Training programme for community service providers who support adults with intellectual disabilities: A systematic quantitative literature review of single-case research

BACKGROUND

Research on training direct support professionals to address challenging behaviour exhibited by adults with intellectual disabilities is essential in generating effective training approaches for this sector. This systematic review's objective was to evaluate the effects of training types and whether specific training delivery components influenced outcomes.

METHODS

Following PRISMA (2020) guidelines, 16 single-case design studies were included that directly evaluated behaviour change of service providers training for adults with intellectual disabilities in community settings. Study quality was assessed using Horner et al. (Exceptional Children, 2005, 71(2), 165-180) criteria. The database searched included Academic Search Complete, CINAHL, Embase, ERIC, Psych Info, and Web of Science.

RESULTS

Descriptive analysis of effect size outcomes suggested that all training types were associated with improved outcomes. Further, in situ training was associated with improved service provider performance. Interestingly, feedback was associated with poorer service provider performance.

CONCLUSIONS

We provide possible explanations for this surprising outcome and propose future research.

Influence of Cognitive Load on Voice Production: A Scoping Review

Cognitive-motor interactions in speech production have a strong theoretical basis. However, majority of the existing literature has primarily focused on subjective and objective measures related to speech and not voice. This systematic review gathered evidence on the potential relationship between cognitive load and voice production. A search of five databases, website, citation review, and author search were completed in a sequential order to find published and unpublished literature from 1992 to 2022 using a combination of search terms including voice, cognitive load/demand/effort/flexibility, dual task, and speech production/motor. Studies for which the primary dependent variables were linguistic, or speech measures were included if voice acoustics was also measured and described. A final sample of nine articles were identified as meeting inclusion criteria: completed between 1992 and 2022, healthy adults (18+), and American English speakers. The review indicated that existing literature on the influence of cognitive load on voice production is limited. Acoustic measures, such as fundamental frequency, sound pressure level, and cepstral peak prominence, do not show consistent patterns of change with an increase in cognitive load. It is likely that the inconsistencies in the speech or cognitive task type and measurement of individual reaction to cognitive load changes may have led to these varied results. Further research using a range/continuum of cognitive tasks varying in load/difficulty level and physiological measurements is warranted to understand the underlying mechanisms of behavioral performance with implications for clinical voice assessment and rehabilitation.

Game-Based Learning for Learners With Disabilities-What Is Next? A Systematic Literature Review From the Activity Theory Perspective

The design, implementation, and outcome of game-based learning for learners with disabilities have not been sufficiently examined systematically. Particularly, learner-based and contextual factors, as well as the essential roles played by various stakeholders, have not been addressed when game-based learning applications are used in special education. Therefore, a systematic literature review using the Activity Theory (AT) was conducted to analyse studies about game-based learning for learners with disabilities. Content analysis of 96 studies reported relevant information with respect to each activity component-(a) subject (learners with disabilities), (b) technology (game-based learning applications), (c) object (target skills or behaviours), (d) rules (implementation procedure and performance measures), (e) community (learners with disabilities, special education professionals, and parents), (f) division of labour (among learners, professionals, and parents) and (g) outcome (performance of target skills or behaviours). Furthermore, this study identified existing gaps from the reviewed studies, including occasional lack of parental engagement, difficulty of standardising performance measures due to the heterogeneity of learner profiles and contradictions (e.g., opposing views among experts on the role of educational games in social interactions). Finally, recommendations were made under each activity component. The study concluded that both general and domain-specific guidelines should be created for each disability category proposed in this review to assist practitioners who wish to use game-based learning with learners with disabilities.

Application of n-of-1 Clinical Trials in Personalized Nutrition Research: A Trial Protocol for Westlake N-of-1 Trials for Macronutrient Intake (WE-MACNUTR)

Personalized dietary recommendations can help with more effective disease prevention. This study aims to investigate the individual postprandial glucose response to diets with diverse macronutrient proportions at both the individual level and population level, and explore the potential of the novel single-patient (n-of-1) trial for personalization of diet. Secondary outcomes include individual phenotypic responses and the effects of dietary ingredients on the composition of gut microbiota. Westlake N-of-1 Trials for Macronutrient Intake is a multiple crossover feeding trial consisting of 3 successive 12-d dietary intervention pairs including a 6-d washout period before each 6-d isocaloric dietary intervention: a 6-d high-fat, low-carbohydrate diet, and a 6-d low-fat, high-carbohydrate diet. The results will help provide personalized dietary recommendations for macronutrients in terms of postprandial blood glucose responses. The proposed n-of-1 trial methods could help in optimizing individual health and advancing health care. This trial was registered with clinicaltrials.gov (NCT04125602).

Challenges and solutions for N-of-1 design studies in health psychology

Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.

Results reporting in single case experiments and single case meta-analysis

Single Case Experimental Design is a discipline grounded in applied behavior analysis where the needs of individual clients and the application of scientific inquiry are fundamental tenets. These two principles remain tantamount in the conduct of research using this methodology and the expansion of the method into evidence-based practice determinations. Although recommendations for quality indicators are widespread, implementation is not. Concurrent to the rise of quality indicators is an increasing interest in analysis methodology. Visual analysis has a history of application and validity, newer forms of analysis less so. While some argue for concordance between the two, it may be the differences that are worth exploration in understanding characteristics of trend and variability in much of the published literature. Design choice and visual analysis decisions are rarely fully articulated. Statistical analyses are likewise inadequately justified or described. Recommendations for the explicit language of reporting as derived from prior meta-analysis and a current review of two leading journals provides a scaffold consistent with existing guidelines but additive in detail, exemplars, and justification. This is intended to improve reporting of results for individual studies and their potential use in future meta-analytic work.

Methodological standards in single-case experimental design: Raising the bar

Single-case experimental designs (SCEDs), or small-n experimental research, are frequently implemented to assess approaches to improving outcomes for people with disabilities, particularly those with low-incidence disabilities, such as some developmental disabilities. SCED has become increasingly accepted as a research design. As this literature base is needed to determine what interventions are evidence-based practices, the acceptance of SCED has resulted in increased critiques with regard to methodological quality. Recent trends include recommendations from a number of expert scholars and institutions. The purpose of this article is to summarize the recent history of methodological quality considerations, synthesize the recommendations found in the SCED literature, and provide recommendations to researchers designing SCEDs with regard to essential and aspirational standards for methodological quality. Conclusions include imploring SCED to increase the quality of their experiments, with particular consideration regarding the applied nature of SCED research to be published in Research in Developmental Disabilities and beyond.

Demonstrating treatment efficacy using the single subject randomization design: A tutorial and demonstration

Single case research refers to the broader category of research designs in which each case serves as his or her own control. A single subject randomization design is a specific form in which sessions are randomly allocated to treatment conditions within subjects. Two tutorials on the application of these designs are provided. In the single subject randomized phase design, baseline probes are administered repeatedly during a no-treatment or usual care phase; subsequently probes are administered repeatedly during the treatment phase of the experiment; the starting point for the treatment phase is determined by random selection. In the single subject randomized alternation design, any session can be randomly allocated to any treatment condition. In either case, the test statistic can be the mean of probe performance during the treatment sessions after subtracting the baseline mean. The significance of the obtained test statistic is determined by resampling test. Specifically, the obtained test statistic is interpreted relative to a distribution of test statistics generated by all possible random allocations. This distribution yields a P value which represents the probability of obtaining a test statistic as large as that obtained by the selected allocation. In addition to the tutorials, two experiments using these designs with a single 8-year-old participant with Childhood Apraxia of Speech are presented to demonstrate the utility of these designs and the application of the associated statistical analysis procedures.