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Naim R, Dombek K, German RE, Haller SP, Kircanski K, Brotman MA. An Exposure-Based Cognitive-Behavioral Therapy for Youth with Severe Irritability: Feasibility and Preliminary Efficacy. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:260-276. [PMID: 37851393 PMCID: PMC11024061 DOI: 10.1080/15374416.2023.2264385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Clinically impairing irritability and temper outbursts are among the most common psychiatric problems in youth and present transdiagnostically; however, few mechanistically informed treatments have been developed. Here, we test the acceptability, feasibility, and preliminary efficacy of a novel exposure-based treatment with integrated parent management skills for youth with severe irritability using a randomized between-subjects multiple baseline design. METHOD N = 41 patients (Age, Mean (SD) = 11.23 years (1.85), 62.5% male, 77.5% white) characterized by severe and impairing temper outbursts and irritability were randomized to different baseline observation durations (2, 4, or 6 weeks) prior to active treatment; 40 participants completed the 12 session treatment of exposure-based cognitive-behavioral therapy for irritability with integrated parent management skills. Masked clinician ratings were acquired throughout baseline and treatment phases, as well as 3- and 6-months post-treatment. To examine acceptability and feasibility, drop-out rates and adverse events were examined. Primary clinical outcome measures included clinician-administered measures of irritability severity and improvement. Secondary clinical outcome measures included multi-informant measures of irritability, depression, anxiety, and attention-deficit/hyperactivity disorder symptoms. RESULTS No patients dropped out once treatment began, and no adverse events were reported. Irritability symptoms improved during the active phase of treatment across all measurements (all βs > -0.04, ps < .011, Cohen's d range: -0.33 to -0.98). Treatment gains were maintained at follow-up (all βs(39) < -0.001, ps > .400). Sixty-five percent of patients were considered significantly improved or recovered post-treatment based on the primary clinician-rated outcome measure. CONCLUSIONS Results support acceptability, feasibility, and preliminary efficacy of this novel treatment for youth with severe irritability. Limitations and future directions are also discussed.
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Affiliation(s)
- Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kelly Dombek
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ramaris E. German
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Simone P. Haller
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Ailey SH, Johnson TJ, Cabrera A. Evaluation of Factors Related to Prolonged Lengths of Stay for Patients With Autism With or Without Intellectual Disability. J Psychosoc Nurs Ment Health Serv 2019; 57:17-22. [PMID: 30753733 DOI: 10.3928/02793695-20190205-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Patients with autism spectrum disorder and/or intellectual disability (ASD/ID) face unique health care challenges. In addition to hospital experiences characterized by fear and insufficient staff training, these patients have 1.5-times longer lengths of stay (LOS) than patients without ASD/ID, and 3.4% of patients with ASD/ID have prolonged LOS (i.e., ≥30 days). Little research exists on factors related to prolonged LOS of patients with ASD/ID, hindering efforts to develop and implement evidence-based practices to improve care and reduce prolonged LOS. The purpose of the current study was to describe factors related to prolonged LOS of adult patients with ASD/ID in acute care settings using a retrospective chart review of 10 patients discharged from one academic medical center. Findings indicate that health care institutions should evaluate performance with this patient population and identify evidence-based strategies to provide a safe environment for care and reduce LOS that is due to non-health care needs. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 17-22.].
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Maragakis A, Vriesman M, LaLonde L, Richling SM, Lancaster B. Quality Improvement and applied behavior analysis: Another name for a rose that smells just as sweet. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ingersoll BR, Wainer AL, Berger NI, Walton KM. Efficacy of low intensity, therapist-implemented Project ImPACT for increasing social communication skills in young children with ASD. Dev Neurorehabil 2017; 20:502-510. [PMID: 28152327 DOI: 10.1080/17518423.2016.1278054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Project ImPACT is a Naturalistic Developmental Behavioral Intervention (NDBI) for young children with ASD. Preliminary research supports its feasibility and efficacy as a parent-mediated intervention; however, its efficacy as a low-intensity, therapist-implemented intervention is unclear. A single-case, multiple-baseline design evaluated the effect of 2 h per week of therapist-implemented Project ImPACT on social engagement, language, and play in nine children with ASD. Language and play skills were targeted separately for five children and together for four children. Children increased their rates of social engagement and language when language or play was the sole target and when language and play were targeted together; however, gains in play skills were evident only when they were targeted separately. This study provides support for the efficacy of the Project ImPACT when implemented by therapists at a low intensity and suggests the way in which skills are targeted can affect child learning.
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Affiliation(s)
- Brooke R Ingersoll
- a Department of Psychology , Michigan State University , East Lansing , MI , USA
| | - Allison L Wainer
- b AARTS Center , Rush University Medical Center , Chicago , IL , USA
| | - Natalie I Berger
- a Department of Psychology , Michigan State University , East Lansing , MI , USA
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Hendriks L, de Kleine RA, Heyvaert M, Becker ES, Hendriks GJ, van Minnen A. Intensive prolonged exposure treatment for adolescent complex posttraumatic stress disorder: a single-trial design. J Child Psychol Psychiatry 2017; 58:1229-1238. [PMID: 29057522 DOI: 10.1111/jcpp.12756] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The current study evaluated the effectiveness and safety of intensive prolonged exposure (PE) targeting adolescent patients with complex posttraumatic stress disorder (PTSD) and comorbid disorders following multiple interpersonal trauma. METHODS Ten adolescents meeting full diagnostic criteria for PTSD were recruited from a specialized outpatient mental health clinic and offered a standardized intensive PE. The intensive PE consisted of three daily 90-min exposure sessions delivered on five consecutive weekdays, followed by 3 weekly 90-min booster sessions. In a single-trial design, the participants were randomly allocated to one of five baseline lengths (4-8 weeks) before starting the intensive PE. Before, during, and after intensive PE completion, self-reported PTSD symptom severity was assessed weekly as a primary outcome (a total of 21 measurements). Furthermore, clinician-administered PTSD diagnostic status and symptom severity (primary outcome), as well as self-reported comorbid symptoms (secondary outcomes), were assessed at four single time points (baseline-to-6-month follow-up). RESULTS Time-series analyses showed that self-reported PTSD symptom severity significantly declined following treatment (p = .002). Pre-postgroup analyses demonstrated significant reductions of clinician-administered PTSD symptom severity and self-reported comorbidity that persisted during the 3- and 6-month follow-ups (all ps < .05), where 80% of adolescents had reached diagnostic remission of PTSD. There was neither treatment dropout nor any adverse events. CONCLUSIONS The results of this first proof of concept trial suggest that intensive PE can be effective and safe in an adolescent population with complex PTSD, although the gains achieved need to be confirmed in a randomized controlled trial.
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Affiliation(s)
- Lotte Hendriks
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands.,Behavioural Science Institute, NijCare, Radboud University, Nijmegen, The Netherlands
| | - Rianne A de Kleine
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands.,Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Mieke Heyvaert
- Faculty of Psychology and Educational Sciences, Methodology of Educational Sciences Research Group, Catholic University of Leuven, Leuven, Belgium
| | - Eni S Becker
- Behavioural Science Institute, NijCare, Radboud University, Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands.,Behavioural Science Institute, NijCare, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Agnes van Minnen
- Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institution for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands.,Behavioural Science Institute, NijCare, Radboud University, Nijmegen, The Netherlands
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Bryant BR, Bryant DP, Porterfield J, Dennis MS, Falcomata T, Valentine C, Brewer C, Bell K. The Effects of a Tier 3 Intervention on the Mathematics Performance of Second Grade Students With Severe Mathematics Difficulties. JOURNAL OF LEARNING DISABILITIES 2016; 49:176-188. [PMID: 24968860 DOI: 10.1177/0022219414538516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to determine the effectiveness of a systematic, explicit, intensive Tier 3 (tertiary) intervention on the mathematics performance of students in second grade with severe mathematics difficulties. A multiple-baseline design across groups of participants showed improved mathematics performance on number and operations concepts and procedures, which are the foundation for later mathematics success. In the previous year, 12 participants had experienced two doses (first and second semesters) of a Tier 2 intervention. In second grade, the participants continued to demonstrate low performance, falling below the 10th percentile on a researcher-designed universal screener and below the 16th percentile on a distal measure, thus qualifying for the intensive intervention. A project interventionist, who met with the students 5 days a week for 10 weeks (9 weeks for one group), conducted the intensive intervention. The intervention employed more intensive instructional design features than the previous Tier 2 secondary instruction, and also included weekly games to reinforce concepts and skills from the lessons. Spring results showed significantly improved mathematics performance (scoring at or above the 25th percentile) for most of the students, thus making them eligible to exit the Tier 3 intervention.
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Bajard A, Chabaud S, Cornu C, Castellan AC, Malik S, Kurbatova P, Volpert V, Eymard N, Kassai B, Nony P. An in silico approach helped to identify the best experimental design, population, and outcome for future randomized clinical trials. J Clin Epidemiol 2015; 69:125-36. [PMID: 26186899 DOI: 10.1016/j.jclinepi.2015.06.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The main objective of our work was to compare different randomized clinical trial (RCT) experimental designs in terms of power, accuracy of the estimation of treatment effect, and number of patients receiving active treatment using in silico simulations. STUDY DESIGN AND SETTING A virtual population of patients was simulated and randomized in potential clinical trials. Treatment effect was modeled using a dose-effect relation for quantitative or qualitative outcomes. Different experimental designs were considered, and performances between designs were compared. One thousand clinical trials were simulated for each design based on an example of modeled disease. RESULTS According to simulation results, the number of patients needed to reach 80% power was 50 for crossover, 60 for parallel or randomized withdrawal, 65 for drop the loser (DL), and 70 for early escape or play the winner (PW). For a given sample size, each design had its own advantage: low duration (parallel, early escape), high statistical power and precision (crossover), and higher number of patients receiving the active treatment (PW and DL). CONCLUSION Our approach can help to identify the best experimental design, population, and outcome for future RCTs. This may be particularly useful for drug development in rare diseases, theragnostic approaches, or personalized medicine.
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Affiliation(s)
- Agathe Bajard
- Centre de Lutte Contre le Cancer Léon Bérard, Unité de Biostatistique et d'Evaluation des Thérapeutiques, 28, rue Laënnec, Lyon 69373, France
| | - Sylvie Chabaud
- Centre de Lutte Contre le Cancer Léon Bérard, Unité de Biostatistique et d'Evaluation des Thérapeutiques, 28, rue Laënnec, Lyon 69373, France.
| | - Catherine Cornu
- CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon 1, UMR 5558 CNRS, Lyon, France; Hôpital Louis Pradel, Centre d'Investigation Clinique et Essais Thérapeutiques, INSERM CIC1407, Bron, France
| | - Anne-Charlotte Castellan
- Hôpital Louis Pradel, Centre d'Investigation Clinique et Essais Thérapeutiques, INSERM CIC1407, Bron, France
| | - Salma Malik
- CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon 1, UMR 5558 CNRS, Lyon, France; Hôpital Louis Pradel, Centre d'Investigation Clinique et Essais Thérapeutiques, INSERM CIC1407, Bron, France
| | - Polina Kurbatova
- Université Lyon 1, UMR 5558 CNRS, Lyon, France; Institut Camille Jordan UMR 5208, Université Claude Bernard Lyon 1, France
| | - Vitaly Volpert
- Institut Camille Jordan UMR 5208, Université Claude Bernard Lyon 1, France
| | - Nathalie Eymard
- Institut Camille Jordan UMR 5208, Université Claude Bernard Lyon 1, France
| | - Behrouz Kassai
- CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon 1, UMR 5558 CNRS, Lyon, France; Hôpital Louis Pradel, Centre d'Investigation Clinique et Essais Thérapeutiques, INSERM CIC1407, Bron, France
| | - Patrice Nony
- CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon 1, UMR 5558 CNRS, Lyon, France
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Increasing Access to an ASD Imitation Intervention Via a Telehealth Parent Training Program. J Autism Dev Disord 2014; 45:3877-90. [DOI: 10.1007/s10803-014-2186-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ingersoll B, Wainer A. Initial efficacy of project ImPACT: a parent-mediated social communication intervention for young children with ASD. J Autism Dev Disord 2013; 43:2943-52. [PMID: 23689760 DOI: 10.1007/s10803-013-1840-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Project ImPACT is a parent-mediated social communication intervention for young children with ASD that was developed in community settings to encourage dissemination. A single-subject, multiple-baseline design was conducted across 8 preschoolers with ASD and their mothers to examine the efficacy of the model for improving parent intervention fidelity and child spontaneous language. Multilevel modeling was used to examine the relationship between parent fidelity and child language within session. All parents increased their use of the intervention techniques. Improvements in spontaneous use of language targets were observed for 6 of the 8 children. There was a significant association between parents' use of the intervention strategies and their child's spontaneous language use.
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Affiliation(s)
- Brooke Ingersoll
- Michigan State University, Psychology Building, Rm 105B, East Lansing, MI, 48824, USA,
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Ingersoll B, Schreibman L. Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: effects on language, pretend play, and joint attention. J Autism Dev Disord 2006; 36:487-505. [PMID: 16568355 DOI: 10.1007/s10803-006-0089-y] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Children with autism exhibit significant deficits in imitation skills which impede the acquisition of more complex behaviors and socialization, and are thus an important focus of early intervention programs for children with autism. This study used a multiple-baseline design across five young children with autism to assess the benefit of a naturalistic behavioral technique for teaching object imitation. Participants increased their imitation skills and generalized these skills to novel environments. In addition, participants exhibited increases in other social-communicative behaviors, including language, pretend play, and joint attention. These results provide support for the effectiveness of a naturalistic behavioral intervention for teaching imitation and offer a new and potentially important treatment option for young children who exhibit deficits in social-communicative behaviors.
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