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Su WC, Cleffi C, Srinivasan S, Bhat A. A Pilot Study Comparing the Efficacy, Fidelity, Acceptability, and Feasibility of Telehealth and Face-to-Face Creative Movement Interventions in Children with Autism Spectrum Disorder. TELEMEDICINE REPORTS 2024; 5:67-77. [PMID: 38558955 PMCID: PMC10979681 DOI: 10.1089/tmr.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 04/04/2024]
Abstract
Aims We compared the efficacy, fidelity, acceptability, and feasibility of a creative movement (CM) intervention for children with autism spectrum disorder (ASD), delivered face-to-face (F2F) or through telehealth (TH). Methods Fifteen children with ASD received the CM intervention F2F or through TH. Motor assessments were used to evaluate effects of F2F and TH interventions on children's motor skills, while video coding was used to assess affect, socially directed verbalization, interpersonal synchrony, and motor coordination during training. Stakeholder feedback and training fidelity data on the intervention were also collected. Results Children in both subgroups showed similar baseline performance and training-related improvements in motor skills, positive/interested affect, socially directed verbalization, interpersonal synchrony, and dual/multilimb coordination. Parents in the TH subgroup considered the intervention feasible and acceptable; however, they reported greater effort to supervise and redirect their child's attention compared to the F2F subgroup. Trainers for the TH subgroup reported more communication difficulties, technological issues, and longer session lengths, but found greater parental involvement compared to the F2F subgroup. Conclusions CM interventions are consistent, acceptable, feasible, and effective in improving social, behavioral-affective, and motor skills of children with ASD, regardless of the method of delivery. Clinicians should make efforts to reduce communication/technological issues and parental burden when delivering CM interventions through TH. ClinicalTrials.Gov Study ID-NCT04258254.
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Affiliation(s)
- Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Corina Cleffi
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Anjana Bhat
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Biomechanics & Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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Su WC, Cleffi C, Srinivasan S, Bhat A. Telehealth Versus Face-to-Face Fine Motor and Social Communication Interventions for Children With Autism Spectrum Disorder: Efficacy, Fidelity, Acceptability, and Feasibility. Am J Occup Ther 2023; 77:7706205130. [PMID: 38048263 PMCID: PMC10846418 DOI: 10.5014/ajot.2023.050282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
IMPORTANCE The efficacy of telehealth (TH) interventions needs to be studied. OBJECTIVE To compare the efficacy, fidelity, acceptability, and feasibility of face-to-face (F2F) versus TH seated play (SP) interventions among children with autism spectrum disorder (ASD). DESIGN As part of a larger randomized controlled trial, children were assigned to the SP group and received TH and F2F interventions over 8 wk using a pretest-posttest study design. SETTING A research lab or through videoconferencing. PARTICIPANTS Fifteen children with ASD (ages 5-14 yr) were randomly assigned to the SP group and received the intervention F2F or through TH. INTERVENTION Children received 16 SP intervention sessions (2 sessions per week for 8 wk). OUTCOMES AND MEASURES Pretests and posttests included standardized fine motor assessments. Video coding compared socially directed verbalization during training sessions. Parents and trainers provided feedback on their experiences. RESULTS Seven children received the intervention F2F, whereas 8 received TH intervention. Children in both subgroups showed similar training improvements in fine motor skills and socially directed verbalizations (ps > .01). Parents rated both interventions as acceptable and feasible; however, they reported longer preparation time and effort during TH interventions (ps < .01). Trainers reported greater parental involvement but more communication and technological issues during TH interventions. Fidelity checks indicated fewer reinforcements during TH versus F2F sessions. CONCLUSIONS AND RELEVANCE TH intervention is feasible and effective in improving fine motor and social communication performance. Clinicians should reduce parental burden and overcome technological issues. What This Article Adds: This study confirmed the efficacy, fidelity, acceptability, and feasibility of delivering seated play, standard of care interventions for children with autism spectrum disorder via telehealth. However, clinicians should work on reducing parental burden and overcoming communication and technological issues related to telehealth.
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Affiliation(s)
- Wan-Chun Su
- Wan-Chun Su, PhD, MS, PT, is Postdoctoral Fellow, National Institutes of Health, Bethesda, Maryland
| | - Corina Cleffi
- Corina Cleffi, BS, is Graduate Student, Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark
| | - Sudha Srinivasan
- Sudha Srinivasan, PhD, MS, PT, is Assistant Professor, Physical Therapy Program, Department of Kinesiology; Institute for Health, Intervention, and Policy; and Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Anjana Bhat
- Anjana Bhat, MS, PhD, PT, is Professor, Department of Physical Therapy, Biomechanics and Movement Science Program, and Department of Psychological and Brain Sciences, University of Delaware, Newark;
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Mahmoud HK, Mourad GM, Zaki RAH, Mohammed HS. Effect of counselling intervention on stress and expressed emotions among family caregivers of children with autism. J Med Life 2023; 16:1646-1651. [PMID: 38406776 PMCID: PMC10893565 DOI: 10.25122/jml-2023-0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/18/2023] [Indexed: 02/27/2024] Open
Abstract
Parenting a child with autism represents an extraordinary challenge for families, resulting in prominent levels of stress and burden that subsequently affect their expressed emotions. This study aimed to evaluate the effect of counseling intervention on stress and expressed emotions among family caregivers of children with autism. The research used a pre-post interventional design, to evaluate 40 family caregivers of children with autism. The interviewing questionnaire assessed socio-demographic data, expressed emotions, and parenting stress, revealing that 57.5% of the evaluated family caregivers had severe stress pre-counseling, compared to 25% post-counseling intervention. Additionally, 80% of them had elevated levels of expressed emotions pre-counseling, compared to 32.5% during the post-counseling intervention. Most family caregivers of children with autism experienced significant levels of expressed emotions, and over half of them had severe levels of stress. However, these levels decreased following the implementation of the counseling interventions. Furthermore, there were highly statistically significant correlations between the total levels of expressed emotions and total stress levels among family caregivers before and after the implementation of the counseling intervention.
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Affiliation(s)
- Hend Karem Mahmoud
- Psychiatric/Mental Health Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | - Ghada Mohammed Mourad
- Psychiatric/Mental Health Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | - Rania Abdel-Hamid Zaki
- Psychiatric/Mental Health Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | - Hoda Sayed Mohammed
- Psychiatric/Mental Health Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
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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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Ferguson J, Dounavi K, Craig EA. The Efficacy of Using Telehealth to Coach Parents of Children with Autism Spectrum Disorder on How to Use Naturalistic Teaching to Increase Mands, Tacts and Intraverbals. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 35:417-447. [PMID: 35919665 PMCID: PMC9334541 DOI: 10.1007/s10882-022-09859-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 05/26/2023]
Abstract
UNLABELLED There is a growing body of evidence supporting the use of telehealth to provide parent training in behaviour analytic interventions and researchers have begun to focus on international demonstrations of this model. The current study assessed the efficacy of a training package focused on naturalistic teaching strategies designed to upskill parents of children with autism spectrum disorder and provide them with ready to use strategies to increase social communication behaviours across verbal operants. Two parent-child dyads were trained to increase mand, tact and intraverbals during play. Parents displayed increases in fidelity for each strategy and viewed the training favourably. Both children showed gains across verbal operants, as captured by a multiple baseline across behaviours design. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10882-022-09859-4.
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Affiliation(s)
- Jenny Ferguson
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| | - Katerina Dounavi
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| | - Emma A. Craig
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
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Pacione L. Telehealth-delivered caregiver training for autism: Recent innovations. Front Psychiatry 2022; 13:916532. [PMID: 36620655 PMCID: PMC9811175 DOI: 10.3389/fpsyt.2022.916532] [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] [Received: 04/09/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Providing treatment to children with autism is a global health priority, and research demonstrates that caregivers can be trained in techniques to promote their child's social interaction, communication, play, positive behavior and skills. These caregiver-mediated interventions have been shown to promote a number of positive outcomes in children with autism, as well as their caregivers. When provided by telehealth, data indicate that caregiver training is acceptable and feasible, and associated with similar positive outcomes as live face-to-face training. Telehealth innovations, which have accelerated during the COVID-19 era, have demonstrated advantages over in-person delivery of services in terms of cost effectiveness and increased accessibility, however, more research is needed on feasibility, acceptability and effectiveness for different populations in different contexts. This brief review will highlight recent caregiver skills training interventions for autism that have been successfully adapted or designed for telehealth delivery. Telehealth interventions that are scalable, adaptable, caregiver-mediated, open-access, and delivered as part of a stepped care model, have the potential to address the global treatment gap for families of children with autism and other neurodevelopmental disabilities. Considerations relevant to the global scale-up of caregiver-mediated interventions will also be discussed.
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Affiliation(s)
- Laura Pacione
- Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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