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Gulsrud AC, Shih W, Paparella T, Kasari C. Comparative efficacy of an early intervention "parent and me" program for infants showing signs of autism: The Baby JASPER model. Infant Behav Dev 2024; 76:101952. [PMID: 38678861 DOI: 10.1016/j.infbeh.2024.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
Despite important advancements into the early detection of autism, there are still few empirically supported interventions for children under the age of two years who are showing early signs. Caregiver-mediated interventions have gained in popularity as a method for delivering support to the child and family. The current study builds on current work by enrolling a comparatively large cohort of infants (ages 12-22 months of age) displaying early signs of autism into a randomized controlled intervention program. Infants and parents received a group-based program using a standard early childhood curriculum. In addition, all families were randomly assigned to receive parent training in the form of either parent-mediated Joint Attention Symbolic Play Engagement and Regulation (JASPER) training or psychoeducation. Infants in both classrooms made substantial gains in social-communication, play, and cognition during a brief, 8-week period. All infants gained over an average of 10 points in DQ and increased in standardized measures of social-communication and play, with these gains maintaining at a 2-month follow-up visit. The classroom that also received JASPER increased in child initiated joint engagement and play level during dyadic interactions with their parents, while the classroom that received psychoeducation increased in joint attention during a standardized assessment delivered by an independent assessor. Infant familial risk for autism (older sibling with autism) also moderated the effect of treatment on child initiated joint engagement where infants in the JASPER classroom without familial risk made the most gains from baseline to exit of the program. This study highlights the promise of intervening at the earliest stages to promote positive outcomes for children and families.
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Affiliation(s)
- Amanda C Gulsrud
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA.
| | - Wendy Shih
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Tanya Paparella
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Connie Kasari
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
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Piccolo A, De Domenico C, Di Cara M, Settimo C, Corallo F, Leonardi S, Impallomeni C, Tripodi E, Quartarone A, Cucinotta F. Parental involvement in robot-mediated intervention: a systematic review. Front Psychol 2024; 15:1355901. [PMID: 39049952 PMCID: PMC11267593 DOI: 10.3389/fpsyg.2024.1355901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Over the years, the conceptual approach to pediatric rehabilitation has reevaluated the parent's role in the therapeutic process, considering parental involvement as a necessary condition for the effectiveness of the intervention. In the field of pediatric intervention, the therapeutic use of robots represents a growing clinical interest, but the feasibility and applicability of these robotic interventions, including those involving parents, remain unclear. This systematic review aims to investigate parental involvement in robot-mediated interventions (RMI) for children and adolescents in the current literature. Our main goal is to analyze and summarize all existing studies to discuss and draw future research directions and implications for clinical practice. Method After collecting results from 1,106 studies, the studies selected were analyzed using thematic analysis. The literature review was conducted in accordance with the PRISMA guidelines by searching databases such as PubMed and Web of Science until 07 February 2023. Studies that met the following inclusion criteria were included: (1) the use of a robot as a therapeutic-rehabilitation tool and (2) the presence/involvement of parents/caregivers in child-robot therapeutic sessions. Results A total of 10 articles were included. The extracted data included study design, participant characteristics, type of robot used, outcome measures, aim, and type of intervention. The results reveal that parental involvement in RMI could be feasible and useful in improving intervention efficacy, particularly in improving the child's social-communicative abilities and the caregiver's educational skills. Discussion RMI intervention with parental participation could be a useful therapeutic strategy in pediatrics. However, to date, few studies have investigated this specific topic, and the reported results may enhance future research to understand its effectiveness in specific areas of use. Systematic review registration identifier: CRD42024553214.
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Román-Oyola R, Bundy A, Lane SJ, Bonilla-Rodríguez VE. Development of the Scale of Parental Playful Attitude During the Co-Occupation of Play. Am J Occup Ther 2024; 78:7804185140. [PMID: 38848283 DOI: 10.5014/ajot.2024.050569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
IMPORTANCE There is a need for tools to measure adults' playfulness in reference to parent-child joint play. OBJECTIVE To (1) develop items for the Scale of Parental Playful Attitude (PaPA), (2) evaluate evidence for validity based on content, and (3) evaluate evidence for validity based on the response process. DESIGN A mixed-methods design with three phases: (1) development of the first draft of the PaPA (based on the literature, focus groups, and semistructured interviews), (2) review by experts and revision of the first draft, and (3) cognitive interviews with parents. SETTING Various (e.g., schools, a university). PARTICIPANTS Phase 1 had 32 participants: 13 parents of children ages 2.5-6 yr without major diagnosed conditions; 8 parents of autistic children age 4-7 yr; and 11 preschoolers age 3-5 yr. Phase 2 involved 10 experts. Phase 3 had 5 participants: 3 mothers and 2 fathers of children ages 2.5-6 yr; 1 child was autistic. OUTCOMES AND MEASURES Interview protocols and experts' review form. RESULTS Phase 1 involved the initial item development. Extrinsic motivation and barriers to play emerged as important areas to include. Experts' review enhanced representation of the construct of playfulness. Content validity index values ranged from .78 to 1.00. Cognitive interviews provided insights into parents' comprehension of PaPA items. CONCLUSIONS AND RELEVANCE Validity related to test content and the response process was supported. Additional sources of validity testing are necessary. Plain-Language Summary: Adult playfulness is critical for both the child and the parent, especially for developing a deeper connection. The Scale of Parental Playful Attitude (PaPA) assesses parents' self-perceptions of their playfulness when playing with their child. The study authors developed the PaPA (in both English and Spanish) to address a lack of tools for assessing how parents perceive their own playfulness relative to their child's playfulness. Understanding how parents perceive their own playful attitudes can create opportunities for occupational therapists to guide parents to approach play with an attitude that is as attuned as possible to their child's playfulness. Future validity studies are needed to support the clinical use of the PaPA.
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Affiliation(s)
- Rosa Román-Oyola
- Rosa Román-Oyola, PhD, MEd, OTR/L, is Professor, Occupational Therapy Program, University of Puerto Rico, San Juan;
| | - Anita Bundy
- Anita Bundy, ScD, OT/L, FAOTA, FOTARA, is Professor and Department Head, Department of Occupational Therapy, Colorado State University, Ft. Collins
| | - Shelly J Lane
- Shelly J. Lane, PhD, OTR/L, FAOTA, is Professor and Academic Program Director, Department of Occupational Therapy, Colorado State University, Ft. Collins
| | - Víctor E Bonilla-Rodríguez
- Víctor E. Bonilla-Rodríguez, PhD, is Professor, Educational Research and Evaluation Master's Program, University of Puerto Rico, San Juan
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Wood JJ, Danial J, Wolpe S. Home-based video assessment of children's autism-related behaviours: Psychometric analysis and linkages with parental responsiveness and context. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:197-212. [PMID: 38214135 DOI: 10.1111/bjc.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/10/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES Assessment of autism-related behaviours (ARBs) in children has generally been limited to direct observations in clinical settings or informant-based reports. The widespread availability of video-streaming devices has made home observations of children's ARBs feasible. This approach could enable assessment of the generalization and durability of interventions and may be able to overcome methodological limitations of predominant current assessment approaches (response biases, limited sensitivity to treatment). DESIGN AND METHODS Forty-four autistic children and their families participated in a repeated-measures study with a correlational design. Approximately 10 hr of unprompted behaviour at home were videorecorded over the course of a week (2 hr per day) for each participant. Gold standard measures of ARBs were also administered (ADOS-2 and ADI-R). Two home-based observational measures of ARBs utilizing streaming video were developed and evaluated: the ARCHER and the CHEERS. Trained independent evaluators made ratings on the ARCHER, CHEERS and an observational measure of parental responsiveness. RESULTS Correlations with the ADOS-2 and ADI-R were .47 and .34 for ARCHER scores and .51 and .48 for CHEERS scores, respectively. In linear mixed models, more responsive parenting was associated with fewer ARBs on a daily basis. Children spent their afternoons engaged in many typical activities including electronics, homework and games with family members, and ARBs were more prominent in some of these contexts (e.g., electronics) than others (e.g., family games). CONCLUSIONS Home-based observational assessment of ARBs may be useful for clinical and descriptive research.
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Affiliation(s)
| | - John Danial
- University of California, Los Angeles, California, USA
| | - Samara Wolpe
- University of California, Los Angeles, California, USA
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Uke P, Gaikwad S, Vagha K, Wandile S. Unraveling the Spectrum: A Comprehensive Review of Autism Spectrum Disorder in India. Cureus 2024; 16:e62753. [PMID: 39036210 PMCID: PMC11260197 DOI: 10.7759/cureus.62753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in social interaction, communication difficulties, and repetitive behaviors that profoundly impact the lives of affected individuals and their families. This article provides a comprehensive overview of ASD, focusing on screening, diagnosis, and intervention strategies. Early signs of ASD can manifest in infancy, but parents may not recognize them until their child falls behind in meeting social milestones. This delay in recognition is often due to a lack of awareness, societal stigma, and limited knowledge about developmental and behavioral disorders. Globally, ASD prevalence is increasing potentially due to broader diagnostic criteria, increased awareness, and improved screening practices. Screening for ASD is crucial for early identification and intervention. Various tools are available such as the Modified Checklist for Autism in Toddlers (M-CHATs), Trivandrum Autism Behavioral Checklist (TABC), and the Social Communication Questionnaire (SCQ). Diagnosing ASD involves using established criteria such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and specific diagnostic tools like the Autism Diagnostic Observation Schedule (ADOS) and the Indian Scale for the Assessment of Autism (ISAA). Interventions for ASD should be multidisciplinary, involving professionals such as developmental pediatricians, psychologists, psychiatrists, special educators, occupational therapists, physiotherapists, speech therapists, and social workers. Applied behavior analysis (ABA), naturalistic developmental behavioral interventions (NDBIs), and parent-mediated treatment are among the evidence-based approaches. Additionally, speech-language therapy, motor therapy, and sensory integration therapy play vital roles in addressing the diverse needs of individuals with ASD. Medical interventions should be used alongside behavioral and environmental strategies. Early screening, accurate diagnosis, and tailored interventions are essential for improving the lives of individuals with ASD. A multidisciplinary approach and increased awareness are crucial in addressing the growing prevalence of ASD worldwide.
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Affiliation(s)
- Punam Uke
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
| | - Sarika Gaikwad
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
| | - Keta Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
| | - Shailesh Wandile
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Reseach, Wardha, IND
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Reichow B, Kogan C, Barbui C, Maggin D, Salomone E, Smith IC, Yasamy MT, Servili C. Caregiver skills training for caregivers of individuals with neurodevelopmental disorders: A systematic review and meta-analysis. Dev Med Child Neurol 2024; 66:713-724. [PMID: 37786292 DOI: 10.1111/dmcn.15764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
AIM To systematically review the effectiveness of caregiver and parent skills training programs, including caregiver-mediated interventions, for caregivers of individuals with neurodevelopmental disorders. METHOD We conducted a systematic review with a random-effects meta-analysis. We searched 11 electronic databases through July 2021 and used a snowball methodology to locate relevant articles of randomized controlled trials. Effect size estimates were pooled using Hedges' g from data extracted from study reports and through author requests using random-effects meta-analyses for three child outcome categories (child development, adaptive behavior, and problem behavior) and three caregiver outcome categories (parenting skills and knowledge, psychological well-being, and interpersonal family relations). RESULTS We located 44 910 records, from which 75 randomized controlled trials involving 4746 individuals with neurodevelopmental disorders and their caregivers were included. Random-effects meta-analyses showed improvements in child development (g = 0.30; 99% confidence interval [CI] = 0.07-0.53) and reduction in reported problem behaviors (g = 0.41; 99% CI = 0.24-0.59), but not a statistically significant improvement in adaptive behavior (g = 0.28; 99% CI = -0.42 to 0.98). Caregivers showed improvements in parenting skills and knowledge (g = 0.72; 99% CI = 0.53-0.90), psychological well-being (g = 0.52; 99% CI = 0.34-0.71), and interpersonal family relations (g = 0.76; 99% CI = 0.32-1.20). INTERPRETATION Caregiver skills training programs benefit both caregivers and children with neurodevelopmental disorders. Skills training programs improve child development and behavior, improve parenting skills, reduce caregiver mental health issues, and improve family functioning. Programs using culturally appropriate training material to improve the development, functioning, and participation of children within families and communities should be considered when caring for children with neurodevelopmental disorders. WHAT THIS PAPER ADDS Caregiver skills training programs are effective interventions for both caregivers and children. Children with neurodevelopmental disorders benefit from improvements in development and reduction of problematic behaviors. Caregivers benefit from enhanced skills and psychological well-being. Improvements in interpersonal family relationships have also been documented.
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Affiliation(s)
- Brian Reichow
- AJ Pappanikou Center for Excellence in Developmental Disabilities Education, Research, and Service, University of Connecticut Health Center, Farmington, CT, USA
- University of Florida, Gainesville, FL, USA
| | - Cary Kogan
- University of Ottawa, Ottawa, ON, Canada
| | - Corrado Barbui
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | | | | | - Isaac C Smith
- AJ Pappanikou Center for Excellence in Developmental Disabilities Education, Research, and Service, University of Connecticut Health Center, Farmington, CT, USA
- Yale University, New Haven, CT, USA
- Virginia Tech, Blacksburg, VA, USA
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Kunze M, Wei Q, Bacon-Yates A, Pompan E, Lockwood H, Witthuhn N. Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match): A Virtual Parent-Mediated Intervention Package for Young Children with Developmental Disabilities. J Autism Dev Disord 2024:10.1007/s10803-024-06386-3. [PMID: 38744741 DOI: 10.1007/s10803-024-06386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
This study aimed to evaluate Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match), a parent-mediated naturalistic developmental behavioral intervention package. An expansion from an earlier pilot study (see Kunze et al., 2021), PRRFCT Match incorporates virtual coaching between a novice coach and parent to implement evidence-based, applied behavior analytic (ABA) techniques during play to increase engagement and decrease unengaged behavior exhibited by their young child with developmental delays (26-50 months old). Ten parent-child dyads were matched with a coach in this concurrent multiple baseline design across participants. Simulating the clinical training level of a novice early interventionist, nine graduate student clinicians received training as coaches on PRRFCT Match implementation and weekly supervision by a research team member. All aspects of training and intervention were delivered virtually. A visual analysis of the data combined with Tau-U revealed a strong basic effect between clinician coaching and parent strategy use. For child participants, a visual analysis and Tau-U results suggest that most increased engagement and decreased their unengaged behavior during the intervention. High variability, overlap, and high engagement at baseline are discussed. This study shows promise for the PRRFCT Match intervention package. The ABA technologies mediated by parents during play increased child engagement and decreased unengagement for most participants.
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Affiliation(s)
- Megan Kunze
- Center on Brain Injury Research & Training, Department of Psychology, University of Oregon, Eugene, OR, USA.
| | - Qi Wei
- Department of Special Education, University of Wisconsin-Whitewater, Whitewater, WI, USA
| | - Alexis Bacon-Yates
- Department of Special Education, University of Texas at Austin, Austin, TX, USA
| | - Emily Pompan
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - Hannah Lockwood
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - Nicole Witthuhn
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
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MacDonald-Prégent A, Saiyed F, Hyde K, Sharda M, Nadig A. Response to Music-Mediated Intervention in Autistic Children with Limited Spoken Language Ability. J Autism Dev Disord 2024; 54:1438-1452. [PMID: 36637597 DOI: 10.1007/s10803-022-05872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Autistic children with limited spoken language ability (LSLA) often do not respond to traditional interventions, reducing their social inclusion. It is essential to identify effective interventions, and sensitive measures to track their intervention response. METHODS Using data from an RCT comparing music-mediated and play-based interventions, we investigated the impact of spoken language ability on outcomes, and measured response to intervention through natural language sample measures. RESULTS Children with lower verbal IQ, relative to higher verbal IQ, made some greater gains over the course of music-mediated intervention. Natural language samples were helpful in characterizing communication and tracking change. CONCLUSION Music-mediated interventions hold promise as effective interventions for autistic children with LSLA. Natural language samples are robust in characterizing this subgroup.
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Affiliation(s)
- Angela MacDonald-Prégent
- School of Communication Sciences and Disorders, McGill University, 2001 Av. McGill College #8, H3A 1G1, Montréal, QC, Canada.
| | - Fauzia Saiyed
- Department of Psychology, McGill University, 2001 Av. McGill College #4, H3A 1G1, Montréal, QC, Canada
| | - Krista Hyde
- International Laboratory for Brain, Music and Sound Research (BRAMS), University of Montréal, Pavillon Marie-Victorin/ Local A-108, 90 Vincent-d'Indy Av, H2V, Outremont, QC, Canada
| | - Megha Sharda
- International Laboratory for Brain, Music and Sound Research (BRAMS), University of Montréal, Pavillon Marie-Victorin/ Local A-108, 90 Vincent-d'Indy Av, H2V, Outremont, QC, Canada
| | - Aparna Nadig
- School of Communication Sciences and Disorders, McGill University, 2001 Av. McGill College #8, H3A 1G1, Montréal, QC, Canada
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Gómez-Espinosa A, Moreno JC, Pérez-de la Cruz S. Assisted Robots in Therapies for Children with Autism in Early Childhood. SENSORS (BASEL, SWITZERLAND) 2024; 24:1503. [PMID: 38475039 PMCID: PMC10934187 DOI: 10.3390/s24051503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
Children with autism spectrum disorder (ASD) have deficits that affect their social relationships, communication, and flexibility in reasoning. There are different types of treatment (pharmacological, educational, psychological, and rehabilitative). Currently, one way to address this problem is by using robotic systems to address the abilities that are altered in these children. The aim of this review will be to analyse the effectiveness of the incorporation of the different robotic systems currently existing in the treatment of children up to 10 years of age diagnosed with autism. A systematic review has been carried out in the PubMed, Scopus, Web of Science, and Dialnet databases, with the following descriptors: child, autism, and robot. The search yielded 578 papers, and nine were selected after the application of the PRISMA guideline. The quality of the studies was analysed with the PEDRo scale, and only those with a score between four and six were selected. From this study, the conclusion is that the use of robots, in general, improves children's behaviour in the short term, but longer-term experiences are necessary to achieve more conclusive results.
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Affiliation(s)
- Ana Gómez-Espinosa
- Department of Informatics, University of Almería, ceiA3, CIESOL, 04120 Almería, Spain;
| | - José Carlos Moreno
- Department of Informatics, University of Almería, ceiA3, CIESOL, 04120 Almería, Spain;
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Fram NR, Liu T, Lense MD. Social interaction links active musical rhythm engagement and expressive communication in autistic toddlers. Autism Res 2024; 17:338-354. [PMID: 38197536 PMCID: PMC10922396 DOI: 10.1002/aur.3090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
Rhythm is implicated in both social and linguistic development. Rhythm perception and production skills are also key vulnerabilities in neurodevelopmental disorders such as autism which impact social communication. However, direct links between musical rhythm engagement and expressive communication in autism is not clearly evident. This absence of a direct connection between rhythm and expressive communication indicates that the mechanism of action between rhythm and expressive communication may recruit other cognitive or developmental factors. We hypothesized that social interactions, including general interpersonal relationships and interactive music-making involving children and caregivers, were a significant such factor, particularly in autism. To test this, we collected data from parents of autistic and nonautistic children 14-36 months of age, including parent reports of their children's rhythmic musical engagement, general social skills, parent-child musical interactions, and expressive communication skills. Path analysis revealed a system of independent, indirect pathways from rhythmic musical engagement to expressive communication via social skills and parent-child musical interactions in autistic toddlers. Such a system implies both that social and musical interactions represent crucial links between rhythm and language and that different kinds of social interactions play parallel, independent roles linking rhythmic musical engagement with expressive communication skills.
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Affiliation(s)
- Noah R. Fram
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center
| | - Talia Liu
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center
- Department of Speech, Language, and Hearing Sciences, Boston University
| | - Miriam D. Lense
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center
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O'Toole C, Cronin S, Kearney M, Flynn D, Frizelle P. The feasibility of measuring fidelity of implementation in parent-child interaction therapy: A clinician and parent fidelity study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:131-145. [PMID: 36724768 DOI: 10.1080/17549507.2022.2162578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Measuring fidelity of implementation in parent-child interaction therapy (PCIT) involves assessing the training delivered by clinicians and how parents implement the techniques with their children. The aim of this study was to determine the feasibility of measuring fidelity of implementation for a PCIT intervention designed for young children with Down syndrome. METHOD We applied a framework to measure dosage, adherence, quality, and participant responsiveness using a mixed methods approach with observational and interview data. RESULT Our results showed that clinicians delivered 94% of the planned dosage; they adhered to the goals of program and reached the quality criterion in 4/6 rated sessions. Parents described their ability to engage with the program and perceived that it changed how they interacted and communicated with their children. Parents were unable to collect dosage data, but did adhere to 7/9 of the targeted techniques and met the quality criterion on 6/9 of these. It was also possible to measure the children's responsiveness scores when interacting with parents during the intervention. CONCLUSION This study revealed the opportunities and challenges that occur when measuring fidelity of implementation. There is a need to refine definitions of fidelity measures and to develop appropriate measurement tools so that a more consistent and useful framework can be used by speech-language pathologists (SLPs) to measure fidelity.
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Affiliation(s)
- Ciara O'Toole
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Sarah Cronin
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Mide Kearney
- Department of Speech and Language Therapy, Down Syndrome Ireland, Cork, Ireland
| | - Deirdre Flynn
- Department of Speech and Language Therapy, Down Syndrome Ireland, Cork, Ireland
| | - Pauline Frizelle
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
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Schlebusch L, Chambers N, Rosenstein D, Erasmus P, de Vries PJ. Supporting caregivers of children with developmental disabilities: Findings from a brief caregiver well-being programme in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:199-214. [PMID: 36352758 DOI: 10.1177/13623613221133182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
LAY ABSTRACT Young children with developmental disabilities and delays who live in low- and middle-income countries are at significant risk of not reaching their full potential. We know that daily interactions with their caregivers (parents or other people taking care of them) play an important role in promoting their development. However, having a child with developmental disabilities can have a negative impact on carers' mental health and well-being, which in turn can influence their capacity to care for their children. To date, very little attention has been given to the caregivers' capacity to care. The World Health Organization developed a Caregiver Skills Training programme which includes a brief, three-session module that focuses on improving caregivers' well-being and mental health. This well-being programme is based on acceptance and commitment therapy. Acceptance and commitment therapy shows increasing evidence of helping people respond to their stressors, thoughts, feelings and experiences a little differently and commit to small changes that are in line with their personal values. Acceptance and commitment therapy has shown promise in improving feelings of well-being in caregivers of children with developmental disabilities. We adapted the World Health Organization Caregiver Skills Training Caregiver well-being module to suit the South African context. The resultant 'Well Beans for Caregivers' was then delivered to caregivers from a rural, low-resource setting in South Africa. We found the intervention easy to implement, highly acceptable to caregivers and showed promising impacts on caregivers' well-being and mental health. This intervention has the potential to be implemented widely and sustainably to build caregivers' capacity to care for their children.
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Deng L, He WZ, Zhang QL, Wei L, Dai Y, Liu YQ, Chen ZL, Ren T, Zhang LL, Gong JB, Li F. Caregiver-child interaction as an effective tool for identifying autism spectrum disorder: evidence from EEG analysis. Child Adolesc Psychiatry Ment Health 2023; 17:138. [PMID: 38098032 PMCID: PMC10722789 DOI: 10.1186/s13034-023-00690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects individuals across their lifespan. Early diagnosis and intervention are crucial for improving outcomes. However, current diagnostic methods are often time-consuming, and costly, making them inaccessible to many families. In the current study, we aim to test caregiver-child interaction as a potential tool for screening children with ASD in clinic. METHODS We enrolled 85 preschool children (Mean age: 4.90 ± 0.65 years, 70.6% male), including ASD children with or without developmental delay (DD), and typical development (TD) children, along with their caregivers. ASD core symptoms were evaluated by Childhood Autism Rating Scale (CARS) and Autism Diagnostic Observation Schedule-Calibrated Severity Scores (ADOS-CSS). Behavioral indicators were derived from video encoding of caregiver-child interaction, including social involvement of children (SIC), interaction time (IT), response of children to social cues (RSC), time for caregiver initiated social interactions (GIS) and time for children initiated social interactions (CIS)). Power spectral density (PSD) values were calculated by EEG signals simultaneously recorded. Partial Pearson correlation analysis was used in both ASD groups to investigate the correlation among behavioral indicators scores and ASD symptom severity and PSD values. Receiver operating characteristic (ROC) analysis was used to describe the discrimination accuracy of behavioral indicators. RESULTS Compared to TD group, both ASD groups demonstrated significant lower scores of SIC, IT, RSC, CIS (all p values < 0.05), and significant higher time for GIS (all p values < 0.01). SIC scores negatively correlated with CARS (p = 0.006) and ADOS-CSS (p = 0.023) in the ASD with DD group. Compared to TD group, PSD values elevated in ASD groups (all p values < 0.05), and was associated with SIC (theta band: p = 0.005; alpha band: p = 0.003) but not IQ levels. SIC was effective in identifying both ASD groups (sensitivity/specificity: ASD children with DD, 76.5%/66.7%; ASD children without DD, 82.6%/82.2%). CONCLUSION Our results verified the behavioral paradigm of caregiver-child interaction as an efficient tool for early ASD screening.
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Affiliation(s)
- Lin Deng
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Wei-Zhong He
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Qing-Li Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ling Wei
- College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China
| | - Yuan Dai
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yu-Qi Liu
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Zi-Lin Chen
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Tai Ren
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Lin-Li Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Jing-Bo Gong
- Shanghai Changning Mental Health Center, Shanghai, 200335, China.
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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14
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Stefanaki A, Gkogkos G, Varlokosta S, Gena A. Applying a Parent Training Program in a Naturalistic Behavior Analytic Context to Improve Attachment in Children with ASD. J Autism Dev Disord 2023; 53:4164-4184. [PMID: 36029399 DOI: 10.1007/s10803-022-05719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
Infants develop attachment to their caregivers very early on. The quality of attachment is considered to be crucial for the emotional development of humans and animals alike. Despite its importance, very little is known about how attachment develops between children with Autism Spectrum Disorder (ASD) and their caregivers. The purpose of the present study was to assess the attachment patterns of two young children with ASD with their parents and to identify the means for promoting parent, child, and parent-child relational characteristics that may contribute to the development of secure attachment. The results replicated prior findings pertaining to attachment quality of children with ASD and demonstrated the effectiveness of a naturalistic, behavior-analytic intervention in improving the quality of their attachment.
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Affiliation(s)
- Areti Stefanaki
- Department of Educational Studies of the National and Kapodistrian University of Athens, Ethnikis Antistaseos 34-38, Nea Filadelfeia, 14343, Athens, Greece.
| | | | - Spyridoula Varlokosta
- Lab of Psycholinguistics and Neurolinguistics, Department of Philology, National and Kapodistrian, University of Athens, Nikomedeias 8, Papagou, 15669, Athens, Greece
| | - Angeliki Gena
- Department of Educational Studies, National and Kapodistrian University of Athens, Nikomedeias 66, Nea Smyrni, 17124, Athens, Greece
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15
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Cheng WM, Smith TB, Butler M, Taylor TM, Clayton D. Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis. J Autism Dev Disord 2023; 53:4147-4163. [PMID: 35996037 PMCID: PMC10539413 DOI: 10.1007/s10803-022-05688-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/11/2022]
Abstract
Children with autism spectrum disorder (ASD) have been shown to benefit from parent-implemented interventions (PIIs). This meta-analysis improved on prior reviews of PIIs by evaluating RCTs and multiple potential moderators, including indicators of research quality. Fifty-one effect sizes averaged moderately strong overall benefits of PIIs (g = 0.553), with studies having lower risk of research bias yielding lower estimates (g = 0.47). Parent and observer ratings yielded similar averaged estimates for positive behavior/social skills (g = 0.603), language/communication (g = 0.545), maladaptive behavior (g = 0.519), and to a lesser extent, adaptive behavior/life skills (g = 0.239). No other study, intervention, or participant characteristic moderated outcomes. PIIs with children with ASD tend to be effective across a variety of circumstances.
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Affiliation(s)
- Wai Man Cheng
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA.
| | - Timothy B Smith
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA.
| | - Marshall Butler
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA
| | - Tina M Taylor
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA
| | - Devan Clayton
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA
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16
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Bey AL, Sabatos-DeVito M, Carpenter KLH, Franz L, Howard J, Vermeer S, Simmons R, Troy JD, Dawson G. Automated Video Tracking of Autistic Children's Movement During Caregiver-Child Interaction: An Exploratory Study. J Autism Dev Disord 2023:10.1007/s10803-023-06107-2. [PMID: 37642871 DOI: 10.1007/s10803-023-06107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
Objective, quantitative measures of caregiver-child interaction during play are needed to complement caregiver or examiner ratings for clinical assessment and tracking intervention responses. In this exploratory study, we examined the feasibility of using automated video tracking, Noldus EthoVision XT, to measure 159 2-to-7-year-old autistic children's patterns of movement during play-based, caregiver-child interactions and examined their associations with standard clinical measures and human observational coding of caregiver-child joint engagement. Results revealed that autistic children who exhibited higher durations and velocity of movement were, on average, younger, had lower cognitive abilities, greater autism-related features, spent less time attending to the caregiver, and showed lower levels of joint engagement. After adjusting for age and nonverbal cognitive abilities, we found that children who remained in close proximity to their caregiver were more likely to engage in joint engagement that required support from the caregiver. These findings suggest that video tracking offers promise as a scalable, quantitative, and relevant measure of autism-related behaviors.
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Affiliation(s)
- Alexandra L Bey
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Maura Sabatos-DeVito
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly L H Carpenter
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lauren Franz
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Institute for Global Health, Duke University, Durham, NC, USA
| | - Jill Howard
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Saritha Vermeer
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ryan Simmons
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jesse D Troy
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA.
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Marcus Center for Cellular Cures, Duke University School of Medicine, Duke University, Durham, NC, USA.
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17
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Kasari C, Shire S, Shih W, Landa R, Levato L, Smith T. Spoken language outcomes in limited language preschoolers with autism and global developmental delay: RCT of early intervention approaches. Autism Res 2023; 16:1236-1246. [PMID: 37070270 PMCID: PMC10460274 DOI: 10.1002/aur.2932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
Preschool autistic children with significant global developmental delays and very limited language skills are at high risk for remaining minimally verbal at entry into primary school. This study compared two early intervention models for improving social communication and spoken language outcomes in 164 children who received intervention in their community preschool program for 6 months, with a six-month follow-up. The primary outcome measure was a standardized language assessment, and secondary measures focused on social communication. Results indicated children on average made 6 months gain in language development in the active 6 months of intervention with no difference between intervention models. Children who initiated joint attention more frequently, or who had higher receptive language at baseline made more progress if assigned to receive JASPER, a naturalistic developmental behavioral intervention. Children who received Discrete Trial Training made greater spoken language progress from exit to follow-up. These findings suggest that progress can be made in autistic children who have very little spoken language and who receive targeted early interventions. Individual trajectories vary and depend in part on initial abilities in social communication and receptive language. Future research might consider methods to systematically personalize approaches to fit child characteristics and family preference. LAY SUMMARY: This study compared two different early intervention approaches for teaching spoken language to minimally verbal, globally delayed autistic preschoolers. Children were given an hour of therapy daily for 6 months and then reassessed 6 months later. The majority of the 164 participants were from historically excluded populations (low income and minority), and therapy was delivered in school community settings by expert clinicians. Results indicated that the participants made significant progress regardless of intervention approach: 6 months gain in standardized language scores over 6 months, but slower progress during the period after therapy ended. Children who initiated joint attention more frequently, or who had higher language understanding at baseline made more progress if assigned to receive JASPER, a naturalistic developmental behavioral intervention. Children who received Discrete Trial Training made greater language progress during 6-month period after therapy ended. These findings suggest that progress can be made in children with ASD who have very little spoken language and who receive targeted early interventions.
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Affiliation(s)
- Connie Kasari
- Human Development & Psychology, Center for Autism Research & Treatment, UCLA, Los Angeles, California, USA
| | - Stephanie Shire
- School of Education, University of Oregon, Eugene, Oregon, USA
| | - Wendy Shih
- Human Development & Psychology, Center for Autism Research & Treatment, UCLA, Los Angeles, California, USA
| | - Rebecca Landa
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lynne Levato
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Tristram Smith
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
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18
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Day TN, Northrup JB, Mazefsky CA. A PROMIS®ing New Measure for Quantifying Emotion Dysregulation in Toddlers and Preschoolers: Development of the Emotion Dysregulation Inventory-Young Child. J Autism Dev Disord 2023; 53:2261-2273. [PMID: 35403207 PMCID: PMC9550886 DOI: 10.1007/s10803-022-05536-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
The Emotion Dysregulation Inventory (EDI) was designed and validated to quantify emotion dysregulation (ED) in school-age children, with a particular emphasis on capturing ED in youth with ASD. We saw a need to adapt the EDI for use in young children (ages 2-5) given early childhood is a formative time for emotion regulation development. The present study discusses the adaptation process for the EDI-Young Child (EDI-YC), including item refinement/generation and cognitive interviews (N = 10 with ASD), consistent with the Patient-Reported Outcomes Measurement Information System (PROMIS®) methodology. The item bank was piloted in a sample of 2-year-olds with and without ASD (N = 31), which provided initial support for the EDI-YC as a valid and reliable measure.
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Affiliation(s)
- Taylor N Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA
- Florida State University, Tallahassee, FL, USA
| | - Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA.
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19
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Guthrie W, Wetherby AM, Woods J, Schatschneider C, Holland RD, Morgan L, Lord CE. The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231159153. [PMID: 36922406 PMCID: PMC10502186 DOI: 10.1177/13623613231159153] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
LAY ABSTRACT Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.
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Affiliation(s)
- Whitney Guthrie
- Children’s Hospital of Philadelphia, USA
- University of Pennsylvania, USA
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20
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Sterrett K, Holbrook A, Landa R, Kaiser A, Kasari C. The effect of responsiveness to speech-generating device input on spoken language in children with autism spectrum disorder who are minimally verbal †. Augment Altern Commun 2023; 39:23-32. [PMID: 36267016 PMCID: PMC10115914 DOI: 10.1080/07434618.2022.2120070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/07/2022] [Accepted: 05/11/2022] [Indexed: 11/02/2022] Open
Abstract
The use of speech-generating devices (SGD) in early interventions for children with autism spectrum disorder (ASD) can improve communication and spoken language outcomes. The purpose of this study was to describe children's responsiveness to SGD input modeled by a social partner during adult-child play interactions over a 24-week intervention trial and explore the effect of that responsiveness on spoken language growth. This secondary analysis consisted of 31 children with less than 20 functional words at study entry who received a blended behavioral intervention (JASPER + EMT) as part of a randomized controlled trial. Significant improvements were seen in rate of responsiveness to both adult SGD models and adult natural speech models; only rate of responsiveness to SGD models at entry was a significant predictor of frequency of commenting and was a more robust predictor of number of different words post-intervention. Lastly, at entry, children with more joint attention and language responded to SGD models at significantly higher rates. Attention and responsiveness to SGD output may be important mechanisms of language growth and children who have more joint attention skills may particularly benefit from use of an SGD.
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Affiliation(s)
- Kyle Sterrett
- University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior; 760 Westwood Plaza, Los Angeles, CA 90024
| | - Alison Holbrook
- University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior; 760 Westwood Plaza, Los Angeles, CA 90024
| | - Rebecca Landa
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, MD, 21211
| | - Ann Kaiser
- Vanderbilt University Vanderbilt University, Department of Special Education, Nashville, TN, 37203
| | - Connie Kasari
- University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior; 760 Westwood Plaza, Los Angeles, CA 90024
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21
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Jatkar A, Garrido D, Zheng S, Silverman G, Elsayed H, Davis PH, Lee H, Crais ER, Sideris J, Turner-Brown L, Baranek GT, Watson LR, Grzadzinski R. Toddlers at Elevated Likelihood for Autism: Exploring Sensory and Language Treatment Predictors. JOURNAL OF EARLY INTERVENTION 2023; 45:39-62. [PMID: 36969559 PMCID: PMC10038203 DOI: 10.1177/10538151211067227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Baseline child characteristics may predict treatment outcomes in children with or at elevated likelihood of developing autism (EL-ASD). Little is known about the role of child sensory and language features on treatment outcome. Participants were randomly assigned to a parent-mediated intervention or control condition. Analyses explored the relationship between baseline child sensory and language characteristics and changes in ASD symptoms over approximately 9 months. Higher baseline sensory hyporeactivity was significantly related to less improvement in social communication (SC) for the treatment group only. More baseline atypical vocalizations were significantly related to less improvement on SC across treatment and control groups. This work provides an initial framework to encourage the tailoring of interventions for EL-ASD children, suggesting sensory reactivity and atypical vocalizations may be useful behaviors to consider in treatment planning.
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Affiliation(s)
- Alapika Jatkar
- The University of North Carolina at Chapel Hill, Carolina
Institute for Developmental Disabilities, Chapel Hill, NC, USA
| | - Dunia Garrido
- The University of Granada, Mind, Brain, and Behaviors
Research Center, Granada, Spain
| | - Shuting Zheng
- The University of California at San Francisco, San
Francisco, CA, USA
| | - Greyson Silverman
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
| | - Heba Elsayed
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
- Alexandria University, Phoniatrics Unit, Otolaryngology
Department, Egypt
| | - Paige Huguely Davis
- The University of North Carolina at Chapel Hill, Carolina
Institute for Developmental Disabilities, Chapel Hill, NC, USA
| | - Helen Lee
- The University of Southern California, Mrs. T.H. Chan
Division of Occupational Science and Occupational Therapy, Los Angeles, CA,
USA
| | - Elizabeth R. Crais
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
| | - John Sideris
- The University of Southern California, Mrs. T.H. Chan
Division of Occupational Science and Occupational Therapy, Los Angeles, CA,
USA
| | - Lauren Turner-Brown
- The University of North Carolina at Chapel Hill, Department
of Psychiatry, Chapel Hill, NC, USA
| | - Grace T. Baranek
- The University of Southern California, Mrs. T.H. Chan
Division of Occupational Science and Occupational Therapy, Los Angeles, CA,
USA
| | - Linda R. Watson
- The University of North Carolina at Chapel Hill, Division
of Speech and Hearing Sciences, Chapel Hill, NC, USA
| | - Rebecca Grzadzinski
- The University of North Carolina at Chapel Hill, Carolina
Institute for Developmental Disabilities, Chapel Hill, NC, USA
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22
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Dimachkie Nunnally A, Baczewski L, Sterrett K, Holbrook A, Kaiser A, Kasari C. Profiles and trajectories of executive functioning in young children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:254-270. [PMID: 36642763 DOI: 10.1111/jir.13008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/18/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Language acquisition strongly predicts executive functioning (EF) in early childhood in typical development and in children with Down syndrome (DS). Both language and EF are critical contributors to later positive social and academic outcomes yet are often areas of concern in children with DS. Despite the wider availability of interventions targeting language development in DS, no efforts have been made to understand how these interventions may influence the development of EF in this population. METHODS This study examined secondary data from 76 preschoolers with DS collected as part of a randomised waitlist control trial of an early social communication intervention (JASPER-EMT). Children's EF skills were measured using the BRIEF-P, at three timepoints over 6 months. Linear regression was used to examine the baseline relationship between child characteristics and the three indices of the BRIEF-P: Emergent Metacognition, Flexibility and Inhibitory Self-Control. Linear mixed effects models were used to estimate change across the three indices of the BRIEF-P and whether that change was moderated by treatment. RESULTS Children in this sample exhibited an uneven profile of EF at baseline, with relative strengths in the Flexibility Index and the Inhibitory Self-Control Index, and relative weaknesses in the Emerging Metacognition Index. Chronological age was associated with all indices at baseline (all P < 0.05). Children in the intervention group exhibited improvements in the Flexibility Index from entry to exit (3 months later) compared with the control, although this treatment effect did not maintain at the follow up at 6 months. CONCLUSIONS Baseline EF profiles of children were consistent with findings of other studies with children with DS. Longitudinal findings suggest that behavioural interventions targeting language may have positive collateral effects on certain EF skills, however these effects may be transitory without ongoing support. These findings illustrate both the need for further exploration of the impact of early language interventions on EF abilities and the malleability of certain EF domains in young children with DS.
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Affiliation(s)
| | - L Baczewski
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - K Sterrett
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - A Holbrook
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - A Kaiser
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - C Kasari
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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23
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Shenouda J, Barrett E, Davidow AL, Sidwell K, Lescott C, Halperin W, Silenzio VMB, Zahorodny W. Prevalence and Disparities in the Detection of Autism Without Intellectual Disability. Pediatrics 2023; 151:e2022056594. [PMID: 36700335 DOI: 10.1542/peds.2022-056594] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Intellectual ability predicts functional outcomes for children with autism spectrum disorder (ASD). It is essential to classify ASD children with and without intellectual disability (ID) to aid etiological research, provide services, and inform evidence-based educational and health planning. METHODS Using a cross-sectional study design, data from 2000 to 2016 active ASD surveillance among 8-year-olds residing in the New York-New Jersey Metropolitan Area were analyzed to determine ASD prevalence with and without ID. Multivariable Poisson regression models were used to identify trends for ASD with ID (ASD-I) and without ID (ASD-N). RESULTS Overall, 4661 8-year-olds were identified with ASD. Those that were ASI-I were 1505 (32.3%) and 2764 (59.3%) were ASD-N. Males were 3794 (81.4%), 946 (20.3%) were non-Hispanic Black (Black), 1230 (26.4%) were Hispanic, and 2114 (45.4%) were non-Hispanic white (white). We observed 2-fold and 5-fold increases in the prevalence of ASD-I and ASD-N, respectively, from 2000-2016. Black children were 30% less likely to be identified with ASD-N compared with white children. Children residing in affluent areas were 80% more likely to be identified with ASD-N compared with children in underserved areas. A greater proportion of children with ASD-I resided in vulnerable areas compared with children with ASD-N. Males had higher prevalence compared with females regardless of ID status; however, male-to-female ratios were slightly lower among ASD-I compared with ASD-N cases. CONCLUSIONS One-in-3 children with ASD had ID. Disparities in the identification of ASD without ID were observed among Black and Hispanic children as well as among children residing in underserved areas.
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Affiliation(s)
- Josephine Shenouda
- Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Emily Barrett
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Amy L Davidow
- New York University School of Global Public Health, New York, New York
| | - Kate Sidwell
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Cara Lescott
- Rutgers New Jersey Medical School, Newark, New Jersey
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Roberts MY, Stern YS, Grauzer J, Nietfeld J, Thompson S, Jones M, Kaat AJ, Kaiser AP. Teaching Caregivers to Support Social Communication: Results From a Randomized Clinical Trial of Autistic Toddlers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:115-127. [PMID: 36525627 PMCID: PMC10023141 DOI: 10.1044/2022_ajslp-22-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Studies of early caregiver-mediated interventions targeting social communication of young autistic children have yielded variable child outcomes. This study examined the effects of combining two caregiver-mediated interventions on caregiver strategy use and child social communication and language outcomes. METHOD This was a multisite parallel randomized controlled trial. Participants included 120 caregivers and their autistic children between 24 and 36 months of age. Dyads were randomly assigned to receive a hybrid intervention that combined Enhanced Milieu Teaching (EMT) and Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) or to a behavior management control condition, each delivered over 6 months. Caregivers in the JASP-EMT group received twice-weekly, in-home, and hour-long sessions. Outcomes were measured at baseline, the end of intervention (T1), and 6 months later (T2) and included a naturalistic language sample procedure, standardized measures, and caregiver report measures. This trial was registered at clinicaltrials.gov (NCT02595697). RESULTS Child outcomes did not differ between conditions at T1 or T2 for child primary (social communication) or secondary (language, play, and autism symptoms) outcomes. Relative to control group caregivers, intervention group caregivers demonstrated significantly higher use of JASP-EMT strategies at T1 and T2, with the exception of two strategies (Responsiveness and Matched Responsiveness), which were used significantly more by control group caregivers. Neither autism severity nor baseline caregiver responsiveness moderated outcomes. Post hoc analyses revealed significant correlations between specific strategies and all child outcomes. CONCLUSIONS Twice-weekly caregiver-mediated intervention that taught caregivers of autistic children to use social communication support strategies did not yield significant child outcomes. Future studies should examine possible sources for the lack of main effects including unexpected differences in linguistic features of caregiver input, changes in control group caregiver behavior, and insufficient intervention dosage. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21714278.
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Affiliation(s)
- Megan Y. Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Yael S. Stern
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jeffrey Grauzer
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Jennifer Nietfeld
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Suzanne Thompson
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Maranda Jones
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Aaron J. Kaat
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ann P. Kaiser
- Department of Special Education, Vanderbilt University, Nashville, TN
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Perzolli S, Bentenuto A, Bertamini G, Venuti P. Play with Me: How Fathers and Mothers Play with Their Preschoolers with Autism. Brain Sci 2023; 13:brainsci13010120. [PMID: 36672101 PMCID: PMC9857312 DOI: 10.3390/brainsci13010120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
(1) Background: Children can develop cognitive and social skills during play. Most research has focused on mothers, but the paternal features in interaction with children with autism spectrum disorder (ASD) are mainly unexplored. This study aimed to compare fathers’ and mothers’ interactive behaviors with their children with ASD to identify similarities and differences during playful exchanges. (2) Methods: A total of 72 mothers and 72 fathers of paired children with ASD (chronological age: M = 44.61 months; SD = 13.37) took part in this study. Data were collected during 10 min of video-recorded semi-structured interactions with mothers and fathers separately in interaction with their children. (3) Results: Mothers showed more symbolic play (W = 3537; p < 0.001) than fathers, who displayed higher levels of exploratory play (t(139.44) = −2.52; p = 0.013) compared to mothers. However, child cognitive functioning impacts maternal play but not the father’s play characteristics. (4) Conclusions: Highlighting mother−child and father−child features may have important service delivery implications for implementing personalized parental-based interventions based on the strengths and weaknesses of both caregivers in a complementary system.
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Affiliation(s)
- Silvia Perzolli
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
- Correspondence:
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Giulio Bertamini
- Department of Child and Adolescent Psychiatry, Pitiè-Salpêtrière Hospital, Sorbonne University, 75651 Paris, France
| | - Paola Venuti
- Laboratory of Observation, Diagnosis, and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
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Lee B, Park S, Kwon HJ, Hwang GS, Kim M. Integrative treatment program for the treatment of children with autism spectrum disorder: A prospective observational case series. Front Neurol 2023; 13:1017005. [PMID: 36686506 PMCID: PMC9846134 DOI: 10.3389/fneur.2022.1017005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Background In a situation where conventional treatments for autism spectrum disorder (ASD) are labor-intensive and there are concerns about the side effects of conventional medications, a 6-month integrative treatment program, including herbal medicine (HM), Floortime, and sensory enrichment therapy (SET) has been used on children with ASD in Korean medicine clinical settings. Methods We observed the treatment responses of 18 children with ASD (66.7% male, mean age 3.9 ± 0.9 years) to the integrative treatment program as part of a prospective, single-center, observational case series. Individualized HMs were administered according to the patient's symptoms, and parents were instructed to perform Floortime and SET with their children at home for 2 h and 20 min a day, 5 days a week, respectively. The Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) were used to evaluate the core symptoms of ASD. A linear mixed model for repeated measures was used for analyzing the effect of the program over time, and logistic regression used to explore the predictors of treatment response. Results The CARS and ABC scores were significantly improved from 34.58 ± 6.27 and 69.28 ± 15.73 at baseline to 28.56 ± 6.05 and 39.67 ± 20.36 after 6 months (p < 0.0001, respectively). No serious adverse events (AEs) were reported, and compliance with HM, Floortime, and SET was high at >90%. Conclusion This 6-month integrative treatment program appears to be a potentially effective, safe, and feasible option for children with ASD. Low baseline CARS scores may be predictors of higher treatment response.
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Affiliation(s)
- Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Serin Park
- Floortime Center Korea, Seoul, South Korea
| | | | - Gwi Seo Hwang
- College of Korean Medicine, Gachon University, Seongnam, South Korea
| | - Moonju Kim
- I-Tomato Korean Medicine Clinic, Seoul, South Korea,*Correspondence: Moonju Kim
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Panganiban J, Kasari C. Educators apply new teaching strategies despite initial attributions of autistic students' controllability of their behaviors. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:379-385. [PMID: 37213585 PMCID: PMC10197991 DOI: 10.1080/20473869.2023.2204560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
Autistic children are less likely to be jointly engaged with a play partner than nonautistic children, negatively impacting social communication development. Promoting joint engagement during play can be an important target for educators of autistic students, but educator perceptions of autistic students may affect their interactions with students. This secondary data analysis investigated educator perceptions of the behaviors of their autistic students, their relationship on educator behavior, and their relationship on the implementation of an intervention promoting joint engagement. Participants included 66 autistic preschool students, and twelve educators from six preschools. Schools were randomized to educator training or a waitlist. Before training, educators rated their students' controllability over autism related behaviors. To observe educator behavior, they were filmed playing for ten minutes with students, before and after receiving training. Ratings of controllability were positively correlated with cognitive scores, and negatively correlated with ADOS (Autism Diagnostic Observation Schedule) comparison scores. Furthermore, educator ratings of controllability predicted joint engagement strategies used by educators during play. Educators tended to use strategies promoting joint engagement for students perceived as more able to control their autism spectrum disorder behavior. Among educators that received JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation) training, ratings of controllability did not predict changes in strategy scores after training. Educators were able to learn and implement new joint engagement strategies despite their initial perceptions.
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Affiliation(s)
- Jonathan Panganiban
- Semel Institute for Neuroscience and Human Behavior, University of CA Los Angeles, Los Angeles, CA, USA
- Correspondence to: Jonathan Panganiban, Semel Institute for Neuroscience and Human Behavior, University of CA Los Angeles, Los Angeles, CA 90024, USA.
| | - Connie Kasari
- Semel Institute for Neuroscience and Human Behavior, University of CA Los Angeles, Los Angeles, CA, USA
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Straiton D, Frost K, Ingersoll B. Factors that influence clinical decisions about offering parent coaching for autistic youth served within the Medicaid system. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231153631. [PMID: 36873579 PMCID: PMC9978664 DOI: 10.1177/26334895231153631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Background Parent coaching is an evidence-based practice for young autistic children, but it is underutilized in lower-resourced community settings like the Medicaid system (Straiton et al., 2021b). Clinicians often struggle to implement parent coaching with low-income and marginalized families (Tomczuk et al., 2022), but little is known about which factors influence clinician decision making processes about providing parent coaching to this population. Methods This qualitative analysis used the framework method and thematic analysis. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (Aarons et al., 2011) to identify factors in the clinical decision-making process that community providers use when offering parent coaching to families of Medicaid-enrolled autistic children. Interviews with 13 providers and a focus group with 13 providers were analyzed. Results The following themes emerged: 1) Policies drive provider task priorities and affect competing demands; 2) Providers are more likely to use parent coaching when agency leaders monitor parent coaching benchmarks, though this is rarely done; 3) Logistical factors like scheduling and treatment location affect perceived feasibility of using parent coaching; 4) Previous experience or coursework in parent coaching and/or family systems supports the quality of parent coaching implementation; 5) Provider perceptions of "parent readiness" are initially indicated by overt expressions of parent interest. Conclusions In the absence of outer-context and inner-context policies, providers have more decision-making power to offer parent coaching based on their own judgements and preferences, which may result in fewer families being offered parent coaching and increased bias related to which families are offered this service. State-, agency-, and clinician-level recommendations are provided for increasing equitable provision of this evidence-based practice for autism.
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Affiliation(s)
| | - Kyle Frost
- Michigan State
University, East Lansing, Michigan, USA
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Pierucci JM, Aquino GA, Pearson A, Perez M, Mwanza-Kabaghe S, Sichimba F, Mooya H. Parent-mediated intervention training for caregivers of children with developmental differences in Zambia. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 132:104373. [PMID: 36413886 DOI: 10.1016/j.ridd.2022.104373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/22/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Lower- and middle-income countries (LAMICs) are under-resourced and have limited intervention services for children with developmental differences and their families. A logical method to address service gaps within resource-scarce contexts is to train caregivers as interventionists, specifically using empirically-supported parent-mediated Naturalistic Developmental Behavioral Interventions (P-M NDBIs; Kasari et al., 2010; Ingersoll & Wainer, 2013). AIMS The study implemented the first P-M NDBI in Zambia and aimed to train caregivers and improve children's social-communication skills. METHODS/PROCEDURES The current study utilized a mixed-methods, pre-post design and implemented Project ImPACT (Ingersoll & Dvortcsak, 2010, 2019). Participants included 19 Zambian caregivers of children (n = 20) with developmental differences including autism spectrum condition, Down syndrome, and cerebral palsy. OUTCOMES/RESULTS Findings indicated that children's language skills and pretend play skills significantly improved from pre- to post-assessment, and caregivers most frequently used intervention strategies for modeling communication and prompting communication. CONCLUSIONS/IMPLICATIONS The success and feasibility of implementing Project ImPACT in Zambia, and recommendations for culturally adapting and implementing P-M NDBIs in LAMICs, were discussed.
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Affiliation(s)
- Jillian M Pierucci
- Department of Psychology, St. Mary's University, One Camino Santa Maria, San Antonio, TX 78228, USA.
| | - Gabriela A Aquino
- Department of Human Development & Family Sciences, University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705, USA.
| | - Alexandra Pearson
- Department of Psychology, Houston Community College, 3100 Main Street, Houston, TX 77002, USA.
| | - Monica Perez
- Department of Psychology, University of Notre Dame, 220 Main Building, Notre Dame, IN 46556, USA.
| | - Sylvia Mwanza-Kabaghe
- Department of Educational Psychology, Sociology and Special Education, University of Zambia, Great East Road Campus, P.O. Box 32379 Lusaka, Zambia.
| | - Francis Sichimba
- Department of Psychology, University of Zambia, Great East Road Campus, P.O. Box 32379 Lusaka, Zambia.
| | - Haatembo Mooya
- Department of Psychology, University of Zambia, Great East Road Campus, P.O. Box 32379 Lusaka, Zambia.
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Mattie LJ, Fanta D. Joint engagement and early language abilities in young children with Down syndrome. Front Psychol 2023; 14:1152559. [PMID: 37207029 PMCID: PMC10191142 DOI: 10.3389/fpsyg.2023.1152559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/05/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Early social strengths likely serve as a foundation for language acquisition for young children with Down syndrome (DS). One way to characterize early social skills is to examine a child's engagement with a caregiver around an object of interest. The current study examines joint engagement in young children with DS and its relation to language abilities at two-time points in early development. Methods Participants were 16 young children with DS and their mothers. At two time points, mother-child free plays were completed and coded for joint engagement. Language abilities were measured at both time points using the Vineland Adaptive Behavior Scales 3rd edition and the number of words understood and produced on the MacArthur-Bates Communication Development Inventory. Results Young children with DS spent more time in supported joint engagement than coordinated joint engagement at both time points. Using a weighted joint engagement variable, children with DS who had higher weighted joint engagement had lower expressive language raw scores on the Vineland when controlling for age at Time 1. At Time 2, children with DS who had higher weighted joint engagement had higher expressive and receptive language raw scores on the Vineland when controlling for age. Predictively, children with DS who had a higher weighted joint engagement at Time 1 had a lower number of words produced at Time 2 when controlling for age at Time 1. Discussion Our results suggest that young children with DS may compensate for their difficulties with language by using joint engagement. These results highlight the importance of teaching parents to be responsive during interactions with their child to move them into both supported and coordinated engagement, which in turn may foster language development.
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Lee H, Pena J, Lee B, Sung C. Promoting Well-Being in Individuals With Autism: Applying Positive Psychology in Rehabilitation Counseling. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2022. [DOI: 10.1891/re-21-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Positive psychology is a subdomain that addresses the importance of human strengths and personal assets in individuals’ well-being. The principles of positive psychology align with the philosophy of rehabilitation counseling by emphasizing individuals’ strengths to promote psychosocial adjustment to disability. Considering the intersection between positive psychology and rehabilitation counseling, applying the positive psychology framework to rehabilitation counseling will be a promising foundation for improvement in services and outcomes. As the number of individuals on the autism spectrum increases, more innovative services are needed to keep abreast of their needs. This article discusses how positive psychology can be applied to the population of individuals with autism spectrum disorder (ASD) and explores possible practices that can be replicated by practitioners to provide quality services for this emerging disability population. Implications for education and research are also discussed.
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Gottfried T, Elefant C, Gold C. Music-oriented parent counseling to promote improvement in level of parental stress, quality of life and the use of music in everyday life among parents of children with autism: A mixed-methods randomized controlled study. NORDIC JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1080/08098131.2022.2131890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tali Gottfried
- Graduate Program for Special Education, Herzog College, Jerusalem, Israel
| | - Cochavit Elefant
- School for Creative Arts Therapies, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa, Israel
| | - Christian Gold
- GAMUT – The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
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Effectiveness of caregiver-mediated intervention: a pilot study for children with neurodevelopmental disorders. Prim Health Care Res Dev 2022; 23:e63. [PMID: 36239147 PMCID: PMC9641652 DOI: 10.1017/s1463423622000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Caregiver-mediated intervention (CMI), based on parent skills training, is a family-mediated intervention model for children with neurodevelopmental disorders, in particular autism spectrum disorder. This study aimed to evaluate the effectiveness of CMI. METHODS Thirty-three children (aged 22-69 months from our department) and their caregivers participated in a two-week training course of ten 90-minute lessons. Caregivers were encouraged to try their best to apply intervention skills in both home routines and play routines to encourage the development of cognition, motion, social adaptability, and behavior of children. Demographic information, video-recorded data, and diagnostic scales were collected at two key time points: baseline and post-training (PT - within six months). RESULTS Three aspects were assessed - primary variables, secondary variables, and correlation analyses. Results showed an improvement in PT in (1) Adult/Child Interaction Fidelity Rating (P < 0.01) and (2) adaptability of Gesell Developmental Scale and stereotyped behaviors and limited interests of Autism Diagnostic Observation Schedule (P < 0.05, P < 0.01). Moreover, a negative correlation occurred between caregiver skill improvement and parent education (P < 0.05), but without correlations with other demographics. CONCLUSIONS As an efficacious family intervention for both children and their caregivers, CMI is worth being generalized widely.
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Rispoli M, Shannon E, Voorhis C, Lang R, Mason R, Kelleher B. Telehealth Training in Naturalistic Communication Intervention for Mothers of Children with Angelman Syndrome. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:549-566. [PMID: 36160311 PMCID: PMC9483349 DOI: 10.1007/s41252-022-00284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Objectives Young children with Angelman syndrome have significant delays in expressive communication. Parents of children with Angelman syndrome require training to support their child's communication development. Unfortunately, parent training focused on the needs of families of children with rare genetic syndromes is unavailable to many families. The purpose of this study was to evaluate a telehealth parent training program on naturalistic communication intervention for young children with Angelman syndrome. Methods Using two single-case multiple baseline designs across a total of six parent-child dyads, we evaluated the effects of a telehealth parent training program on parent implementation fidelity of a naturalistic communication intervention, child communication, and child engagement. Results With the telehealth parent training program, parent implementation fidelity of naturalistic communication intervention improved, maintained and generalized to untrained home routines. Small effects on child communication and engagement were observed during the program. Conclusions Parents of children with Angelman syndrome were successfully taught via telehealth to implement a naturalistic communication intervention with their child at home. Additional research is needed to promote positive child communication outcomes through parent-mediated intervention.
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Affiliation(s)
- Mandy Rispoli
- Department of Curriculum, Instruction, and Special Education, University of Virginia, PO Box 400273, Charlottesville, VA 22904 USA
| | | | | | | | - Rose Mason
- Purdue University, West Lafayette, IN USA
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Franz L, Goodwin CD, Rieder A, Matheis M, Damiano DL. Early intervention for very young children with or at high likelihood for autism spectrum disorder: An overview of reviews. Dev Med Child Neurol 2022; 64:1063-1076. [PMID: 35582893 PMCID: PMC9339513 DOI: 10.1111/dmcn.15258] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
AIM To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes. METHOD We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered. RESULTS From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified. INTERPRETATION While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base. WHAT THIS PAPER ADDS Naturalistic developmental behavioral interventions, as well as developmental and behavioral interventions, improve child outcomes in autism spectrum disorder (ASD). If only randomized controlled trials are considered, guidelines for early intensive behavioral intervention in younger children should be revisited. The greatest intervention impacts were on proximal, intervention-specific outcomes. Inadequacies in the quality of the early ASD intervention evidence base were observed.
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | | | - Amber Rieder
- Duke Global Health Institute, Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Maya Matheis
- Center on Disability Studies, College of Education, University of Hawai’i at Mānoa, Honolulu, Hawai’i, USA
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Montiel-Nava C, Tregnago M, Marshall J, Sohl K, Curran AB, Mahurin M, Warne-Griggs M, Dixon P. Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities. Front Psychiatry 2022; 13:909947. [PMID: 36101706 PMCID: PMC9464274 DOI: 10.3389/fpsyt.2022.909947] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri. Methods We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3-7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits. Results Four main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST via telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency (p < 0.05) and impact (p < 0.01), while atypical behaviors decreased (p < 0.01). For caregivers' outcomes, only confidence in skills (p < 0.05) and parental sense of competence (p < 0.05) showed a positive change. Conclusion Our results support the feasibility of implementing the WHO-CST program via telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility via telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children.
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Affiliation(s)
- Cecilia Montiel-Nava
- Department of Psychological Science, University of Texas Rio Grande Valley-Edinburg, Edinburg, TX, United States
| | | | | | - Kristin Sohl
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, United States
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Alicia Brewer Curran
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Melissa Mahurin
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Melissa Warne-Griggs
- Missouri Telehealth Network, School of Medicine University of Missouri, Columbia, MO, United States
| | - WHO CST Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Bradshaw J, Wolfe K, Hock R, Scopano L. Advances in Supporting Parents in Interventions for Autism Spectrum Disorder. Pediatr Clin North Am 2022; 69:645-656. [PMID: 35934491 PMCID: PMC11017782 DOI: 10.1016/j.pcl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The rising prevalence of autism spectrum disorder (ASD) calls for clear referral and treatment guidelines for children with ASD and their caregivers. Caregiver involvement in intervention is a standard practice of care and research suggests that teaching intervention strategies to caregivers can improve child outcomes and increase caregiver efficacy. Caregiver-mediated interventions that are naturalistic, developmental, and behavioral are effective in improving social and communication skills for children with ASD. Caregiver training models that use behavioral strategies are effective in reducing challenging behaviors. Finally, reducing caregiver barriers to treatment implementation, including stress and strain, are becoming critical components for improving the well-being and care of children with ASD and their families.
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Affiliation(s)
- Jessica Bradshaw
- University of South Carolina, 1800 Gervais Street, Columbia, SC 29201, USA.
| | - Katie Wolfe
- University of South Carolina, 820 Main Street, Columbia, SC 29208, USA
| | - Robert Hock
- University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Layne Scopano
- University of South Carolina, 1800 Gervais Street, Columbia, SC 29201, USA
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Panganiban J, Kasari C. Super responders: Predicting language gains from JASPER among limited language children with autism spectrum disorder. Autism Res 2022; 15:1565-1575. [PMID: 35437928 PMCID: PMC9357035 DOI: 10.1002/aur.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 01/03/2023]
Abstract
Early intervention can provide a great benefit for children with autism spectrum disorder (ASD). However, no single intervention is effective for all children. Even when an intervention is effective overall, individual child response varies. Some children make incredible progress, and others make slow or no progress. Therefore, it is important that the field move towards developing methods to personalize intervention. Operationalizing meaningful change and predicting intervention response are critical steps in designing systematic and personalized early intervention. The present research used improvement in expressive language to group children that received a targeted social communication early intervention, Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER), into super responders and slow responders. Using baseline data from traditional standardized assessments of cognition and behavioral data from validated experimental measures of play and social communication, we used conditional inference tree models to predict responder status. From a sample of 99 preschool age, limited language children with ASD, play diversity was the most significant predictor of responder status. Children that played functionally with a wider variety of toys had increased odds of being a super responder to JASPER. A combination of lower play diversity and impairments in fine motor abilities increased the odds of children being slow responders to JASPER. Results from the present study can inform future efforts to individualize intervention and systematic approaches to augmenting treatment in real time. LAY SUMMARY: To help us answer the question of for whom an intervention works best, we examined 99 children, age three to five, who qualified as being limited spoken language communicators, and received a targeted intervention for social communication and language. We used child characteristics before intervention to predict which children would improve their language the most and found that the ability to play appropriately with a wider variety of toys predicted the best improvements in expressive language. These findings will help better inform future work to individualize intervention based on the unique needs of each child.
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Affiliation(s)
- Jonathan Panganiban
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
| | - Connie Kasari
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
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Qu L, Chen H, Miller H, Miller A, Colombi C, Chen W, Ulrich DA. Assessing the Satisfaction and Acceptability of an Online Parent Coaching Intervention: A Mixed-Methods Approach. Front Psychol 2022; 13:859145. [PMID: 35967644 PMCID: PMC9367480 DOI: 10.3389/fpsyg.2022.859145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Parent-mediated intervention (PMI) has been studied in promoting skill acquisition or behavior change in the children with autism spectrum disorder. Most studies emphasize on the improvement of child's core symptoms or maladaptive behaviors, making parental perceived competence and self-efficacy secondary. Yet, the evaluations of intervention implementation are under-reported, especially when translating such interventions into a new population or context. This research investigated the intervention implementation of a 12-week parent coaching intervention which was delivered through telehealth and tailored to Chinese population. The intervention was based on the Parent-mediated Early Start Denver Model with culturally adapted lectures, manuals, and demonstration and commentary videos. This study aimed to evaluate the intervention implementation by assessing parents' satisfaction, acceptability, appropriateness, and feasibility. Method A randomized controlled trial was conducted with two telehealth conditions: self-directed and web+group therapy. Parents in the self-directed condition received intervention individually through the online learning platform. The web+group therapy condition navigated the same program with weekly 1.5-h group coaching sessions via videoconferencing. This mixed-methods study used a concurrent convergent design to evaluate the intervention implementation at post-intervention. The quantitative data was collected from the Program Evaluation Survey and the qualitative data was collected from five focus groups. Results Parents in self-directed group reported significantly lower scores in total perceived competence than parents in web+group therapy condition, while there was no group difference on the total self-efficacy. Tailored feedback, demonstration and commentary videos, peer commenting, live coaching, and guided reflection were the top-five acceptable telehealth strategies that were strongly endorsed by parents. Family centered care, home-based intervention, strategies relative to daily activities, the remote learning platform, and the program-based community were elements that parents considered when evaluating the program's appropriateness. Parent modeling, step-by-step instructions, and tailored feedback were key components in making intervention strategies feasible for parents to implement at home. Conclusion Findings indicate the application of telehealth was acceptable, appropriate, and feasible for Chinese parents. Group-based parent coaching intervention via videoconferencing could be a promising home-based service model to increase parental perceived competence. A large-scale RCT is needed to investigate the effectiveness of group-based PMI via telehealth.
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Affiliation(s)
- Lu Qu
- Institute of AI for Education, East China Normal University, Shanghai, China
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Huiying Chen
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Haylie Miller
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Alison Miller
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Weiyun Chen
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Dale A. Ulrich
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
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40
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Park JEJ. A Parent-Focused Creative Approach as a Treatment for a High-Functioning Child with Autism Spectrum Disorder (ASD) in Korea: A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7836. [PMID: 35805495 PMCID: PMC9266258 DOI: 10.3390/ijerph19137836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023]
Abstract
This study was conducted on a 6-year-old girl with autism spectrum disorder (ASD) in Korea. The case was initiated in February 2015, and intensive treatment was provided for one year. Then, the case was monitored over the course of 6 years until December 2021. The intervention plan was an art therapy-based treatment plan (Individual Therapeutic Education Plan: ITEP) with two integral foci: (1) creative arts-based parent counseling and education and (2) didactic art therapy with the child. This was a new type of integral approach that was not a standard of care practice in Korea, acknowledging the importance of including parents in therapy and the notion of creative arts therapy. There was no scientific evidence supporting this qualitive approach; however, the intervention was a notable success, sustaining a positive outcome-the intervention (1) reduced the anxiety levels of both the mother and the child in the short term; (2) enhanced the child-parent relationship as well as the home environment of the child while the art therapy-based counseling and education increased the mother's competence; and (3) enhanced the communicative and adaptive functioning of the child and the mother, with art becoming the supportive breakthrough for their emotional obstacles. The findings suggest that a parent-focused creative approach impacts parental changes and child development: the evidence indicates that parent-driven interventions are a viable option for parents and children with ASD to build a better home environment that supports the child's development.
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Affiliation(s)
- Jung Eun Jeanne Park
- Mogul Institute, Seoul 05649, Korea;
- Department of Psychology and Psychotherapy, College of Health & Welfare, Dankook University, Cheonan 31116, Korea
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van Noorden LE, Sigafoos J, Waddington HL. Evaluating a Two-Tiered Parent Coaching Intervention for Young Autistic Children Using the Early Start Denver Model. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:473-493. [PMID: 35669342 PMCID: PMC9149339 DOI: 10.1007/s41252-022-00264-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Early intervention can improve the outcomes of young autistic children, and parents may be well placed to deliver these interventions. The Early Start Denver Model (ESDM) is a naturalistic developmental behavioral intervention that can be implemented by parents with their own children (P-ESDM). This study evaluated a two-tiered P-ESDM intervention that used a group parent coaching program, and a 1:1 parent coaching program. We evaluated changes in parent use of the ESDM and parent stress, as well as child engagement, communication, and imitation. METHODS Seven autistic or probably autistic children (< 60 months old) and their parents participated. A multiple-baseline design was used to compare individual changes between Baseline 1, Group Coaching (Tier 1), Baseline 2, and 1:1 Coaching (Tier 2). Parent and child behaviors were analyzed from weekly videos and graphed. Parenting stress was measured. RESULTS All parents improved in their use of ESDM strategies after the Tier 1 intervention. Changes in parent fidelity during Tier 2 were mixed, but all parents maintained higher than baseline levels of fidelity. Six parents demonstrated above 75% ESDM fidelity in at least one session. There were positive changes in parent stress levels pre- post-intervention. Positive results were found for most children's levels of engagement, imitation, and communication. There were significant positive relationships between parent fidelity and both child engagement and child functional utterances. CONCLUSIONS Group P-ESDM is a promising approach for improving parent fidelity and some child outcomes. Future randomized and controlled studies of group P-ESDM, using standardized outcome measures, are warranted. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s41252-022-00264-8.
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Affiliation(s)
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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"Going Mobile"-increasing the reach of parent-mediated intervention for toddlers with ASD via group-based and virtual delivery. J Autism Dev Disord 2022; 52:5207-5220. [PMID: 35608785 PMCID: PMC9128315 DOI: 10.1007/s10803-022-05554-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
Evidence supports early intervention for toddlers with ASD, but barriers to access remain, including system costs, workforce constraints, and a range of family socio-demographic factors. An urgent need exists for innovative models that maximize resource efficiency and promote widespread timely access. We examined uptake and outcomes from 82 families participating in a parent-mediated intervention comprising group-based learning and individual coaching, delivered either in-person (n = 45) or virtually (n = 37). Parents from diverse linguistic, ethnic, and educational backgrounds gained intervention skills and toddlers evidenced significant social-communication gains. Few differences emerged across socio-demographic factors or delivery conditions. Findings highlight the feasibility, acceptability, and promise of group-based learning when combined with individual coaching, with added potential to increase program reach via virtual delivery.
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43
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Kwok E, Cermak CA, Hatherly K, Cunningham BJ. Intervention Goals for Preschoolers With Language Difficulties and Disorders: A Scoping Review Using the International Classification of Functioning, Disability and Health Framework. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1-70. [PMID: 35302873 DOI: 10.1044/2021_ajslp-21-00226] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from birth to 5;0 [years;months]) with language difficulties and disorders within the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for two language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition). METHOD The scoping review followed Arksey and O'Malley (2005) guidelines. Articles were retrieved from speechBITE, with age (under 5 years), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components, and the distribution of goals across ICF components was compared for studies involving children with the two language difficulty/disorder subtypes. RESULTS A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the activities component of the ICF framework, followed by participation (26%), environmental factors (20%), body functions and structures (3%), and personal factors (3%). Most participation-focused goals were reported from intervention studies involving preschoolers with a language difficulty/disorder associated with a biomedical condition. CONCLUSIONS Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice.
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Affiliation(s)
- Elaine Kwok
- CanChild, McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
- Richard and Roxelyn Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Carly A Cermak
- School of Communication Sciences and Disorders, London, Ontario, Canada
| | - Kathryn Hatherly
- School of Communication Sciences and Disorders, London, Ontario, Canada
| | - Barbara Jane Cunningham
- CanChild, McMaster University, Institute of Applied Health Sciences, Hamilton, Ontario, Canada
- School of Communication Sciences and Disorders, London, Ontario, Canada
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Panganiban JL, Shire SY, Williams J, Kasari C. Supporting peer engagement for low-income preschool students with autism spectrum disorder during academic instruction: A pilot randomized trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2175-2187. [PMID: 35420044 PMCID: PMC9596950 DOI: 10.1177/13623613221085339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Schools are the portal through which many children with autism spectrum disorder access early intervention. Collaborating with teachers can be an effective way to implement evidence-based practices. In this study, teachers learned to embed strategies from the Joint Attention, Symbolic Play, Engagement, and Regulation intervention into the standard preschool curriculum. Twelve schools with special education preschool classrooms for students with moderate to severe disabilities from under-resourced neighborhoods were randomized to augment their curriculum with Joint Attention, Symbolic Play, Engagement, and Regulation strategies or continue the standard curriculum. Teachers’ strategy implementation, children’s time on task, and social communication were examined before and after completing the intervention phase. Teachers in the Joint Attention, Symbolic Play, Engagement, and Regulation group implemented more Joint Attention, Symbolic Play, Engagement, and Regulation strategies than the control group after the intervention phase. Children in both groups increased time on task during teacher-led small group instruction. Children in the Joint Attention, Symbolic Play, Engagement, and Regulation group were more likely to be engaged with peers during small group instruction at the end of the intervention phase. Children from both groups improved in standardized measures of joint attention, requesting, expressive language, and receptive language. Training teachers to embed Joint Attention, Symbolic Play, Engagement, and Regulation strategies into small group instruction can help facilitate peer engagement, providing children more opportunities for peer socialization.
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Montagut-Asunción M, Crespo-Martín S, Pastor-Cerezuela G, D’Ocon-Giménez A. Joint Attention and Its Relationship with Autism Risk Markers at 18 Months of Age. CHILDREN 2022; 9:children9040556. [PMID: 35455600 PMCID: PMC9027970 DOI: 10.3390/children9040556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
(1) Joint attention is the ability to coordinate attention to share a point of reference with another person. It has an early onset and is a clear indicator of understanding the representations of others, and it is essential in the development of symbolic thought and the acquisition of language. Deficiencies in this prelinguistic early communication skill are strong markers of the risk of autism spectrum disorder (ASD); (2) this longitudinal study aimed to evaluate joint attention skills in a group of 32 infants at two developmental moments (8 and 12 months) in order to explore whether their performance on this skill was related to the presence of early signs of ASD at 18 months. Logistic multiple regressions were carried out for the data analysis; (3) results of the analysis showed that the variables of initiating joint attention at 8 months and responding to joint attention at 12 months were linked to the risk of ASD at 18 months of age; (4) in conclusion, early joint attention skills had a pivotal role in defining early manifestations of ASD.
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Affiliation(s)
- Maite Montagut-Asunción
- Department of Neuropsychobiology, Methodology, and Basic and Social Psychology, Universidad Católica de Valencia San Vicente Mártir, 46100 Burjassot, Valencia, Spain;
| | - Sarah Crespo-Martín
- Department of Basic Psychology, Universitat de València, 46010 Valencia, Spain; (S.C.-M.); (A.D.-G.)
| | - Gemma Pastor-Cerezuela
- Department of Basic Psychology, Universitat de València, 46010 Valencia, Spain; (S.C.-M.); (A.D.-G.)
- Correspondence:
| | - Ana D’Ocon-Giménez
- Department of Basic Psychology, Universitat de València, 46010 Valencia, Spain; (S.C.-M.); (A.D.-G.)
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46
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Pérez-Fuster P, Herrera G, Kossyvaki L, Ferrer A. Enhancing Joint Attention Skills in Children on the Autism Spectrum through an Augmented Reality Technology-Mediated Intervention. CHILDREN (BASEL, SWITZERLAND) 2022; 9:258. [PMID: 35204977 PMCID: PMC8870736 DOI: 10.3390/children9020258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Patricia Pérez-Fuster
- Department of Educational Psychology and Psychobiology, School of Education, Universidad Internacional de La Rioja, 26006 Logroño, Spain
- Autism and Technologies Laboratory, University Research Institute on Robotics and Information and Communication Technologies (IRTIC), Universitat de València, 46010 Valencia, Spain;
| | - Gerardo Herrera
- Autism and Technologies Laboratory, University Research Institute on Robotics and Information and Communication Technologies (IRTIC), Universitat de València, 46010 Valencia, Spain;
| | - Lila Kossyvaki
- Department of Disability, Inclusion and Special Needs (DISN), School of Education, University of Birmingham, Birmingham B15 2TT, UK;
| | - Antonio Ferrer
- Department of Developmental and Educational Psychology, Faculty of Psychology, Universitat de València, 46010 Valencia, Spain;
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Davis PH, Elsayed H, Crais ER, Watson LR, Grzadzinski R. Caregiver responsiveness as a mechanism to improve social communication in toddlers: Secondary analysis of a randomized controlled trial. Autism Res 2022; 15:366-378. [PMID: 34799999 PMCID: PMC8821206 DOI: 10.1002/aur.2640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.
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Affiliation(s)
- Paige Huguely Davis
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC
| | - Heba Elsayed
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,Phoniatrics unit, ENT Department, Faculty of Medicine, Alexandria University, Egypt
| | - Elizabeth R. Crais
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Linda R. Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Rebecca Grzadzinski
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC
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Schlink A, Williams J, Pizzano M, Gulsrud A, Kasari C. Parenting stress in caregiver-mediated interventions for toddlers with autism: An application of quantile regression mixed models. Autism Res 2022; 15:353-365. [PMID: 34797038 PMCID: PMC8821158 DOI: 10.1002/aur.2637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/15/2021] [Accepted: 10/30/2021] [Indexed: 02/03/2023]
Abstract
Traditional longitudinal modeling approaches require normally distributed data and do not account for sample heterogeneity. Parenting stress, in particular, can be difficult to model across time without transforming the data as it is usually high for caregivers of children with ASD. This study used novel linear quantile mixed models (LQMMs) to model non-normal parent stress scores across two caregiver-mediated interventions involving toddlers with ASD. The sample included 86 caregiver-child dyads who were randomized to either a parent-only psychoeducational intervention or hands-on parent training in a naturalistic developmental intervention. Child and parent-related domains of the Parenting Stress Index (PSI) were the primary outcomes in this study. The PSI was collected at entry, 10-week exit, 3-month follow-up, and 6-month follow-up periods. Separate LQMMs were used to model five specific quantiles ( τ=0.1,0.25,0.5,0.75,and0.9) of the two PSI domains across the complete intervention timeline. These five quantiles effectively modeled the entire conditional distribution of parenting stress scores. The LQMMs indicated that child-related parenting stress decreased across all quantiles within both interventions, with no difference in the rate of parenting stress change between the intervention groups. For parent-related parenting stress, the effect of intervention depended on the group's stress level; some parents increased their perceived stress within the hands-on intervention at the 3-month follow-up. Overall, this study demonstrated that the use of LQMMs yielded additional information, beyond traditional longitudinal models, regarding the relationship between parenting stress within two caregiver-mediated intervention protocols. This study also discussed the methodological contributions and potential future applications of LQMMs. LAY SUMMARY: This study used a newer longitudinal modeling technique to examine how parenting stress changed across two caregiver-mediated interventions for toddlers with ASD. Results showed that certain parents in the JASPER condition might require additional support as they exit the study and enter into their first follow-up period. It was also determined that this new modeling technique could be a valuable tool to analyze highly variable data often present in ASD intervention studies.
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Affiliation(s)
- Andrew Schlink
- Department of Education, University of California, Los Angeles, Los Angeles, CA, UCLA Semel Institute 68-268, 760 Westwood Plaza, Los Angeles, CA 90095
| | - Justin Williams
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, UCLA Semel Institute 68-268, 760 Westwood Plaza, Los Angeles, CA 90095
| | - Maria Pizzano
- Department of Education, University of California, Los Angeles, Los Angeles, CA, UCLA Semel Institute 68-268, 760 Westwood Plaza, Los Angeles, CA 90095
| | - Amanda Gulsrud
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, UCLA Semel Institute 68-268, 760 Westwood Plaza, Los Angeles, CA 90095
| | - Connie Kasari
- Department of Education, University of California, Los Angeles, Los Angeles, CA, UCLA Semel Institute 68-268, 760 Westwood Plaza, Los Angeles, CA 90095
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Brian J, Drmic I, Roncadin C, Dowds E, Shaver C, Smith IM, Zwaigenbaum L, Sacrey LAR, Bryson SE. Effectiveness of a parent-mediated intervention for toddlers with autism spectrum disorder: Evidence from a large community implementation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1882-1897. [PMID: 35037520 DOI: 10.1177/13623613211068934] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
LAY ABSTRACT In an effort to increase access to intervention as early as possible for toddlers with autism spectrum disorder or signs thereof, many researchers have developed interventions that can be delivered by parents in their own homes. These parent-mediated approaches have gained a lot of research attention in recent years and have been found to be helpful in terms of parent and toddler learning. Several studies have used a rigorous research design (a randomized controlled trial) to show that parent-mediated intervention can work under ideal well-controlled conditions. To build on this evidence, we also need to examine whether parent-mediated interventions can be taught well through community service providers and delivered in more "real-world" conditions. This study used a research-community partnership to provide a parent-mediated intervention (called the Social ABCs) to 179 families (mean toddler age was 25 months; ranging from 14 to 34 months). Almost 90% of the families completed the 12-week program and 70% returned for a follow-up assessment 3 months later. Analyses showed that parents learned the strategies that were designed to help them support their toddlers' development. Also, toddlers made gains in their language, communication, and social skills. Importantly, parents' use of the strategies was related to toddlers' skill gains, suggesting that the use of the strategies made a difference for the toddlers. Findings support the use of parent-mediated intervention in this very young age group and suggest that such intervention approaches should be made available for community delivery.
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Affiliation(s)
- Jessica Brian
- Bloorview Research Institute, Canada.,University of Toronto, Canada
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50
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Pillay S, Duncan M, de Vries PJ. "We are doing the best we can to bridge the gap" - service provider perspectives of educational services for autism spectrum disorder in South Africa. Front Psychiatry 2022; 13:907093. [PMID: 35928780 PMCID: PMC9343733 DOI: 10.3389/fpsyt.2022.907093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The South African education system is increasingly unable to meet the growing needs of children with autism spectrum disorder (ASD). Recent studies in the Western Cape, one of the better resourced provinces in South Africa, showed that the pathway to care for children with ASD was an inconsistent and lengthy process, and that many children with ASD waited for extended periods to get access to an appropriate school placement. It is therefore clear that scalable and sustainable solutions are required to improve access to appropriate education for children with ASD. METHODS Here we performed a qualitative study using thematic analysis of ten multi-sectorial ASD service provider interviews in the Western Cape Province to examine provider perspectives and proposed solutions to meet the educational needs of children with ASD. RESULTS Provider perspectives were grouped in three categories: "bridging the gap across the spectrum and lifespan", "gaps to bridge", and "building bridges". The first category captured provider perspectives of the service-related needs inherent to a diagnosis of ASD. The second category summarized service provider views of the challenges associated with providing services to children with ASD and the third category captured provider perspectives on potential actions to improve ASD education services delivery in the province. The overarching theme that emerged was "We're doing the best we can to bridge the gap". CONCLUSION Participants provided ten key recommendations for service strengthening that may lead to contextually relevant innovations to meet the educational needs of children with ASD in the province. Findings from this study has direct relevance to other South African provinces and may have relevance to improve pathways and reduce service delivery gaps also in other low-and-middle-income countries.
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Affiliation(s)
- Sarosha Pillay
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa.,Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Madeleine Duncan
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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