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Stefanaki A, Gkogkos G, Varlokosta S, Gena A. Applying a Parent Training Program in a Naturalistic Behavior Analytic Context to Improve Attachment in Children with ASD. J Autism Dev Disord 2023; 53:4164-4184. [PMID: 36029399 DOI: 10.1007/s10803-022-05719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
Infants develop attachment to their caregivers very early on. The quality of attachment is considered to be crucial for the emotional development of humans and animals alike. Despite its importance, very little is known about how attachment develops between children with Autism Spectrum Disorder (ASD) and their caregivers. The purpose of the present study was to assess the attachment patterns of two young children with ASD with their parents and to identify the means for promoting parent, child, and parent-child relational characteristics that may contribute to the development of secure attachment. The results replicated prior findings pertaining to attachment quality of children with ASD and demonstrated the effectiveness of a naturalistic, behavior-analytic intervention in improving the quality of their attachment.
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Affiliation(s)
- Areti Stefanaki
- Department of Educational Studies of the National and Kapodistrian University of Athens, Ethnikis Antistaseos 34-38, Nea Filadelfeia, 14343, Athens, Greece.
| | | | - Spyridoula Varlokosta
- Lab of Psycholinguistics and Neurolinguistics, Department of Philology, National and Kapodistrian, University of Athens, Nikomedeias 8, Papagou, 15669, Athens, Greece
| | - Angeliki Gena
- Department of Educational Studies, National and Kapodistrian University of Athens, Nikomedeias 66, Nea Smyrni, 17124, Athens, Greece
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2
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Vismara LA, Nyugen L, McCormick CEB. Abbreviating the Early Start Denver Model for community-based family-centered care. Front Psychol 2023; 14:1167885. [PMID: 37546470 PMCID: PMC10399628 DOI: 10.3389/fpsyg.2023.1167885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Parent-mediated approaches for young children with or with a higher likelihood of autism have gained traction, with mounting evidence of efficacy, but a research-to-gap practice exists, and community effectiveness remains to be firmly established. Methods Using a community-participatory framework, a total of 10 parent-child dyads received a five-day workshop and six follow-up sessions of ESDM parent coaching. Intervention was implemented across two phases with in-person and telehealth delivery. Results From pre to post intervention across both phases, parents improved in their fidelity of intervention implementation and children maid gains on proximal measures of social communication. Discussion Community delivery of an evidence-based parent-mediated interventions for toddlers on the autism spectrum is feasible and promising. Giving resource efficiencies associated with parent-mediated approaches, particularly when delivered through government-funded programs, findings bolster current efforts to promote earlier and more widespread community access to necessary interventions. Facilitators and barriers to supporting parent learning and behavior change via interactive strategies are discussed.
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Affiliation(s)
| | - Lucy Nyugen
- Thrive Autism Collaborative, Denver, CO, United States
| | - Carolyn E. B. McCormick
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, United States
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3
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Klusek J, Will E, Moser C, Hills K, Thurman AJ, Abbeduto L, Roberts JE. Predictors, Parental Views, and Concordance Across Diagnostic Sources of Autism in Male Youth with Fragile X Syndrome: Clinical Best Estimate and Community Diagnoses. Res Child Adolesc Psychopathol 2023; 51:989-1004. [PMID: 36867382 PMCID: PMC10795511 DOI: 10.1007/s10802-023-01044-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
Persons with fragile X syndrome (FXS) with cooccurring autism spectrum disorder (ASD) are at risk for poorer educational, medical, employment, and independent living outcomes. Thus, the identification of ASD in those with FXS is fundamental to ensuring access to appropriate supports to achieve good quality of life. Yet, optimal diagnostic methods and the exact rate of ASD comorbidity remains controversial, and description of ASD identification in the community in FXS has been limited. This study characterized ASD in a sample of 49 male youth with FXS across multiple diagnostic sources: parent-reported community diagnoses, classification derived from ADOS-2 and ADI-R thresholds, and clinical best-estimate classifications from an expert multidisciplinary team. High concordance was found between ADOS-2/ADI-R and clinical best estimate classifications, with both methods supporting ASD in ~ 75% of male youth with FXS. In contrast, 31% had a community diagnosis. Findings supported gross under-identification of ASD in male youth with FXS in community settings; 60% of those who met clinical best estimate criteria for ASD had not received a diagnosis in the community. Moreover, community diagnoses were poorly aligned with the presence of ASD symptoms as perceived by parents and professionals and, unlike clinical best estimate diagnoses, were not associated with cognitive, behavioral, or language features. Findings highlight under-identification of ASD in community settings as a significant barrier to service access for male youth with FXS. Clinical recommendations should emphasize the benefits of seeking a professional ASD evaluation for children with FXS who are noted to display key ASD symptoms.
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Affiliation(s)
- Jessica Klusek
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, 1705 College Street, Columbia, SC, 29208, USA.
| | - Elizabeth Will
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Carly Moser
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, 1705 College Street, Columbia, SC, 29208, USA
| | - Kimberly Hills
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Jane E Roberts
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
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4
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"Corp-Osa-Mente", a Combined Psychosocial-Neuropsychological Intervention for Adolescents and Young Adults with Fragile X Syndrome: An Explorative Study. Brain Sci 2023; 13:brainsci13020277. [PMID: 36831819 PMCID: PMC9953950 DOI: 10.3390/brainsci13020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Fragile X Syndrome is the most known inherited form of intellectual disability due to an expansion in the full mutation range (>200 CGG repeats) of the promoter region of the FMR1 gene located on X chromosomes leading to gene silencing. Despite clear knowledge of the cognitive-behavioral phenotype of FXS and the necessity of tailored interventions, empirical research on the effectiveness of behavioral treatments among patients with FXS is still lacking, with studies on adolescents and young adults even more insufficient. Here we present "Corposamente", a combined psychosocial-neuropsychological intervention conducted with a group of ten adolescents/young adults with FXS, who are non-ASD and without significant behavioral problems. In total, 20 sessions were performed, alternating between online and face-to-face meetings. At the end of the intervention, participants, family members and participants' educators anonymously completed a survey that was designed around key areas of improvement as well as treatment satisfaction. The survey results indicated that participants improved mostly in their ability to cope with negative emotions and that occupational intervention was considered the most effective technique both from families and participants. Our exploratory study suggests that group therapy for the management of the FXS cognitive-behavioral phenotype may be a promising approach to continue to pursue, mostly in adolescence when the environmental demands increase.
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5
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A Review of Parent-Implemented Early Start Denver Model for Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020285. [PMID: 35205005 PMCID: PMC8870866 DOI: 10.3390/children9020285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this review is to provide an overview of findings from selected research published between 2012 and 2022 in English-language peer-reviewed journals to evaluate the effectiveness of the parent-implemented Early Start Denver Model (P-ESDM). Thirteen studies used quantitative methods to examine the relationship between variables. We considered four categories of variables in the analysis: child characteristics, intervention intensity and duration, child outcome measures, and parent-related outcome measures and parental fidelity. The findings revealed positive child-parent-related outcomes. In addition, the quality of implementation, relating to parent fidelity, should be considered when evaluating the efficacy of the intervention. However, only half the studies revealed that the standard benchmark for acceptable fidelity was being achieved. Implications for future research and practice are discussed.
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6
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Protic DD, Aishworiya R, Salcedo-Arellano MJ, Tang SJ, Milisavljevic J, Mitrovic F, Hagerman RJ, Budimirovic DB. Fragile X Syndrome: From Molecular Aspect to Clinical Treatment. Int J Mol Sci 2022; 23:ijms23041935. [PMID: 35216055 PMCID: PMC8875233 DOI: 10.3390/ijms23041935] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
Fragile X syndrome (FXS) is a neurodevelopmental disorder caused by the full mutation as well as highly localized methylation of the fragile X mental retardation 1 (FMR1) gene on the long arm of the X chromosome. Children with FXS are commonly co-diagnosed with Autism Spectrum Disorder, attention and learning problems, anxiety, aggressive behavior and sleep disorder, and early interventions have improved many behavior symptoms associated with FXS. In this review, we performed a literature search of original and review articles data of clinical trials and book chapters using MEDLINE (1990-2021) and ClinicalTrials.gov. While we have reviewed the biological importance of the fragile X mental retardation protein (FMRP), the FXS phenotype, and current diagnosis techniques, the emphasis of this review is on clinical interventions. Early non-pharmacological interventions in combination with pharmacotherapy and targeted treatments aiming to reverse dysregulated brain pathways are the mainstream of treatment in FXS. Overall, early diagnosis and interventions are fundamental to achieve optimal clinical outcomes in FXS.
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Affiliation(s)
- Dragana D. Protic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia
- Correspondence: (D.D.P.); (D.B.B.); Tel.: +381-11-36-43-389 (D.D.P.); +1-443-923-2634 (D.B.B.)
| | - Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
- Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Maria Jimena Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Si Jie Tang
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
| | - Jelena Milisavljevic
- Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia; (J.M.); (F.M.)
| | - Filip Mitrovic
- Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia; (J.M.); (F.M.)
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute UCDH, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA; (R.A.); (M.J.S.-A.); (S.J.T.); (R.J.H.)
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Dejan B. Budimirovic
- Department of Psychiatry, Fragile X Clinic, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Psychiatry & Behavioral Sciences-Child Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Correspondence: (D.D.P.); (D.B.B.); Tel.: +381-11-36-43-389 (D.D.P.); +1-443-923-2634 (D.B.B.)
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7
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Lamson AL, Hodgson JL, Pratt KJ, Mendenhall TJ, Wong AG, Sesemann EM, Brown BJ, Taylor ES, Williams-Reade JM, Blocker DJ, Harsh Caspari J, Zubatsky M, Martin MP. Couple and family interventions for high mortality health conditions: A strategic review (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:307-345. [PMID: 34741539 DOI: 10.1111/jmft.12564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.
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Affiliation(s)
- Angela L Lamson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Jennifer L Hodgson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Services, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education & Human Ecology, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tai J Mendenhall
- Department of Family Social Science, University of Minnesota, Saint Paul, Minnesota, USA
| | - Alison G Wong
- Department of Marriage and Family Therapy, Fuller School of Psychology and Marriage and Family Therapy, Pasadena, California, USA
| | | | - Braden J Brown
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Athletics Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Erika S Taylor
- Department of Family Medicine, Behavioral Medicine Section, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Daniel J Blocker
- Pomona Valley Family Medicine Residency, Pomona Valley Hospital Medical Center, Pomona, California, USA
| | - Jennifer Harsh Caspari
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Matthew P Martin
- Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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8
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Alfieri P, Scibelli F, Casula L, Piga S, Napoli E, Valeri G, Vicari S. Cooperative Parent-Mediated Therapy in Children with Fragile X Syndrome and Williams Beuren Syndrome: A Pilot RCT Study of a Transdiagnostic Intervention-Preliminary Data. Brain Sci 2021; 12:8. [PMID: 35053752 PMCID: PMC8773548 DOI: 10.3390/brainsci12010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/05/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023] Open
Abstract
Children with fragile X syndrome and William Beuren syndrome share several socio-communicative deficits. In both populations, around 30/35% of individuals meets criteria for autism spectrum disorder on gold standard instruments. Notwithstanding, few studies have explored feasibility and validity of therapy for socio-communicative deficits in individuals with these genetic conditions. In this study, we present preliminary data on a pilot RCT aimed to verify the effectiveness of cooperative parent-mediated therapy for socio-communicative deficits in a transdiagnostic perspective in a small sample of 12 participants. Our preliminary data showed that the experimental group had significant improvement in one socio-communicative skill (responsivity) and in clinical global impression, while the control group in an adaptive measure of socialization and word production. Implications of these results are then discussed.
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Affiliation(s)
- Paolo Alfieri
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children′s Hospital, IRCCS, 00165 Rome, Italy; (F.S.); (L.C.); (E.N.); (G.V.); (S.V.)
| | - Francesco Scibelli
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children′s Hospital, IRCCS, 00165 Rome, Italy; (F.S.); (L.C.); (E.N.); (G.V.); (S.V.)
| | - Laura Casula
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children′s Hospital, IRCCS, 00165 Rome, Italy; (F.S.); (L.C.); (E.N.); (G.V.); (S.V.)
| | - Simone Piga
- Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Eleonora Napoli
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children′s Hospital, IRCCS, 00165 Rome, Italy; (F.S.); (L.C.); (E.N.); (G.V.); (S.V.)
| | - Giovanni Valeri
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children′s Hospital, IRCCS, 00165 Rome, Italy; (F.S.); (L.C.); (E.N.); (G.V.); (S.V.)
| | - Stefano Vicari
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children′s Hospital, IRCCS, 00165 Rome, Italy; (F.S.); (L.C.); (E.N.); (G.V.); (S.V.)
- Department of Life Sciences and Public Health, Catholic University, 00168 Rome, Italy
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9
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Will EA, Roberts JE. Motor Influences on Communication: Comparisons Between Down Syndrome and Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:460-476. [PMID: 34700347 PMCID: PMC8764748 DOI: 10.1352/1944-7558-126.6.460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
Motor skills, an important foundation for language and communication, are considerably delayed in children with Down syndrome (DS) and fragile X syndrome (FXS). However, the impact of these impairments on expressive and receptive communication and the phenotypic specificity of these associations remains unknown. Participants included 37 with DS and 37 age and developmentally matched children with FXS. Syndrome-specific motor and communication profiles emerged, with higher communication scores seen in the DS versus FXS on, but lower gross motor scores. Significant associations between domains of motor and communication were identified for both groups with additional phenotype-specific patterns. Findings demonstrate the importance of early motor abilities for communication in DS and FXS. Implications for phenotypic specificity and targeted intervention are discussed.
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Affiliation(s)
- Elizabeth A. Will
- Corresponding Author: Dr. Elizabeth A. Will, Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, South Carolina, 29208 ()
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10
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Shire SY, Worthman LB, Arbuckle S. A Technology-Enabled Adaptation of Face-to-Face Caregiver-Mediated JASPER Intervention: Preliminary Examination of Video Conferenced Caregiver Coaching. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:421-434. [PMID: 34428271 DOI: 10.1352/1944-7558-126.5.421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
Family-centered practices that involve direct participation of caregivers as part of intervention is critical to effective early intervention. However, regularly scheduled, in person service delivery is not always possible in remote communities, prompting a need for adaptations to the delivery of services, such as the use of live video conferencing to coach caregivers in strategies to promote their children's development. In this study, caregivers and their children ages 2-9 with autism who were living in rural and remote Canadian communities were included. A concurrent multiple baseline design across participants was applied to examine the effects of live video conference caregiver coaching on children's time jointly engaged with caregivers and caregivers' intervention strategy implementation. Results indicated that all children demonstrated greater time jointly engaged and caregivers demonstrated greater use of strategies in comparison to baseline. The results of this study offer preliminary evidence of the effectiveness of real time video conference coaching for caregivers engaging their children with ASD in play.
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Bullard L, Abbeduto L. Responsive Parenting as a Target for Telehealth Language Interventions in Fragile X Syndrome: Implications for Scalability and Best Practices. Semin Speech Lang 2021; 42:287-300. [PMID: 34311481 DOI: 10.1055/s-0041-1730989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review highlights the ways in which telehealth procedures can be implemented to help bridge the research-to-practice gap in supporting developmental outcomes for youth with fragile X syndrome (FXS). We review how the literature to date has informed potential treatment targets in the areas of speech and language development with a focus on understanding and supporting the dyadic relationship between the child and their biological mother, who is also impacted biologically. Notably, parental responsivity is an area that is strongly related to child language outcomes, both early and into adolescence, and thus, it is an important treatment target for subsequent interventions. To date, several parent-implemented interventions have been done in FXS across a broad age range (2-17-year-olds) all showing support not only that parents are successful in learning responsive strategies but also that there are subsequent impacts to child language development. Moreover, these interventions were successfully implemented at a distance through telehealth procedures including video teleconferencing and shared recordings of parent-child interactions. This review also addresses potential moderators of treatment gains. Implications for scaling such interventions in the future as well as best practices for incorporating telehealth procedures into future research and intervention programs are also discussed.
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Affiliation(s)
- Lauren Bullard
- MIND Institute, UC Davis Health, Sacramento, California.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
| | - Leonard Abbeduto
- MIND Institute, UC Davis Health, Sacramento, California.,Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, California
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12
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The effectiveness of early parental coaching in the autism spectrum disorder. J Pediatr (Rio J) 2021; 97:453-458. [PMID: 33069667 PMCID: PMC9432305 DOI: 10.1016/j.jped.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Analysis of the effectiveness of early Parental Coaching in the Autism Spectrum Disorder. METHOD Randomized, controlled and blinded clinical trial to analyze parent-child interaction videos. RESULTS The sample consisted of 18 children being followed up at the Autism Outpatient Clinic of a Neuropediatric Center in southern Brazil diagnosed with Autism Spectrum Disorder, between 29 and 42 months of age, randomly allocated to two groups: the Study Group (SG; n=9), which received Parental Coaching performed by a professional certified by the Early Start Denver Model; and the Control Group (CG; n=9), which was in a routine follow-up, without treatment and training of parents by a trained professional. The parents of the SG were willing to attend weekly meetings and to apply the instructional techniques at home with their children. It took 12 weeks and an average of 2h per meeting. CONCLUSIONS The learning rate for comprehensive development skills in the Early Start Denver Model checklist, such as receptive communication, expressive communication, social capacity, imitation, cognition, games, fine motor skills, gross motor skills, behavior, and personal independence was significantly higher in the SG, as well as the strategies and the quality of interaction between parents and children. Thus, Parental Coaching presents as a possibility of early intervention in children with Autism Spectrum Disorder.
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13
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Wheeler AC, Gwaltney A, Raspa M, Okoniewski KC, Berry-Kravis E, Botteron KN, Budimirovic D, Hazlett HC, Hessl D, Losh M, Martin GE, Rivera SM, Roberts JE, Bailey DB. Emergence of Developmental Delay in Infants and Toddlers With an FMR1 Mutation. Pediatrics 2021; 147:peds.2020-011528. [PMID: 33911031 PMCID: PMC8086007 DOI: 10.1542/peds.2020-011528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Children with FMR1 gene expansions are known to experience a range of developmental challenges, including fragile X syndrome. However, little is known about early development and symptom onset, information that is critical to guide earlier identification, more accurate prognoses, and improved treatment options. METHODS Data from 8 unique studies that used the Mullen Scales of Early Learning to assess children with an FMR1 gene expansion were combined to create a data set of 1178 observations of >500 young children. Linear mixed modeling was used to explore developmental trajectories, symptom onset, and unique developmental profiles of children <5 years of age. RESULTS Boys with an FMR1 gene full mutation showed delays in early learning, motor skills, and language development as young as 6 months of age, and both sexes with a full mutation were delayed on all developmental domains by their second birthday. Boys with a full mutation continued to gain skills over early childhood at around half the rate of their typically developing peers; girls with a full mutation showed growth at around three-quarters of the rate of their typically developing peers. Although children with a premutation were mostly typical in their developmental profiles and trajectories, mild but significant delays in fine motor skills by 18 months were detected. CONCLUSIONS Children with the FMR1 gene full mutation demonstrate significant developmental challenges within the first 2 years of life, suggesting that earlier identification is needed to facilitate earlier implementation of interventions and therapeutics to maximize effectiveness.
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Affiliation(s)
- Anne C. Wheeler
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Angela Gwaltney
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Melissa Raspa
- Research Triangle Institute International, Research Triangle Park, North Carolina
| | | | | | - Kelly N. Botteron
- Departments of Psychiatry and Radiology, School of Medicine, Washington University, St Louis, Missouri
| | | | - Heather Cody Hazlett
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David Hessl
- Department of Psychiatry and Behavioral Sciences, MIND Institute, Sacramento, California
| | - Molly Losh
- School of Communication, Northwestern University, Evanston, Illinois
| | - Gary E. Martin
- Department of Communication Sciences and Disorders, St. John’s University, Staten Island, New York
| | - Susan M. Rivera
- Department of Psychiatry and Behavioral Sciences, MIND Institute, Sacramento, California;,Department of Psychology, College of Letters and Science, University of California, Davis, Davis, California; and
| | - Jane E. Roberts
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Donald B. Bailey
- Research Triangle Institute International, Research Triangle Park, North Carolina
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Hall SS, Monlux KD, Rodriguez AB, Jo B, Pollard JS. Telehealth-enabled behavioral treatment for problem behaviors in boys with fragile X syndrome: a randomized controlled trial. J Neurodev Disord 2020; 12:31. [PMID: 33218305 PMCID: PMC7679978 DOI: 10.1186/s11689-020-09331-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/07/2020] [Indexed: 01/18/2023] Open
Abstract
Background Children with fragile X syndrome (FXS) are at increased risk for exhibiting problem behaviors such as aggression and self-injury. However, many children with FXS have limited access to behavioral treatments that have known efficacy due to the low availability of treatment providers and the wide geographical dispersion of families with FXS across the country. Telehealth may offer a cost-effective and practical solution to overcome these significant barriers. We examined the effect of administering an established behavior analytic intervention called functional communication training (FCT) via telehealth on levels of problem behaviors exhibited by boys with FXS. We also examined treatment acceptability, as well as the effect of the treatment on levels of parenting stress. Methods Boys with FXS, aged 3 to 10 years, who displayed problem behaviors daily, were randomized to receive FCT via telehealth (n = 30) or treatment as usual (n = 27) over 12 weeks. Outcome measures included in-session observations of problem behavior, the Aberrant Behavior Checklist—Community (ABC-C), the Treatment Acceptability Rating Form—Revised (TARF-R), and the Parenting Stress Index, 4th edition (PSI-4). Results Intention-to-treat analyses indicated that scores on the irritability subscale of the ABC-C, our primary outcome measure, decreased significantly for boys who received FCT via telehealth compared to boys who received treatment as usual (p < .001, Cohen’s d = 0.65). In-session observations conducted for those who received treatment showed that levels of problem behavior decreased by 91% from baseline. Levels of parenting stress related to child behavioral problems were also lower following FCT treatment, and caregivers reported that the intervention was acceptable. Conclusions These findings support telehealth-enabled FCT as a framework for expanding access to behavioral treatments for problem behaviors in children with FXS. Expanded delivery of behavior analytic treatment via telehealth also has the potential to lower healthcare costs, improve child and family quality of life, and lead to advances in the treatment of problem behavior in the broader population of individuals with neurodevelopmental disorders. Trial registration ClinicalTrials.gov, NCT03510156. Registered 27 April 2018
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Affiliation(s)
- Scott S Hall
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Katerina D Monlux
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Arlette Bujanda Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Behavior Change Institute, Oakland, CA, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joy S Pollard
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Behavior Change Institute, Oakland, CA, USA
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15
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Talbott MR, Miller MR. Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:688-700. [PMID: 32701034 PMCID: PMC7541743 DOI: 10.1080/15374416.2020.1790382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.
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Affiliation(s)
- Meagan R Talbott
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
| | - Meghan R Miller
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
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16
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Usher LV, DaWalt LS, Hong J, Greenberg JS, Mailick MR. Trajectories of Change in the Behavioral and Health Phenotype of Adolescents and Adults with Fragile X Syndrome and Intellectual Disability: Longitudinal Trends Over a Decade. J Autism Dev Disord 2020; 50:2779-2792. [PMID: 32040800 PMCID: PMC7377950 DOI: 10.1007/s10803-020-04367-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study examined trajectories of daily living skills, behavior problems, body mass index (BMI), and health conditions spanning nearly a decade in adolescents and adults with fragile X syndrome (N = 134; age range at study end = 19-49 years), examining influences of sex and autism spectrum disorder (ASD) symptoms. Hierarchical linear modeling revealed early increases in daily living skills, with decreases at older ages. Behavior problems became less severe over time, with some increases at older ages. Individuals gained weight and had increasing health problems over time. Fewer ASD symptoms were associated with greater daily living skills and fewer behavior problems at study start. This study offers some of the first prospective quantitative analyses of behavioral and health life course trajectories in FXS.
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Affiliation(s)
- Lauren V Usher
- University of Wisconsin-Madison Waisman Center, 1500 Highland Avenue, Room 531A, Madison, WI, 53705, USA.
| | - Leann S DaWalt
- University of Wisconsin-Madison Waisman Center, 1500 Highland Avenue, Room 531A, Madison, WI, 53705, USA
| | - Jinkuk Hong
- University of Wisconsin-Madison Waisman Center, 1500 Highland Avenue, Room 531A, Madison, WI, 53705, USA
| | - Jan S Greenberg
- University of Wisconsin-Madison Waisman Center, 1500 Highland Avenue, Room 531A, Madison, WI, 53705, USA
| | - Marsha R Mailick
- University of Wisconsin-Madison Waisman Center, 1500 Highland Avenue, Room 531A, Madison, WI, 53705, USA
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17
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Thurman AJ, Potter LA, Kim K, Tassone F, Banasik A, Potter SN, Bullard L, Nguyen V, McDuffie A, Hagerman R, Abbeduto L. Controlled trial of lovastatin combined with an open-label treatment of a parent-implemented language intervention in youth with fragile X syndrome. J Neurodev Disord 2020; 12:12. [PMID: 32316911 PMCID: PMC7175541 DOI: 10.1186/s11689-020-09315-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/27/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to conduct a 20-week controlled trial of lovastatin (10 to 40 mg/day) in youth with fragile X syndrome (FXS) ages 10 to 17 years, combined with an open-label treatment of a parent-implemented language intervention (PILI), delivered via distance video teleconferencing to both treatment groups, lovastatin and placebo. METHOD A randomized, double-blind trial was conducted at one site in the Sacramento, California, metropolitan area. Fourteen participants were assigned to the lovastatin group; two participants terminated early from the study. Sixteen participants were assigned to the placebo group. Lovastatin or placebo was administered orally in a capsule form, starting at 10 mg and increasing weekly or as tolerated by 10 mg increments, up to a maximum dose of 40 mg daily. A PILI was delivered to both groups for 12 weeks, with 4 activities per week, through video teleconferencing by an American Speech-Language Association-certified Speech-Language Pathologist, in collaboration with a Board-Certified Behavior Analyst. Parents were taught to use a set of language facilitation strategies while interacting with their children during a shared storytelling activity. The main outcome measures included absolute change from baseline to final visit in the means for youth total number of story-related utterances, youth number of different word roots, and parent total number of story-related utterances. RESULTS Significant increases in all primary outcome measures were observed in both treatment groups. Significant improvements were also observed in parent reports of the severity of spoken language and social impairments in both treatment groups. In all cases, the amount of change observed did not differ across the two treatment groups. Although gains in parental use of the PILI-targeted intervention strategies were observed in both treatment groups, parental use of the PILI strategies was correlated with youth gains in the placebo group and not in the lovastatin group. CONCLUSION Participants in both groups demonstrated significant changes in the primary outcome measures. The magnitude of change observed across the two groups was comparable, providing additional support for the efficacy of the use of PILI in youth with FXS. TRIAL REGISTRATION US National Institutes of Health (ClinicalTrials.gov), NCT02642653. Registered 12/30/2015.
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Affiliation(s)
- Angela John Thurman
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA. .,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA.
| | - Laura A Potter
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Pediatrics, University of California Davis Health, Sacramento, USA
| | - Kyoungmi Kim
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Public Health Sciences, University of California Davis Health, Sacramento, USA
| | - Flora Tassone
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Biochemistry and Molecular Medicine, University of California Davis Health, Sacramento, USA
| | - Amy Banasik
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| | - Sarah Nelson Potter
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Human Ecology, University of California Davis, Davis, USA
| | - Lauren Bullard
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Human Ecology, University of California Davis, Davis, USA
| | - Vivian Nguyen
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| | - Andrea McDuffie
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
| | - Randi Hagerman
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Pediatrics, University of California Davis Health, Sacramento, USA
| | - Leonard Abbeduto
- MIND Institute, University of California Davis Health, 2825 50th Street, Room 2335, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, USA
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