Training Medical Professionals to Work with Patients with Neurodevelopmental Disorders: A Systematic Review.

Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders.  Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes.  Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders.  Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.

A Pilot Evaluation of a Treatment Package to Teach Social Conversation via Video-Chat.

By engaging with family members through video-chat technology, children with autism spectrum disorder (ASD) may access additional opportunities to develop social connections to build familial cohesion and access emotional support. The purpose of this study was to evaluate a behavioral intervention package in teaching social conversation via video-chat. Using a non-concurrent multiple-baseline across participants with an embedded alternating treatments design, three seven-year-old males with ASD were taught two variations of a social conversation. Their conversation skills generalized to unfamiliar adults, some of whom had no prior experience with children with ASD. When visual supports were removed, participants appropriately varied their social conversations. Social conversations continued to occur 2 weeks following the completion of the study. Results and implications are discussed.

Further examination of video-based preference assessments without contingent access.

The first purpose of this study was to attempt to replicate previous findings that video-based preference assessments without access to selected stimuli may accurately predict relative reinforcing efficacy of stimuli. To do this, we conducted a concurrent operant reinforcer assessment in which we evaluated the relative reinforcing value of highly preferred and less preferred items identified in a video-based preference assessment. The second purpose of this study was to begin to evaluate the potential behavioral mechanisms responsible for the validity of this assessment. To conduct this analysis, we evaluated the relative reinforcing value of those same stimuli depicted in video format and then compared results to results obtained during the reinforcer assessment for tangible stimuli. For all five participants, stimuli identified as highly preferred functioned as reinforcers, and four of five participants, responding during the reinforcer assessment was similar in the presence of tangible stimuli and videos depicting those stimuli.

Using videos to assess preference for novel stimuli in children with autism.

A primary effort of preference assessment research has been to develop strategies to identify potential reinforcers for educational, social, and behavioral programming for individuals with disabilities, including children with autism. However, little attention has been paid to the identification of preferred stimuli children with autism may not have previous experience with. The purpose of this study was to evaluate the extent to which a video-based preference assessment may accurately identify preference for novel stimuli. We compared the results of the video-based preference assessment with no access to novel stimuli to the results of a preference assessment conducted in a tangible format with access. We then conducted the same video-based preference assessment a second time to evaluate the extent to which exposure to stimuli affected assessment results. The results provide preliminary support that a video-based preference assessment may accurately identify preference for novel stimuli. Implications and future directions are discussed.

A comparison of general and explicit delay cues to reinforcement for tangible-maintained challenging behaviour.

OBJECTIVES: This compares effects of explicit delay cue to reinforcement to general delay cue to reinforcement when attempting to decrease tangible-maintained challenging behaviours of children with autism spectrum disorder (ASD). METHODS: Two school-age children with ASD participated in this study. In order to evaluate the effects of a general cue versus an explicit cue on the participants' tangibly maintained challenging behaviours, a multiple baseline design across settings with an embedded alternating treatments design was used. RESULTS: Results suggested that both types of delay cue to reinforcement demonstrated effectiveness on decreasing tangible-maintained behaviours of the participant. For both participants, an explicit delay cue demonstrated slightly better effects on the participants' challenging behaviours then a general delay cue. CONCLUSIONS: This study adds an evidence to support that delayed reinforcement can be used as an effective strategy to reduce both escape and tangible-maintained challenging behaviours of children with ASD across multiple settings.

Examining the operant function of challenging behavior in young males with fragile X syndrome: a summary of 12 cases.

This study used experimental functional analyses to examine the operant function of challenging behaviors exhibited by 12 males (ages 27-51 months) with fragile X syndrome (FXS). Eight children met criteria for negatively reinforced challenging behavior in the form of escape from demands and/or escape from social interactions. Nine children met criteria for positively reinforced challenging behavior in the form of obtaining access to highly preferred items. Attention was identified as a maintaining consequence for three children. The functional analysis was inconclusive for one child. Results suggest that, for young males with FXS, challenging behaviors may more likely be tangibly and escape maintained than attention maintained. Our findings affirm past research suggesting a unique behavioral phenotype for this population.

Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: an aggregate study of single-case research with individuals with ASD.

OBJECTIVE: The purpose of this meta-analysis was to evaluate the potential moderating effects of intervention setting and type of aided augmentative and alternative communication (AAC) on outcome variables for students with autism spectrum disorders. METHODS: Improvement rate difference, an effect size measure, was used to calculate aggregate effects across 35 single-case research studies. RESULTS: Results indicated that the largest effects for aided AAC were observed in general education settings. With respect to communication outcomes, both speech generating devices (SGDs) and the Picture Exchange Communication System (PECS) were associated with larger effects than other picture-based systems. With respect to challenging behaviour outcomes, SGDs produced larger effects than PECS. CONCLUSION: This aggregate study highlights the importance of considering intervention setting, choice of AAC system and target outcomes when designing and planning an aided AAC intervention.

Impacts of a PECS instructional coaching intervention on practitioners and children with autism.

There is a growing research literature on the potential benefits of augmentative and alternative communication (AAC) for individuals with autism; however few studies have investigated implementation of AAC within real-life contexts. Thus, the purpose of this study was to investigate the impact of training for practitioners in implementation of aided AAC, and to examine implementation of Picture Exchange Communication System (PECS) in real-life contexts. In particular, this study involved the implementation of instructional coaching to increase opportunities offered by behavioral therapists for their preschool-aged clients to use PECS to make requests. Results indicated increases in therapist implementation of AAC and client use of AAC in trained contexts, with limited generalization to untrained contexts.

Effects of peer-mediated implementation of visual scripts in middle school.

Although research has investigated the impact of peer-mediated interventions and visual scripts on social and communication skills in children with autism spectrum disorders, no studies to date have investigated peer-mediated implementation of scripts. This study investigated the effects of peer-implemented scripts on a middle school student with autism, intellectual impairments, and speech-language impairment via a multiple baseline single-case research design across behaviors. The target student demonstrated improvements in three communicative behaviors when implemented by a trained peer; however, behaviors did not generalize to use with an untrained typically developing peer.

A meta-analysis of single case research studies on aided augmentative and alternative communication systems with individuals with autism spectrum disorders.

Many individuals with autism cannot speak or cannot speak intelligibly. A variety of aided augmentative and alternative communication (AAC) approaches have been investigated. Most of the research on these approaches has been single-case research, with small numbers of participants. The purpose of this investigation was to meta-analyze the single case research on the use of aided AAC with individuals with autism spectrum disorders (ASD). Twenty-four single-case studies were analyzed via an effect size measure, the Improvement Rate Difference (IRD). Three research questions were investigated concerning the overall impact of AAC interventions on targeted behavioral outcomes, effects of AAC interventions on individual targeted behavioral outcomes, and effects of three types of AAC interventions. Results indicated that, overall, aided AAC interventions had large effects on targeted behavioral outcomes in individuals with ASD. AAC interventions had positive effects on all of the targeted behavioral outcome; however, effects were greater for communication skills than other categories of skills. Effects of the Picture Exchange Communication System and speech-generating devices were larger than those for other picture-based systems, though picture-based systems did have small effects.

Problem behavior during preference assessments: an empirical analysis and practical recommendations.

Preferences of 2 children with developmental disabilities, whose functional analyses indicated that their problem behavior was maintained by access to tangible items, were assessed using three formats (i.e., paired stimulus [PS], multiple-stimulus without replacement [MSWO], and free operant [FO]). The experimenter administered each format five times and compared levels of problem behavior across formats in a multielement design. Both participants exhibited problem behavior in PS and MSWO formats but not in the FO format. Results are discussed in terms of recommendations for practitioners.