting Play.

A multiple probe across participants with an embedded withdrawal single case research design was used to examine the effectiveness of a progressive time delay (PTD) procedure to teach preschoolers with disabilities to imitate their peers during a sculpting play activity. Data indicated the presence of a functional relation between the use of PTD and contingent reinforcement on increased levels of peer imitation across participants; levels also decreased when PTD was withdrawn, although not to baseline levels. Overall levels of peer imitation had a greater magnitude of change than demonstrated in previous research.

Using Progressive Time Delay to Increase Levels of Peer Imitation During Play With Preschoolers With Disabilities.

Research suggests peer imitation can be taught using systematic procedures and can be embedded into ongoing play contexts with preschool-age children. However, additional research is needed to test procedures that may increase levels of peer imitation with toddlers with disabilities and in generalized contexts. We used a multiple probe across participants research design to evaluate the effectiveness of progressive time delay (PTD) to teach peer imitation to preschoolers with disabilities during a play activity with a peer. We also examined the efficacy of PTD in a generalized context (i.e., new peers, implementer, and materials). Visual analysis indicated a functional relation between PTD and unprompted peer imitation; however, generalization was variable across participants. Our results support previous research indicating PTD is effective in teaching children with disabilities to imitate their peers.

Teaching Object Play to Young Children With Disabilities: A Systematic Review of Methods and Rigor.

In this systematic review, we examined the rigor and outcomes across 27 object play intervention studies using single-case research methodology. We focused on studies including children age 5 years or younger and examined several descriptive characteristics including materials, instructional packages, and settings. We also analyzed the facilitation and measurement of generalized play and several methodological features including quality, rigor, and visual analysis procedures. Overall, the identified studies demonstrated positive outcomes, although quality and rigor limited interpretations of the outcomes. Previous reviews also have noted strong outcomes and weak to moderate quality for single-case studies. Our results should be interpreted with caution given previous reviews of play intervention studies identified strong outcomes and quality from group-design studies. Additional replications testing robust interventions using single-case research with strong methodological rigor are warranted.

Functional Analysis and Treatment of Pica on a Preschool Playground.

Appropriate use of function-based assessments and interventions is crucial for improving educational outcomes and ensuring the well-being of children who engage in dangerous problem behaviors such as pica. A function-based assessment was conducted for a child engaging in pica in an inclusive childcare setting. Results suggest pica was maintained by access to adult attention. Function-based interventions were developed, assessed, and shared with the child's teaching team. Follow-up data suggest that his teachers continued to use the intervention and that levels of pica remained low.

Effects of School-Home Communication With Parent-Implemented Reinforcement on Off-Task Behavior for Students With ASD.

School-home communication is highly valued for parents of students with autism spectrum disorders (ASD) and other developmental disabilities. However, parents report poor communication as a common barrier to developing partnerships with schools. Using a multiple baseline design, we evaluated the effects of a school-home note intervention with parent-implemented reinforcement for decreasing off-task behavior of students with ASD at school. We also evaluated social validity (i.e., feasibility and acceptability) of the intervention and outcomes. Only two of the four participants showed clear behavior change, which precluded the demonstration of functional relations. However, all participating parents and teachers reported the school-home note and parent-implemented contingent reinforcement were highly feasible and acceptable, and indicated positive outcomes relating to improved family-school partnership and communication. Findings of this study, which meets single-case design standards and quality indicators, are discussed in terms of future research and practice.

A Primer on Single-Case Research Designs: Contemporary Use and Analysis.

The overarching purpose of this article is to provide an introduction to the use of rigorous single-case research designs (SCRDs) in special education and related fields. Authors first discuss basic design types and research questions that can be answered with SCRDs, examine threats to internal validity and potential ways to control for and detect common threats, and provide guidelines for selection of specific designs. Following, contemporary standards regarding rigor, measurement, description, and outcomes are presented. Then, authors discuss data analytic techniques, differentiating rigor, positive outcomes, functional relations, and magnitude of effects.

Comparison of visual analysis, non-overlap methods, and effect sizes in the evaluation of parent implemented functional assessment based interventions.

We used an existing body of research (i.e., parent implemented functional-assessment based interventions) to examine visual analysis features and processes and evaluate the reliability of two frequently used non-overlap indices (NAP & Tau-U) and a novel effect size index-the between-case standardized mean difference (BC-SMD). Results indicated that visual analysis terms and procedures were inconsistently used across studies. Further, there was limited agreement between the non-overlap indices and independent visual analysis. Results regarding the BC-SMD were inconclusive given only 5 of the 15 studies were eligible for analyses for different dependent variables. Our results suggest that visual analysis standards are needed by which single case researchers analyze and report their results. Further, additional research is needed refining SCR effect sizes, which can be used to describe the magnitude of change within and across SCR studies with functional relations.

Systematic Protocols for the Visual Analysis of Single-Case Research Data.

Researchers in applied behavior analysis and related fields such as special education and school psychology use single-case designs to evaluate causal relations between variables and to evaluate the effectiveness of interventions. Visual analysis is the primary method by which single-case research data are analyzed; however, research suggests that visual analysis may be unreliable. In the absence of specific guidelines to operationalize the process of visual analysis, it is likely to be influenced by idiosyncratic factors and individual variability. To address this gap, we developed systematic, responsive protocols for the visual analysis of A-B-A-B and multiple-baseline designs. The protocols guide the analyst through the process of visual analysis and synthesize responses into a numeric score. In this paper, we describe the content of the protocols, illustrate their application to 2 graphs, and describe a small-scale evaluation study. We also describe considerations and future directions for the development and evaluation of the protocols.

Development and applications of the single-case design risk of bias tool for evaluating single-case design research study reports.

Systematic reviews and meta-analyses can be a useful method for synthesizing evidence across multiple studies to draw conclusions about a research base. An important aspect of rigorous systematic reviews is an assessment of the study methods and potential biases impacting results or interpretations and conclusions of the primary studies. Single-case design (SCD) research has been a primary mechanism for identifying evidence-based practices across disciplines, but primarily in behavioral fields and special education. While the Cochrane Risk of Bias tool has been adapted for use in reviews of non-randomized studies, there is currently no guidance for evaluating SCD research. Hence, we developed a single case design risk of bias tool (SCD RoB) based on current conceptualizations of biases that might affect the validity of claims from single-case design research. We used the Cochrane risk of bias criteria and contemporary single-case design quality indicators and design standards to guide development. We describe the SCD RoB tool and two early applications of its use to demonstrate its application and provide initial validation. We also provide an overview of future areas of research using the SCD RoB tool in an effort to advance the science of single-case design research methods.

Between-case standardized effect size analysis of single case designs: Examination of the two methods.

An increasing movement in single case research is to employ statistical analyses as one form of data analysis. Researchers have proposed different statistical approaches. The purpose of this paper is to examine the utility and discriminant validity of two novel types of between-case standardized effect size analyses with two existing systematic reviews. The between-case analyses found greater effect sizes for the studies in the object play review and smaller effect sizes for studies of sensory intervention, which were consistent with the overall conclusions reached in the original systematic reviews. These findings provide evidence of discriminant validity, although concerns remain around the methods' utility across different single case research designs. Future directions for research and development also are provided.

Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).

BACKGROUND: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorders. Early intensive behavioral intervention (EIBI) is a treatment based on the principles of applied behavior analysis. Delivered for multiple years at an intensity of 20 to 40 hours per week, it is one of the more well-established treatments for ASD. This is an update of a Cochrane review last published in 2012. OBJECTIVES: To systematically review the evidence for the effectiveness of EIBI in increasing functional behaviors and skills, decreasing autism severity, and improving intelligence and communication skills for young children with ASD. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 12 additional electronic databases and two trials registers in August 2017. We also checked references and contacted study authors to identify additional studies. SELECTION CRITERIA: Randomized control trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.We synthesized the results of the five studies using a random-effects model of meta-analysis, with a mean difference (MD) effect size for outcomes assessed on identical scales, and a standardized mean difference (SMD) effect size (Hedges' g) with small sample correction for outcomes measured on different scales. We rated the quality of the evidence using the GRADE approach. MAIN RESULTS: We included five studies (one RCT and four CCTs) with a total of 219 children: 116 children in the EIBI groups and 103 children in the generic, special education services groups. The age of the children ranged between 30.2 months and 42.5 months. Three of the five studies were conducted in the USA and two in the UK, with a treatment duration of 24 months to 36 months. All studies used a treatment-as-usual comparison group.Primary outcomesThere is low quality-evidence at post-treatment that EIBI improves adaptive behaviour (MD 9.58 (assessed using Vineland Adaptive Behavior Scale (VABS) Composite; normative mean = 100, normative SD = 15), 95% confidence interval (CI) 5.57 to 13.60, P < 0.0001; 5 studies, 202 participants), and reduces autism symptom severity (SMD -0.34, 95% CI -0.79 to 0.11, P = 0.14; 2 studies, 81 participants; lower values indicate positive effects) compared to treatment as usual.No adverse effects were reported across studies.Secondary outcomesThere is low-quality evidence at post-treatment that EIBI improves IQ (MD 15.44 (assessed using standardized IQ tests; scale 0 to 100, normative SD = 15), 95% CI 9.29 to 21.59, P < 0.001; 5 studies, 202 participants); expressive (SMD 0.51, 95% CI 0.12 to 0.90, P = 0.01; 4 studies, 165 participants) and receptive (SMD 0.55, 95% CI 0.23 to 0.87, P = 0.001; 4 studies, 164 participants) language skills; and problem behaviour (SMD -0.58, 95% CI -1.24 to 0.07, P = 0.08; 2 studies, 67 participants) compared to treatment as usual. AUTHORS' CONCLUSIONS: There is weak evidence that EIBI may be an effective behavioral treatment for some children with ASD; the strength of the evidence in this review is limited because it mostly comes from small studies that are not of the optimum design. Due to the inclusion of non-randomized studies, there is a high risk of bias and we rated the overall quality of evidence as 'low' or 'very low' using the GRADE system, meaning further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.It is important that providers of EIBI are aware of the current evidence and use clinical decision-making guidelines, such as seeking the family's input and drawing upon prior clinical experience, when making recommendations to clients on the use EIBI. Additional studies using rigorous research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.

Single-case synthesis tools II: Comparing quantitative outcome measures.

Varying methods for evaluating the outcomes of single case research designs (SCD) are currently used in reviews and meta-analyses of interventions. Quantitative effect size measures are often presented alongside visual analysis conclusions. Six measures across two classes-overlap measures (percentage non-overlapping data, improvement rate difference, and Tau) and parametric within-case effect sizes (standardized mean difference and log response ratio [increasing and decreasing])-were compared to determine if choice of synthesis method within and across classes impacts conclusions regarding effectiveness. The effectiveness of sensory-based interventions (SBI), a commonly used class of treatments for young children, was evaluated. Separately from evaluations of rigor and quality, authors evaluated behavior change between baseline and SBI conditions. SBI were unlikely to result in positive behavior change across all measures except IRD. However, subgroup analyses resulted in variable conclusions, indicating that the choice of measures for SCD meta-analyses can impact conclusions. Suggestions for using the log response ratio in SCD meta-analyses and considerations for understanding variability in SCD meta-analysis conclusions are discussed.

Single-case synthesis tools I: Comparing tools to evaluate SCD quality and rigor.

Tools for evaluating the quality and rigor of single case research designs (SCD) are often used when conducting SCD syntheses. Preferred components include evaluations of design features related to the internal validity of SCD to obtain quality and/or rigor ratings. Three tools for evaluating the quality and rigor of SCD (Council for Exceptional Children, What Works Clearinghouse, and Single-Case Analysis and Design Framework) were compared to determine if conclusions regarding the effectiveness of antecedent sensory-based interventions for young children changed based on choice of quality evaluation tool. Evaluation of SCD quality differed across tools, suggesting selection of quality evaluation tools impacts evaluation findings. Suggestions for selecting an appropriate quality and rigor assessment tool are provided and across-tool conclusions are drawn regarding the quality and rigor of studies. Finally, authors provide guidance for using quality evaluations in conjunction with outcome analyses when conducting syntheses of interventions evaluated in the context of SCD.

Using e-coaching to support an early intervention provider's implementation of a functional assessment-based intervention.

This study examined the effects of e-coaching on the implementation of a functional assessment-based intervention delivered by an early intervention provider in reducing challenging behaviors during home visits. A multiple baseline design across behavior support plan components was used with a provider-child dyad. The e-coaching intervention consisted of weekly training and support delivered via video conferencing software. Results demonstrated a functional relation between e-coaching and early intervention provider implementation of targeted behavior support plan strategies. Further, the child's challenging behaviors decreased over the course of the study. Contributions to the literature, implications for practice, and future directions are discussed.

An Analysis of State Autism Educational Assessment Practices and Requirements.

States differ in the procedures and criteria used to identify ASD. These differences are likely to impact the prevalence and age of identification for children with ASD. The purpose of the current study was to examine the specific state variations in ASD identification and eligibility criteria requirements. We examined variations by state in autism assessment practices and the proportion of children eligible for special education services under the autism category. Overall, our findings suggest that ASD identification practices vary across states, but most states use federal guidelines, at least in part, to set their requirements. Implications and recommendations for policy and practice are discussed.

A systematic review of sensory-based treatments for children with disabilities.

Sensory-based therapies are designed to address sensory processing difficulties by helping to organize and control the regulation of environmental sensory inputs. These treatments are increasingly popular, particularly with children with behavioral and developmental disabilities. However, empirical support for sensory-based treatments is limited. The purpose of this review was to conduct a comprehensive and methodologically sound evaluation of the efficacy of sensory-based treatments for children with disabilities. Methods for this review were registered with PROSPERO (CRD42012003243). Thirty studies involving 856 participants met our inclusion criteria and were included in this review. Considerable heterogeneity was noted across studies in implementation, measurement, and study rigor. The research on sensory-based treatments is limited due to insubstantial treatment outcomes, weak experimental designs, or high risk of bias. Although many people use and advocate for the use of sensory-based treatments and there is a substantial empirical literature on sensory-based treatments for children with disabilities, insufficient evidence exists to support their use.

A Synthesis of Peer-Mediated Academic Interventions for Secondary Struggling Learners.

A synthesis of the extant research on peer-mediated reading and math interventions for students in regular or alternative education settings with academic difficulties and disabilities in Grades 6 to 12 (ages 11-18) is presented. Interventions conducted between 2001 and 2012 targeting reading and math were included if they measured effects on at least one academic outcome measure. A total of 13 intervention studies were synthesized in which 10 studies employed an experimental or quasi-experimental design and three studies used a single-case design. Findings from the 13 studies revealed mostly moderate to high effects favoring peer mediation, particularly when implementing a peer-mediated feedback component. In addition, findings suggest such interventions have social validity among adolescents and teachers. More rigorous research on secondary peer-mediated math interventions, peer-mediated interventions in alternative settings, and effective ways to pair dyads to incorporate a structured feedback component is warranted. Implications for peer-mediated instruction for academically struggling adolescents are discussed.

Evaluating autism diagnostic and screening tools for cultural and linguistic responsiveness.

While clear guidelines and best practices exist for the assessment of autism spectrum disorders (ASD), little information is available about assessing for ASD in culturally and linguistically diverse (CLD) populations. CLD populations might be misidentified and under-identified with ASD due to the assessment practices that we employ. Four autism diagnostic tools and six autism screeners were selected and evaluated for their cultural and linguistic responsiveness. Although the evaluation of ASD within CLD populations is highly complex, this study identified the need for improved autism assessment tools and practices. Without the appropriate assessment of these populations, CLD children will likely continue to be misidentified (or not identified at all) and will miss crucial intervention opportunities.

Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).

BACKGROUND: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorder. Early intensive behavioral intervention (EIBI), a treatment based on the principles of applied behavior analysis delivered for multiple years at an intensity of 20 to 40 hours per week, is one of the more well-established treatments for ASD. OBJECTIVES: To systematically review the evidence for the effectiveness of EIBI in increasing the functional behaviors and skills of young children with ASD. SEARCH METHODS: We searched the following databases on 22 November 2011: CENTRAL (2011 Issue 4), MEDLINE (1948 to November Week 2, 2011), EMBASE (1980 to Week 46, 2011), PsycINFO (1806 to November Week 3, 2011), CINAHL (1937 to current), ERIC (1966 to current), Sociological Abstracts (1952 to current), Social Science Citation Index (1970 to current), WorldCat, metaRegister of Controlled Trials, and Networked Digital Library of Theses and Dissertations. We also searched the reference lists of published papers. SELECTION CRITERIA: Randomized control trials (RCTs), quasi-randomized control trials, or clinical control trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. DATA COLLECTION AND ANALYSIS: Two authors independently selected and appraised studies for inclusion and assessed the risk of bias in each included study. All outcome data were continuous, from which standardized mean difference effect sizes with small sample correction were calculated. We conducted random-effects meta-analysis where possible, which means we assumed individual studies would provide different estimates of treatment effects. MAIN RESULTS: One RCT and four CCTs with a total of 203 participants were included. Reliance on synthesis from four CCTs limits the evidential base and this should be borne in mind when interpreting the results. All studies used a treatment-as-usual comparison group. We synthesized the results of the four CCTs using a random-effects model of meta-analysis of the standardized mean differences. Positive effects in favor of the EIBI treatment group were found for all outcomes. The mean effect size for adaptive behavior was g = 0.69 (95% CI 0.38 to 1.01; P < 0.0001). The mean effect size for IQ was g = 0.76 (95% CI 0.40 to 1.11; P < 0.0001). Three measures of communication and language skills all showed results in favor of EIBI: expressive language g = 0.50 (95% CI 0.05 to 0.95; P = 0.03), receptive language g = 0.57 (95% CI 0.20 to 0.94; P = .03), and daily communication skills g = 0.74 (95% CI 0.30 to 1.18; P = 0.0009). The mean effect size for socialization was g = 0.42 (95% CI 0.11 to 0.73; P = 0.0008), and for daily living skills was g = 0.55 (95% CI 0.24 to 0.87; P = 0.0005). Additional descriptive analyses of other aspects related to quality of life and psychopathology are presented. However, due to the inclusion of non-randomized studies, there is a high risk of bias and the overall quality of evidence was rated as 'low' using the GRADE system, which rates the quality of evidence from meta-analyses to determine recommendations for practice. AUTHORS' CONCLUSIONS: There is some evidence that EIBI is an effective behavioral treatment for some children with ASD. However, the current state of the evidence is limited because of the reliance on data from non-randomized studies (CCTs) due to the lack of RCTs. Additional studies using RCT research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.