Measuring Developmental Delays: Comparison of Parent Report and Direct Testing.

PURPOSE: Developmental assessment is part of a comprehensive autism evaluation. During in-person evaluations, developmental assessment is completed via direct testing by an examiner. In telehealth evaluations, developmental assessment relies on caregiver-report instruments. This study examined correspondence between caregiver report and direct testing of developmental skills. METHODS: Participants were 93 children, aged 18-42 months, undergoing evaluation for possible autism spectrum disorder (ASD). Caregivers were interviewed with the Developmental Profile, 4th edition (DP-4) via telehealth platform and children were tested in person 2-4 weeks later using the Mullen Scales of Early Learning (MSEL). RESULTS: Correlations between the DP-4 and MSEL were high (ranging from 0.50 to 0.82) across standard scores, age equivalents, and functional categories, as well as across individual subtests and overall composite scores. CONCLUSION: The high convergent validity found in this study suggests that the DP-4 provides a suitable proxy for direct developmental testing using the MSEL in the context of telehealth evaluations for ASD in young children, delivering a good estimate of both developmental functioning and presence of delays. TRIAL REGISTRATION: Data were obtained from registered clinical trial NCT05047224, date of registration 2021-09-07.

Enhancing Diagnostic Follow-up and Care Coordination for Children with Autism in a Busy Resident Continuity Clinic: Leveraging the Electronic Health Record.

PURPOSE: A high-quality primary care clinic should provide clear action points and important care coordination for a child receiving a new diagnosis of autism spectrum disorder (ASD). Unfortunately, a substantial proportion of caregivers report little-to-no post-diagnosis support from their home clinics and primary care providers often report lack of training and resources in providing these supports. METHODS: We implemented an intervention package to investigate the impact on the frequency and quality of follow-up care for children with ASD in a busy, high-volume resident continuity clinic. The package consisted of a care coordination scheduling pathway and a standardized clinical template-embedded in the electronic health record (EHR)-that guided providers through best-practice recommendations and patient resources. RESULTS: As a result of these interventions, 74% of patients had ASD-specific follow-up, a more than threefold increase from baseline with a majority of providers using the EHR-embedded template to guide their visit. Providers also indicated a high degree of usability for the system and that it aided them in following best-practice guidelines for ASD care. CONCLUSION: Through explicit scheduling pathways and a novel EHR template, we saw a significant increase in ASD-specific follow-up visits and implementation of best practices for ASD care, demonstrating a new process for training and engaging primary care providers in clear action steps for post-diagnostic care without having to rely on tertiary referrals.

A Randomized Trial of the Accuracy of Novel Telehealth Instruments for the Assessment of Autism in Toddlers.

PURPOSE: Telemedicine approaches to autism (ASD) assessment have become increasingly common, yet few validated tools exist for this purpose. This study presents results from a clinical trial investigating two approaches to tele-assessment for ASD in toddlers. METHODS: 144 children (29% female) between 17 and 36 months of age (mean = 2.5 years, SD = 0.33 years) completed tele-assessment using either the TELE-ASD-PEDS (TAP) or an experimental remote administration of the Screening Tool for Autism in Toddlers (STAT). All children then completed traditional in-person assessment with a blinded clinician, using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3), and Autism Diagnostic Observation Schedule (ADOS-2). Both tele-assessment and in-person assessment included a clinical interview with caregivers. RESULTS: Results indicated diagnostic agreement for 92% of participants. Children diagnosed with ASD following in-person assessment who were missed by tele-assessment (n = 8) had lower scores on tele- and in-person ASD assessment tools. Children inaccurately identified as having ASD by tele-assessment (n = 3) were younger than other children and had higher developmental and adaptive behavior scores than children accurately diagnosed with ASD by tele-assessment. Diagnostic certainty was highest for children correctly identified as having ASD via tele-assessment. Clinicians and caregivers reported satisfaction with tele-assessment procedures. CONCLUSION: This work provides additional support for the use of tele-assessment for identification of ASD in toddlers, with both clinicians and families reporting broad acceptability. Continued development and refinement of tele-assessment procedures is recommended to optimize this approach for the needs of varying clinicians, families, and circumstances.

Examining the maintenance and generalization effects of repeated practice: A comparison of three interventions.

Repeated reading (RR) procedures are consistent with the procedures recommended by Haring and Eaton's (1978) Instructional Hierarchy (IH) for promoting students' fluent responding to newly learned stimuli. It is therefore not surprising that an extensive body of literature exists, which supports RR as an effective practice for promoting students' reading fluency of practiced passages. Less clear, however, is the extent to which RR helps students read the words practiced in an intervention passage when those same words are presented in a new passage. The current study employed randomized control design procedures to examine the maintenance and generalization effects of three interventions that were designed based upon Haring and Eaton's (1978) IH. Across four days, students either practiced reading (a) the same passage seven times (RR+RR), (b) one passage four times and three passages each once (RR+Guided Wide Reading [GWR]), or (c) seven passages each once (GWR+GWR). Students participated in the study across 2weeks, with intervention being provided on a different passage set each week. All passages practiced within a week, regardless of condition, contained four target low frequency and four high frequency words. Across the 130 students for whom data were analyzed, results indicated that increased opportunities to practice words led to greater maintenance effects when passages were read seven days later but revealed minimal differences across conditions in students' reading of target words presented within a generalization passage.

Repeated versus wide reading: A randomized control design study examining the impact of fluency interventions on underlying reading behavior.

Repeated readings (RR) has garnered much attention as an evidence based intervention designed to improve all components of reading fluency (rate, accuracy, prosody, and comprehension). Despite this attention, there is not an abundance of research comparing its effectiveness to other potential interventions. The current study presents the findings from a randomized control trial study involving the assignment of 168second grade students to a RR, wide reading (WR), or business as usual condition. Intervention students were provided with 9-10weeks of intervention with sessions occurring four times per week. Pre- and post-testing were conducted using Woodcock-Johnson III reading achievement measures (Woodcock, McGrew, & Mather, 2001, curriculum-based measurement (CBM) probes, measures of prosody, and measures of students' eye movements when reading. Changes in fluency were also monitored using weekly CBM progress monitoring procedures. Data were collected on the amount of time students spent reading and the number of words read by students during each intervention session. Results indicate substantial gains made by students across conditions, with some measures indicating greater gains by students in the two intervention conditions. Analyses do not indicate that RR was superior to WR. In addition to expanding the RR literature, this study greatly expands research evaluating changes in reading behaviors that occur with improvements in reading fluency. Implications regarding whether schools should provide more opportunities to repeatedly practice the same text (i.e., RR) or practice a wide range of text (i.e., WR) are provided.

Decreasing transition times in elementary school classrooms: Using computer-assisted instruction to automate intervention components.

Research suggests that students spend a substantial amount of time transitioning between classroom activities, which may reduce time spent academically engaged. This study used an ABAB design to evaluate the effects of a computer-assisted intervention that automated intervention components previously shown to decrease transition times. We examined the effects of the intervention on the latency to on-task behavior of 4 students in 2 classrooms. Data also were collected on students' on-task behavior during activities and teachers' use of prompts and praise statements. Implementation of the intervention substantially decreased students' latencies to on-task behavior and increased on-task behavior overall. Further, the 2 teachers used fewer prompts to cue students to transition and stay on task and provided more praise during intervention phases. We discuss how automating classroom interventions may affect student and teacher behavior as well as how it may increase procedural fidelity.

Examining the impact of feedback and repeated readings on oral reading fluency: let's not forget prosody.

Although extensive research supports repeated readings (RR) as an intervention for improving reading fluency, it largely ignores reading prosody, which is a key component of reading fluency. The current study extends the RR literature by examining the impact of RR on prosody and whether the content of directions and feedback might impact what components of fluency are improved. Elementary students (N = 76) were randomly assigned to either a rate- or prosody-focused RR intervention. The study differs from existing RR research in that (a) students were average as opposed to struggling students, (b) prosody was evaluated, and (c) measures of prosody were objective as opposed to subjective. Results support previous research suggesting that RR improves fluency but indicate that the nature of the instruction and performance feedback provided to students influences the components of reading fluency (i.e., rate or prosody) that are improved.