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Zitter A, Rinn H, Szapuova Z, Avila-Pons VM, Coulter KL, Stahmer AC, Robins DL, Vivanti G. Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism? J Autism Dev Disord 2023; 53:1618-1628. [PMID: 34855051 PMCID: PMC9160204 DOI: 10.1007/s10803-021-05371-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
There is increasing evidence supporting the effectiveness of the Early Start Denver Model (ESDM) for children on the autism spectrum. However, substantial variability in response to the ESDM has been reported across participants. We examined the plausible yet untested hypothesis that variations in the fidelity level of therapists delivering the intervention contribute to variability in children's response to the ESDM. Videotaped sessions (n = 40) of toddlers on the autism spectrum who received the ESDM from trained therapists were coded to obtain measures of therapist fidelity and children's learning in response to the therapists' instruction. Variations in overall fidelity, along with variations in most items included in the ESDM fidelity checklist, contributed to the children's learning response during the sessions.
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Affiliation(s)
- Ashley Zitter
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Hezekiah Rinn
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Zofia Szapuova
- Lekárska Fakulta, UK Bratislava, Špitálska 24, 813 72, Bratislava, Slovakia
| | - Vanessa M Avila-Pons
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, 95817, USA
| | - Kirsty L Coulter
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, 95817, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA.
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
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Wieckowski AT, Thomas RP, Chen CMA, Zitter A, Fein DA, Barton ML, Adamson LB, Robins DL. Effect of Brief Training to Identify Autism Spectrum Disorder During Toddler Well-Child Care Visits. J Dev Behav Pediatr 2021; 42:666-671. [PMID: 34618724 PMCID: PMC8497937 DOI: 10.1097/dbp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effect of a brief Enhanced training using the information-motivation-behavior (IMB) change model on improving providers' surveillance rates and accuracy of autism spectrum disorder (ASD) detection. METHOD Toddlers (n = 5,672) were screened for ASD during their pediatric well-child visits. Pediatric providers (n = 120) were randomized to receive Enhanced (incorporating components of the IMB model) or Control training. Providers indicated whether they had an ASD concern at each well-child visit. Toddlers who were positive on any screener and/or whose provider indicated ASD concern were invited for a diagnostic evaluation. Differences in provider-indicated ASD concerns before and after training were evaluated using log-linear analyses. RESULTS The Enhanced training did not have a significant effect on provider-endorsed ASD concerns (p = 0.615) or accuracy of endorsing concerns (p = 0.619). Providers in the Control training showed a significant reduction in indicating whether or not they had concerns after the training (from 71.9% to 64.3%), which did not occur in the Enhanced group. The Enhanced training led to more frequent endorsements of language (χ2 = 8.772, p = 0.003) and restricted and repetitive behavior (χ2 = 7.918, p = 0.005) concerns for children seen after training. CONCLUSION Provider training had limited impact on ASD surveillance, indicating the importance of using formal screening instruments that rely on parent report during well-child visits to complement developmental surveillance. Future research should examine whether providers who indicate specific concerns are more likely to accurately refer children for ASD evaluations.
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Affiliation(s)
| | - Rebecca P. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Chi-Ming A. Chen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Ashley Zitter
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Deborah A. Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Marianne L. Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | | | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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McCleery JP, Zitter A, Solórzano R, Turnacioglu S, Miller JS, Ravindran V, Parish-Morris J. Safety and Feasibility of an Immersive Virtual Reality Intervention Program for Teaching Police Interaction Skills to Adolescents and Adults with Autism. Autism Res 2020; 13:1418-1424. [PMID: 32762029 DOI: 10.1002/aur.2352] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/17/2020] [Accepted: 06/18/2020] [Indexed: 11/07/2022]
Abstract
Low-cost, wireless immersive virtual reality (VR) holds significant promise as a flexible and scalable intervention tool to help individuals with autism spectrum disorder (ASD) learn and develop critical practical life skills, including interacting safely and effectively with police officers. Previous research suggests that VR is a motivating intervention platform, but many individuals with ASD also exhibit anxiety and sensory sensitivities which might make it difficult to tolerate VR experiences. Here, we describe the results of a relatively large-scale, National Institutes of Health-funded systematic examination of the safety, feasibility, and usability of an immersive VR training program in adolescents and adults with ASD, aged 12 and older. Sixty verbally fluent individuals with no personal or immediate family history of seizures or migraines participated in either one (n = 30) or three 45-min (n = 30) VR sessions using a lightweight wireless headset, and were monitored for side effects. Participants also reported on system usability, enjoyment, and willingness to engage in further VR sessions. Results confirm that immersive VR is safe, feasible, and highly usable for verbally fluent adolescents and adults with ASD. LAY SUMMARY: Immersive virtual reality (VR) holds promise as a means to provide social skills interventions for individuals with autism spectrum disorder (ASD), but it is unclear whether associated anxiety and sensory symptoms might limit feasibility. Here, we report data that indicate that immersive VR is both safe and feasible for use in verbally fluent adolescents and adults with ASD, for up to three 45-min sessions. Autism Res 2020, 13: 1418-1424. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph P McCleery
- Department of Psychology, Kinney Center for Autism Education and Support, Saint Joseph's University, Philadelphia, Pennsylvania, USA.,Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ashley Zitter
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Judith S Miller
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Julia Parish-Morris
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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