Individual and environmental determinants of engagement in autism

Assessing engagement in rehabilitation: development, validity, reliability, and responsiveness to change of the Rehabilitation Observation Measure of Engagement (ROME)

PURPOSE

We describe the development of an observational video coding tool, the Rehabilitation Observation Measure of Engagement (ROME), to quantify engagement in rehabilitative settings at the person (internal state of an individual) and between-system (interaction between individuals) level.

METHODS

Forty-nine children with unilateral spastic cerebral palsy (29 males; Age: M = 9.28 yrs, SD = 3.08 yrs) and their interventionists were videotaped during different activities. Construct validity was examined by correlating the ROME with the Engagement vs. Disaffection with Learning Survey and the Pediatric Rehabilitation Intervention Measure of Engagement - Observation questionnaire. Inter- and intra-rater reliability were examined using two independent raters. The ROME's responsiveness to change was examined by comparing scores across activities.

RESULTS

For construct validity, results showed a positive correlation for person-level engagement (r = 0.444, p = 0.003). No relationship was found between-system-level engagement. High intrarater (91.8%) and interrater (96.1%) reliability was found. The ROME's responsiveness to change was supported by children exhibiting lower engagement scores during repetitive shaping activities.

CONCLUSION

These findings provide evidence that the ROME is a reliable tool to objectively examine the construct of engagement within rehabilitation and is valid for quantifying person-level engagement. It provides information that cannot be extracted from questionnaires and can help guide intervention decisions.

Blink Rate Patterns Provide a Reliable Measure of Individual Engagement with Scene Content

Eye-blinking has emerged as a promising means of measuring viewer engagement with visual content. This method capitalizes on the fact that although we remain largely unaware of our eye-blinking in everyday situations, eye-blinks are inhibited at precise moments in time so as to minimize the loss of visual information that occurs during a blink. Probabilistically, the more important the visual information is to the viewer, the more likely he or she will be to inhibit blinking. In the present study, viewer engagement was experimentally manipulated in order to: (1) replicate past studies suggesting that a group of viewers will blink less often when watching content that they perceive as more important or relevant; (2) test the reliability of the measure by investigating constraints on the timescale over which blink rate patterns can be used to accurately quantify viewer engagement; and (3) examine whether blink rate patterns can be used to quantify what an individual - as opposed to a group of viewers-perceives as engaging. Results demonstrate that blink rate patterns can be used to measure changes in individual and group engagement that unfold over relatively short (1 second) and long (60 second) timescales. However, for individuals with lower blink rates, blink rate patterns may provide less optimal measures when engagement shifts rapidly (at intervals of 1 second or less). Findings support the use of eye-blink measures in future studies investigating a person's subjective perception of how engaging a stimulus is.

The role of technology-mediated music-making in enhancing engagement and social communication in children with autism and intellectual disabilities

Very little research has explored the impact of interventions combining music and technology on children with a dual diagnosis of autism and intellectual disabilities (ID) incorporating the active involvement of school staff. Video recordings and group interviews were used to collect data in this study. Video recordings of five children with autism and ID were conducted as they engaged with a technology-mediated music-making intervention over a period of 5 weeks. Additionally, five group interviews with classroom staff were carried out. This study is the first to explore the impact of a technology-mediated music-making intervention on the engagement levels and social communication skills of children with autism and ID at school. Some positive outcomes, especially regarding social communication skills, are reported, which are of significant value to educational researchers and school staff.

Implementation Fidelity and Common Elements of High Quality Teaching Sequences for Students with Autism Spectrum Disorder in COMPASS

BACKGROUND

Evidence-based educational instruction includes teaching elements common across different approaches as well as specific elements of the chosen evidence-based practice. We were interested in evaluating the use and impact of common elements of teaching. Specifically, we adopted a model of elements of high quality teaching sequences and developed and tested an instructional quality index to capture evidence-based features within teaching sequences (Grisham-Brown & Ruble, 2014).

METHOD

The current investigation examined 29 special education teachers who received a consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple & McGrew, 2012) that results in personalized teaching plans for young students with ASD and embeds elements of evidence-based teacher coaching of self-reflection and performance-based feedback. We analyzed the teaching plans to understand which of the common elements were present, and if teachers demonstrated improved performance after coaching.

RESULTS

Analysis of the use of common elements during the first and fourth coaching session demonstrated that all teachers showed improvement. Most importantly, the use of common elements correlated with student goal attainment outcomes.

CONCLUSIONS

These results suggest that common elements of teaching sequences which we view as core features of teaching quality, can be improved as a result of coaching, and most importantly, are associated with students' educational outcomes.

From start to finish: teenagers on the autism spectrum developing their own collaborative game

Purpose

The purpose of this paper is to investigate how teenagers on the autism spectrum respond to their involvement in the creation of a collaborative game, meeting the curriculum requirements in programming at secondary level in England.

Design/methodology/approach

Two autistic teenagers were involved in participatory design processes to elaborate and develop together a collaborative game of their choice using the visual programming software, Kodu Game Lab.

Findings

With the support of adults (teachers and the researcher), the participants were able to demonstrate and strengthen their participation, problem-solving and programming skills. The participants expressed their preferences through their attitudes towards the tasks. They created a game where the players did not need to initiate any interaction between each other to complete a level. Furthermore, the students naturally decided to work separately and interacted more with the adults than with each other.

Research limitations/implications

This is a small case study and so cannot be generalised. However, it can serve as starting point for further studies that involve students with autism in the development of interactive games.

Practical implications

It has been shown that disengaged students can develop various skills through their involvement in software programming.

Originality/value

Overall, this paper presents the involvement of teenagers on the autism spectrum in the initial design and development of a collaborative game with an approach that shaped, and was shaped by, the students’ interests. Although collaboration was emphasised in the intended learning outcomes for the game, as well as through the design process, this proved difficult to achieve in practice suggesting that students with autism may require stronger scaffolding to engage in collaborative learning.

Engagement for Students With Severe Intellectual Disability: The Need for a Common Definition in Inclusive Education

Classroom engagement is an area of frequent discussion and study in the field of education, though engagement is defined differently for various student populations. The purpose of this article is to examine how engagement is defined for students without disability, at risk, or with mild disability as compared to those with severe intellectual disability. We discuss engagement for both populations of students and the resulting implications for inclusive practice. Finally, we emphasize the importance of utilizing a universal definition within the framework of the Universal Design for Learning to enhance learning outcomes for all students, including those with severe intellectual disability.

Evaluation of Classroom Active Engagement in Elementary Students with Autism Spectrum Disorder

This study evaluated the classroom measure of active engagement (CMAE), an observational tool designed to measure active engagement in students with autism spectrum disorder (ASD). Participants included 196 students with ASD and their educators (n = 126) who were video-recorded at the beginning of the school year. Findings documented limited active engagement overall, with students spending less than half of the observation well-regulated, productive, or independent and infrequently directing eye gaze and communicating. Confirmatory factor analysis indicated that the structure of the CMAE was represented by a 5-factor model. These findings underscore the need for improved active engagement in students with ASD and show promise for a tool to measure behaviors associated with positive educational outcomes in students with ASD.

The Engagement for Learning Framework: connecting with learning and evidencing progress for children with autism spectrum conditions

Purpose

– The purpose of this paper is to describe and illustrate the use of the Engagement for Learning Framework developed through the Complex Learning Difficulties and Disabilities (CLDD) Research Project (2009-2011). The resources support mainstream and special educators to extend the engagement of learners with CLDD.

Design/methodology/approach

– In total, 95 educational settings and 224 students took part across three phases of research (November 2009-March 2011) comprising a resource development phase and two trial phases in mainstream and special schools. The researchers used an exploratory, multiple case study approach and action research methodologies. A recent case study from Hamilton School, Birmingham, illustrates the Engagement for Learning Framework.

Findings

– The resulting Engagement Profile and Scale data showed increases in engagement for similar proportions of the student cohort. Across the three phases, 81-85 per cent (mean: 83 per cent) increased their levels of engagement for learning, 2-9 per cent (mean: 5.3 per cent) showed no change, while 5.5-16 per cent (mean: 11.6 per cent) showed decreased levels of engagement. Descriptive data corroborated these scores.

Originality/value

– This original research added value to existing work by developing resources for educators that enabled them to adapt activities to encourage students’ engagement in seven engagement areas (awareness, curiosity, investigation, discovery, anticipation, persistence and initiation). The resources enabled educators to score learner engagement over time to show progress and collected associated descriptive data.

Teacher and child predictors of achieving IEP goals of children with autism

It is encouraging that children with autism show a strong response to early intervention, yet more research is needed for understanding the variability in responsiveness to specialized programs. Treatment predictor variables from 47 teachers and children who were randomized to receive the COMPASS intervention (Ruble et al. in The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) were analyzed. Predictors evaluated against child IEP goal attainment included child, teacher, intervention practice, and implementation practice variables based on an implementation science framework (Dunst and Trivette in J Soc Sci 8:143-148, 2012). Findings revealed one child (engagement), one teacher (exhaustion), two intervention quality (IEP quality for targeted and not targeted elements), and no implementation quality variables accounted for variance in child outcomes when analyzed separately. When the four significant variables were compared against each other in a single regression analysis, IEP quality accounted for one quarter of the variance in child outcomes.

The ICF-CY-based structural equation model of factors associated with participation in children with autism

OBJECTIVE

The aim of this study was to apply the International Classification of Functioning, Disability and Health - Child and Youth (ICF-CY) framework to identify the factors related to the participation of children with autism.

METHOD

A convenience sample included 162 preschool children with autism ages 36 to 72 months. The raters collected data using the ICF-CY-based questionnaire as an instrument to construct the structural equation modeling of factors associated with participation.

RESULTS

The internal structure of the model was acceptable, indicating that the observed variables would suffice in accounting for latent variables. The structural model showed that the performance of participation in children with autism was influenced by body functions and personal factors. All the variables accounted for 77% of the explained variance for activities and for participation by 71% of the children with autism.

CONCLUSION

These findings may provide critical information pertaining to predictive factors of participation for parents, educators, and professionals who work with children with autism.

The association between parental interaction style and children's joint engagement in families with toddlers with autism

PURPOSE

This study examines the relationship between parental interaction style (responsive vs directive) and child-initiated joint engagement within caregiver-child interactions with toddlers diagnosed with autism spectrum disorders.

METHOD

Videotaped interactions of 85 toddler-caregiver dyads were coded for child engagement and both parental responsiveness and directiveness.

RESULTS

Altogether, children spent less than one-third of the interaction jointly engaged. After controlling for child characteristics, parental style was associated with the initiator (child or parent) of joint engagement. Specifically, responsiveness predicted total time in child-initiated joint engagement, while directiveness predicted total time in parent-initiated joint engagement. Children's social behaviours were associated with child-initiated joint engagement.

DISCUSSION

Social initiations are a key target for children with autism spectrum disorders. Results demonstrate that child initiations and global social behaviour ratings are associated with parental responsivity. Responsivity may be a critical factor to facilitate children's initiations.

Understanding how adolescents with autism respond to facial expressions in virtual reality environments

Autism Spectrum Disorders (ASD) are characterized by atypical patterns of behaviors and impairments in social communication. Among the fundamental social impairments in the ASD population are challenges in appropriately recognizing and responding to facial expressions. Traditional intervention approaches often require intensive support and well-trained therapists to address core deficits, with many with ASD having tremendous difficulty accessing such care due to lack of available trained therapists as well as intervention costs. As a result, emerging technology such as virtual reality (VR) has the potential to offer useful technology-enabled intervention systems. In this paper, an innovative VR-based facial emotional expression presentation system was developed that allows monitoring of eye gaze and physiological signals related to emotion identification to explore new efficient therapeutic paradigms. A usability study of this new system involving ten adolescents with ASD and ten typically developing adolescents as a control group was performed. The eye tracking and physiological data were analyzed to determine intragroup and intergroup variations of gaze and physiological patterns. Performance data, eye tracking indices and physiological features indicated that there were differences in the way adolescents with ASD process and recognize emotional faces compared to their typically developing peers. These results will be used in the future for an online adaptive VR-based multimodal social interaction system to improve emotion recognition abilities of individuals with ASD.

Design of a virtual reality based adaptive response technology for children with autism

Children with autism spectrum disorder (ASD) demonstrate potent impairments in social communication skills including atypical viewing patterns during social interactions. Recently, several assistive technologies, particularly virtual reality (VR), have been investigated to address specific social deficits in this population. Some studies have coupled eye-gaze monitoring mechanisms to design intervention strategies. However, presently available systems are designed to primarily chain learning via aspects of one's performance only which affords restricted range of individualization. The presented work seeks to bridge this gap by developing a novel VR-based interactive system with Gaze-sensitive adaptive response technology that can seamlessly integrate VR-based tasks with eye-tracking techniques to intelligently facilitate engagement in tasks relevant to advancing social communication skills. Specifically, such a system is capable of objectively identifying and quantifying one's engagement level by measuring real-time viewing patterns, subtle changes in eye physiological responses, as well as performance metrics in order to adaptively respond in an individualized manner to foster improved social communication skills among the participants. The developed system was tested through a usability study with eight adolescents with ASD. The results indicate the potential of the system to promote improved social task performance along with socially-appropriate mechanisms during VR-based social conversation tasks.

Effect of classroom modification on attention and engagement of students with autism or dyspraxia

Students with autism display sensory sensitivities to environmental stimuli that affect their attending and engagement in classroom learning activities. The purpose of the study was to determine whether attending of 4 male students, ages 13-20, increased after the installation of sound-absorbing walls and halogen lighting. The multiple single-subject, mixed-method design, AB(B+C), included a 2-wk baseline and two intervention phases: 2 wk after sound-absorbing wall installation using the Owens Corning Basement Finishing System™ (Owens Corning, Toledo, OH) and 2 wk after halogen light installation. We calculated nonattending frequencies from videotaped class sessions and used visual analysis to measure within-phase and between-phase characteristics. Results included increased frequency and stability of attending and engagement and improved classroom performance, comfort, and mood. Journaling provided students' perspective on the modifications and reflected overall increased sensory comfort and themes of improved classroom environment, positive emotional response (mood), and improved classroom performance.

Classification of activity engagement in individuals with severe physical disabilities using signals of the peripheral nervous system

Communication barriers often result in exclusion of children and youth with disabilities from activities and social settings that are essential to their psychosocial development. In particular, difficulties in describing their experiences of activities and social settings hinder our understanding of the factors that promote inclusion and participation of this group of individuals. To address this specific communication challenge, we examined the feasibility of developing a language-free measure of experience in youth with severe physical disabilities. To do this, we used the activity of the peripheral nervous system to detect patterns of psychological arousal associated with activities requiring different patterns of cognitive/affective and interpersonal involvement (activity engagement). We demonstrated that these signals can differentiate among patterns of arousal associated with these activities with high accuracy (two levels: 81%, three levels: 74%). These results demonstrate the potential for development of a real-time, motor- and language-free measure for describing the experiences of children and youth with disabilities.

Design of a gaze-sensitive virtual social interactive system for children with autism

Impairments in social communication skills are thought to be core deficits in children with autism spectrum disorder (ASD). In recent years, several assistive technologies, particularly Virtual Reality (VR), have been investigated to promote social interactions in this population. It is well known that children with ASD demonstrate atypical viewing patterns during social interactions and thus monitoring eye-gaze can be valuable to design intervention strategies. While several studies have used eye-tracking technology to monitor eye-gaze for offline analysis, there exists no real-time system that can monitor eye-gaze dynamically and provide individualized feedback. Given the promise of VR-based social interaction and the usefulness of monitoring eye-gaze in real-time, a novel VR-based dynamic eye-tracking system is developed in this work. This system, called Virtual Interactive system with Gaze-sensitive Adaptive Response Technology (VIGART), is capable of delivering individualized feedback based on a child's dynamic gaze patterns during VR-based interaction. Results from a usability study with six adolescents with ASD are presented that examines the acceptability and usefulness of VIGART. The results in terms of improvement in behavioral viewing and changes in relevant eye physiological indexes of participants while interacting with VIGART indicate the potential of this novel technology.

Engaged Moments: Mediated Action and Children with Autism in the Classroom Setting

The purpose of this microethnographic study is to explore ways to better understand engagement in occupation of children with autism spectrum disorder. Using video data, moments of engagement were examined in a child with autism spectrum disorder during the daily classroom activity of Circle Time. The interpretive frame focused on mediated action, the interaction between the agent, and cultural tools. Three scenes were analyzed using narrative and micro-analytic strategies. Analyses of two scenes highlighted how social and material mediators offer opportunities for engagement. Other children with autism provided appropriate scaffolds and demonstrated evidence of intersubjectivity, whereas material tools provided proximal prompts that enabled the child to engage. The third scene suggests that engagement may not always be observable (i.e., engagement may be a subjective state). Implications for practice and methodological insights are offered.

Effectiveness of Therapy Ball Chairs on Classroom Participation in Children With Autism Spectrum Disorders

A single-subject design was used to assess the effectiveness of therapy ball chairs on classroom participation in 6 boys with autism spectrum disorder (ASD). The sensory processing pattern of each participant was assessed using the Sensory Processing Measure. Data on in-seat behavior and engagement were collected using digital video recordings during Circle Time. During baseline, participants sat on chairs. During intervention, participants sat on therapy ball chairs. Social validity was assessed by means of a questionnaire completed by the teacher. Each child demonstrated a unique response. The ball chair appeared to have a positive effect on in-seat behavior for the child who had the most extreme vestibular–proprioceptive-seeking behaviors. Children with poor postural stability were less engaged when sitting on the therapy ball chair. The results illuminate the complex nature of children with ASD and the importance of using sound clinical reasoning skills when recommending sensory strategies for the classroom.