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Family-Centric Applied Behavior Analysis Facilitates Improved Treatment Utilization and Outcomes. J Clin Med 2024; 13:2409. [PMID: 38673682 PMCID: PMC11051390 DOI: 10.3390/jcm13082409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objective: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by lifelong impacts on functional social and daily living skills, and restricted, repetitive behaviors (RRBs). Applied behavior analysis (ABA), the gold-standard treatment for ASD, has been extensively validated. ABA access is hindered by limited availability of qualified professionals and logistical and financial barriers. Scientifically validated, parent-led ABA can fill the accessibility gap by overcoming treatment barriers. This retrospective cohort study examines how our ABA treatment model, utilizing parent behavior technicians (pBTs) to deliver ABA, impacts adaptive behaviors and interfering behaviors (IBs) in a cohort of children on the autism spectrum with varying ASD severity levels, and with or without clinically significant IBs. Methods: Clinical outcomes of 36 patients ages 3-15 years were assessed using longitudinal changes in Vineland-3 after 3+ months of pBT-delivered ABA treatment. Results: Within the pBT model, our patients demonstrated clinically significant improvements in Vineland-3 Composite, domain, and subdomain scores, and utilization was higher in severe ASD. pBTs utilized more prescribed ABA when children initiated treatment with clinically significant IBs, and these children also showed greater gains in their Composite scores. Study limitations include sample size, inter-rater reliability, potential assessment metric bias and schedule variability, and confounding intrinsic or extrinsic factors. Conclusion: Overall, our pBT model facilitated high treatment utilization and showed robust effectiveness, achieving improved adaptive behaviors and reduced IBs when compared to conventional ABA delivery. The pBT model is a strong contender to fill the widening treatment accessibility gap and represents a powerful tool for addressing systemic problems in ABA treatment delivery.
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Empowering Hong Kong Chinese families with autism: A preliminary study of the online Hanen More Than Words Program. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2024; 9:23969415241245096. [PMID: 38638395 PMCID: PMC11025426 DOI: 10.1177/23969415241245096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Purpose Parent involvement is crucial for tailored early intervention programs. The Hanen More Than Words (HMTW) program is a parent-implemented language intervention for autistic children. The current study examined the effectiveness of the HMTW program delivered online among Chinese families. Methods Using a randomized controlled trial design, 22 Chinese families of autistic children in Hong Kong completed the trial. Baseline and post-intervention assessments were conducted to measure changes in parent-child interaction, parents' use of linguistic facilitation techniques (LFTs), and children's communication skills. Additionally, the influence of parental self-efficacy and parenting stress on treatment outcomes was explored. Results The intervention group demonstrated significant improvements in parent-child attention synchrony. Although the treatment effect on children's spontaneous communication was not significant, the intervention group showed a larger effect size compared to the controls. The treatment outcomes were mainly influenced by the parents' initial levels of self-efficacy but not by parenting stress. Conclusion These findings provide preliminary evidence of the effectiveness of the online-delivered HMTW program for Chinese parents of autistic children. Further research involving a larger sample and focusing on long-term effects is needed.
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Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts. J Autism Dev Disord 2023; 53:3319-3342. [PMID: 35768672 PMCID: PMC10465672 DOI: 10.1007/s10803-022-05637-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.
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A multicenter clinical study on parent-implemented early intervention for children with global developmental delay. Front Pediatr 2023; 11:1052665. [PMID: 36873631 PMCID: PMC9975705 DOI: 10.3389/fped.2023.1052665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Early identification and intervention for children with global developmental delay (GDD) can significantly improve their prognosis and reduce the possibility of developing intellectual disability in the future. This study aimed to explore the clinical effectiveness of a parent-implemented early intervention program (PIEIP) for GDD, providing a research basis for the extended application of this intervention strategy in the future. METHODS During the period between September 2019 and August 2020, children aged 3 to 6 months diagnosed with GDD were selected from each research center as the experimental group and the control group. For the experimental group, the PIEIP intervention was conducted for the parent-child pair. Mid-term and end-stage assessments were performed, respectively, at 12 and 24 months of age, and parenting stress surveys were completed. RESULTS The average age of the enrolled children was 4.56 ± 1.08 months for the experimental group (n = 153) and 4.50 ± 1.04 months for the control group (n = 153). The comparative analysis of the variation in the progress between the two groups by independent t-test showed that, after the experimental intervention, the developmental quotient (DQ) of locomotor, personal-social, and language, as well as the general quotient (GQ) of the Griffiths Mental Development Scale-Chinese (GDS-C), the children in the experimental group demonstrated higher progress than those in the control group (P < 0.05). Furthermore, there was a significant decrease in the mean standard score of dysfunctional interaction, difficult children and the total level of parental stress in the term test for the experimental groups (P < 0.001 for all). CONCLUSIONS PIEIP intervention can significantly improve the developmental outcome and prognosis of children with GDD, especially in the areas of locomotor, personal-social, and language.
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Using Telehealth to Provide Interventions for Children with ASD: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023; 10:82-112. [PMID: 34306962 PMCID: PMC8282771 DOI: 10.1007/s40489-021-00278-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/25/2021] [Indexed: 10/27/2022]
Abstract
As the need for accessible interventions for autism spectrum disorder (ASD) grows, empirically supported telehealth interventions become increasingly necessary. With the current COVID-19 public health crisis, in-person interventions have become largely infeasible; therefore, it is crucial that providers have information regarding the effectiveness of telehealth interventions. This systematic review evaluates and synthesizes existing group design research on telehealth ASD interventions. Sixteen articles were evaluated on implementer and child-level intervention outcomes as well as factors that promote equitable access to intervention. Findings suggest that telehealth programs are highly acceptable, comparable to face-to-face interventions, and can be an effective method of training implementers in interventions. Recommendations for future research and for maximizing equitable access to telehealth interventions are presented.
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Differential Predictors of Response to Early Start Denver Model vs. Early Intensive Behavioral Intervention in Young Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:1499. [PMID: 36358426 PMCID: PMC9688546 DOI: 10.3390/brainsci12111499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 08/12/2023] Open
Abstract
The effectiveness of early intensive interventions for Autism Spectrum Disorder (ASD) is now well-established, but there continues to be great interindividual variability in treatment response. The purpose of this systematic review is to identify putative predictors of response to two different approaches in behavioral treatment: Early Intensive Behavioral Interventions (EIBI) and the Early Start Denver Model (ESDM). Both are based upon the foundations of Applied Behavioral Analysis (ABA), but the former is more structured and therapist-driven, while the latter is more naturalistic and child-driven. Four databases (EmBase, PubMed, Scopus and WebOfScience) were systematically screened, and an additional search was conducted in the reference lists of relevant articles. Studies were selected if participants were children with ASD aged 12-48 months at intake, receiving either EIBI or ESDM treatment. For each putative predictor, p-values from different studies were combined using Fisher's method. Thirteen studies reporting on EIBI and eleven on ESDM met the inclusion criteria. A higher IQ at intake represents the strongest predictor of positive response to EIBI, while a set of social cognitive skills, including intention to communicate, receptive and expressive language, and attention to faces, most consistently predict response to ESDM. Although more research will be necessary to reach definitive conclusions, these findings begin to shed some light on patient characteristics that are predictive of preferential response to EIBI and ESDM, and may provide clinically useful information to begin personalizing treatment.
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A systematic review of emotion regulation in parent-mediated interventions for autism spectrum disorder. Front Psychiatry 2022; 13:846286. [PMID: 36213921 PMCID: PMC9544248 DOI: 10.3389/fpsyt.2022.846286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Autistic individuals are at elevated risk for difficulties with emotion regulation (ER) that emerge early in life and are associated with a range of internalizing and externalizing disorders. Existing interventions that support ER have focused on school-age autistic children and adolescents as well as adults. Proactive approaches to improving ER in early childhood are thus needed, as is understanding the approaches by which ER skills can be feasibly supported in this young population. This review summarizes how ER has been measured within parent-mediated interventions for children at or under the age of 6 years and the extent to which ER is measured concurrently with or distinctly from observable behaviors that have been referenced in existing literature as externalizing or challenging behavior. Using PsycInfo, EBSCOhost, and PubMed databases, we searched for peer-reviewed journal articles published through August 2021, that focused on the use of parent-mediated interventions targeting ER and/or challenging behavior. The systematic search resulted in 4,738 publications; following multi-stage screening, the search yielded 20 studies. Eighteen of 20 studies were designed to target challenging behavior using manualized curricula or behavior analytic methodologies and assessed child outcomes through validated caregiver rating scales and/or direct behavioral observation. One study measured changes in ER as secondary to the social communication skills that were targeted in the intervention. Only one study specifically supported ER skill development and measured changes in ER as the primary intervention outcome. Findings highlight the need for better assessment of ER outcomes within the context of parent-mediated interventions for toddlers and young autistic children.
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Piloting an E-Learning Applied Behavior Analysis Course for Caregivers of Children with Autism in the Czech Republic. JOURNAL OF BEHAVIORAL EDUCATION 2022:1-32. [PMID: 36097521 PMCID: PMC9452282 DOI: 10.1007/s10864-022-09493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
The telehealth model can allow for cost-effective supports in areas where limited applied behavior analysis (ABA) services are available. As a result, e-learning programs for parents of children with autism have become part of the telehealth paradigm. In the Czech Republic, one of the many places where there are limited ABA supports and no available ABA e-learning courses for families, the development of an e-learning course that is freely available, and linguistically and culturally appropriate, is needed. It was anticipated that this course could mirror some of the free e-learning materials available to English-speaking caregivers and provide foundational knowledge to later support more intensive ABA services. Therefore, a pilot study was developed to assess an ABA e-learning course for caregivers in the Czech Republic with the aim of validating its efficacy and assessing whether a synchronous component was needed for the best outcomes. The materials were not meant to replace best practices in more intensive caregiver training but provide foundational skills for later more successful local services. Results demonstrated that a total of 33 caregivers completed the course, making statistically significant gains in their ABA knowledge and rating the course highly. Interestingly, the addition of the synchronous component only impacted the knowledge gain outcome. Suggestions for supporting caregivers in e-learning course completion and directions for future research are additionally explored.
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Mothers and fathers of pre-school children: a study on parenting stress and child's emotional-behavioral difficulties. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 36035250 PMCID: PMC9395769 DOI: 10.1007/s12144-022-03599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
The present study aimed to analyze the differences between maternal and paternal parenting stress and children's behavioral functioning, as determined by teacher and parent reports. In addition, it sought to evaluate the presence of clusters based on parenting stress and to determine whether perceptions of children's behavioral functioning varied across these clusters. The sample was composed of the parents and teachers of N = 201 children. Parents completed a self-report questionnaire on parenting stress and parents and teachers filled out report-form questionnaires assessing children's emotional and behavioral functioning. The results showed that mothers had higher levels of parenting stress than fathers, and both parents reported more prosocial behavior in children than did teachers. Furthermore, middle stressed parents had children who expressed more prosocial behavior than did parents in other clusters. The findings also showed that parenting stress influenced partners' perceptions of children's behavioral functioning. The multiplicity of child observers facilitated a better understanding of how parenting stress, linked to parent-child interactions, may play an important role in shaping parents' perceptions of their children.
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Evaluation of Circadian Rhythm and Sleep Focused mHealth Intervention for the Prevention of Accelerated Summer Weight Gain among Elementary School-Age Children: Protocol for a Randomized Controlled Feasibility Study (Preprint). JMIR Res Protoc 2022; 11:e37002. [PMID: 35576573 PMCID: PMC9152728 DOI: 10.2196/37002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background The i♥rhythm project is a mobile health adaptation of interpersonal and social rhythm therapy designed to promote healthy sleep and behavioral rhythms among 5-8-year olds during summer for the prevention of accelerated summer weight gain. Objective This pilot study will examine the feasibility, acceptability, and preliminary efficacy of the i♥rhythm intervention. This will ensure that the research protocol and procedures work as desired and are acceptable to families in preparation for the fully powered randomized controlled trial. The proposed study will examine the willingness of participants to participate in the intervention and determine whether modifications to the intervention, procedures, and measures are needed before conducting a fully powered study. We will assess our ability to (1) recruit, consent, and retain participants; (2) deliver the intervention; (3) implement the study and assessment procedures; (4) assess the reliability of the proposed measures; and (5) assess the acceptability of the intervention and assessment protocol. Methods This study will employ a single-blinded 2-group randomized control design (treatment and no-treatment control) with randomization occurring after baseline (Time 0) and 3 additional evaluation periods (postintervention [Time 1], and 9 months [Time 2] and 12 months after intervention [Time 3]). A sample of 40 parent-child dyads will be recruited. Results This study was approved by the institutional review board of Baylor College of Medicine (H-47369). Recruitment began in March 2021. As of March 2022, data collection and recruitment are ongoing. Conclusions This study will address the role of sleep and circadian rhythms in the prevention of accelerated summer weight gain and assess the intervention’s effects on the long-term prevention of child obesity. Trial Registration ClinicalTrials.gov NCT04445740; https://clinicaltrials.gov/ct2/show/NCT04445740. International Registered Report Identifier (IRRID) DERR1-10.2196/37002
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Risk and protective factors of quality of life for children with autism spectrum disorder and their families during the COVID-19 lockdown. An Italian study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 120:104130. [PMID: 34826776 PMCID: PMC8602998 DOI: 10.1016/j.ridd.2021.104130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND The lockdown due to the COVID-19 pandemic has been a difficult period for children with Autism Spectrum Disorder (ASD), and their families. AIMS The aim of this study was to investigate the predictors of the quality of life (QoL) of children with ASD and their parents throughout the first lockdown, providing a snapshot of the impact of the pandemic on these families life. METHOD AND PROCEDURES A cohort of 243 parents of children with ASD (2-15 years old) completed an original online survey regarding the modification of ASD cores symptoms during lockdown, the type of interventions they had done before and during lockdown and the activities performed by the child. Respondents filled the PedsQL for themselves and their children. OUTCOME AND RESULTS The data obtained show a worsening of specific ASD core symptoms during lockdown and their role in predicting parents and children's QoL. Furthermore, protective factors for a better children's QoL as the Telehealth intervention, and some activities done at home during the lockdown as physical activity and play with parents are identified. CONCLUSIONS This study identifies the QoL's risk and protective factors for children with ASD and their families. Furthermore, reveals the fundamental role of the parents as children's QoL protective factor, suggesting a higher collaboration between families and health care providers, whilst potentially improving families and children's QoL.
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Effectiveness of parent-training program on children with autism spectrum disorder in China. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 68:495-499. [PMID: 35937175 PMCID: PMC9351564 DOI: 10.1080/20473869.2020.1813063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVE This study intends to explore the effect of parent-training program on the rehabilitation intervention in children with autism spectrum disorder (ASD) in Chinese-speaking areas of China by offering parent skill training and psychology counseling. METHODS From January 2018 to June 2019, a total of 80 children diagnosed with ASD from the Department of Children Healthcare of Wuxi Children's Hospital were randomly grouped into the parent training groups and control groups. Parents in the training group received 12 weeks of skill training, including 8 group and 2 individual training sessions, as well as psychology counseling. This enabled them to give their children >2 h of intervention training daily in a natural environment. Children in the control group were placed on a rehabilitation waiting list or received general community training. Before grouping and after the intervention, all children underwent neuropsychological evaluations with Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Gesell Developmental Schedule (GDS). GDS covers five sectors, namely adaptive behavior, gross motor, fine motor, language, and personal-social behavior. RESULTS Statistically significant differences were not detected between the two groups in ABC, CARS, and GDS scoring at baseline evaluation. And significant differences were detected between the two groups in ABC, CARS, adaptive behavior, and personal-social behavior scoring at endpoint evaluation. Furthermore, the re-evaluation results of ABC scoring and CARS scoring of the children in the parent training group decreased significantly from the preliminary evaluation results when compared before and after the intervention. Moreover, the intragroup comparison of adaptive behavior scoring, language scoring, and personal-social behavior scoring of the experiment group increased significantly from the preliminary evaluation results, while the difference of the same of the children in the control group between re-evaluation and preliminary evaluation did not differ significantly. CONCLUSIONS In China, the parent-training program enables parents to train ASD children in a natural environment, which would markedly improve behavioral problems, core symptoms, adaptability, language competence, and social development capability.
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Supporting Young Children With Disabilities During the COVID-19 Pandemic: Evidence From Caregivers in Virginia. AERA OPEN 2022; 8:23328584221134525. [PMID: 36348652 PMCID: PMC9634186 DOI: 10.1177/23328584221134525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Early care and education (ECE) experiences shape children's developmental trajectories, particularly for children who have or may have disabilities. However, caregivers of children with disabilities have faced considerable challenges finding care for their children, which have increased during the COVID-19 pandemic. Using survey data from nearly 3,000 caregivers of preschool-age children in Virginia collected in December 2020 and January 2021, we find that caregivers of children with disabilities were less likely to find ECE programs that met their needs, more likely to experience high levels of stress, and more likely to be concerned about their children's development than were caregivers of children without disabilities. Concerns about child development were particularly pronounced among caregivers of children with disabilities in remote instructional settings. Our findings suggest a disproportionate impact of ECE disruption on caregivers of children with disabilities and the need for targeted supports for these caregivers moving forward.
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Infralimbic cortex pyramidal neuron GIRK signaling contributes to regulation of cognitive flexibility but not affect-related behavior in male mice. Physiol Behav 2021; 242:113597. [PMID: 34536435 DOI: 10.1016/j.physbeh.2021.113597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Dysfunction of the infralimbic cortical (ILC) region of the medial prefrontal cortex (mPFC) is thought to be an underlying factor in both affect- and cognition-related behavioral deficits that co-occur across neuropsychiatric disorders. Increasing evidence highlights pathological imbalances in prefrontal pyramidal neuron excitability and associated aberrant firing as an underlying factor in this dysfunction. G protein-gated inwardly rectifying K+ (GIRK/Kir3) channels mediate excitability of mPFC pyramidal neurons, however the functional role of these channels in ILC-dependent regulation of behavior and pyramidal neuron excitation is unknown. The present study used a viral-cre approach in male mice harboring a 'floxed' version of the kcnj3 (Girk1) gene, to disrupt GIRK1-containing channel expression in pyramidal neurons within the ILC. Loss of GIRK1-dependent signaling increased excitability and spike firing of pyramidal neurons but did not alter affective behavior measured in an elevated plus maze, forced swim test, or progressive ratio test of motivation. Alternatively, ablation of GIRK1 impaired performance in an operant-based attentional set-shifting task designed to assess cognitive flexibility. These data highlight a unique role for GIRK1 signaling in ILC pyramidal neurons in the regulation of strategy shifting but not affect and suggest that these channels may represent a therapeutic target for treatment of cognitive deficits in neuropsychiatric disease.
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Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment. PSYCHOLOGICAL RECORD 2021; 72:601-617. [PMID: 34866659 PMCID: PMC8628834 DOI: 10.1007/s40732-021-00496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.
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Comparing the Impact of Differing Preschool Autism Interventions on Parents in Two Canadian Provinces. J Autism Dev Disord 2021; 52:5018-5032. [PMID: 34837153 DOI: 10.1007/s10803-021-05349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
Early Intensive Behavioural Intervention (EIBI) is effective for preschoolers with autism spectrum disorder (ASD). Parental measures are rarely included in EIBI effectiveness studies, yet parental distress and lower self-efficacy are associated with poorer child outcomes. Parents of preschoolers with ASD (N = 485) were surveyed at baseline (T1), one-year post-intervention (T2), and school entry (T3) about family distress/crisis, parental self-efficacy, and satisfaction with services in two Canadian provinces. Family distress/crisis decreased and parental self-efficacy increased from T1 to T2. Increases in self-efficacy were largely maintained at T3. Parents were highly satisfied with services. Greater satisfaction for those residing in the province utilizing a parent-coaching model suggests that parent involvement is associated with positive parent outcomes.
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Suppression of pyramidal neuron G protein-gated inwardly rectifying K+ channel signaling impairs prelimbic cortical function and underlies stress-induced deficits in cognitive flexibility in male, but not female, mice. Neuropsychopharmacology 2021; 46:2158-2169. [PMID: 34158613 PMCID: PMC8505646 DOI: 10.1038/s41386-021-01063-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022]
Abstract
Imbalance in prefrontal cortical (PFC) pyramidal neuron excitation:inhibition is thought to underlie symptomologies shared across stress-related disorders and neuropsychiatric disease, including dysregulation of emotion and cognitive function. G protein-gated inwardly rectifying K+ (GIRK/Kir3) channels mediate excitability of medial PFC pyramidal neurons, however, the functional role of these channels in mPFC-dependent regulation of affect, cognition, and cortical dynamics is unknown. We used a viral-cre approach in male and female mice harboring a "floxed" version of the kcnj3 (Girk1) gene, to disrupt GIRK1-containing channel expression in pyramidal neurons within the prelimbic cortex (PrL). In males, loss of pyramidal GIRK1-dependent signaling differentially impacted measures of affect and impaired working memory and cognitive flexibility. Unexpectedly, ablation of PrL GIRK1-dependent signaling did not impact affect or cognition in female mice. Additional studies used a model of chronic unpredictable stress (CUS) to determine the impact on PrL GIRK-dependent signaling and cognitive function. CUS exposure in male mice produced deficits in cognition that paralleled a reduction in PrL pyramidal GIRK-dependent signaling akin to viral approaches whereas CUS exposure in female mice did not alter cognitive flexibility performance. Stress-induced behavioral deficits in male mice were rescued by systemic injection of a novel, GIRK1-selective agonist, ML297. In conclusion, GIRK1-dependent signaling in male mice, but not females, is critical for maintaining optimal PrL function and behavioral control. Disruption of this inhibition may underlie stress-related dysfunction of the PrL and represent a therapeutic target for treating stress-induced deficits in affect regulation and impaired cognition that reduce quality of life.
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Parent-Mediated Interventions for Infants under 24 Months at Risk for Autism Spectrum Disorder: A Systematic Review of Randomized Controlled Trials. J Autism Dev Disord 2021; 52:2553-2574. [PMID: 34236590 PMCID: PMC9114042 DOI: 10.1007/s10803-021-05148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Prodromal symptoms of Autism Spectrum Disorder (ASD) have been detected within the first year of life. This review evaluated evidence from randomized controlled trials (RCTs) of parent-mediated interventions for infants under 24 months who are at risk for ASD. Electronic databases, including grey literature, were searched up till November 2019. Seven RCTs were identified. There was substantial heterogeneity in recruitment, outcome measures and effect size calculations. Interventions did not reduce the risk of later ASD diagnosis and post-intervention effects on infant outcomes were inconsistent, with five studies reporting significant improvements across both treatment and control groups. Moderate level of evidence of intervention effects on parental interaction skills and the small number of RCTs, and significant limitations restrict generalizability across studies.
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Symptom Severity, Internalized and Externalized Behavioral and Emotional Problems: Links with Parenting Stress in Mothers of Children Recently Diagnosed with Autism. J Autism Dev Disord 2021; 52:2400-2413. [PMID: 34120257 DOI: 10.1007/s10803-021-05131-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
The present study examined which aspects of the child's behavior and clinical profile accounted for three dimensions of parenting stress: related to parenting roles, to interactions with the child, and to the child. Measures of adaptive behavior, intellectual functioning, autism symptom severity, and challenging behavior and emotional difficulties were examined as predictors of parenting stress in 157 mothers of children recently diagnosed with autism. Children's emotional problems and aggressive behavior were most predictive of parenting distress, whereas autism symptoms along with emotional problems and aggressive behavior, respectively, were linked to stress pertaining to interactions and to the child. These findings underscore the need for comprehensive and complementary interventions that focus on children's behavior and symptoms but also on parent adjustment.
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Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder. Behav Modif 2021; 46:971-1001. [PMID: 34041956 DOI: 10.1177/01454455211018815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.
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Emotional Availability and Play in Mother-Child Dyads with ASD: Changes during a Parental Based Intervention. Brain Sci 2020; 10:brainsci10120904. [PMID: 33255424 PMCID: PMC7761008 DOI: 10.3390/brainsci10120904] [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: 10/26/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 01/16/2023] Open
Abstract
(1) Background: Parental involvement during intervention with children with Autism Spectrum Disorder (ASD) has been demonstrated to be fundamental for children’s developmental outcomes. However, most research focused on child gains especially considering cognitive functioning and symptoms severity, whereas parental and dyadic changes during intervention need further investigation. (2) Methods: 29 mothers in interaction with their preschool children with ASD were analyzed through two standardized behavioral and observational measures to evaluate the dyadic Emotional Availability (EA) and play skills before (T1) and after (T2) a parental-based intervention. (3) Results: Results revealed mothers increased affective quality and major awareness in understanding the signals produced by the child, that in turn was more responsive, involving also using more complex play strategies. Interestingly, the role of specific factors able to predict parental characteristics was investigated, pointing out the important contribution of mothers’ perceptions of having a difficult child and child language communicative abilities. (4) Conclusions: the study enhances knowledge about child and caregiver variables that impact on dyadic outcomes, identifying important target areas to be addressed during intervention. Further, our results suggest that a parental-based intervention supports and facilitates improvements in both children’s and caregivers’ affective quality and cognitive abilities.
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A randomized clinical trial of a virtual-training program for teaching applied-behavior-analysis skills to parents of children with autism spectrum disorder. J Appl Behav Anal 2020; 53:1856-1875. [PMID: 32989771 DOI: 10.1002/jaba.778] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022]
Abstract
Parents play an important role in the treatment of their children's symptoms of autism spectrum disorder (ASD); thus, developing effective, efficient, socially acceptable, and accessible procedures for training parents to implement applied-behavior-analysis (ABA) interventions is critically important. One potential approach involves delivering training via a virtual private network (VPN) over the internet (Fisher et al., 2014). In this study, we conducted a randomized clinical trial to evaluate a virtual parent-training program with e-learning modules and scripted role-play via a VPN. We evaluated parent implementation of ABA skills using direct-observation measures in structured-work and play-based training contexts. Parents in the treatment group showed large, statistically significant improvements on all dependent measures; those in the waitlist-control group did not. Parents rated the training as highly socially acceptable. Results add to the growing literature on the efficacy and acceptability of virtually delivered training in ABA.
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Coping with caregiving: Humor styles and health outcomes among parents of children with disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103700. [PMID: 32497974 DOI: 10.1016/j.ridd.2020.103700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Parents of children with developmental disabilities experience greater stress and worse mental and physical health outcomes than parents of typically developing children. The use of various humor styles to cope with stressors has been associated with mental and, to a lesser extent, physical health outcomes in other populations, but has not been previously examined among parents of children with disabilities. AIMS To examine relations of adaptive vs. maladaptive humor styles with depression, daily affect, mental and physical functioning, somatic symptoms, and health behaviors, and to examine whether social support or positive reappraisal mediate relations of humor with health outcomes. METHOD 80 parents of children with disabilities completed online surveys at T1. 40 parents completed T2 surveys 4 months later. RESULTS As predicted, the adaptive humor styles - self-enhancing and affiliative - were associated with enhanced mental health outcomes, and these relations were mediated by social support and, to a lesser extent, positive reappraisal. Self-defeating humor was associated with worse mental health, greater symptoms, and worse health behavior; these relations were mediated by social support. CONCLUSION Adaptive humor use may facilitate caregivers' ability to garner support from others and reframe stressors, which ultimately may contribute to mental and physical resilience to stress.
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Family-Based Practices to Promote Well-Being. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:349-352. [PMID: 32936889 DOI: 10.1352/1944-7558-125.5.349] [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] [Indexed: 06/11/2023]
Abstract
Interventions that promote parent and child well-being in families with children with intellectual and developmental disabilities (IDD) are important, given the caregiving burden often associated with supporting children with developmental and behavioral challenges. This article summarizes a presentation made at the 2019 AAIDD annual conference and reviews evidence-based interventions that promote parenting skills, enhance caregiver well-being, and reduce child challenging behavior. The article reviews the role that behavioral and mindfulness-based interventions play in enhancing family well-being. A discussion of research gaps and future directions is included, especially as they relate to the role of technology in scaling up interventions and making them accessible to a broader audience.
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Cooperative parent-mediated therapy for Italian preschool children with autism spectrum disorder: a randomized controlled trial. Eur Child Adolesc Psychiatry 2020; 29:935-946. [PMID: 31549310 DOI: 10.1007/s00787-019-01395-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
Parent-mediated intervention is widely used for pre-schoolers with autism spectrum disorder (ASD). Previous studies indicate small-to-moderate effects on social communication skills, but with a wide heterogeneity that requires further research. In this randomized controlled trial (RCT), cooperative parent-mediated therapy (CPMT) an individual parent coaching program for young children with ASD was administered to preschool children with ASD. All children received the same low-intensity psychosocial intervention (LPI) delivered in community settings, to evaluate the potential additional benefit of CPMT. Thirty-four participants with ASD (7 females; 27 males; aged 2, 6, 11 years) and their parents were included in the trial. The primary blinded outcome was social communication skills, assessed using the ADOS-G social communication algorithm score (ADOS-G SC). Secondary outcomes included ASD symptom severity, parent-rated language abilities and emotional/behavioral problems, and self-reported caregiver stress. Evaluations were made at baseline and post-treatment (at 6 months) by an independent multidisciplinary team. Results documented that CPMT showed an additional benefit on LPI with significant improvements of the primary blinded outcome, socio-communication skills, and of some secondary outcomes such as ASD symptom severity, emotional problems and parental stress related to parent-child dysfunctional interaction. No additional benefit was found for language abilities. Findings of our RCT show that CPMT provide an additional significant short-term treatment benefit on ASD core symptoms, when compared with active control group receiving only LPI.
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Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1537-1560. [PMID: 32384865 PMCID: PMC7842122 DOI: 10.1044/2020_jslhr-19-00167] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/31/2019] [Accepted: 01/15/2020] [Indexed: 05/10/2023]
Abstract
Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.
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Abstract
Research has directed surprisingly little attention to the quality of Early Intensive Behavioral Intervention (EIBI) in autism spectrum disorder (ASD) as a potential predictor of outcome. Therefore, using a preschool delivery model within a sample of 30 children, we examined the predictive power of EIBI quality on treatment outcome. EIBI quality was assessed at baseline by the York Measure of Quality of Intensive Behavioral Intervention (YMQI) and treatment outcome was evaluated after a period of 4 to 6 months using a battery of behavioral tests and scales to evaluate treatment success. Multinomial logistic regressions demonstrated that general EIBI quality predicted clinically significant change at follow-up. Particularly improvements in basic language and learning skills and global clinical impression were observed. Specific quality indicators that influenced overall treatment success were treatment organization, teaching level and differential reinforcement. In addition to previously examined predictors of EIBI treatment effects, such as child characteristics and intervention quantity, our findings highlight the importance of adequate EIBI quality assurance.
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Staff Perceptions and Implementation Fidelity of an Autism Spectrum Disorder Care Pathway on a Child/Adolescent General Psychiatric Inpatient Service. J Autism Dev Disord 2020; 51:158-168. [PMID: 32394312 DOI: 10.1007/s10803-020-04509-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
While youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates, general psychiatric settings are not designed to meet their unique needs. Previous evaluations of an ASD-Care Pathway (ASD-CP) on a general psychiatric unit revealed sustained reductions in crisis interventions (intramuscular medication use, holds/restraints; Cervantes et al. in J Autism Dev Disord 49(8):3173-3180, https://doi.org/10.1007/s10803-019-04029-6 , 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082-4089, https://doi.org/10.1007/s10803-018-3666-y , 2018). The current study investigated staff perceptions of the ASD-CP (N = 30), and examined rates of ASD-CP implementation fidelity in relation to patient outcomes (N = 28). Staff identified visual communication aids and reward strategies as most helpful. The number of days of reward identification early in the inpatient stay was associated with fewer crisis interventions later in a patient's stay.
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Mindfulness-Based Stress Reduction for Parents Implementing Early Intervention for Autism: An RCT. Pediatrics 2020; 145:S81-S92. [PMID: 32238534 PMCID: PMC8025402 DOI: 10.1542/peds.2019-1895k] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Systems of care emphasize parent-delivered intervention for children with autism spectrum disorder (ASD). Meanwhile, multiple studies document psychological distress within these parents. This pilot longitudinal randomized controlled trial compared the parent-implemented Early Start Denver Model (P-ESDM) to P-ESDM plus mindfulness-based stress reduction (MBSR) for parents. We evaluated changes in parent functioning during active treatment and at follow-up. METHODS Participants included children (<36 months old) with autism spectrum disorder and caregivers. Participants were randomly assigned to P-ESDM only (n = 31) or P-ESDM plus MBSR (n = 30). Data were collected at baseline, midtreatment, the end of treatment, and 1, 3, and 6 months posttreatment. Multilevel models with discontinuous slopes were used to test for group differences in outcome changes over time. RESULTS Both groups improved during active treatment in all subdomains of parent stress (β = -1.42, -1.25, -0.92; P < 0.001), depressive symptoms, and anxiety symptoms (β = -0.62 and -0.78, respectively; P < 0.05). Parents who received MBSR had greater improvements than those receiving P-ESDM only in parental distress and parent-child dysfunctional interactions (β = -1.91 and -1.38, respectively; P < 0.01). Groups differed in change in mindfulness during treatment (β = 3.15; P < .05), with P-ESDM plus MBSR increasing and P-ESDM declining. Treatment group did not significantly predict change in depressive symptoms, anxiety symptoms, or life satisfaction. Differences emerged on the basis of parent sex, child age, and child behavior problems. CONCLUSIONS Results suggest that manualized, low-intensity stress-reduction strategies may have long-term impacts on parent stress. Limitations and future directions are described.
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Quantifying Caregiver Change Across Early Autism Interventions Using the Measure of NDBI Strategy Implementation: Caregiver Change (MONSI-CC). J Autism Dev Disord 2020; 50:1364-1379. [PMID: 31925669 PMCID: PMC7103564 DOI: 10.1007/s10803-019-04342-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study aimed to provide initial validity and reliability of the Measure of NDBI Strategy Implementation-Caregiver Change (MONSI-CC), a novel measure that captures changes in caregivers' implementation of NDBI strategies during early intervention. The MONSI-CC was applied to 119 observations of 43 caregiver-child dyads of preschoolers with autism spectrum disorders (ASD). The MONSI-CC showed high inter-rater and test-retest reliability and captured significant improvements in caregivers' implementation of NDBI strategies. Significant associations between improvements in caregiver NDBI implementation and improvements in the child's ASD symptoms also emerged. Our work shows promising evidence for the utility of the MONSI-CC to evaluate implementation of NDBI strategies by caregivers as a mediating and moderating factor for treatment effects on children with ASD.
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Systematic literature review and meta-analysis of the relationship between adherence, competence and outcome in psychotherapy for children and adolescents. Eur Child Adolesc Psychiatry 2020; 29:417-431. [PMID: 30604132 PMCID: PMC7103576 DOI: 10.1007/s00787-018-1265-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
The extent to which therapist adherence to guidelines and clinician skill or competence may play a role in the prediction of therapeutic outcomes remains inconclusive. This systematic literature review and meta-analysis considers whether adherence or competence predicts youth outcome in child and adolescent psychotherapy, and whether there are any identifiable factors which moderate the strength or direction of this relationship. A systematic literature search identified 35 studies in 52 papers. The studies contained 29 effect sizes for the relationship between adherence and outcome, while nine effect sizes were extracted for competence, and a further five effects measured a composite of adherence and competence constructs, referred to as fidelity in this report. The meta-analysis indicated a small but significant relationship between therapist adherence and outcome, although the small size of effect suggests that outcomes are likely to be more strongly associated with factors other than adherence. No significant relationship was identified between competence or composite fidelity and outcome. Although variance was observed in effect sizes, no significant moderation by client group, intervention type, or implementation measure informant was identified. Further study is needed to understand the specific circumstances under which adherence and outcome are related.
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PRESS-Play: Musical Engagement as a Motivating Platform for Social Interaction and Social Play in Young Children with ASD. MUSIC & SCIENCE 2020; 3:10.1177/2059204320933080. [PMID: 32832103 PMCID: PMC7440205 DOI: 10.1177/2059204320933080] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Musical experiences are ubiquitous in early childhood. Beyond potential benefits of musical activities for young children with typical development, there has long been interest in harnessing music for therapeutic purposes for individuals with autism spectrum disorder (ASD). However, there is debate as to the effectiveness of these approaches and thus a need to identify mechanisms of change (or active ingredients) by which musical experiences may impact social development in young children with ASD. In this review, we introduce the PRESS-Play framework, which conceptualizes musical activities for young children with ASD within an applied behavior analysis framework consistent with the principles of naturalistic developmental behavioral interventions. Specifically, the PRESS-Play framework proposes that musical activities support key elements of evidence-based approaches for social engagement including predictability, reinforcement, emotion regulation, shared attention, and social play context, providing a platform for delivery and receipt of social and behavioral instruction via a transactional, developmental approach. PRESS-Play considers that these factors may impact not only the child with ASD but also their interaction partner, such as a parent or peer, creating contexts conducive for validated social engagement and interaction. These principles point to focused theories of change within a clinical-translational framework in order to experimentally test components of social-musical engagement and conduct rigorous, evidence-based intervention studies.
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Predictors of Change in Play-Based Communication and Behavior Intervention for High-Risk ASD: The Role of Mother-Child Dyadic Synchrony. Front Pediatr 2020; 8:581893. [PMID: 33344381 PMCID: PMC7738436 DOI: 10.3389/fped.2020.581893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Interindividual variability is important in the evolution of adaptative profiles of children with ASD having benefited from an early intervention make up for deficits in communication, language and social interactions. Therefore, this paper aimed to determine the nature of factors influencing the efficacy variability of a particular intervention technique i.e., "Play-based communication and behavior intervention" (PCBI). Methods: The participants comprised 70 13-30-month-old toddlers with ASD enrolled in PCBI for 12 weeks. The Autism Treatment Evaluation Checklist (ATEC) was used to evaluate the efficacy of PCBI. Video recordings of 5 min of free-play before and after PCBI were used to examine behaviors of mothers and children and parent-child dyadic synchrony. Hierarchical multiple regression analyses and machine learning algorithms were performed to explore the effect of these potential predictors (mothers' factors, children's factors and videotaped mother-child interaction) of intervention efficacy. Results: The hierarchical regression analysis and the machine learning algorithms indicated that parenting stress, level of completion of training at home and mother-child dyadic synchrony were crucial factors in predicting and monitoring the efficacy of PCBI. Conclusions: In summary, the findings suggest that PCBI could be particularly beneficial to children with ASD who show a good performance in the mother-child dyadic synchrony evaluation. A better dyadic mother-child synchrony could enhance the PCBI efficacy through adapted emotional and behavioral responses of the mother and the child and has a beneficial influence on the child's psychological development.
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The Effects of Parent Training Programs on the Quality of Life and Stress Levels of Parents Raising a Child with Autism Spectrum Disorder: a Systematic Review of the Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00190-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Brief Parent-Mediated Intervention for Children with Autism Spectrum Disorder: A Feasibility Study from South India. J Autism Dev Disord 2019; 49:3146-3158. [PMID: 31053990 DOI: 10.1007/s10803-019-04032-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study assesses the acceptability and feasibility of a brief parent-mediated home-based intervention for children with autism spectrum disorder (ASD), deliverable in resource-limited settings, with an emphasis on addressing parental stress from a socio-cultural perspective. 50 children (2-6 years), with a DSM 5 diagnosis of ASD were randomized to intervention (n = 26) or active control group (n = 24). The intervention based on naturalistic developmental behavioral approach, focusing on joint attention, imitation, social and adaptive skills was structured to be delivered in five outpatient sessions over 12 weeks. All children were followed up at 4, 8 and 12 weeks. Parents of children randomized to the intervention group reported more improvements across parental stress and child outcome measures compared to those in the control group. The intervention was found to be acceptable and feasible, with high fidelity measures and retention rates.
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Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses. J Autism Dev Disord 2019; 49:3477-3493. [PMID: 31127486 PMCID: PMC6667419 DOI: 10.1007/s10803-019-04061-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed.
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Quality of Life in Families of Young Children With Autism Spectrum Disorder. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 124:535-548. [PMID: 31756145 DOI: 10.1352/1944-7558-124.6.535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The present study investigated family quality of life (FQOL) as experienced by 493 mothers and fathers (295 families) of young children with autism spectrum disorder (ASD) prior to receiving early intervention services in the province of Québec. These families were most satisfied with their physical and material well-being and least satisfied with their family interactions. Children's level of functioning across various standardized and subjective measures were positively associated with parents' FQOL. In both parents, family characteristics associated with financial and personal resources were also linked to FQOL. The child's age and the number of children were associated with mothers' FQOL. Overall, these findings provide a portrait of ASD-related stressors and resources relevant to both parents during the early childhood period.
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Effects of a brief mindfulness-infused behavioral parent training for mothers of children with autism spectrum disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
IMPORTANCE Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language. OBJECTIVE To examine the association between parent training and language and communication outcomes in young children. DATA SOURCES Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018. STUDY SELECTION Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included. MAIN OUTCOMES AND MEASURES Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment. RESULTS This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedges g, -0.33 [0.06]; P < .001). The association between parent training and parent use of language support strategies was large (mean [SE] Hedges g, 0.55 [0.11], P < .001). Children with developmental language disorder had the largest social communication outcomes (mean [SE] Hedges g, 0.37 [0.17]); large and significant associations were observed for receptive (mean [SE] Hedges g, 0.92 [0.30]) and expressive language (mean [SE] Hedges g, 0.83 [0.20]). Children at risk for language impairments had moderate effect sizes across receptive language (mean [SE] Hedges g, 0.28 [0.15]) and engagement outcomes (mean [SE] Hedges g, 0.36 [0.17]). CONCLUSIONS AND RELEVANCE The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.
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Treatment Utilization Trajectories among Children with Autism Spectrum Disorder: Differences by Race-Ethnicity and Neighborhood. J Autism Dev Disord 2019; 49:2173-2183. [PMID: 30701434 DOI: 10.1007/s10803-019-03896-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Health coverage of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is expanding. Yet there is no longitudinal research on patterns of or inequities in utilization of EIBI. We integrated state administrative records with Medicaid and Census data for children enrolled in an EIBI Medicaid waiver (N = 730) to identify and describe the type and prevalence of treatment utilization trajectories, and to examine the association between trajectory types and (a) child race-ethnicity and (b) neighborhood racial composition, poverty, affluence, and urbanicity. We identified four utilization trajectories (Low, Low-Moderate, Moderate, and High users). Race-ethnicity and neighborhood affluence were associated with trajectory membership. As coverage expands, policy makers should consider strategies to improve overall treatment utilization and enhance equity.
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Teaching Parents Behavioral Strategies for Autism Spectrum Disorder (ASD): Effects on Stress, Strain, and Competence. J Autism Dev Disord 2019; 48:1031-1040. [PMID: 28988339 DOI: 10.1007/s10803-017-3339-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on parent outcomes from a randomized clinical trial of parent training (PT) versus psychoeducation (PEP) in 180 children with autism spectrum disorder (ASD) and disruptive behavior. We compare the impact of PT and PEP on parent outcomes: Parenting Stress Index (PSI), Parent Sense of Competence (PSOC), and Caregiver Strain Questionnaire (CGSQ). Mixed-effects linear models evaluated differences at weeks 12 and 24, controlling for baseline scores. Parents in PT reported greater improvement than PEP on the PSOC (ES = 0.34), CGSQ (ES = 0.50), and difficult child subdomain of the PSI (ES = 0.44). This is the largest trial assessing PT in ASD on parent outcomes. PT reduces disruptive behavior in children, and improves parental competence while reducing parental stress and parental strain.
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Understanding stress in parents of children with autism spectrum disorder: A focus on under-represented families. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 65:20-30. [PMID: 30873280 PMCID: PMC6411305 DOI: 10.1080/20473869.2017.1347228] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Parents of children with autism spectrum disorder (ASD) report high levels of stress that can interfere with important child and family treatments. Limited past research considers how the caregiving experience and social determinants of health may contribute to treatment engagement and outcomes, particularly in under-represented families, who already experience service and health disparities. We aimed to assess the experiences of caring for an individual with ASD, with specific emphasis on perceptions of stress. METHODS Three key informant interviews were conducted with parents (n=1) and providers (n=2) of children with ASD to refine interview guide questions. Once questions were refined, four focus groups (n=17) and one key informant interview were conducted with parents of children with ASD who were (a) non-white, (b) Spanish speakers, (c) of limited financial resources, and/or (d) living in rural counties. All participants lived in Western New York, with the majority residing in Rochester. Content analysis by two independent coders was used to identify and refine themes. RESULTS Themes included: (a) caregiving for an individual with ASD can cause interference with family functioning, (b) misperceptions of ASD contribute to caregiver stress, (c) culture contributes to stressors for parents, and (d) service navigation difficulties are a significant source of stress. Suggestions for interventions to address parents stress included: modular and integrative treatments for multiple content areas, addressing cultural barriers to treatment engagement, and education on ASD to the community. CONCLUSIONS Parent-focused interventions for caregivers of children with ASD should specifically explore and address service and health disparities for parents, especially those predicated on race, ethnicity, rurality, and language of origin. Interventions should also be individualized to parent characteristics and experiences. In future research on parent training, the unique contributions of caregiver stress and other characteristics (e.g., race-related stress, geographic location) should be included as potential modifiers of treatment.
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Mindfulness-Based Stress Reduction for Parents of Children with Developmental Delays: Understanding the Experiences of Latino Families. Mindfulness (N Y) 2018; 10:1017-1030. [PMID: 31191735 DOI: 10.1007/s12671-018-1011-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents of children with developmental delays (DD) report elevated mental health difficulties compared to parents of children with typical development, which appear largely associated with child behavior problems. Latino parents of children with DD may experience heightened risk for poor mental health outcomes due additional stressors associated with minority status. Mindfulness-Based Stress Reduction (MBSR) appears to be efficacious for reducing parenting stress and improving wellbeing in families of children with DD; however, studies have rarely focused on families from racial and ethnic minority backgrounds. The current study employed a mixed-methods, waitlist-control design to examine the efficacy of MBSR for improving parent and child outcomes in Latino and non-Latino families. Results indicate that MBSR is similarly efficacious for Latino and non-Latino families in improving parent mental health (parenting stress, depressive symptomatology, and life satisfaction) and reducing parent-reported child behavior problems. Qualitative analyses further highlight avenues for improving the efficacy of MBSR for Latino families by providing intervention directly in Spanish, rather than using translation services, for Spanish-speaking families. Findings reveal the efficacy of standard MSBR for Latino parents of children with DD and underscore the potential benefits of disseminating this practice to traditionally underrepresented families.
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Integrating a Parent-Implemented Blend of Developmental and Behavioral Intervention Strategies into Speech-Language Treatment for Toddlers at Risk for Autism Spectrum Disorder. Semin Speech Lang 2018; 39:114-124. [PMID: 29558767 DOI: 10.1055/s-0038-1627483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Naturalistic developmental behavioral interventions include an explicit focus on coaching parents to use therapy techniques in daily routines and are considered best practice for young children with autism. Unfortunately, these approaches are not widely used in community settings, possibly due to the clinical expertise and training required. This article presents the work of the Bond, Regulate, Interact, Develop, Guide, Engage (BRIDGE Collaborative), a multidisciplinary group of service providers (including speech-language pathologists), parents, funding agency representatives, and researchers dedicated to improving the lives of young children with autism spectrum disorder and their families. The group selected and adapted a parent coaching naturalistic developmental behavioral intervention specifically for use with toddlers and their families for community implementation. Lessons learned from the implementation process include the importance of therapist background knowledge, the complexity of working with parents of young children, and needed supports for those working closely with parents, including specific engagement strategies and the incorporation of reflective practice.
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The effect of caregiver-delivered social-communication interventions on skill generalization and maintenance in ASD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 74:57-71. [PMID: 29360047 DOI: 10.1016/j.ridd.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/06/2017] [Accepted: 01/15/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND Although caregiver-delivered social communication interventions have been considered scientifically proven practices for individuals with autism spectrum disorders, it is not well examined if these types of intervention modes are truly effective in promoting skill generalization and maintenance within those individuals with autism spectrum disorders. AIMS The purpose of this meta-analysis was to evaluate the status of the extant literature regarding the measures on generalization and/or maintenance of effects of caregiver-delivered communication interventions for children with autism spectrum disorders. METHODS AND PROCEDURES This systematic literature review and meta-analysis evaluated peer-reviewed research regarding the effects of caregiver-implemented interventions on the maintenance and generalization of the social-communication skills for children with autism spectrum disorders. A total of 34 articles were included following a systematic search. Articles were summarized according to the following categories: (a) generalization dimension, (b) generalization assessment design, (c) maintenance assessment design, (d) generalization/maintenance teaching strategy, and (e) latency to maintenance probes. After application of design standards, aggregate Tau-U and non-overlap of pairs effect sizes were calculated with a total of 67 separate contrasts across seven studies. OUTCOMES AND RESULTS Overall, effect size scores ranged from small to large effects across all comparisons. On average, most of the baseline to maintenance and generalization comparisons produced moderate to large effects. Whereas, small to moderate or even deteriorate effects were found in most of the intervention to maintenance and generalization comparisons. CONCLUSIONS AND IMPLICATIONS The findings in this review suggest that caregiver-delivered social-communication interventions are likely to result in mixed effects on skill generalization and maintenance within children with autism spectrum disorders. Implications for future research and practice are discussed.
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Abstract
With advances in the field's ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.
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Strength-Based Approaches to Working with Families of Children with ASD. HANDBOOK OF PARENT-IMPLEMENTED INTERVENTIONS FOR VERY YOUNG CHILDREN WITH AUTISM 2018. [DOI: 10.1007/978-3-319-90994-3_10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Evaluating the effects of Acceptance and Commitment Training on the overt behavior of parents of children with autism. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2017.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Interventions to Promote Well-Being in Parents of Children with Autism: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2017. [DOI: 10.1007/s40489-017-0123-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Intellectual Disability and Developmental Risk: Promoting Intervention to Improve Child and Family Well-Being. Child Dev 2017; 88:436-445. [DOI: 10.1111/cdev.12740] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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