Feasibility of an app-based parent-mediated speech production intervention for minimally verbal autistic children: development and pilot testing of a new intervention

Barriers and facilitators to paediatric caregivers' participation in virtual speech, language, and hearing services: A scoping review

Purpose

Virtual care-related technologies are transforming the way in which health services are delivered. A growing number of studies support the use of virtual care in the field of audiology and speech-language pathology; however, there remains a need to identify and understand what influences caregiver participation within the care that is virtual and family-focused. This review aimed to identify, synthesize, and summarize the literature around the reported barriers and facilitators to caregiver participation in virtual speech/hearing assessment and/or intervention appointments for their child.

Methods

A scoping review was conducted following the Joanna Briggs Institute manual for evidence synthesis. A search was conducted using six databases including MEDLINE, CINAHL, SCOPUS, ERIC, Nursing and Allied Health, and Web of Science to collect peer-reviewed studies of interest. Data was extracted according to a protocol published on Figshare, outlining a predefined data extraction form and search strategy.

Results

A variety of service delivery models and technology requirements were identified across the 48 included studies. Caregiver participation was found to vary across levels of attendance and involvement according to eight categories: Attitudes, child behavioral considerations, environment, opportunities, provider-family relationship, role in care process, support, and technology.

Conclusions

This review presents a description of the key categories reported to influence caregiver participation in virtual care appointments. Future research is needed to explore how the findings can be used within family-centered care models to provide strategic support benefiting the use and outcomes of virtual care.

The Implementation of Application Software to Improve Verbal Communication in Children with Autism Spectrum Disorder: A Review

Autism-assistive apps offer therapists and caregivers new approaches for educating and assisting individuals with autism spectrum disorder (ASD), mainly in social interaction. Even though these apps are deemed effective, they are not. These autism-assistive apps are not highly customizable, which limits their usefulness. This article examined the application software that was applied to encourage verbal communication in the intervention for children with ASD. The aim was to determine the minimum requirements for a verbal communication intervention app that adequately satisfies children with ASD, caregivers, and therapists. Databases were searched, including Scopus, Springer, PubMed, Education Resources Information Centre, and Google Scholar, with the following free-text terms combining Boolean operators: autism, children, intervention, verbal communication, software, app, and technology. A total of fifteen studies were found relevant, and the following information was collected: participant characteristics, information on the devices and apps, target behaviors, intervention procedures, and intervention outcomes. The findings suggest that the autism-assistive apps effectively improve verbal communication of children with ASD. For that, the apps should be attractive and engaging to the children with ASD, able to identify the child’s capability and suggest appropriate lesson activities, as well as encompass specific learning outcomes with multilevel lesson strategy. The apps should also use systematic evidence-based intervention procedures in the activities, be able to evaluate the child’s learning progress, and allow caregivers or therapists to keep track of application usage and performance. The use of apps in intervention does provide many benefits. However, they should never replace qualified therapists. App-based interventions make home-based treatment more focused, systematic, and economical.

A Randomized Case Series Approach to Testing Efficacy of Interventions for Minimally Verbal Autistic Children

BACKGROUND

Randomized Controlled Trials (RCTs) are the gold standard for assessing whether an intervention is effective; however, they require large sample sizes in order to detect small effects. For rare or complex populations, we advocate a case series approach as a more realistic and useful first step for intervention evaluation. We consider the importance of randomization to such designs, and advocate for the use of Randomization Tests and Between Case Effect Sizes to provide a robust and statistically powerful evaluation of outcomes. In this tutorial, we describe the method, procedures, and analysis code necessary to conduct robust single case series, using an empirical example with minimally verbal autistic children.

METHOD

We applied a pre-registered (https://osf.io/9gvbs) randomized baseline design with between-case effect size to a case series (n = 19), to test the efficacy of a novel, parent-mediated, app-based speech production intervention (BabbleBooster) for minimally verbal autistic children. Parent-rated probe scores were used to densely sample performance accuracy over time.

RESULTS

Parents were able to reliably code their children's speech productions using BabbleBooster. A non-significant Randomization Test and small Between-Case Effect Size (d = 0.267), suggested there was no evidence that BabbleBooster improved speech production in minimally verbal autistic children, relative to baseline scores, during this brief period of intervention.

CONCLUSION

The current analyses exemplify a more robust approach to examining treatment effects in rare or complex populations, where RCT may be difficult or premature to implement. To facilitate adoption of this method by researchers and practitioners, we provide analysis code that can be adapted using open source R packages. Future studies could use this case series design to evaluate interventions aiming to improve speech and language outcomes for minimally verbal autistic children, and other heterogeneous and hard to reach populations.