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Yeom JS, Kim J. Effectiveness of online responsive teaching in young children with developmental disabilities: a pilot study. Clin Exp Pediatr 2024; 67:303-311. [PMID: 38772408 DOI: 10.3345/cep.2023.01662] [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: 12/05/2023] [Accepted: 04/07/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Responsive teaching (RT) interventions, which enhance developmental outcomes by improving children's engagement behaviors, are traditionally delivered in person. However, the coronavirus disease 2019 pandemic complicated this approach. PURPOSE This study aimed to evaluate the efficacy and acceptance of online RT in children with developmental disabilities and their parents. METHODS This pilot study was conducted in Jinju, South Korea, and enrolled parent-child dyads referred to Gyeongsang National University Hospital for developmental concerns between April and September 2022. The children underwent a comprehensive developmental evaluation. The parents received a 5-session RT intervention via ZOOM on a mostly weekly basis. The first 2 sessions involved child development and RT lectures, while the others involved coaching on 3 of the 66 RT strategies. Problem behaviors, parent-child interactions, and parenting stress were assessed pre- versus postintervention using the Korean versions of the Child Behavior Checklist, Maternal/Child Behavior Rating Scale, and Parent Stress Index 4th Edition Short Form, respectively. Acceptability was evaluated using a self-administered questionnaire. RESULTS Of the 30 recruited parent-child pairs, 23 (76%) completed the intervention and assessments. The children (mean age, 2.66±0.86 years) included 12 with language delays, 7 with autism spectrum disorder, and 4 with global delays. Predominantly mothers (96%) participated. Online RT significantly improved pivotal behaviors- including joint attention (P=0.04), cooperation (P=0.01), and affect (P=0.01)-and reduced overall problem behaviors (P=0.04). Parents reported less parenting stress (P=0.01), improved interactive behaviors with increased responsiveness (P<0.01), and decreased directiveness (P<0.01). High satisfaction with online RT interventions was also previously reported. CONCLUSION These findings suggest that online RT can improve children's emotional and behavioral outcomes and maternal interaction styles and reduce parenting stress, offering accessible interventions amid challenges such as limited access and pandemics.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University of Hospital, Jinju, Korea
- Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Jeongmee Kim
- Department of Child Psychotherapy, The Graduate School of Hanyang University, Seoul, Korea
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Del Lucchese B, Parravicini S, Filogna S, Mangani G, Beani E, Di Lieto MC, Bardoni A, Bertamino M, Papini M, Tacchino C, Fedeli F, Cioni G, Sgandurra G. The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders - a systematic review. Front Public Health 2024; 12:1295273. [PMID: 38694988 PMCID: PMC11061864 DOI: 10.3389/fpubh.2024.1295273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/08/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research. Method This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally. Results A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting. Discussion This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions. Systematic review registration PROSPERO (CRD42020210663).
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Affiliation(s)
- Benedetta Del Lucchese
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Stefano Parravicini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Pediatric Neuroscience Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Filogna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Gloria Mangani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Chiara Di Lieto
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | | | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - Chiara Tacchino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Nuhu NN, Muething C, Gillespie SE, Mevers JL, Scheithauer M. Individualized Parent-Mediated Behavioral Treatment for Challenging Behavior: A Program Description. Behav Modif 2024; 48:111-127. [PMID: 37864323 DOI: 10.1177/01454455231201957] [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] [Indexed: 10/22/2023]
Abstract
Past research suggests behavioral treatments are effective for challenging behavior in children and young adults with neurodevelopmental disorders, such as autism spectrum disorder (ASD). However, access to these services can be limited and require substantial resources. To address this issue, the current study provides a programmatic description of an individualized parent-mediated service model targeting moderate challenging behavior. In the program, therapists coached parents to implement functional analyses and individualized function-based treatment packages. Forty-one families of children and young adults with neurodevelopmental disorders participated. Most clients (75.6%) met all admission treatment goals and parents reported significant decreases in frequency and severity of challenging behaviors at discharge. Parents also reported less stress at discharge. Outcomes of the study suggest this parent-mediated treatment model is a viable option to treating moderate challenging behavior in children and young adults with intellectual and developmental disorders.
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Affiliation(s)
- Nadrat N Nuhu
- Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, GA, USA
| | - Colin Muething
- Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, GA, USA
| | | | - Joanna Lomas Mevers
- Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, GA, USA
| | - Mindy Scheithauer
- Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
- Children's Healthcare of Atlanta, GA, USA
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4
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Jiang Y, Routh B, Fakuajo OA. Increasing access to quality parent education through a virtual synchronous setting: A qualitative study. Child Care Health Dev 2024; 50:e13235. [PMID: 38421048 DOI: 10.1111/cch.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/22/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND America's crisis of youth mental health challenges has been worsened by COVID-19. Group-based parent education has been proven effective in intervention and prevention; however, a lack of universal access and the busyness of parents are significant barriers to participation. Rapid growth in technology-based education aims to increase accessibility but live, virtual parent education was understudied. E3 Parent Education (E3 PE) was a free, virtual, and synchronous group programme offered in Montana by a certified parent educator to support families navigating common and uncommon challenges. METHODS Through qualitative evaluation with eight programme participants (n = 8), this study aimed to understand impacts and access of this parent education programme. RESULTS All participants (100%) aligned on three themes describing the virtual, synchronous parent education experience: convenience, connection, and comfort. Participants suggested strategies for improvement as well. DISCUSSION A free, virtual, synchronous, group-based format provided equitable access and lowered the barriers to participation. Findings advised that the developers, facilitators, and policymakers consider adding virtual options alongside in-person settings to reduce participant barriers and meet the needs of different families.
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Affiliation(s)
- Yu Jiang
- FamilyKind, New York, New York, USA
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5
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Ferrante C, Sorgato P, Fioravanti M, Pacione L, Arduino GM, Ghersi S, Scattoni ML, Servili C, Salomone E. Supporting Caregivers Remotely During a Pandemic: Comparison of WHO Caregiver Skills Training Delivered Online Versus in Person in Public Health Settings in Italy. J Autism Dev Disord 2024; 54:765-784. [PMID: 36454366 PMCID: PMC9713075 DOI: 10.1007/s10803-022-05800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/05/2022]
Abstract
Feasibility, acceptability and effectiveness data of a virtual adaptation of the WHO Caregiver Skills Training (CST; n = 25) were compared with those of a pilot RCT of CST delivered in person (n = 43) against treatment as usual (TAU; n = 43). Virtual CST was delivered with high levels of integrity, but received lower ratings in some caregiver- and facilitator-rated acceptability and feasibility dimensions. Qualitative analysis identified both benefits (flexibility, convenience, clinical usefulness) and challenges, (technological issues, distraction from family members, emotional distance). Virtual and in-person CST improved significantly more on caregiver competence than TAU; there were no other significant effects. Potential for use of virtual CST as a clinical response in contexts where in-person delivery is not possible is discussed.
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Affiliation(s)
- Camilla Ferrante
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Paola Sorgato
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Mariachiara Fioravanti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Laura Pacione
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Giuseppe Maurizio Arduino
- Centro Autismo e Sindrome di Asperger, Ospedale Regina Montis Regalis Mondovì, Mondovì (Cuneo), Italy
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Erica Salomone
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy.
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
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Jellinek ER, Duda TA, Fein RH. The RUBI Parent Training for Disruptive Behavior in a Child with Electrical Status Epilepticus in Sleep (ESES): A Case Report. J Clin Psychol Med Settings 2023; 30:770-779. [PMID: 36840783 PMCID: PMC9959946 DOI: 10.1007/s10880-023-09949-1] [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: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Children with electrical status epilepticus in sleep (ESES) often present with cognitive deficits and behavioral difficulties. Children that present with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), intellectual disability, and ESES would be expected to manifest more complex symptoms and increased behavioral difficulties given the nature of these disorders. Despite the complex presentation, there is little research to support effective treatments that manage behavior challenges and associated symptoms of ASD in such patients. In the present case report, the authors implemented a validated parent management training intervention, The Research Unit on Behavioral Interventions (RUBI) Autism Network Parent Training program (RUBI-PT) via telemedicine to manage symptoms of ADHD, ASD, and disruptive behaviors in an 8-year-old South-Asian boy with ESES and associated mild intellectual disability. The family participated in 15 RUBI-PT sessions over 22 weeks. Parent report and ratings using the clinical global impression, improvement scale (CGI-I) indicated reductions in challenging behavior and improvement in adaptive skills. The current case report demonstrates the utility of RUBI-PT in the treatment of behavioral difficulties in a patient with ASD, ADHD, and ESES. Further, the present study explores future directions for the use of RUBI-PT to address behavioral challenges associated with ESES and commonly co-occurring conditions and highlights the importance of cultural responsive practice in the context of parent management training.
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Affiliation(s)
- Emily R Jellinek
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, 491 Farish Hall, Houston, TX, 77204-5023, USA.
| | - Thomas A Duda
- Psychology Service, Texas Children's Hospital, 6701 Fannin Street, CCC 1630, Houston, TX, 77030-2399, USA
| | - Rachel H Fein
- Psychology Service, Texas Children's Hospital, 6701 Fannin Street, CCC 1630, Houston, TX, 77030-2399, USA
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Bravo A, Ibañez LV, Scott S, Dick C, Carpentier P, Stone WL. Telehealth Delivery in Part C Early Intervention: Provider and Caregiver Perspectives. J Autism Dev Disord 2023; 53:4545-4559. [PMID: 36153443 PMCID: PMC9510265 DOI: 10.1007/s10803-022-05734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.
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Affiliation(s)
- Alice Bravo
- College of Education, University of Washington, Seattle, WA, 98115, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Sabine Scott
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Catherine Dick
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Pascale Carpentier
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, WA, 98115, USA
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8
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Guastaferro K, Melchior M, Murphy-Costanzo A, S S, Neimeyer A, Stewart S, Noll J. Adapting prevention programs for virtual delivery: A case study in adapting a parent-focused child sexual abuse prevention module. J Public Health Res 2023; 12:22799036231208329. [PMID: 37901193 PMCID: PMC10605695 DOI: 10.1177/22799036231208329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/01/2023] [Indexed: 10/31/2023] Open
Abstract
Background Evolving and emerging contexts require interventions to respond and adapt. The COVID-19 pandemic necessitated a quick adaptation from in-person to virtual delivery. Not only were there few programs able to transition to virtual delivery, there was a lack of parent-focused CSA-prevention programs. The current study describes the responsive adaptation of a parent-focused child sexual abuse (CSA) prevention module (Smart Parents-Safe and Healthy Kids; SPSHK) for virtual delivery. Design and methods This two-phase study used mixed-methods to inform and pilot test adaptations to the virtual module. In Phase 1, parenting providers with and without experience delivering SPSHK (N = 110) completed anonymous surveys and a subsample (n = 27) subsequently participated in brief interviews elaborate on challenges and needed adaptations for virtual platforms. Results Providers indicated the greatest technological difficulties with parents' access to technology noting the inability to use a screensharing function. Thus, providers recommended no adaptations for the virtual delivery of SPSHK. In Phase 2, the virtual SPSHK module was piloted with nine parents. Results demonstrated virtual SPSHK was acceptable and feasibly implemented. Pre-posttest assessments indicated increases in parents' CSA-related awareness and use of protective behaviors. Conclusion The current study suggests the promise of virtual SPSHK implementation and may act as a blueprint for other parent-focused CSA-prevention programs, but also more general parenting programs, considering virtual delivery.
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Affiliation(s)
- Kate Guastaferro
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Mia Melchior
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Alexis Murphy-Costanzo
- Department of Psychology, College of Liberal Arts, The Pennsylvania State University, University Park, PA, USA
| | - Sunshine S
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Alexis Neimeyer
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Sydni Stewart
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Jennie Noll
- Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
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Hippman C, Mah JWT, MacFadden M. Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01597-8. [PMID: 37740798 DOI: 10.1007/s10578-023-01597-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/25/2023]
Abstract
Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.
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Affiliation(s)
- Catriona Hippman
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Janet W T Mah
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Megan MacFadden
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
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10
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Fell LA, Albright CM, Kryszak EM, Butter E, Kuhlthau KA. Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:1196-1203. [PMID: 36871611 PMCID: PMC9985515 DOI: 10.1016/j.acap.2023.02.016] [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] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns. METHODS From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified. RESULTS Providers across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care. CONCLUSIONS Results suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.
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Affiliation(s)
- Lucy A Fell
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston.
| | - Charles M Albright
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Elizabeth M Kryszak
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Eric Butter
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Karen A Kuhlthau
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, MA
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11
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Safer-Lichtenstein J, McIntyre LL, Rodriguez G, Gomez D, Puerta S, Neece CL. Feasibility and Acceptability of Spanish-Language Parenting Interventions for Young Children With Developmental Delays. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:307-325. [PMID: 37536693 PMCID: PMC10575569 DOI: 10.1352/1934-9556-61.4.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/06/2023] [Indexed: 08/05/2023]
Abstract
Hispanic/Latinx parents of children with developmental delays/disabilities (DD) face disparities in service access and research participation. In the present study, 60 Spanish-speaking caregivers of young children with DD participated in randomly assigned stress reduction interventions (psychoeducation/support groups or Mindfulness-Based Stress Reduction [MBSR]), followed by behavioral parent training (BPT). Caregiver attendance and satisfaction ratings were measured, and focus groups gathered additional information on caregivers' takeaways from the interventions. Caregivers demonstrated high satisfaction across interventions, with slightly greater preference for psychoeducation/support groups, and qualitative data indicated that the relevance of the information and style of delivery may be responsible. Researchers and clinicians may attain greater engagement with this population by focusing on intervention services that include psychoeducation and peer support elements.
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Affiliation(s)
- Jonathan Safer-Lichtenstein
- Jonathan Safer-Lichtenstein, Laura Lee McIntyre, Geovanna Rodriguez, and Douglas Gomez, University of Oregon
| | - Laura Lee McIntyre
- Jonathan Safer-Lichtenstein, Laura Lee McIntyre, Geovanna Rodriguez, and Douglas Gomez, University of Oregon
| | - Geovanna Rodriguez
- Jonathan Safer-Lichtenstein, Laura Lee McIntyre, Geovanna Rodriguez, and Douglas Gomez, University of Oregon
| | - Douglas Gomez
- Jonathan Safer-Lichtenstein, Laura Lee McIntyre, Geovanna Rodriguez, and Douglas Gomez, University of Oregon
| | | | - Cameron L Neece
- Stephanie Puerta and Cameron L. Neece, Loma Linda University
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Tomeny TS, Hudac CM, Malaia EA, Morett LM, Tomeny KR, Watkins L, Kana RK. Serving Individuals With Autism Spectrum Disorder in the Age of COVID-19: Special Considerations for Rural Families. RURAL SPECIAL EDUCATION QUARTERLY 2023; 42:105-118. [PMID: 38602929 PMCID: PMC10155053 DOI: 10.1177/87568705231167440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This position paper explores the needs of rural families of children, adolescents, and adults with autism spectrum disorder (ASD) during the COVID-19 pandemic. Prior to COVID-19, literature portrays elevated stress in families of individuals with ASD and health and socioeconomic disparities for rural and underserved populations. These disparities were exacerbated due to COVID-19 and subsequent lockdowns and economic turmoil. Academic and adaptive skills training were particularly impacted due to school closures, with parents tasked with taking some responsibility for training these skills. Our goals for this article focus on special considerations for rural families regarding (a) neurobiological and developmental impacts of stressful experiences like COVID-19, (b) delineation of the impacts on individuals with ASD and other comorbid and related conditions, and (c) education and intervention needs during these times. Finally, we offer suggestions for future care during pandemic events, including recommendations for improving service delivery under such conditions.
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Ros-DeMarize R, Boan A, Bradley C, Klein J, Carpenter L. Tele-PCIT: Initial Examination of Internet Delivered PCIT for Young Children with Autism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01539-4. [PMID: 37171780 DOI: 10.1007/s10578-023-01539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Parent-Child Interaction Therapy (PCIT) is an empirically supported behavioral parenting program for disruptive behavior and has been shown to also be effective for children with autism spectrum disorder (ASD). Telehealth delivery of PCIT (Tele-PCIT) is also supported, but no trials have focused on children with ASD. The purpose of the study was to examine the initial efficacy of a time limited version of Tele-PCIT within an ASD sample. METHODS Participants included parents of 20 children (ages 2-6) with ASD who received 10 sessions of Tele-PCIT. Parents reported on their parenting stress, parenting practices, and child behavior. A play observation was coded for parent use of treatment skills and for child compliance. RESULTS 80% of participants completed treatment (n = 16) and results revealed significant improvements across parenting and child outcomes. Parents reported decreases in parenting stress from pre-to-post-treatment, which were maintained at a 3-month follow-up, along with decreases in negative parenting practices (i.e., Laxness and Overactivity) from pre-to-post treatment that were also maintained at follow-up. Significant increases in parent use of positive parenting skills (i.e., "Do" Skills) during child-led play and decreases in negative parenting skills (i.e., "Don't" Skills) were observed. Results also revealed significant reductions in parent rated child externalizing behavior problems from pre-to-post-treatment that were also maintained at follow-up. CONCLUSIONS Results of the current study support the initial efficacy of Tele-PCIT for treating disruptive behavior in young children with ASD. Findings from this pilot will inform larger examinations of Tele-PCIT for youth with ASD.
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Affiliation(s)
- Rosmary Ros-DeMarize
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Andrea Boan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine Bradley
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan Klein
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Carpenter
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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14
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Martin RJ, Crowley-Zalaket J, Gould K, Weddle S, Anderson CM. Behavioral Parent Training via Telehealth for Autistic Children: Further Exploration of Feasibility During the COVID-19 Pandemic. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2023:1-14. [PMID: 37363188 PMCID: PMC10177738 DOI: 10.1007/s41252-023-00336-3] [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: 05/02/2023] [Indexed: 06/28/2023]
Abstract
Objectives Many autistic children exhibit challenging and disruptive behaviors that can present challenges for both children and their families by interfering with acquisition of adaptive skills and affecting family and peer relationships. Behavioral parent training (BPT) is an evidence-based approach to reducing autistic children's disruptive behavior, but many families face a number of barriers to accessing BPT, such as availability of BPT in their community, and transportation and scheduling challenges. Therefore, we sought to explore the feasibility and promise of effectiveness of adapting an established BPT program to a telehealth format during the COVID-19 pandemic. Methods A feasibility trial of BPT via telehealth was conducted with fourteen parents of autistic children. Results Parents and clinicians were able to implement BPT via telehealth with a high degree of fidelity, and parents rated both BPT and the telehealth format favorably. The program also showed promise of effectiveness in reducing autistic children's disruptive behavior, improving their adaptive skills, as well as reducing parents' stress, and improving parents' sense of parenting competence. Conclusions The findings replicate and extend findings from previous studies, further demonstrating the promise of telehealth as a viable alternative format for delivering BPT. We also explore implications for future research, including the opportunity for more thorough evaluation of the effectiveness of BPT via telehealth.
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Affiliation(s)
- Ryan J. Martin
- May Institute, Randolph, MA USA
- Mosaic Pediatric Therapy, 2810 Coliseum Centre Dr, Charlotte, NC USA
| | - Jaime Crowley-Zalaket
- May Institute, Randolph, MA USA
- Children’s Specialized Hospital, New Brunswick, NJ USA
| | - Kaitlin Gould
- May Institute, Randolph, MA USA
- The College of Saint Rose, Albany, NY USA
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15
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Kenworthy L, Childress D, Armour AC, Verbalis A, Zhang A, Troxel M, Handsman R, Kocher K, Myrick Y, Werner M, Alexander KC, Cannon L, Anthony LG. Leveraging technology to make parent training more accessible: Randomized trial of in-person versus online executive function training for parents of autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:616-628. [PMID: 35916246 PMCID: PMC9892365 DOI: 10.1177/13623613221111212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
LAY ABSTRACT This study compared the first online parent training program for executive function intervention for autism to in-person parent training on the same content. Participants were parents of autistic children, who were between 8 and 12 years of age and did not have intellectual disability. Parents were randomized to the in-person (n = 51) or online (n = 46) training conditions. Both trainings were developed with stakeholder (parents and autistic people) guidance. In this trial, most parents reported that they liked both trainings and that they were able to implement what they learned with their children. Parents in both groups spent equivalent amounts of time (about 8 hours) with the training materials, but while 94% of parents in the in-person training attended both parent trainings, only 59% of parents in the online group completed all 10 online modules. Parents reported that it was difficult to stay motivated to complete the online trainings over the 10-week trial. Parent and child outcomes did not differ significantly between the groups. Overall, parents reported that the trainings resulted in a reduction in their own parenting strain and improvements in their child's flexibility, emotional control, and global executive function, but not planning and organization. These findings indicated brief in-person and online training can help parents learn to support and improve their autistic children's executive function abilities, reducing their own experience of parenting strain. The finding that the online training was equivalent to the in-person trainings is important because it is accessible to parents who encounter barriers to in-person care.
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Affiliation(s)
| | | | | | | | | | - Mary Troxel
- University of Colorado School of Medicine, USA
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16
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Denusik L, Servais M, Glista D, Hatherly K, Moodie S, Cardy JO, Weitzman E, Cunningham BJ. Families' Experiences in the Virtual Hanen More Than Words Program During the COVID-19 Pandemic. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:701-716. [PMID: 36877765 DOI: 10.1044/2022_ajslp-22-00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE The COVID-19 pandemic required most pediatric rehabilitation programs to shift to a virtual delivery format without the benefits of evidence to support this transition. Our study explored families' experiences participating virtually in More Than Words, a program for parents of autistic children, with the goal of generating new evidence to inform both virtual service delivery and program development. METHOD Twenty-one families who recently completed a virtual More Than Words program participated in a semistructured interview. The interviews were transcribed and analyzed in NVivo using a top-down deductive approach that referenced a modified Dynamic Knowledge Transfer Capacity model. RESULTS Six themes capturing families' experiences with different components of virtual service delivery were identified: (a) experiences participating from home, (b) accessing the More Than Words program, (c) delivery methods and program materials, (d) the speech-language pathologist-caregiver relationship, (e) new skills learned, and (f) virtual program engagement. CONCLUSIONS Most participants had a positive experience in the virtual program. Suggested areas for improvement included the time and length of intervention sessions and increasing social connections with other families. Practice considerations related to the importance of childcare during group sessions and having another adult to support the videorecording of parent-child interactions. Clinical implications include suggestions for how clinicians can create a positive virtual experience for families. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22177601.
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Affiliation(s)
| | - Michelle Servais
- University of Western Ontario, London, Canada
- Thames Valley Children's Centre, London, Ontario, Canada
| | | | | | | | | | | | - Barbara Jane Cunningham
- University of Western Ontario, London, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
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17
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Enneking B, Ryan T, Tang Q, James C, Rouse M, Curtin M, Keehn RM. Acceptability and Access Metrics for Telehealth Consultation of Pediatric Neurodevelopmental Disabilities During COVID-19. J Pediatr Health Care 2023; 37:200-207. [PMID: 36175312 DOI: 10.1016/j.pedhc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We report caregiver agreement to attend telehealth neurodevelopmental consultation during COVID-19, demographic differences in agreement, reasons families declined, and clinical access metrics before and during COVID-19. METHOD Data were gathered from telehealth referrals and consultations from April to July 2020. Schedulers documented agreement status and reasons for the decline. Wait time, lag time, and missed appointment rates were calculated to measure access. RESULTS Ninety-one percent agreed to attend telehealth consultation; 55% of those who declined preferred in-person services. There were no demographic differences between those who accepted, declined, or did not respond. The median wait time from referral to appointment was 60 days. Missed appointment rates were consistent with prepandemic rates. DISCUSSION Findings support literature suggesting patients are agreeable to telehealth. They diverged from evidence suggesting telehealth reduces missed appointments. Overall, results indicate telehealth is an acceptable alternative; however, further telehealth innovation is needed to address existing disparities.
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18
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Gerow S, Kirkpatrick M, McGinnis K, Sulak TN, Davis TN, Fritz S. Evaluation of a Telehealth ABA Program for Caregivers of Children with ASD. Behav Modif 2023; 47:349-379. [PMID: 36317793 DOI: 10.1177/01454455221130001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Children with autism spectrum disorder (ASD) often experience skill deficits that can negatively affect long-term outcomes. Interventions based on applied behavior analysis (ABA) yield improvements in targeted skills. However, families often have difficulty accessing ABA services. The purpose of this study was to evaluate the efficacy of a caregiver coaching program delivered via telehealth. Thirty children with ASD and their caregivers (e.g., parents, grandparents) participated in all phases of the study. The program consisted of therapists providing coaching in English or Spanish to caregivers of children with ASD via synchronous video call telehealth visits, typically provided one to two times per week. Caregivers received coaching in interventions (e.g., functional communication training, discrete trial teaching, total task chaining, and naturalistic teaching) to address individualized goals. We collected data on caregiver treatment fidelity and child outcomes (i.e., Vineland-3, observation, and analysis of time series data). Caregivers implemented intervention procedures with 95% accuracy on average. The single-case effect sizes calculated based on the time series baseline and intervention data yielded medium, large, or very large improvements for 85% of goals addressed. Results indicated that the children improved on appropriate engagement (measured via observation), but there was no statistically significant improvement for the remaining pre-post measures. These results, along with the results of previous studies, provide preliminary support for the use of telehealth to provide ABA services. However, there is a need for additional research evaluating the efficacy of these types of programs.
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19
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Preas E, Carroll RA, Van Den Elzen G, Halbur M, Harper M. Evaluating the Use of Video Modeling With Voiceover Instructions to Train Therapists to Deliver Caregiver Training Through Telehealth. Behav Modif 2023; 47:402-431. [PMID: 35850543 DOI: 10.1177/01454455221111988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Caregiver training is an important component of behavioral intervention; however, many barriers exist for in-person training. Alternatively, behavioral therapists may use telehealth as a service delivery method. To effectively train caregivers through telehealth, therapists should receive explicit training, but there has been limited research on effective methods for teaching this skill. The purpose of the current study was to evaluate video modeling with voice-over instruction (VMVO) to train therapists to implement 11 component skills of caregiver training through telehealth to teach confederate caregivers to implement a guided compliance procedure. We measured the therapist's implementation of the component skills during a scripted role-play before and after video-model training within a multiple baseline design across participants. We also conducted maintenance and generalization probes to a novel skill. All seven therapists learned the skill, but three therapists required a feedback component in addition to the VMVO. The results suggest that VMVO may be an efficient and effective method for training therapists to conduct caregiver training via telehealth. Furthermore, results indicate that component skill analyses may be valuable to monitor skills that require remediation.
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Affiliation(s)
- Elizabeth Preas
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Regina A Carroll
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | | | - Mary Halbur
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Megan Harper
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
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20
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Marino F, Failla C, Bruschetta R, Vetrano N, Scarcella I, Doria G, Chilà P, Minutoli R, Vagni D, Tartarisco G, Cerasa A, Pioggia G. TeleRehabilitation of Social-Pragmatic Skills in Children with Autism Spectrum Disorder: A Principal Component Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3486. [PMID: 36834179 PMCID: PMC9967556 DOI: 10.3390/ijerph20043486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
In many therapeutic settings, remote health services are becoming increasingly a viable strategy for behavior management interventions in children with autism spectrum disorder (ASD). However, there is a paucity of tools for recovering social-pragmatic skills. In this study, we sought to demonstrate the effectiveness of a new online behavioral training, comparing the performance of an ASD group carrying out an online treatment (n°8) with respect to a control group of demographically-/clinically matched ASD children (n°8) engaged in a traditional in-presence intervention (face-to-face). After a 4-month behavioral treatment, the pragmatic skills language (APL test) abilities detected in the experimental group were almost similar to the control group. However, principal component analysis (PCA) demonstrated that the overall improvement in socio-pragmatic skills was higher for ASD children who underwent in-presence training. In fact, dimensions defined by merging APL subscale scores are clearly separated in ASD children who underwent in-presence training with respect to those performing the online approach. Our findings support the effectiveness of remote healthcare systems in managing the social skills of children with ASD, but more approaches and resources are required to enhance remote services.
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Affiliation(s)
- Flavia Marino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
| | - Chiara Failla
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Classical Linguistic Studies and Education Department, Kore University of Enna, 94100 Enna, Italy
| | - Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Noemi Vetrano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Department of Cognitive, Psychological and Pedagogical Sciences, and Cultural Studies, University of Messina, Via Concezione, 6/8, 98121 Messina, Italy
| | - Ileana Scarcella
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Corso Vittorio Emanuele II, 39, 00186 Roma, Italy
| | - Germana Doria
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Corso Vittorio Emanuele II, 39, 00186 Roma, Italy
| | - Paola Chilà
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Corso Vittorio Emanuele II, 39, 00186 Roma, Italy
| | - Roberta Minutoli
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Corso Vittorio Emanuele II, 39, 00186 Roma, Italy
| | - David Vagni
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
- S’Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Arcavacata, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
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21
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Ogourtsova T, Boychuck Z, O'Donnell M, Ahmed S, Osman G, Majnemer A. Telerehabilitation for Children and Youth with Developmental Disabilities and Their Families: A Systematic Review. Phys Occup Ther Pediatr 2023; 43:129-175. [PMID: 36042567 DOI: 10.1080/01942638.2022.2106468] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To determine the level of evidence for the effectiveness of telerehabilitation against comparison interventions in improving child- and parent-related outcomes in children and youth with developmental disabilities. METHOD A systematic approach, comprised of a comprehensive search; transparent study selection, data extraction, quality assessment by independent reviewers; and synthesis of sufficiently similar data (per diagnostic group, health profession, and overall level of evidence for each outcome) was undertaken. RESULTS Fifty-five studies (29 randomized trials) were included across six diagnostic groups and ten health professions. Common telerehabilitation targets varied across diagnostic groups and included motor function, behavior, language, and parental self-efficacy. Telerehabilitation was found to be either more effective or as effective versus comparison intervention in improving 46.9% or 53.1% of outcomes, respectively. It was never found to be detrimental or less effective. Strong to moderate, limited, and insufficient levels of evidence were found for 36.5%, 24.5%, and 38.6% of the outcomes, respectively. CONCLUSION There is sufficient evidence suggesting that telerehabilitation is a promising alternative when face-to-face care is limited. It is comparable to usual care and is more effective than no treatment. Blending in-person and telerehabilitation approaches could be beneficial for the post-pandemic future of rehabilitation in pediatric care.
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Affiliation(s)
- Tatiana Ogourtsova
- Research Center of the Jewish Rehabilitation Hospital, CISSS (Center Intégré de Santé et de Services Sociaux) Laval, Site of CRIR, Quebec, Canada.,Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Zachary Boychuck
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,CanChild Center for Childhood Disability Research and Department of Pediatrics, McMaster University, Ontario, Canada
| | - Maureen O'Donnell
- Provincial Health Services Authority BC, Vancouver, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sara Ahmed
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
| | - Galil Osman
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Annette Majnemer
- Research Center of the Jewish Rehabilitation Hospital, CISSS (Center Intégré de Santé et de Services Sociaux) Laval, Site of CRIR, Quebec, Canada.,Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
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22
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de Nocker YL, Toolan CK. Using Telehealth to Provide Interventions for Children with ASD: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023; 10:82-112. [PMID: 34306962 PMCID: PMC8282771 DOI: 10.1007/s40489-021-00278-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/25/2021] [Indexed: 10/27/2022]
Abstract
As the need for accessible interventions for autism spectrum disorder (ASD) grows, empirically supported telehealth interventions become increasingly necessary. With the current COVID-19 public health crisis, in-person interventions have become largely infeasible; therefore, it is crucial that providers have information regarding the effectiveness of telehealth interventions. This systematic review evaluates and synthesizes existing group design research on telehealth ASD interventions. Sixteen articles were evaluated on implementer and child-level intervention outcomes as well as factors that promote equitable access to intervention. Findings suggest that telehealth programs are highly acceptable, comparable to face-to-face interventions, and can be an effective method of training implementers in interventions. Recommendations for future research and for maximizing equitable access to telehealth interventions are presented.
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Affiliation(s)
- Yanicka L. de Nocker
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Box 956967, Los Angeles, CA 90095 USA
| | - Christina K. Toolan
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Box 956967, Los Angeles, CA 90095 USA
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23
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Mazzoni N, Bentenuto A, Filosofi F, Tardivo A, Strathearn L, Zarei K, De Falco S, Venuti P, Iandolo G, Giannotti M. Parenting a Child with a Neurodevelopmental Disorder during the Early Stage of the COVID-19 Pandemic: Quantitative and Qualitative Cross-Cultural Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:499. [PMID: 36612822 PMCID: PMC9819011 DOI: 10.3390/ijerph20010499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Research during the COVID-19 pandemic has shown a strong relationship between child symptoms, parental stress, and mental health challenges. The pandemic has changed family routines, worsening child symptomatology and parental burden. The aim of this study was to investigate how the magnitude of the perceived changes in child externalizing behavior, parental stress, and discontinuity of therapy-from before to during the COVID-19 pandemic-affected parental mental health during the pandemic. Moreover, we sought to compare these aspects cross-culturally between European countries and the USA. To these purposes, we asked Italian, Spanish, and U.S. parents of children with neurodevelopmental disabilities (NDD) to complete an online survey. Quantitative results showed that increased parental stress may have contributed to a worsening in parental psychological distress, regardless of culture. Moreover, they suggested an indirect effect of child externalizing behaviors on parents' psychological distress via parental stress. Qualitative analyses highlighted that the lack, or discontinuity, of therapeutic activities may have been one of the key contributors to parenting burden during the COVID-19 pandemic. Finally, qualitative results highlighted resilience factors that could have decreased the risk of psychological problems during the pandemic, such as a strong sense of parental efficacy and the ability to adapt to changing family dynamics.
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Affiliation(s)
- Noemi Mazzoni
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
| | - Fabio Filosofi
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
| | - Angela Tardivo
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
- Observation and Functional Diagnosis Division, PSISE Clinical and Developmental Psychological Service, Calle Albendiego 7, 28029 Madrid, Spain
| | - Lane Strathearn
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Center for Disabilities and Development, University of Iowa Stead Family Children’s Hospital, Iowa City, IA 52242, USA
- Hawkeye Intellectual and Developmental Disabilities Research Center (Hawk-IDDRC), University of Iowa, Iowa City, IA 52242, USA
| | - Kasra Zarei
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Center for Disabilities and Development, University of Iowa Stead Family Children’s Hospital, Iowa City, IA 52242, USA
| | - Simona De Falco
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
| | - Paola Venuti
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
| | - Giuseppe Iandolo
- Observation and Functional Diagnosis Division, PSISE Clinical and Developmental Psychological Service, Calle Albendiego 7, 28029 Madrid, Spain
- Department of Psychology, School of Biomedical Sciences, European University of Madrid, Calle Tajo S/N, (Urb. El Bosque), Villaviciosa de Odón (Madrid), 28670 Madrid, Spain
| | - Michele Giannotti
- Laboratory of Observation, Diagnosis and Educational (ODFLAB), Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Trento, Italy
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24
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Isensee C, Schmid B, Marschik PB, Zhang D, Poustka L. Impact of COVID-19 pandemic on families living with autism: An online survey. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 129:104307. [PMID: 35908370 PMCID: PMC9271458 DOI: 10.1016/j.ridd.2022.104307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The current SARS-CoV-2 global pandemic presents a great challenge for governments, health care professionals and the general population. Individuals with autism spectrum disorder (ASD) might be especially vulnerable to restrictions imposed by the crisis. AIM The objective of the study was to examine the impact of the SARSCoV- 2 pandemic on children with ASD and their families. METHODS AND PROCEDURES We conducted an online survey two months after the beginning of lock-down (18th of May to 5th of July 2020) in Germany and Austria. We investigated behavioral and emotional changes of children related to the lock-down alongside parental stress and intrafamilial burden OUTCOME AND RESULTS: Of the 216 participating families with an autistic child (mean age: 12.23 years), nearly 50% reported aggravation of autistic symptoms and heightened parental stress. Families reported discontinuation of therapy, more intrafamilial conflicts and increase of psychopharmacological medication of the child. CONCLUSIONS AND IMPLICATIONS Our report on short-term detrimental effects of the pandemic calls for thorough investigation of long-term sequalae for children and families.
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Affiliation(s)
- Corinna Isensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Benjamin Schmid
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Peter B Marschik
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany; Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet Stockholm, Sweden
| | - Dajie Zhang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany; Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Austria
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany.
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25
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Hendrix NM, Pickard KE, Binion GE, Kushner E. A systematic review of emotion regulation in parent-mediated interventions for autism spectrum disorder. Front Psychiatry 2022; 13:846286. [PMID: 36213921 PMCID: PMC9544248 DOI: 10.3389/fpsyt.2022.846286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Autistic individuals are at elevated risk for difficulties with emotion regulation (ER) that emerge early in life and are associated with a range of internalizing and externalizing disorders. Existing interventions that support ER have focused on school-age autistic children and adolescents as well as adults. Proactive approaches to improving ER in early childhood are thus needed, as is understanding the approaches by which ER skills can be feasibly supported in this young population. This review summarizes how ER has been measured within parent-mediated interventions for children at or under the age of 6 years and the extent to which ER is measured concurrently with or distinctly from observable behaviors that have been referenced in existing literature as externalizing or challenging behavior. Using PsycInfo, EBSCOhost, and PubMed databases, we searched for peer-reviewed journal articles published through August 2021, that focused on the use of parent-mediated interventions targeting ER and/or challenging behavior. The systematic search resulted in 4,738 publications; following multi-stage screening, the search yielded 20 studies. Eighteen of 20 studies were designed to target challenging behavior using manualized curricula or behavior analytic methodologies and assessed child outcomes through validated caregiver rating scales and/or direct behavioral observation. One study measured changes in ER as secondary to the social communication skills that were targeted in the intervention. Only one study specifically supported ER skill development and measured changes in ER as the primary intervention outcome. Findings highlight the need for better assessment of ER outcomes within the context of parent-mediated interventions for toddlers and young autistic children.
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Affiliation(s)
- Nicole M. Hendrix
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Katherine E. Pickard
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Grace E. Binion
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Elizabeth Kushner
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
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26
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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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27
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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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28
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Chen Y, Zhou Z, Cao M, Liu M, Lin Z, Yang W, Yang X, Dhaidhai D, Xiong P. Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies. Neurosci Biobehav Rev 2022; 138:104683. [PMID: 35523302 DOI: 10.1016/j.neubiorev.2022.104683] [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: 11/09/2021] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 12/17/2022]
Abstract
World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.
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Affiliation(s)
- Yuhan Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhuoren Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Min Cao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Min Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhihao Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Weixin Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiao Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Denzel Dhaidhai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
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29
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Graucher T, Sinai-Gavrilov Y, Mor Y, Netzer S, Cohen EY, Levi L, Avtalion TB, Koller J. From Clinic Room to Zoom: Delivery of an Evidence-Based, Parent-mediated Intervention in the Community Before and During the Pandemic. J Autism Dev Disord 2022; 52:5222-5231. [PMID: 35764769 PMCID: PMC9244456 DOI: 10.1007/s10803-022-05592-1] [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] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
Disruptive behaviors (DBs) are common in children with autism, affecting child and family quality of life. Parent-mediated interventions (PMIs) are a cost-effective and accessible way to decrease DBs. COVID-19 increased need for telehealth interventions. This study explored a group delivery of an evidence-based PMI (RUBI), delivered face-to-face and virtually in Israel, before and during the pandemic. Fifty-five families of children with autism and DB participated, 24 receiving face-to-face intervention and 31 receiving virtual. Outcome measures included the Aberrant Behavior Checklist and Home Situations Questionnaires. Results indicate reduction of DBs across groups, with > 50% of treatment-responders showing reliable change. This study is the first to assess RUBI outside the US among a sociodemographically diverse population, in both in-person and virtual contexts.
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Affiliation(s)
- Tobi Graucher
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yana Sinai-Gavrilov
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaniv Mor
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel.,The Open University, Ra'anana, Israel
| | - Shay Netzer
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Y Cohen
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Linoy Levi
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Judah Koller
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel.
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30
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Expectations and Concerns about the Use of Telemedicine for Autism Spectrum Disorder: A Cross-Sectional Survey of Parents and Healthcare Professionals. J Clin Med 2022; 11:jcm11123294. [PMID: 35743364 PMCID: PMC9224762 DOI: 10.3390/jcm11123294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Telemedicine has recently been used for diagnosis and interventions inpatients with autism spectrum disorder (ASD), traditionally performed in-person, but little attention has been paid to user expectations prior to its use. The aim of this study is to compare the expectations and concerns of 50 healthcare professionals and 45 parents of children with ASD regarding the use of telemedicine for diagnostic or treatment purposes. Parents have higher expectations for the use of telemedicine as an alternative (p = 0.0223) and supplement (p = 0.0061) to in-person diagnosis of ASD, as well as a supplement to traditional intervention (p ≤ 0.0001). In addition, while they also have greater hope for improvement in family routines (p = 0.0034) and parenting skills in child management (p = 0.0147), they express greater concern about the need for active parental involvement/supervision during telemedicine services (p = 0.015) and changes in the behaviour of the child with ASD during telemedicine services (p = 0.049). On the other hand, healthcare professionals are more concerned about barriers such as lack of devices (p = 0.000), unfamiliarity with the technology (p = 0.000), poor quality of internet connection (p = 0.006), and severity of ASD (p = 0.000). To achieve promising healthcare for ASD patients, the telemedicine service should try to meet the needs and preferences of both healthcare professionals and parents, as well as identify and, if possible, reduce perceived barriers.
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31
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Pompa-Craven P, Tierman E, Martino J, Lotfizadeh AD. Caregiver Satisfaction with Delivery of Telehealth Autism Services. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:196-205. [PMID: 35531083 PMCID: PMC9058747 DOI: 10.1007/s41252-022-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. METHODS A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. RESULTS There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. CONCLUSIONS The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.
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Affiliation(s)
- Paula Pompa-Craven
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Emily Tierman
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Joelle Martino
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Amin D. Lotfizadeh
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
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32
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Gentile M, Messineo L, La Guardia D, Arrigo M, Città G, Ayala A, Cusimano G, Martines P, Mendolia G, Allegra M. A Parent-Mediated Telehealth Program for Children with Autism Spectrum Disorder : Promoting Parents' Ability to Stimulate the Children's Learning, Reduce Parenting Stress, and Boost Their Sense of Parenting Empowerment. J Autism Dev Disord 2022; 52:5285-5300. [PMID: 35235129 DOI: 10.1007/s10803-022-05482-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 01/05/2023]
Abstract
This study investigates the effectiveness of a 6-month parent-mediated early intervention telehealth program for children with an autism spectrum disorder. The participants comprised a total of 27 parents. The findings showed that participation in the program promotes parents' empowerment and reduce parental stress and a general improvement in the parents' ability to stimulate children's learning. Moreover, the study reveals an effect of parents' age in mediating the relationship among the parents' ability, stress, and empowerment levels. These results suggest that an early intervention telehealth program may help parents become aware of how to benefit from interactions with their children, promote their empowerment, and reduce parenting stress.
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Affiliation(s)
- Manuel Gentile
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Linda Messineo
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy.
| | - Dario La Guardia
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Marco Arrigo
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Giuseppe Città
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Antonia Ayala
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Gaspare Cusimano
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Pio Martines
- Azienda Sanitaria Provinciale di Trapani, Cittadella della Salute, viale della Provincia, 2, 91016, Erice Casa-Santa, Trapani, Italy
| | - Giovanna Mendolia
- Azienda Sanitaria Provinciale di Trapani, Cittadella della Salute, viale della Provincia, 2, 91016, Erice Casa-Santa, Trapani, Italy
| | - Mario Allegra
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
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33
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Aranki J, Wright P, Pompa-Craven P, Lotfizadeh AD. Acceptance of Telehealth Therapy to Replace In-Person Therapy for Autism Treatment During COVID-19 Pandemic: An Assessment of Patient Variables. Telemed J E Health 2022; 28:1342-1349. [PMID: 35119331 DOI: 10.1089/tmj.2021.0397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Importance: Children with autism achieve improved behavioral outcomes with applied behavior analytic (ABA) interventions. Typically, ABA is delivered in a participant's home or in a clinic setting. At the onset of COVID-19, treatment in these environments was not available due to health exposure concerns. A large social service organization in California rapidly pivoted to the delivery of ABA intervention through telehealth. Access disparity for telehealth has been a historical concern in health care delivery, particularly for disenfranchised populations within the autistic participant population. Objective: This study evaluated the demographic and behavioral variables associated with the acceptance or declination of telehealth by the pediatric participants' caregivers at the onset of the pandemic. Design, Setting, Participants: A non-experimental design was used, and archival data were compared for a random sample of 100 participants with autism who accepted telehealth interventions with 100 participants who declined it. Main Outcomes and Measures: Socioeconomic data, gender, age, ethnicity, language, and household size were compared. Clinical data were compared for treatment dosage, standardized Vineland Adaptive Behavior Scales scores, and Verbal Behavior Milestones Assessment and Placement Program scores. Results: None of the demographic variables were statistically significant in a participant's acceptance or declination of telehealth, but there were moderate differences in treatment dosage across the groups. Conclusions: It is concerning that a large portion of participants initially declined intervention via telehealth, resulting in these participants experiencing a gap in intervention during the pandemic. As intervention is imperative for pediatric autism participants, it is untenable that ∼40% of the population initially declined telehealth at the start of the pandemic.
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Affiliation(s)
- Jenna Aranki
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | | | - Paula Pompa-Craven
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
| | - Amin D Lotfizadeh
- Autism Services Division, Easterseals Southern California, Irvine, California, USA
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34
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Lee JD, Hacker RE, Meadan H, Haidar BS. Challenging Behaviors Online Modules for Parents of Young Children with Disabilities: A Pilot Feasibility Study. EDUCATION & TREATMENT OF CHILDREN 2022; 45:341-355. [PMID: 35002056 PMCID: PMC8720550 DOI: 10.1007/s43494-021-00067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Challenging behaviors exhibited by young children negatively affect development and may also prevent children from receiving appropriate education. These behaviors may also hinder positive family interactions and have a significant impact on parents and other family members. Although various parent training approaches exist to increase parents' capacity to address these challenging behaviors, many parents are reportedly not able to access training due to time and resource constraints. To address inequitable dissemination of information, we developed and piloted the use of the Challenging Behavior Online Modules with 10 parents of children with disabilities. In particular, we examined the feasibility of the Challenging Behavior Online Modules for increasing parents' knowledge and use of positive parenting practices with their young children. Parents reported satisfaction with the contents and delivery method of the intervention. Implications and directions for future research are also suggested.
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Affiliation(s)
- James D. Lee
- Juniper Gardens Children’s Project, University of Kansas, 444 Minnesota Avenue, Kansas City, KS 66101 USA
| | - Rebecca E. Hacker
- Juniper Gardens Children’s Project, University of Kansas, 444 Minnesota Avenue, Kansas City, KS 66101 USA
| | - Hedda Meadan
- Department of Special Education, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Ban Sleiman Haidar
- Department of Special Education, University of Illinois at Urbana-Champaign, Champaign, IL USA
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35
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Li F, Wu D, Ren F, Shen L, Xue M, Yu J, Zhang L, Tang Y, Liu X, Tao M, Zhou L, Jiang L, Xu M, Li F. Effectiveness of Online-Delivered Project ImPACT for Children With ASD and Their Parents: A Pilot Study During the COVID-19 Pandemic. Front Psychiatry 2022; 13:806149. [PMID: 35401276 PMCID: PMC8987566 DOI: 10.3389/fpsyt.2022.806149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/25/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, face-to-face intervention services for families of children with autism spectrum disorder (ASD) were limited. This study aimed to evaluate the effectiveness of an 8-week, online-delivered Project ImPACT program for children with ASD and their parents in China during the COVID-19 pandemic. METHODS A pilot non-randomized study with a waitlist control group was conducted in 68 children with ASD and their parents in the Department of Developmental and Behavioral Pediatrics between April 15, 2020 and March 19, 2021. Participants were allocated to either the intervention (IG) or the waitlist group (WLG) according to their order of recruitment. Parents in the IG immediately received 8 weeks of the online-delivered Project ImPACT program, and the WLG received the same program with a delay when the IG had completed all sessions. Participants in both groups received treatment as usual during the research period. RESULTS The online-delivered Project ImPACT program significantly improved the parent-reported social communication skills of children with ASD. Furthermore, parent's involvement in the training program produced a collateral reduction in parenting stress and an increase in perceived competence in the parental role. Parents rated the program acceptable in terms of curriculum schedule, session content, homework assignments, and therapist feedback. CONCLUSIONS The 8-week, online-delivered Project ImPACT program is a feasible and effective social skill training program for families of children with ASD in China during the COVID-19 pandemic. Due to the methodological limitations, randomized controlled studies with larger sample sizes are suggested to provide more solid evidence.
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Affiliation(s)
- Fēi Li
- School of Nursing, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danping Wu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Ren
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixiao Shen
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minbo Xue
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juehua Yu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingli Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Tang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Faculty of Education, Yunnan Normal University, Kunming, China
| | - Xin Liu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minyi Tao
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhou
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyu Xu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Ministry of Education (MOE)-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee J, Lee TS, Lee S, Jang J, Yoo S, Choi Y, Park YR. Development and Application of Metaverse-based Social Skills Training Program for Children with Autism Spectrum Disorder to Improve Social Interaction: Protocol for a Randomized Controlled Trial (Preprint). JMIR Res Protoc 2021; 11:e35960. [PMID: 35675112 PMCID: PMC9218883 DOI: 10.2196/35960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 01/29/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is characterized by abnormalities in social communication and limited and repetitive behavioral patterns. Children with ASD who lack social communication skills will eventually not interact with others and will lack peer relationships when compared to ordinary people. Thus, it is necessary to develop a program to improve social communication abilities using digital technology in people with ASD. Objective We intend to develop and apply a metaverse-based child social skills training program aimed at improving the social interaction abilities of children with ASD aged 7-12 years. We plan to compare and analyze the biometric information collected through wearable devices when applying the metaverse-based social skills training program to evaluate emotional changes in children with ASD in stressful situations. Methods This parallel randomized controlled study will be conducted on children aged 7-12 years diagnosed with ASD. A metaverse-based social skills training program using digital technology will be administered to children who voluntarily wish to participate in the research with consent from their legal guardians. The treatment group will participate in the metaverse-based social skills training program developed by this research team once a week for 60 minutes per session for 4 weeks. The control group will not intervene during the experiment. The treatment group will use wearable devices during the experiment to collect real-time biometric information. Results The study is expected to recruit and enroll participants in March 2022. After registering the participants, the study will be conducted from March 2022 to May 2022. This research will be jointly conducted by Yonsei University and Dobrain Co Ltd. Children participating in the program will use the internet-based platform. Conclusions The metaverse-based Program for the Education and Enrichment of Relational Skills (PEERS) will be effective in improving the social skills of children with ASD, similar to the offline PEERS program. The metaverse-based PEERS program offers excellent accessibility and is inexpensive because it can be administered at home; thus, it is expected to be effective in many children with ASD. If a method can be applied to detect children's emotional changes early using biometric information collected through wearable devices, then emotional changes such as anxiety and anger can be alleviated in advance, thus reducing issues in children with ASD. Trial Registration Clinical Research Information Service KCT0006859; https://tinyurl.com/4r3k7cmj International Registered Report Identifier (IRRID) PRR1-10.2196/35960
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Affiliation(s)
- JooHyun Lee
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Seon Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - SeungWoo Lee
- Graduate School of Information and Communication Technology, Ajou University, Suwon, Republic of Korea
| | - JiHye Jang
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - YeJin Choi
- DoBrain Co, Ltd, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
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37
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Andrews ML, Garcia YA, Catagnus RM, Gould ER. Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment. PSYCHOLOGICAL RECORD 2021; 72:601-617. [PMID: 34866659 PMCID: PMC8628834 DOI: 10.1007/s40732-021-00496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.
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Affiliation(s)
- Meredith L. Andrews
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
| | | | - Robyn M. Catagnus
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
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38
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Johnsson G, Bulkeley K. Practitioner and Service User Perspectives on the Rapid Shift to Teletherapy for Individuals on the Autism Spectrum as a Result of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11812. [PMID: 34831567 PMCID: PMC8620428 DOI: 10.3390/ijerph182211812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Prior to COVID-19, research into teletherapy models for individuals on the autism spectrum was slowly progressing. Following the onset of COVID-19, teletherapy became a necessity for continuity of services, however, research was still emerging for how to translate best practice autism support to the online environment. The aim of this research was to gain insight into the rapid shift to teletherapy for practitioner and service users and the implications for the broader disability sector. Survey responses were collected from 141 allied health practitioners (speech pathologists, occupational therapists, psychologists, educators, and social workers) from four Australian states and territories. A total of 806 responses were collected from service users following an individual teletherapy session. Five themes were identified during the qualitative analysis; (1) technology-love it or hate it; (2) teletherapy as a "new normal"; (3) short term pain, for long term gain; (4) the shape of service delivery has changed; (5) is teletherapy always an option? Data from the quantitative analysis provided further insights into the first two themes. While COVID-19 has brought forward significant advances in telehealth models of practice, what is needed now is to delve further into what works, for who, and in which context, and explore the potentiality, efficiencies, and scalability of a post-pandemic hybrid approach. This will inform practice guidelines and training, as well as information for service users on what to expect.
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Affiliation(s)
- Genevieve Johnsson
- Individual and Community Services, Autism Spectrum Australia, Sydney 2153, Australia
- Centre for Disability Research and Policy, University of Sydney, Sydney 2153, Australia;
| | - Kim Bulkeley
- Centre for Disability Research and Policy, University of Sydney, Sydney 2153, Australia;
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39
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Agazzi H, Hayford H, Thomas N, Ortiz C, Salinas-Miranda A. A nonrandomized trial of a behavioral parent training intervention for parents with children with challenging behaviors: In-person versus internet-HOT DOCS. Clin Child Psychol Psychiatry 2021; 26:1076-1088. [PMID: 34156883 DOI: 10.1177/13591045211027559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral parent training (BPT) programs are the first-line interventions for childhood disruptive behaviors. In light of the COVID-19 pandemic, adapting these programs to telehealth modalities is necessary to ensure continued services to children and families. This study evaluates the use of telehealth versus in-person modality to deliver the Helping Our Toddlers, Developing Our Children's Skills (HOT DOCS) BPT. The study design was quasi-experimental with two nonequivalent groups: in-person HOT DOCS (n = 152) and internet-HOT DOCS (n = 46). Participants were caregivers of children ages 2-5 exhibiting disruptive behaviors. Pre- and post-intervention outcome measures were collected for child disruptive behavior and parenting stress and post-test only for consumer satisfaction. Multiple linear and Poisson regression models were performed to assess the effect of class modality on the outcomes. Child disruptive behavior and parenting stress post-test scores for in-person and telehealth groups were not significantly different, even after adjusting for baseline characteristics. Consumer satisfaction scores were significantly more positive for the in-person group. The results of this study provide preliminary evidence for the i-HOT DOCS modality as being as effective as the in-person program. Study findings may be beneficial to practitioners utilizing telehealth interventions during the COVID-19 pandemic and onward.
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Affiliation(s)
- Heather Agazzi
- Departments of Pediatrics & Psychiatry, 33697University of South Florida, Tampa, FL, USA
| | - Holland Hayford
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Nicholas Thomas
- Harrell Center for the Study of Family Violence, College of Public Health, 27117University of South Florida, Tampa, FL, USA
| | - Cristina Ortiz
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Abraham Salinas-Miranda
- Harrell Center for the Study of Family Violence & USF Center of Excellence in Maternal and Child Health Education, Science and Practice, University of South Florida, Tampa, FL, USA
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40
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Vasa RA, Singh V, Holingue C, Kalb LG, Jang Y, Keefer A. Psychiatric problems during the COVID-19 pandemic in children with autism spectrum disorder. Autism Res 2021; 14:2113-2119. [PMID: 34231323 PMCID: PMC8420610 DOI: 10.1002/aur.2574] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/27/2023]
Abstract
Children with autism spectrum disorder (ASD) are at elevated risk for psychiatric problems in response to the COVID-19 pandemic. This risk is due to their high rates of pre-pandemic psychiatric comorbidities and the pandemic's disruption to routines and access to necessary supports. Prior research has indicated that children with ASD may experience a worsening of specific psychiatric symptoms in response to COVID-19, though this body of work is limited in scope. The present study expands this literature by examining specific types of psychiatric problems that emerged about 2 months after the onset of the pandemic, and risk factors predicting changes in these psychiatric symptoms. Parents of children with a confirmed ASD diagnosis (N = 257), who enrolled in a clinic registry at an outpatient specialty autism center, were included in this study. All data were gathered online via customized and standardized questionnaires. Results showed that 59% of children experienced either a worsening of their pre-pandemic psychiatric diagnoses and/or the development of new psychiatric symptoms during the pandemic. Multivariable regression models indicated that risk factors for increased psychiatric problems included child understanding of COVID-19, COVID-19 illness in the family, low family income, and elevated parental depression and anxiety symptoms (all p < 0.05). Findings from this study emphasize the urgent need to provide effective and accessible psychiatric services for children with ASD and their families during and after the pandemic. LAY SUMMARY: Children with ASD are at high risk for psychiatric problems during the COVID-19 pandemic. We found that 59% of children in our clinical sample are experiencing increased psychiatric problems. The child's understanding of COVID-19, COVID-19 illness in the family, low family income, and depression and anxiety symptoms in the parent increase the risk for poor mental health during the pandemic. These findings indicate the importance of helping children with ASD access mental health treatment during COVID-19.
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Affiliation(s)
- Roma A. Vasa
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Vini Singh
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
| | - Calliope Holingue
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Luther G. Kalb
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yeon Jang
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
| | - Amy Keefer
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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41
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:857-883. [PMID: 33884535 PMCID: PMC8411365 DOI: 10.1007/s10488-021-01133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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42
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Ellison KS, Guidry J, Picou P, Adenuga P, Davis TE. Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade. Clin Child Fam Psychol Rev 2021; 24:599-630. [PMID: 34114135 PMCID: PMC8191715 DOI: 10.1007/s10567-021-00358-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 01/20/2023]
Abstract
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
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Affiliation(s)
- Kimberly S Ellison
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Jerrica Guidry
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Picou
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Adenuga
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thompson E Davis
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
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43
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:884-908. [PMID: 34196884 DOI: 10.1007/s10488-021-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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44
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Duncan A, Liddle M, Stark LJ. Iterative Development of a Daily Living Skills Intervention for Adolescents with Autism Without an Intellectual Disability. Clin Child Fam Psychol Rev 2021; 24:744-764. [PMID: 34196895 PMCID: PMC8247110 DOI: 10.1007/s10567-021-00360-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 01/24/2023]
Abstract
Daily living skill deficits commonly co-occur in individuals with autism spectrum disorder (ASD). These deficits in adolescence are associated with poor outcomes, in both employment and independent living skills as adults. Currently, there are no interventions that directly target daily living skill acquisition in adolescents with ASD without an intellectual disability to facilitate a successful transition to adulthood. In this paper, we discuss the development, refinement, and initial efficacy studies of Surviving and Thriving in the Real World (STRW), a 14-session group treatment for both adolescents with ASD and their parent/caregiver that promotes attainment of critical daily living skills. We summarize initial feasibility studies that have been instrumental in the iterative development of STRW. The structure, core treatment elements, and content of STRW are described in detail. Lastly, we discuss the transition of the in-person STRW intervention to STRW-telehealth, which allows for adolescents with ASD to work on daily living skills in their own home with support from a therapist.
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Affiliation(s)
- Amie Duncan
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 USA
- University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Melissa Liddle
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 USA
| | - Lori J. Stark
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039 USA
- University of Cincinnati College of Medicine, Cincinnati, OH USA
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45
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O'Brien MJ, Pelzel KE, Hendrix NM, Schieltz KM, Miller K, Call NA, Tsami L, Lerman DC, Berg WK, Kopelman TG, Wacker DP, Lindgren SD. Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder. Behav Modif 2021; 46:971-1001. [PMID: 34041956 DOI: 10.1177/01454455211018815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.
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Affiliation(s)
- Matthew J O'Brien
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Kelly E Pelzel
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Nicole M Hendrix
- Marcus Autism Center, Atlanta, GA, USA.,Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Kelly M Schieltz
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Kenzie Miller
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Nathan A Call
- Marcus Autism Center, Atlanta, GA, USA.,Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Loukia Tsami
- The University of Houston - Clear Lake, Houston, TX, USA
| | | | - Wendy K Berg
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Todd G Kopelman
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - David P Wacker
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Scott D Lindgren
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
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46
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Wainer AL, Arnold ZE, Leonczyk C, Valluripalli Soorya L. Examining a stepped-care telehealth program for parents of young children with autism: a proof-of-concept trial. Mol Autism 2021; 12:32. [PMID: 33964979 PMCID: PMC8105688 DOI: 10.1186/s13229-021-00443-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Intervention during the first years of life for children with autism spectrum disorder (ASD) may have the strongest impact on long-term brain development and functioning. Yet, barriers such as a shortage of trained professionals contribute to significant delays in service. The goal of this proof-of-concept study was to explore strategies that support timely and equitable deployment of ASD-specific interventions. Methods This 15-week, randomized proof-of-concept study explored the acceptability of a digital parent mediated intervention online reciprocal imitation training (RIT; a naturalistic developmental behavioral intervention) and compared it to a treatment as usual (TAU) control on parent and child outcomes. Eligible children were between 18 and 60 months, met the cutoff for ASD on the Autism Diagnostic Observation Schedule-2nd Edition and demonstrate significant social imitation deficits. Primary outcomes include the acceptability of RIT (Scale of Treatment Perceptions) and the feasibility of the Online RIT digital intervention (online RIT attributes). Secondary outcomes included parent fidelity (RIT parent fidelity form) and parental self-efficacy (Early Intervention Parenting Self-Efficacy Scale). Exploratory outcome measures included child social communication (Social Communication Checklist), child imitation skills (Unstructured Imitation Assessment), and family quality of life (Beach Center Family Quality of Life Scale). Results Twenty participants were randomized in a 1:1 fashion. The acceptability and feasibility of RIT and the Online RIT digital intervention were rated highly. Among the secondary outcomes, there were significant group differences in parent fidelity (p < .001) and self-efficacy (p = .029). On exploratory outcomes, there were group differences in child social communication (p = .048). There were no significant group differences in imitation ability (p = .05) or family quality of life (p = .22). Limitations There are several limitations with this study, including the small sample size as well as lack of data on enactment and website engagement. This study was not able to address questions related to which variables predict program engagement and treatment response, which will be critical for determining which families may benefit from such a stepped-care delivery model. Conclusions Overall, the Online RIT program delivered in a stepped-care format shows strong acceptability and holds promise as an innovative delivery model. Trial registration ClinicalTrials.gov, NCT04467073. Registered 10 July 2020- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04467073
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Affiliation(s)
- Allison L Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA.
| | - Zachary E Arnold
- Department of Psychology, University of Alabama At Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Caroline Leonczyk
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
| | - Latha Valluripalli Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
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Wallis KE, Mulé C, Mittal S, Cerda N, Shaffer R, Scott A, Langkamp D, Augustyn M, Perrin E, Soares N, Blum NJ. Use of Telehealth in Fellowship-Affiliated Developmental Behavioral Pediatric Practices During the COVID-19 Pandemic. J Dev Behav Pediatr 2021; 42:314-321. [PMID: 33350655 DOI: 10.1097/dbp.0000000000000897] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to describe the use of telehealth in developmental behavioral pediatric (DBP) fellowship-affiliated practices during the coronavirus disease 2019 (COVID-19) global pandemic. METHODS An electronic survey was disseminated to all DBP fellowship-associated practice locations to determine the use of telehealth in DBP care provision, before and since the beginning of the COVID-19 pandemic. We analyzed responses using descriptive statistics. RESULTS A total of 35 of 42 eligible practice sites responded (83% response rate). Most sites (51.4%) reported using telehealth less than once per month before the COVID-19 pandemic. Since the onset of COVID-19, 100% of programs reported conducting video-based telehealth visits multiple days per week. Most sites reported conducting evaluations and follow-up visits for attention-deficit/hyperactivity disorder, autism spectrum disorder, behavioral concerns, developmental delay, genetic disorders, and learning disability. Most sites were able to continue medication management by telehealth (>88%), offer interpreter services for families with limited English proficiency participating in telehealth visits (>90%), and incorporate trainees and interdisciplinary team members in telehealth visits (>90%). Greater variability was observed in sites' ability to collect telehealth practice evaluation measures. CONCLUSION Most sites are providing evaluations and ongoing care for DBP conditions through telehealth. The rapid adoption of telehealth can have ramifications for the way that DBP care is delivered in the future; therefore, it is imperative to understand current practice patterns and variations to determine the best use of telehealth.
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Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christina Mulé
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA
| | - Shruti Mittal
- Developmental and Behavioral Pediatrics of the Carolinas, Atrium Health, Charlotte, NC
| | - Natalie Cerda
- Developmental Medicine Center, Boston Children's Hospital, Boston, MA
| | - Rebecca Shaffer
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH
| | - Angela Scott
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Diane Langkamp
- NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, OH
| | - Marilyn Augustyn
- Division of Developmental and Behavioral Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Ellen Perrin
- Division of Developmental-Behavioral Pediatrics, Tufts Children's Hospital, Boston, MA
| | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | - Nathan J Blum
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Design of an Interactive Two-Way Telemedicine Service System for Smart Home Care for the Elderly. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6632865. [PMID: 33936578 PMCID: PMC8060097 DOI: 10.1155/2021/6632865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022]
Abstract
In this paper, we deeply analyse and study the interactive telemedicine service system for elderly care in smart homes and design a data summarization method for large concurrent scenarios. The method first parses and reconstructs the data received by the system initially and then stores the reconstructed valid data into the local database, which realizes the fast data summarization under the heavy concurrency scenario. Secondly, a multiformat data adaptation method is designed for the problem that the data to be provided and processed are in various formats. The method uses a unified data format and adaptation process constraints to achieve centralized management of heterogeneous data from multiple sources, which provide a unified data support service for the system and upper-layer applications. Again, to deal with the application problem of highly correlated data, the data-sharing system provides data for each functional component of the telemedicine platform according to business requirements based on standardized data structure and unified storage management. This enables the barrier-free flow of multisource highly correlated data. When the consultation is in progress, the doctor can communicate with the patient with video and audio devices and, at the same time, can access the patient's historical medical records and the medical records uploaded by the patient; after the consultation is completed, the consultation doctor needs to fill in the consultation record. The consultation assistance module can statistically analyse the workload of doctors and other information according to the background data, and the telemedicine system will play an increasingly important role in the medical and health care business.
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Jurek L, Occelli P, Denis A, Amestoy A, Maffre T, Dauchez T, Oreve MJ, Baghdadli A, Schroder C, Jay A, Zelmar A, Revah-Levy A, Gallifet N, Aldred C, Garg S, Green J, Touzet S, Geoffray MM. Efficacy of parent-mediated communication-focused treatment in toddlers with autism (PACT) delivered via videoconferencing: a randomised controlled trial study protocol. BMJ Open 2021; 11:e044669. [PMID: 33827837 PMCID: PMC8031029 DOI: 10.1136/bmjopen-2020-044669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/04/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Intervention in the preschool period is currently recommended for autism spectrum disorder. Therapies delivered by parents are particularly suitable for young children. Preschool Autism Communication Trial (PACT) is a parent-mediated therapy that has shown a significant and sustained impact on autism symptom reduction. However, access to such evidence-based therapies for families is limited due to autism centres located in large urban areas. Using videoconferencing to deliver PACT training to parents may improve accessibility for families living in underserved areas. METHODS AND ANALYSIS This single-blind randomised controlled trial, involving six sites in France, will investigate the efficacy of a telehealth, videoconferencing-based, parent-mediated PACT therapy on autism symptoms, over a 12-month period. It will compare PACT plus treatment as usual (TAU) against TAU only in a cohort of 238 toddlers (119 per group) aged 18-36 months at inclusion and living with their families more than 40 min away from the specialist centres for autism. Primary outcome will include change of overall autism score on the Autism Diagnostic Observation Scale (ADOS) at 12 months. Secondary outcomes will measure change in child skills, child functioning, impact on parents (stress, health, priorities) and implementation characteristics. Repeated measures analyses will be used to test the effect of PACT intervention on the overall ADOS module 1 score over the 12-month study period. Linear mixed models will be used with time, treatment allocation and the interaction between treatment and time as fixed effects and individual variation as random effect. ETHICS AND DISSEMINATION This protocol (V.5, date: 25 October 2019) is approved by the French National Review Board (reference no 2018-A02516-49). The results will be disseminated via peer-reviewed journals TRIAL REGISTRATION NUMBER: NCT04244721.
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Affiliation(s)
- Lucie Jurek
- Academic department of Child and adolescent neurodevelopmental psychiatry, Hospital Centre Vinatier, Bron, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
| | - Pauline Occelli
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
- Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Angelique Denis
- Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Anouck Amestoy
- Child and Adolescent Psychiatry, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Thierry Maffre
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre de Ressources Autisme Midi-Pyrénées, University Hospital Centre Toulouse, Toulouse, France
| | - Tom Dauchez
- Child and Adolescent Psychiatry, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Marie-Joelle Oreve
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Amaria Baghdadli
- Center of ressources in Autism and Center of Excellence in Autism and Neurodevelopment disorders, University Hospital Centre Montpellier, Montpellier, France
- UVSQ, Inserm, CESP, "DevPsy", Paris-Saclay University, Villejuif, France
| | - Carmen Schroder
- Department of Child and Adolescent Psychiatry, Hopitaux universitaires de Strasbourg, Strasbourg, France
- CNRS UPR 3212 - Team 9, University of Strasbourg, Strasbourg, France
| | - Agathe Jay
- Academic department of Child and adolescent neurodevelopmental psychiatry, Hospital Centre Vinatier, Bron, France
| | - Amélie Zelmar
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
- Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Anne Revah-Levy
- Centre de Soins Psychotherapeutiques de Transition pour Adolescents, Argenteuil Health and Social Services Centre, Lachute, Quebec, Canada
- Centre of Research in Epidemiology and Statistics, ECSTRRA Team UMR-1153, INSERM, Université de Paris, Paris, France
| | - Natacha Gallifet
- Academic department of Child and adolescent neurodevelopmental psychiatry, Hospital Centre Vinatier, Bron, France
| | | | - Shruti Garg
- Division of Neuroscience and Experimental Psychology, Faculty of Biological Medical & Health Sciences, The University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, Faculty of Biological Medical & Health Sciences, The University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sandrine Touzet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
- Pôle de santé publique, Hospices Civils de Lyon, Lyon, France
| | - Marie-Maude Geoffray
- Academic department of Child and adolescent neurodevelopmental psychiatry, Hospital Centre Vinatier, Bron, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Universite Claude Bernard Lyon 1, Lyon, France
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Sadeghi S, Pouretemad HR, Shalani B. Internet-based versus face-to-face intervention training for parents of young children with excessive screen-time and autism spectrum disorder-like symptoms: a comparative study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:744-755. [PMID: 36210895 PMCID: PMC9542763 DOI: 10.1080/20473869.2021.1895699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 06/16/2023]
Abstract
Internet-based intervention approach is one novel strategy to train. However, only a few clinical trials have compared internet-based parent training intervention with an equal face-to-face intervention for children with autism spectrum disorder (ASD)-like symptoms. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for young children with excessive screen-time and ASD-like symptoms. A total of 40 mother-young children with excessive screen-time and ASD-like symptoms dyads were assigned to the Internet-based (n = 20) and to the face-to-face intervention (n = 20). Parents in both groups received intervention that involves 7 sessions (one session per week). Primary outcome measures were the Gilliam autism rating scale - second edition (GARS-2), repetitive behavior scale- revised (RBS-R) and parenting stress index (PSI). The analysis yielded no significant between-group difference for any of the pre- to post-intervention measurements. At post-intervention both intervention conditions revealed significant symptoms changes compared to before the intervention. Also, the parental stress was significant related to the child's autism symptoms and repetitive behaviors severity. Internet-based parent training intervention for young children with excessive screen-time and ASD-like symptoms and their parents is equally beneficial to regular face-to-face parent training intervention. These findings support the potential for using telehealth to provide research-based parent training interventions to any family that has access to the Internet.
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Affiliation(s)
- Saeid Sadeghi
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
- Center of Excellence in Cognitive Neuropsychology, Shahid Beheshti University, Tehran, Iran
| | - Hamid Reza Pouretemad
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
- Center of Excellence in Cognitive Neuropsychology, Shahid Beheshti University, Tehran, Iran
| | - Bita Shalani
- Department of Psychology, Tarbiat Modares University, Tehran, Iran
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