Effects of an individual work system on the independent functioning of students with autism

The use of Treatment and Education of Autistic and Related Communication Handicapped Children in schools to improve the ability of children with autism to complete tasks independently: A single-case meta-analysis

OBJECTIVE

To investigate the effectiveness of a Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) intervention in schools for improving independent task performance in children with autism spectrum disorders (ASD).

METHODS

We screened relevant studies published up to December 2022 from Web of science, ERIC, PsycINFO and other databases using predefined inclusion/exclusion criteria to identify suitable intervention studies for meta-analysis. Tau-U effect sizes were calculated for each A-B comparison extracted from the included experiments. Moderated analyses were conducted to examine the type of intervention (independent variable), intervention target behaviours (dependent variable), participant characteristics, setting characteristics and intervener characteristics.

RESULTS

A total of 14 studies (38 participants) met the criteria and were included in the meta-analysis. The analysis results showed that TEACCH had a significant intervention effect, and the overall intervention effect size was Tau-U = 0.85[0.77, 0.91]. There were significant differences in the intervention target behaviour variables (p < 0.01), limited variation in the intervention type variables, but no differences in participant characteristics, setting characteristics and intervenor characteristics.

CONCLUSION

The use of TEACCH is effective in improving independent task completion in children with ASD and provides evidence-based recommendations for its extended use in schools.

Consistency in Single-Case ABAB Phase Designs: A Systematic Review

The current article presents a systematic review of consistency in single-case ABAB phase designs. We applied the CONsistency of DAta Patterns (CONDAP) measure to a sample of 460 data sets retrieved from 119 applied studies published over the past 50 years. The main purpose was to (a) identify typical CONDAP values found in published ABAB designs and (b) develop interpretational guidelines for CONDAP to be used for future studies to assess the consistency of data patterns from similar phases. The overall distribution of CONDAP values is right-skewed with several extreme values to the right of the center of the distribution. The B-phase CONDAP values fall within a narrower range than the A-phase CONDAP values. Based on the cumulative distribution of CONDAP values, we offer the following interpretational guidelines in terms of consistency: very high, 0 ≤ CONDAP ≤ 0.5; high, 0.5 < CONDAP ≤ 1; medium, 1 < CONDAP < 1.5; low, 1.5 < CONDAP ≤ 2; very low, CONDAP > 2. We give examples of combining CONDAP benchmarks with visual analysis of single-case ABAB phase designs and conclude that the majority of data patterns (41.2%) in published ABAB phase designs is medium consistent.

Systematic Review on Environmental Design for Adaptive and Problem Behaviors of People With Intellectual and Developmental Disabilities

OBJECTIVES

The presented systematic review explores the empirical studies regarding environmental design strategies that support adaptive behaviors while improving problem behaviors of people with intellectual and developmental disabilities (IDD).

BACKGROUND

People with IDD perceive and interact with their environment differently from people without disabilities. Design research has not always considered these differences, and environmental design solutions are not commonly found.

METHODS

The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols. The study reports the findings from the systematic review of 32 peer-reviewed studies published in EBSCO, ERIC, ProQuest, PsycINFO, MEDLINE CINAHL, Consumer Health Complete (EBSCOhost), and Psychology and Behavioral Sciences Collection between 1990 and 2020. In addition, quality assessment tools appraised the study's quality.

RESULTS

The review identified 26 design strategies. Five themes qualitatively organized these environmental attributes: coherence, affordance, control, stimulation, and restoration.

CONCLUSION

The evidence indicates that adequately designed physical environments can support the adaptive behaviors of people with IDD while alleviating behavioral problems. Design features not supported by strong empirical evidence should be further addressed in future studies.

Teaching Graduate Students to Translate Nonbehavioral Treatments Into Behavioral Principles

Behavior analytic translations of nonbehavioral treatments were recommended by Brodhead in Behavior Analysis in Practice, 8(1), 70-78 (2015) as part of a decision-making framework for practitioners working on interprofessional treatment teams. Professionals from different disciplines often have overlapping scopes of practice and competence, yet each recommends interventions according to their discipline-specific worldview and training. Nonbehavioral treatment recommendations may be especially challenging for behavior analytic practitioners who are committed to the science of human behavior and who are also ethically obligated to work cooperatively and in the best interest of the client. Learning to translate nonbehavioral treatments into behavior analytic principles and procedures may function as a valuable means of improving professional judgment, thereby promoting evidence-based practice and effective collaboration. Behavioral translations may expose procedures that are, in fact, conceptually systematic, creating more opportunities for behavior analysts to partner in interprofessional care. Using a behavioral skills training package, graduate students of applied behavior analysis were taught to translate nonbehavioral treatments into behavior analytic principles and procedures. All students produced more comprehensive translations following training.

Maintaining On-Task Behavior of Adolescents with Autism Spectrum Disorder in the Absence of an Instructor

Despite the vast amount of research on increasing independence for individuals with autism spectrum disorder, there is a lack of research on techniques for fostering independent on-task behavior and accuracy in the absence of an instructor. Though increasing distance of the instructor and altering reinforcer delivery have been shown in a few studies to produce independence in the absence of an instructor, no study to date has compared the effects of systematic fading and complete removal of an instructor. In the current study, we evaluated the effects of three conditions on the on-task behavior and accuracy of adolescents with autism spectrum disorder: instructor present (instructor with participant and conditioned reinforcers delivered within session ), instructor absent (instructor not with the participant and no within-session conditioned reinforcers), and instructor fading (gradual, systematic fading of instructor and thinning of within-session conditioned reinforcers). Across all three participants, the intervention was effective in maintaining criterion levels of on-task behavior and accuracy. Responding generalized to novel instructors and remained high during maintenance evaluations for all participants. Clinicians rated the procedures as having high social validity.

Enhancing Joint Attention Skills in Children on the Autism Spectrum through an Augmented Reality Technology-Mediated Intervention

In the present study, the effects of an intervention based on an augmented reality technology called Pictogram Room were examined. The objective of the intervention was to improve the responding to joint attention (RJA) skills of gaze following and pointing in six children on the autism spectrum between 3 and 8 years old. A multiple baseline single-subject experimental design was conducted for 12 weeks in a school setting. Results indicated that all of the participant children improved performance in RJA following the intervention. Improvements were maintained over time and generalised to real-world situations. These findings demonstrate that autistic children can improve their RJA skills with a targeted and engaging intervention based on an accessible augmented reality technology tool.

Iterative Development of a Daily Living Skills Intervention for Adolescents with Autism Without an Intellectual Disability

Daily living skill deficits commonly co-occur in individuals with autism spectrum disorder (ASD). These deficits in adolescence are associated with poor outcomes, in both employment and independent living skills as adults. Currently, there are no interventions that directly target daily living skill acquisition in adolescents with ASD without an intellectual disability to facilitate a successful transition to adulthood. In this paper, we discuss the development, refinement, and initial efficacy studies of Surviving and Thriving in the Real World (STRW), a 14-session group treatment for both adolescents with ASD and their parent/caregiver that promotes attainment of critical daily living skills. We summarize initial feasibility studies that have been instrumental in the iterative development of STRW. The structure, core treatment elements, and content of STRW are described in detail. Lastly, we discuss the transition of the in-person STRW intervention to STRW-telehealth, which allows for adolescents with ASD to work on daily living skills in their own home with support from a therapist.

Mixed methods analysis of an exploratory apprenticeship model employment program for young adults with developmental disabilities

BACKGROUND: Individuals with developmental disabilities experience lower employment, higher underemployment, and higher job switching rates than the general population. OBJECTIVE: The current study investigated: (1) the vocational and support experiences of individuals with developmental disabilities, and (2) the differences in participant outcomes between an apprenticeship-model employment program and the comparison group. METHODS: Qualitative and quantitative methods were used to assess outcomes and experiences of participants in the apprenticeship model employment program (N = 22) and a community-based “Job Club” (N = 11). Thematic analysis was used to analyze interview transcripts. Independent samples T-tests and paired samples T-tests were utilized to analyze within-group and between group differences. RESULTS: Parent interview data regarding past and current experiences of the participants in the apprenticeship model employment program suggest 6 major themes. Independent samples T-tests determined that the apprenticeship program participants were significantly less employed than the comparison group at pre-, then similarly employed as the comparison group at post-intervention. Within-group analyses determined that some aspects of participant confidence in their vocational skills and problem-solving skills significantly increased from pre- to post-intervention, according to parent report. CONCLUSIONS: The apprenticeship model of employment appears to be a promising model in need of further study with a larger sample size.

Using Visual Supports to Facilitate Audiological Testing for Children With Autism Spectrum Disorder

Purpose One in 59 children is diagnosed with autism spectrum disorder (ASD). Due to overlapping symptoms between hearing loss and ASD, children who are suspected of having ASD require an audiological evaluation to determine their hearing status for the purpose of differential diagnosis. The purpose of this article is twofold: (a) to increase audiologists' knowledge of ASD by discussing the challenges associated with testing and interpreting clinical data for children with ASD or suspected ASD and (b) to provide visual supports that can be used to facilitate audiological assessment. Method Eight children (ages 4-12 years) were recruited as video model participants. Videos were filmed using scripts that used concise and concrete language while portraying common clinical procedures. Using the video models, corresponding visual schedules were also created. Conclusion Although obtaining reliable hearing data from children with ASD is challenging, incorporating visual supports may facilitate testing. Video models and visual schedules have been created and made freely available for download online under a Creative Commons License (Creative Commons-Attribution-NonCommercial-ShareAlike 4.0 International License). Incorporating visual supports during clinical testing has the potential to reduce the child's and family's stress, as well as to increase the probability of obtaining a reliable and comprehensive audiological evaluation. Future research is warranted to determine the effectiveness and feasibility of implementing these tools in audiology clinics. Supplemental Material https://doi.org/10.23641/asha.10086434.

Psychoeducational Interventions for Adults With Level 3 Autism Spectrum Disorder: A 50-Year Systematic Review

There is face validity to the expectation that adults with level 3 autism spectrum disorder (ASD-3) will benefit from a range of psychoeducational interventions. This paper reviews the empirical evidence supporting the effectiveness of these interventions, many of which are currently used in clinical settings. We reviewed 56 peer-reviewed studies of psychoeducational interventions for adults with ASD-3, written in English and since 1968, that met our criteria. The reviewing team included educators, clinicians, researchers, and a biostatistician. The available literature was limited, and most, if not all, of the studies presented some significant methodological limitations. When using Cochrane's criteria to assess seven key outcome domains-activities of daily living, aggressive/destructive behaviors, emotional functioning, language/communication skills, self-injurious behaviors, stereotypy/mannerisms, and vocational skills-we found only moderately reliable evidence to support the effectiveness of interventions designed to improve emotional functioning in adults with ASD-3. The reliability of evidence relevant to the six other outcome domains was rated as low or very low. Based on this review, we suggest directions for future study of interventions for adults with ASD-3, including topics, subpopulations, and approaches that should be explored. We also propose some crucial changes in how future studies regarding this population should be designed, analyzed, and documented, while balancing clinical considerations with scientific/educational utility.

An evaluation of the TEACCH approach for teaching functional skills to adults with autism spectrum disorders and intellectual disabilities

BACKGROUND

The Treatment & Education of Autistic and Communication Related Handicapped Children (TEACCH) approach has been widely adopted around the world, but most previous studies focus on applying it to teaching children with autism spectrum disorders (ASD) who have high functioning or without intellectual disabilities.

AIMS

This study evaluated the application and effectiveness of a TEACCH approach in teaching functional skills to young adults with ASD who have mild to moderate intellectual disabilities.

METHODS AND PROCEDURES

The study employed an experimental design which compared the training goal attainment of an experimental (n = 32) and a comparison (n = 31) group. We administered the TEACCH Transitional Assessment Profile (TTAP) to identify suitable areas of training and devised three individualized training goals for each participant using the goal attainment scaling (GAS) methodology. The experimental group participated in a standardized, individualized, 20-session training program based on the TEACCH approach, on top of their regular training in day activity centers.

RESULTS

All the participants showed improvements in functional skills over the baseline, mid-program, and post-program assessments (F = 146.66, p <  .001). The experimental group had significantly larger improvement in the GAS scores than the comparison group (F = 15.40, p <  .001). There were no significant changes between the pre- and post-program TTAP scores of both groups.

CONCLUSIONS AND IMPLICATIONS

The TEACCH approach is effective in teaching specific functional skills to young adults with ASD and mild to moderate intellectual disabilities. The clinical and research implications of the study are discussed.

The Big Four: Functional Assessment Research Informs Preventative Behavior Analysis

Current practice guidelines suggest that the assessment and treatment of challenging behavior should consist of conducting a functional behavior assessment following the onset of problem behavior. This assessment process can include indirect and direct assessment, as well as manipulation of variables to determine function. The purpose of this article is to outline a proposal that would add prevention practices to early intervention guidelines for problem behavior. Based on decades of research, the suggestion is to proactively teach children at risk for problem behavior to navigate four of the most common conditions that have been demonstrated to occasion problem behavior. Prevention is made a possibility because a large body of research examining the conditions under which challenging behavior occurs has been reliably replicated. Preventative approaches are an emerging phenomenon and reflect a progression in the practice of behavior analysis. Prevention may lead to acquisition of prosocial behavior before problems arise, to expedited and enhanced treatment, to increased access to favorable learning environments, and, we hope, to improvement in the quality of life for many children at risk for the development of problem behavior.

Promoting Task Accuracy and Independence in Students with Autism Across Educational Setting Through the Use of Individual Work Systems

Strategies that promote the independent demonstration of skills across educational settings are critical for improving the accessibility of general education settings for students with ASD. This research assessed the impact of an individual work system on the accuracy of task completion and level of adult prompting across educational setting. Student accuracy and adult prompting were measured in both special and general education settings during academic work periods. Work systems, an element of structured teaching developed by Division TEACCH, are organized sets of visual information that inform a student about participation in work areas. A multiple-probe-across-participants design was used to evaluate the effects of the individual work systems. All participants demonstrated increased accuracy yet required less adult support across special and general education settings. Results were maintained when measured during a1-month follow-up probe.

'Participation': a systematic review of language, definitions, and constructs used in intervention research with children with disabilities

AIM

Improving participation of children with disabilities is a priority; however, the participation construct lacks clarity. This systematic review investigated how researchers defined 'participation' and the language used in participation intervention research.

METHOD

Nine health and education databases were searched for intervention studies of children with disabilities that included a participation outcome. Quantitative data were extracted using a customized form, and participation text data were extracted verbatim. Themes were derived using a thematic coding approach. These participation themes were applied to the outcome measures used in the included studies to compare participation language with the methods used to quantify participation changes.

RESULTS

Of the 2257 articles retrieved, 25 were included in this review. Five participation themes and nine subthemes were developed. Two themes, attendance and involvement, were directly related to the participation construct. Three additional themes described related concepts: preferences, activity competence, and sense of self.

INTERPRETATION

Attendance and involvement seem to describe the essence of the participation concept. The related themes may provide important avenues to enhance participation outcomes. This review highlighted the need for researchers to define the construct under investigation clearly and select measures carefully, as measurement choice is the mechanism through which the concept is operationalized in research.

Effectiveness of Work, Activities of Daily Living, Education, and Sleep Interventions for People With Autism Spectrum Disorder: A Systematic Review

OBJECTIVE. To examine interventions addressing work, activities of daily living (ADLs), instrumental activities of daily living (IADLs), education, and sleep for people with autism spectrum disorder.

METHOD. A total of 23 studies were identified, and 9 work-, 11 ADL/IADL-, and 3 education-related interventions were examined. No sleep studies were identified.

RESULTS. Use of mobile and tablet technologies for vocational skills was supported. Support for ADL/IADL intervention is variable, with indications that Cognitive Orientation to Occupational Performance, sensory integration, and contextual interventions may increase occupational performance. Preliminary evidence suggests that daily yoga and brief exercise may improve classroom performance and behavior; group physical activities may assist with school readiness variables. Evidence for using technologies for IADLs was limited, as was evidence determining effective interventions for feeding and eating issues.

CONCLUSIONS. Studies investigating interventions related to sleep are lacking. More studies are needed in all areas, presenting opportunities for the expansion of science-driven occupational therapy practice and research for people with ASD.

Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders

A comprehensive review of the literature was conducted for articles published between 1993 and 2013 to evaluate the quality of the Visual Activity Schedules (VAS) literature using current evidence-based criteria developed by Horner et al. (Except Child 71:165-179, 2005). Authors sought to determine whether VAS can be considered an evidence-based practice by expanding on the findings from previous reviews. A total of 31 studies met inclusion criteria for the use of VAS to various behaviors to students with autism spectrum disorder (ASD). Of these studies, 16 met criteria for acceptable quality. Results suggest that VAS can be considered an EBP for individuals with ASD, especially when used in combination with systematic instructional procedures. VAS can be used to increase, maintain, and generalize a range of skills of individuals from preschool through adulthood in a variety of settings (e.g., general education, community). Implications for practitioners using VAS, limitations, and recommendations for future research are discussed.

Comparative efficacy of LEAP, TEACCH and non-model-specific special education programs for preschoolers with autism spectrum disorders

LEAP and TEACCH represent two comprehensive treatment models (CTMs) that have been widely used across several decades to educate young children with autism spectrum disorders. The purpose of this quasi-experimental study was to compare high fidelity LEAP (n = 22) and TEACCH (n = 25) classrooms to each other and a control condition (n = 28), in which teachers in high quality special education programs used non-model-specific practices. A total of 198 children were included in data analysis. Across conditions, children's performances improved over time. This study raises issues of the replication of effects for CTMs, and whether having access to a high quality special education program is as beneficial as access to a specific CTM.

Advance Notice for Transition-Related Problem Behavior: Practice Guidelines

Transitions between daily activities can occasion or elicit problem behavior in individuals with intellectual and developmental disabilities (IDD). Providing advance notice to signal an upcoming transition is a common practice in early and special education settings (e.g., Riffel 2010; Sandall et al. 2005). While the literature contains many demonstrations of the efficacy of various advance notice procedures, other studies have shown negative results. Practitioners are faced with the challenge of deciding whether advance notice is a viable treatment option for transition-related problem behavior in light of these contradictory findings. To assist the practitioner in this decision-making process, we provide a brief review of the advance notice literature, concentrating on the studies reporting that advance notice is ineffective at reducing transition-related problems. The goal is to provide practitioners with a better understanding of the environmental conditions under which advance notice is likely to be ineffective at decreasing problem behavior as well as the conditions under which it can be effective at reducing transition-related problem behavior. Discriminating these conditions may yield a useful set of practice guidelines for deciding when advance notice is a viable treatment option for decreasing transition-related problem behavior.

Application of cognitive rehabilitation theory to the development of smart prompting technologies

Older adults with cognitive impairments often have difficulty performing instrumental activities of daily living (IADLs). Prompting technologies have gained popularity over the last decade and have the potential to assist these individuals with IADLs in order to live independently. Although prompting techniques are routinely used by caregivers and health care providers to aid individuals with cognitive impairment in maintaining their independence with everyday activities, there is no clear consensus or gold standard regarding prompt content, method of instruction, timing of delivery, or interface of prompt delivery in the gerontology or technology literatures. In this paper, we demonstrate how cognitive rehabilitation principles can inform and advance the development of more effective assistive prompting technologies that could be employed in smart environments. We first describe cognitive rehabilitation theory (CRT) and show how it provides a useful theoretical foundation for guiding the development of assistive technologies for IADL completion. We then use the CRT framework to critically review existing smart prompting technologies to answer questions that will be integral to advancing development of effective smart prompting technologies. Finally, we raise questions for future exploration as well as challenges and suggestions for future directions in this area of research.

Evaluation of two instruction methods to increase employment options for young adults with autism spectrum disorders

We evaluated the efficacy of a vocational training program including behavioral skills training, and a "performance cue system" (i.e., a proprietary iPhone application adapted for the study) to teach targeted social-vocational skills to six young adults with an Autism Spectrum Disorder. In two separate studies, participants were employed to assist in the delivery of a fire safety education program. Participants were asked to wear an inflatable firefighter WalkAround® mascot costume and to perform 63 scripted behaviors in coordination with a fire prevention specialist who was the lead program presenter. In Study 1, three participants were initially exposed to established company training procedures comprised of behavioral skills training components to determine whether they met mastery of the skills. If necessary to reach criteria, participants were then exposed to a performance cue system. In Study 2, three additional participants were provided with the performance cue system alone, and then behavioral skills training if required. A single case, multiple-baseline design across subjects was used to evaluate efficacy of each intervention. Results indicate that 5 of 6 participants reached criterion only after introduction of the cue system while the sixth reached criterion with behavioral skills training alone. The program received high satisfaction ratings from participants, their parents, and consumers. Implications and potential use of the PCS in other employment settings are discussed.

Evidence-based practices and autism

Interventions for autism are increasing being held to standards such as 'evidence-based practice' in psychology and 'scientifically-based research' in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special education has raised additional concerns. An analysis of the benefits and limitations of current approaches to empiricism in autism interventions is presented, and suggestions for future research are made.

Enhancing the effectiveness of a play intervention by abolishing the reinforcing value of stereotypy: a pilot study

An alternating treatments design compared one condition in which a child with autism was allowed to engage in stereotypy freely prior to the intervention (abolishing operation component) to a second condition without the free-access period. Levels of stereotypy and problem behavior were lower and levels of functional play were higher in the condition with the abolishing operation component. These data provide preliminary support for the use of abolishing operations in interventions to increase the play skills of children with autism.

The Effects of an Abolishing Operation Intervention Component on Play Skills, Challenging Behavior, and Stereotypy

The purpose of this study was to reduce stereotypy and challenging behavior during play skills instruction by adding an abolishing operation component (AOC) to the intervention strategy. An alternating treatments design compared one condition in which participants were allowed to engage in stereotypy freely before beginning the play skills intervention (AOC condition) to a second condition without this free access period (No AOC condition). Across 4 participants with autism spectrum disorders (ASD), levels of stereotypy and challenging behavior were lower and functional play was higher during play intervention sessions that followed the AOC. These data provided support for the inclusion of an AOC in interventions aimed at increasing the play skills of children with ASD who present with stereotypy.

Increasing independence in autism spectrum disorders: a review of three focused interventions

The features of autism that inhibit the independent demonstration of skills, as well as three effective interventions for increasing independence, are explored in this review article. Independent performance may prove difficult for individuals with autism spectrum disorders (ASD) due to the core deficits of the disability, as well as executive function deficits that impact initiation and generalization. These difficulties, coupled with intervention strategies that encourage over-reliance on adult support, contribute to poor long term outcomes for adults with ASD in employment, housing, and relationship development. Self-monitoring, video modeling, and individual work systems each emphasize a shift in stimulus control from continuous adult management to an alternative stimulus and have proven successful in addressing executive function deficits and increasing independence.