Advances in Our Understanding of Behavioral Intervention: 1980 to 2020 for Individuals Diagnosed with Autism Spectrum Disorder

Mapping the Evidence on Compassion Skills in Applied Behavior Analysis: Protocol for Scoping Review

BACKGROUND

Applied behavior analysis (ABA) is a scientific approach that applies principles of learning and motivation to assess, design, implement, and evaluate social and environmental modifications to produce meaningful changes in human behavior. It has been widely used in various settings, particularly in the treatment of individuals with autism spectrum disorders and other developmental disabilities. Recently, compassion has emerged as a topic of growing scientific interest within ABA. To improve socially relevant behaviors, it is essential to explore how behavior analysts can provide maximum support to clients and promote significant changes through compassionate care. Although compassion skills have been studied by ABA researchers, the literature still presents gaps in understanding how these skills can be effectively integrated into ABA practice.

OBJECTIVE

This study aimed to map, identify, and provide data available in the existing literature on compassion skills and applied behavior analysis.

METHODS

This scoping review will follow the methodological framework of Arksey and O'Malley with previously proposed refinements. The search strategy will use combinations of descriptors and their synonyms according to the Health Sciences Descriptors and MeSH (Medical Subject Headings) terms, using the PCC (population, concept, and context) mnemonic, combined with the Boolean operators AND Mesh OR. The electronic databases to be searched include Embase, Index Psicologia, Lilacs, PubMed, Scopus, and Web of Science. Studies published between 2020 and 2024 in English, Portuguese, and Spanish will be included. Two independent reviewers will screen titles, abstracts, and full texts, with a third reviewer resolving any disagreements.

RESULTS

As this is a protocol, results are pending. The review will synthesize definitions of compassion in ABA, map compassionate skills, analyze existing interventions, and identify outcomes associated with compassionate ABA practice.

CONCLUSIONS

This scoping review is expected to contribute to the evolution of ABA toward a more compassionate and holistic approach, potentially leading to improved outcomes for clients and practitioners. The findings may inform the development of compassion training programs and influence care policies in ABA.

TRIAL REGISTRATION

OSF Registries 10.17605/OSF.IO/F3A6H; https://osf.io/f3a6h.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/66399.

Primary Care Autism Screening with the Parent's Observations of Social Interactions

PURPOSE

To report results of the Parent's Observations of Social Interactions (POSI) and identify associations between POSI results with referrals for developmental evaluations and autism diagnoses.

METHODS

We examined data from electronic health records of POSI-screened children attending 18- and 24-month health supervision visits from July 2018 to July 2022 for POSI screening results and autism diagnoses. Descriptive statistics and regression models were used for analysis.

RESULTS

In 6669 POSI-screened children (age at follow-up, 42-107 months), 1065 of 4228 children screened at 18 months (25.2%) and 851 of 4896 children at 24 months (17.4%) screened positive. In 1079 children with positive POSI screenings, 233 children (21%) were referred for developmental evaluation. Autism was diagnosed in 184 of all 6669 children (2.8%). The POSI sensitivity for autism was 66.4% (95% CI 59.2-72.8%) and the positive predictive value was 9.2% (95% CI 7.4-10.6%). A positive POSI increased the likelihood of autism diagnosis at 18 months (adjusted odds ratio, 5.21; 95% CI 3.45-7.86) and 24 months (adjusted odds ratio 10.21; 95% CI 7.07-14.76). Autism was diagnosed 13 months earlier in children with a positive rather than negative POSI (35.5 vs 48.1 months; P < 0.001).

CONCLUSION

The POSI is a sensitive screening instrument for autism with a low positive predictive value (high percentage of false positive screenings), indicating the need for clarification about which children require further evaluation. Screening positive on the POSI was associated with a greater likelihood and earlier diagnosis of children with autism.

Using the ADDIE Model of Instructional Design to Create Programming for Comprehensive ABA Treatment

ABA research abounds with articles on increasing or decreasing a small set of behaviors. These articles fit nicely within the framework of Focused ABA Treatment in which the goal of treatment centers on only a few behaviors. However, many behavioral practitioners spend most of their time developing Comprehensive ABA Treatment in which a large number of behaviors are systematically changed across multiple developmental domains. Few resources are available to help in designing and implementing such programming. This article presents a model from the field of instructional design for the development of comprehensive programming. Applying the ADDIE model-Analyze, Design, Develop, Implement, Evaluate-the article identifies a consistent process to follow, critical actions to take, and helpful resources to use when developing comprehensive programming for individuals with autism.

High definition transcranial direct current stimulation of the Cz improves social dysfunction in children with autism spectrum disorder: A randomized, sham, controlled study

The purpose of this study was to determine the effect of the Cz of high-definition 5-channel tDCS (HD-tDCS) on social function in 4-12 years-old children with autism spectrum disorder (ASD). This study was a randomized, double-blind, pseudo-controlled trial in which 45 ASD children were recruited and divided into three groups with sex, age, and rehabilitation treatment as control variables. Each group of 15 children with ASD was randomly administered active HD-tDCS with the Cz as the central anode, active HD-tDCS with the left dorsolateral prefrontal cortex (F3) as the central anode, and sham HD-tDCS with the Cz as the central anode with 14 daily sessions in 3 weeks. The Social Responsiveness Scale Chinese Version (SRS-Chinese Version) was compared 1 week after stimulation with values recorded 1 week prior to stimulation. At the end of treatment, both the anodal Cz and anodal left DLFPC tDCS decreased the measures of SRS-Chinese Version. The total score of SRS-Chinese Version decreased by 13.08%, social cognition decreased by 18.33%, and social communication decreased by 10.79%, which were significantly improved over the Cz central anode active stimulation group, especially in children with young age, and middle and low function. There was no significant change in the total score and subscale score of SRS-Chinese Version over the Cz central anode sham stimulation group. In the F3 central anode active stimulation group, the total score of SRS-Chinese Version decreased by 13%, autistic behavior decreased by 19.39%, and social communication decreased by 14.39%, which were all significantly improved. However, there was no significant difference in effect between the Cz and left DLPFC stimulation conditions. HD-tDCS of the Cz central anode may be an effective treatment for social dysfunction in children with ASD.

De-implementation of Low-Value Practices for Autism Spectrum Disorder

Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.

Understanding the effect of COVID-19 on two children with autism and their caregivers: a case study research design

Concerns regarding the COVID-19 pandemic include threat to one's physical health and shifts in daily routine, which are considered significant life stressors. The COVID-19 outbreak can be considered a global disaster, and exposure associated with disasters has been linked to negative psychological outcomes (e.g. symptoms of depression, anxiety, post-traumatic stress disorder). The COVID-19 pandemic has affected various communities in unique ways, including the neurodivergent community; therefore, we explored the experience of two children with autism spectrum disorder (ASD) and their parents throughout the pandemic to increase awareness of the specific needs of this population. Utilizing a case study research design, we identified eight core themes across their experience and explored effects on targeted areas of child functioning (i.e. behaviors). For one participant, visual data indicated decreases in each behavioral area (i.e. positive interactions, negative interactions, and repetitive behaviors), whereas for the second participant, visual data indicated increases in each behavioral area. These findings support that autism is a heterogeneous condition in which youth with ASD will experience and respond to emergency situations in unique ways. With this study, we aim to support the growing body of literature narrating the experience of children with ASD and their caregivers during natural disasters.

Pediatric Media Guidance for Parents of Children on the Autism Spectrum: A Thematic Analysis

Very little is known about pediatric media guidance, or the one-on-onse advice that medical and clinical professionals (MCPs) communicate to parents about their children's recreational media and technology (RMT) use. One population that stands to benefit from a closer examination is children on the autism spectrum due to their behavior and communication challenges. We surveyed one group of pediatric autism MCPs, applied behavioral analysis (ABA) providers (N = 234), due to their proximity to families and conducted an applied thematic analysis of RMT advice they deliver. Providers reported primarily suggesting that caregivers employ restrictive parental mediation with their autistic child, that RMT should primarily be limited to use as a reward or reinforcement, and that parents should set time limits. Our findings offer new insights into the intersections of health communication theory and practice, while highlighting the need for greater research into RMT guidance for children with and without disabilities.

Integrating Diversity, Equity, and Inclusion Readings within Coursework: Suggestions for Instructors Teaching Behavior Analysis

Behavior analysis graduate programs must train their students to be culturally responsive so that they are prepared to effectively serve a diverse clientele. One important strategy for helping students gain a culturally responsive repertoire is embedding diversity, equity, and inclusion materials into behavior analysis graduate course sequences. However, little guidance exists for selecting content related to diversity, equity, and inclusion within behavior analysis to include in behavior analytic coursework. This article provides suggested readings for diversity, equity, and inclusion within behavior analysis that can be embedded into typical course structures in behavior analysis graduate programs. Each course requirement in the Association for Behavior Analysis International's Verified Course Sequence is given specific recommendations.

Social Brain Network of Children with Autism Spectrum Disorder: Characterization of Functional Connectivity and Potential Association with Stereotyped Behavior

Objective: To identify patterns of social dysfunction in adolescents with autism spectrum disorder (ASD), study the potential linkage between social brain networks and stereotyped behavior, and further explore potential targets of non-invasive nerve stimulation to improve social disorders. Methods: Voxel-wise and ROI-wise analysis methods were adopted to explore abnormalities in the functional activity of social-related regions of the brain. Then, we analyzed the relationships between clinical variables and the statistical indicators of social-related brain regions. Results: Compared with the typically developing group, the functional connectivity strength of social-related brain regions with the precentral gyrus, postcentral gyrus, supplementary motor area, paracentral lobule, median cingulum, and paracingulum gyri was significantly weakened in the ASD group (all p < 0. 01). The functional connectivity was negatively correlated with communication, social interaction, communication + social interaction, and the total score of the ADOS scale (r = -0.38, -0.39, -0.40, and -0.3, respectively; all p < 0.01), with social awareness, social cognition, social communication, social motivation, autistic mannerisms, and the total score of the SRS scale (r = -0.32, -0.32, -0.40, -0.30, -0.28, and -0.27, respectively; all p < 0.01), and with the total score of SCQ (r = -0.27, p < 0.01). In addition, significant intergroup differences in clustering coefficients and betweenness centrality were seen across multiple brain regions in the ASD group. Conclusions: The functional connectivity between social-related brain regions and many other brain regions was significantly weakened compared to the typically developing group, and it was negatively correlated with social disorders. Social network dysfunction seems to be related to stereotyped behavior. Therefore, these social-related brain regions may be taken as potential stimulation targets of non-invasive nerve stimulation to improve social dysfunction in children with ASD in the future.

Cognitive rehabilitation in people with autism spectrum disorder: a systematic review of emerging virtual reality-based approaches

Introduction

Emerging virtual technologies and cognitive rehabilitation methods are two new treatment approaches that can be used to strengthen cognitive functions in Autism Spectrum Disorder (ASD). The main aim of this study was to examine the effect of using virtual reality-based approaches on cognitive disorders of children and adults with ASD.

Methods

This systematic review was conducted on scientific papers to determine the effects of virtual reality-based technologies on the cognitive functions of children and adults with ASD. We identified 688 studies related to this topic and filtered them down to 17 articles, and then extracted the effects of interventions on cognitive outcomes.

Results

A total of 17 studies met the inclusion criteria, in which 226 persons with ASD had taken place. The sample size in the selected studies ranged from 1 to 56 participants (Median: 8, Q1: 3.5, Q3: 15.5). Four of the studies were case–control studies, ten were pre-test/post-test studies, and three were Randomized Control Trials (RCTs). Results of 16 studies showed significant progress in various cognitive indexes, such as task learning, attention, executive functioning, and daily skills in people with ASD. In most studies, virtual technologies had beneficial effects on reducing cognitive problems, but existing limitations could reduce their effectiveness. These limitations included the cost of virtual reality devices, inappropriate size of software, the weight of devices, potential addiction, intolerance of wearing glasses or headsets by people with autism (especially in children), and the possibility of eye injury.

Conclusion

Applying appropriate virtual-based approaches could improve cognitive indexes in people with ASD. However, further studies are needed to investigate the real effects of these technologies in the long run.

Celebrating 40 years since DSM-III

This special section celebrates the first official recognition of Autism as a diagnostic concept in 1980 in the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual. The articles in this special section note the many areas of significant progress made as well as areas that remain important topics for continued and future research. The official recognition of autism as a diagnostic concept has significantly advanced both clinical work and research.

Theories of Autism and Autism Treatment from the DSM III Through the Present and Beyond: Impact on Research and Practice

The purely descriptive definition of autism introduced by the DSM III in 1980 marked a departure from previous DSM editions, which mixed phenomenological descriptions with psychoanalytic theories of etiology. This provided a blank slate upon which a variety of novel theories emerged to conceptualize autism and its treatment in the following four decades. In this article we examine the contribution of these different theoretical orientations with a focus on their impact on research and practice, areas of overlap and conflict between current theories, and their relevance in the context of the evolving landscape of scientific knowledge and societal views of autism.

Tele-Assisted Behavioral Intervention for Families with Children with Autism Spectrum Disorders: A Randomized Control Trial

Background: Telehealth is useful for both autism spectrum disorder (ASD) diagnosis and treatment, but studies with a direct comparison between teletherapy and traditional in-person therapy are limited. Methods: This randomized control trial—ISRCTN (International Standard Randomised Controlled Trial Number) primary clinical trial registry ID ISRCTN15312724—was aimed at comparing the effect of a tele-assisted and in-person intervention based on a behavioral intervention protocol for families with children affected by ASDs. Forty-two parents with children with autism (30 months to 10 years old) were randomly assigned to 12 sessions of an applied behavioral analysis (ABA) intervention implemented in an individual and group setting, either with or without the inclusion of tele-assistance. Pre- and postintervention assessments were conducted using the Home Situation Questionnaire (HSQ-ASD) and the Parental Stress Index (PSI/SF). Results: Substantial improvements in the perception and management of children’s behavior by parents, as well as in the influence of a reduction in parent stress levels on said children’s behavior through the use of a tele-assisted intervention, were obtained. Conclusions: This randomized controlled trial demonstrates the evidence-based potential for telehealth to improve treatment of ASDs.