Relationships Between Psychological Distress and Affective, Behavioral, and Cognitive Experiences of Stuttering.

PURPOSE: People who stutter (PWS) are vulnerable to the development of various psychopathological symptoms, although prevalence data are mixed and less clarity exists about factors that potentially influence their occurrence. The current study sought to shed light on the prevalence of self-reported psychopathology in PWS and aimed to identify relationships between affective, behavioral, and cognitive (ABC) experiences of stuttering and psychological distress (PD). METHOD: Forty-four PWS were administered the Behavior Assessment Battery (BAB) for Adults who Stutter and the Brief Symptom Inventory-18. The prevalence of clinically significant PD was calculated via BSI-18 global severity index t-score cutoffs. Regression analyses examined relationships between ABC variables of stuttering and PD. RESULTS: Participants' BAB scores approximated normative values, while the PD score distribution was similar to that of a nonclinical sample. Nine percent of participants met thresholds for clinically significant PD. All ABC correlates of stuttering significantly and positively correlated with PD scores, capturing considerable amounts of shared variance. CONCLUSIONS: Levels of PD in PWS approximate those of the general community, highlighting the existence of psychologically distressed subgroups of PWS. Speech situation-specific anxiety had the strongest relationship to PD, followed closely by one's report of situation-specific speech disruption. To a lesser but still significant extent, PWS' frequency to which they engage in various avoidance/escape behaviors, as well as their communication attitude, predicted levels of psychopathology. These data inform diagnostic and clinical decision making, drawing attention to factors that should be attended to in treatment.

Miniature Linguistic Systems for Individuals With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.

PURPOSE: Miniature linguistic systems (also known as matrix training) is a method of organizing learning targets to achieve generative learning or recombinative generalization. This systematic review is aimed at determining whether matrix training is effective for individuals with autism spectrum disorder (ASD) in terms of improving recombinative generalization for instruction-following, expressive language, play skills, and literacy skills. METHOD: A systematic review methodology was employed to limit bias in the various review stages. A multifaceted search was conducted. Potential primary studies were imported into Covidence, a systematic review software, and inclusion criteria were applied. Data were extracted regarding (a) participant characteristics, (b) matrix designs, (c) intervention methods, and (d) dependent variable. A quality appraisal using the What Works Clearinghouse (WWC) Single-Case Design Standards (Version 1.0, Pilot) was carried out. In addition to the visual analysis of the data, an effect size estimate, non-overlap of all pairs (NAP), was generated for each participant. Independent t tests and between-subjects analyses of variance were conducted to identify moderators of effectiveness. RESULTS: Twenty-six studies including 65 participants met criteria for inclusion. All included studies were single-case experimental designs. Eighteen studies received a rating of Meets Standards Without Reservations or Meets Standards With Reservations. The aggregated combined NAP scores for acquisition, recombinative generalization, and maintenance of a range of outcomes were in the high range. CONCLUSIONS: Findings suggested that matrix training is an effective teaching method for individuals with ASD for acquisition, recombinative generalization, and maintenance of a range of outcomes. Statistical analyses to identify moderators of effectiveness were insignificant. Based on the WWC Single-Case Design Standards matrix training meets criteria to be considered an evidence-based practice for individuals with ASD.

Providing visual directives via a smart watch to a student with Autism Spectrum Disorder: an intervention note.

Smart watches are discreet and wearable tools that may be repurposed to improve directive-following for individuals with autism spectrum disorder (ASD). Specifically, a mentor can transmit just-in-time (JIT) visual supports (e.g., video clips, photographs, text) that depict an upcoming directive to a learner's smart watch to prompt the learner as needed from a distance. Using a single-case multiple probe design across settings, this investigation evaluated the effectiveness of providing text-based prompts on an Apple Watch 1 to a child with ASD within a school setting. A mentor transmitted 2-step written directives via text message to the participant's Apple Watch. The participant was instructed to attend to, read, and follow directives received on the watch. Results demonstrated that the intervention improved directive-following as well as increased the instructor's distance from the learner. It is proposed that JIT supports sent to a learner's smart watch may reduce the obtrusiveness of traditional prompting while also maintaining the naturalness of ongoing social or academic interactions. Clinical limitations and implications are discussed.

Effects of an iPad-based Speech-Generating Device Infused into Instruction with the Picture Exchange Communication System for Adolescents and Young Adults with Severe Autism Spectrum Disorder.

This study used a multiple baseline, single-subject research design to investigate the efficacy of an iPad®-based speech-generating device (SGD). The iPad was equipped with the SPEAKall!® application to function as a SGD. SGDs are a form of aided augmentative and alternative communication (AAC) allowing a user to communicate using digitized and/or synthesized speech. Instruction followed a modified version of the intervention phases from the Picture Exchange Communication System (PECS). This modified PECS protocol was implemented with two adolescents and one young adult between the ages of 14 and 23. All three participants were diagnosed with severe autism spectrum disorder and little to no functional speech. Dependent measures included the ability to request for edible and tangible items as the primary measure, and the ability to engage in natural speech production as an ancillary measure to determine simultaneous, additive effects on speech acquisition. Results indicated increases in requesting behaviors for all three participants across intervention and maintenance phases. Once participants mastered requesting of edible items, they were able to generalize the skill to tangible items. However, mixed results were found when targeting natural speech production. Based on the current findings, the infusion of an iPad-based SGD into PECS instruction may be effective in increasing initial requesting skills; however, a facilitative effect on increasing speech acquisition cannot necessarily be expected for every participant.

Appraisal of comparative single-case experimental designs for instructional interventions with non-reversible target behaviors: Introducing the CSCEDARS ("Cedars").

Evidence-based practice as a process requires the appraisal of research as a critical step. In the field of developmental disabilities, single-case experimental designs (SCEDs) figure prominently as a means for evaluating the effectiveness of non-reversible instructional interventions. Comparative SCEDs contrast two or more instructional interventions to document their relative effectiveness and efficiency. As such, these designs have great potential to inform evidence-based decision-making. To harness this potential, however, interventionists and authors of systematic reviews need tools to appraise the evidence generated by these designs. Our literature review revealed that existing tools do not adequately address the specific methodological considerations of comparative SCEDs that aim to compare instructional interventions of non-reversible target behaviors. The purpose of this paper is to introduce the Comparative Single-Case Experimental Design Rating System (CSCEDARS, "cedars") as a tool for appraising the internal validity of comparative SCEDs of two or more non-reversible instructional interventions. Pertinent literature will be reviewed to establish the need for this tool and to underpin the rationales for individual rating items. Initial reliability information will be provided as well. Finally, directions for instrument validation will be proposed.

The efficacy of the cycles approach: a multiple baseline design.

UNLABELLED: The purpose of this study was to evaluate the efficacy of the Cycles Phonological Remediation Approach as an intervention for children with speech sound disorders (SSD). A multiple baseline design across behaviors was used to examine intervention effects. Three children (ages 4;3 to 5;3) with moderate-severe to severe SSDs participated in two cycles of therapy. Three phonological patterns were targeted for each child. Generalization probes were administered during baseline, intervention, and follow-up phases to assess generalization and maintenance of learned skills. Two of the three participants exhibited statistically and clinically significant gains by the end of the intervention phase and these effects were maintained at follow-up. The third participant exhibited significant gains at follow-up. Phonologically known target patterns showed greater generalization than unknown target patterns across all phases. Individual differences in performance were examined at the participant level and the target pattern level. LEARNING OUTCOMES: The reader will be able to: (1) enumerate the three major components of the cycles approach, (2) describe factors that should be considered when selecting treatment targets, and (3) identify variables that may affect a child's outcome following cycles treatment.

Comparative efficacy of the picture exchange communication system (PECS) versus a speech-generating device: effects on social-communicative skills and speech development.

The Picture Exchange Communication System (PECS) and a speech-generating device (SGD) were compared in a study with a multiple baseline, alternating treatment design. The effectiveness of these methods in increasing social-communicative behavior and natural speech production were assessed with three elementary school-aged children with severe autism who demonstrated extremely limited functional communication skills. Results for social-communicative behavior were mixed for all participants in both treatment conditions. Relatively little difference was observed between PECS and SGD conditions. Although findings were inconclusive, data patterns suggest that Phase II of the PECS training protocol is conducive to encouraging social-communicative behavior. Data for speech outcomes did not reveal any increases across participants, and no differences between treatment conditions were observed.

Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review.

PURPOSE: This systematic review aimed to determine the effects of augmentative and alternative communication (AAC) intervention on speech production in children with autism or pervasive developmental disorder-not otherwise specified. METHOD: A systematic review methodology was utilized to limit bias in searching, selecting, coding, and synthesizing relevant treatment studies. This involved a multifaceted search for studies written between 1975 and May 2007 using various bibliographic databases, dissertation databases, hand searches of selected journals and published compilations of AAC theses and dissertations, and ancestry searches. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment characteristics, design and measurement, and outcomes. RESULTS: Nine single-subject experimental design (27 participants) and 2 group studies (98 participants) were included. Results indicated that AAC interventions do not impede speech production. In fact, most studies reported an increase in speech production. However, in-depth analyses revealed that the gains were rather modest. CONCLUSIONS: Although AAC interventions do not appear to impede speech production and may result in increased speech production, the modest gains observed require realistic expectations among clinicians and other stakeholders. Future research should be more hypothesis driven and aim to identify predictive child characteristics, such as prior speech imitation and object exploration skills.

A chip-based platform for the in vitro generation of tissues in three-dimensional organization.

We describe a multi-purpose platform for the three-dimensional cultivation of tissues. The device is composed of polymer chips featuring a microstructured area of 1-2 cm(2). The chip is constructed either as a grid of micro-containers measuring 120-300 x 300 x 300 microm (h x l x w), or as an array of round recesses (300 microm diameter, 300 microm deep). The micro-containers may be separately equipped with addressable 3D-micro-electrodes, which allow for electrical stimulation of excitable cells and on-site measurements of electrochemically accessible parameters. The system is applicable for the cultivation of high cell densities of up to 8 x 10(6) cells and, because of the rectangular grid layout, allows the automated microscopical analysis of cultivated cells. More than 1000 micro-containers enable the parallel analysis of different parameters under superfusion/perfusion conditions. Using different polymer chips in combination with various types of bioreactors we demonstrated the principal suitability of the chip-based bioreactor for tissue culture applications. Primary and established cell lines have been successfully cultivated and analysed for functional properties. When cells were cultured in non-perfused chips, over time a considerable degree of apoptosis could be observed indicating the need for an active perfusion. The system presented here has also been applied for the differentiation analysis of pluripotent embryonic stem cells and may be suitable for the analysis of the stem cell niche.

Use of information-seeking strategies for developing systematic reviews and engaging in evidence-based practice: the application of traditional and comprehensive Pearl Growing. A review.

BACKGROUND: Efficient library searches for research evidence are critical to practitioners who wish to engage in evidence-based practice (EBP) as well as researchers who seek to develop systematic reviews. AIMS: This review will propose the benefits of the search technique 'Pearl Growing' ('Traditional Pearl Growing') as well as an adaptation of this technique ('Comprehensive Pearl Growing'), until now ignored by the literature on EBP and systematic reviews, to aid in the retrieval of research evidence. These search techniques are illustrated with examples from the field of augmentative and alternative communication. MAIN CONTRIBUTIONS: Traditional Pearl Growing is proposed as an important addition to the arsenal of EBP search strategies for practitioners. The literature on Traditional Pearl Growing is extended in that EBP presents a newly identified purpose for this technique and the benefits in identifying appropriate quality filter goes beyond its previously exclusive focus on keywords. Comprehensive Pearl Growing is projected as a new strategy for researchers searching for studies to be included in systematic reviews. Not only does it provide data-based guidance in selecting effective keywords and quality filters, but also it provides appropriate databases. CONCLUSIONS: Although the techniques Traditional Pearl Growing and Comprehensive Pearl Growing are believed to be useful for locating research evidence in any field, it may be particularly important for interdisciplinary topics where the use of effective controlled vocabulary plays a greater role in bringing together evidence that may be scattered across databases.