Appropriateness of the TOBY Application, an iPad Intervention for Children with Autism Spectrum Disorder: A Thematic Approach

This study aimed to explore the appropriateness of an ICT intervention, the Therapeutic Outcomes by You application (TOBY app), from the perspectives of the parents. Parental experiences of twenty-four parents of a child with ASD who had participated in a three-month trial using the TOBY app were collected using semi-structured interviews. Thematic analysis was conducted and themes were mapped against an appropriateness framework. Collectively, parents felt the TOBY app was relevant and important to them and their children's needs, while expressing partial support of the TOBY app as: a positive experience for them and their children, beneficial for them and their children, a socially and ecological valid intervention, and an intervention that supported change and continuation in the skills learnt.

The feasibility and appropriateness of a peer-to-peer, play-based intervention for improving pragmatic language in children with autism spectrum disorder

Purpose: This study trialled a play-based, peer-to-peer intervention with children with autism spectrum disorder (ASD) to identify suitable instruments for measuring changes in pragmatic language following the intervention, and evaluate preliminary effectiveness. It also aimed to investigate the appropriateness of the intervention for participants. Method: Ten children with ASD, their typically developing peers, and parents participated. The Pragmatics Observational Measure (POM), Social Emotional Evaluation (SEE) and Profiling Elements of Prosody in Speech Communication (PEPS-C) measured the participant's social communication skills before, after, and 2-months following the intervention. Parent interviews were conducted two months after the intervention and responses were analysed using a thematic approach. Result: Children demonstrated gains in pragmatic language on the POM (χ²(3) = 11.160, p = 0.011) and related higher-level language on the SEE (χ²(2) = 6.686, p = 0.035). The PEPS-C did not produce any significant results. Parent interview responses indicated the intervention was appropriate for the children and families involved. Conclusion: The intervention warrants further investigation of effectiveness with a more robust research design. Consideration should be given to using observational measures of pragmatic language away from the clinic environment to evaluate generalisation, and future development of the intervention might consider variations in playmates and group size.

Parents' perceptions of the long-term appropriateness of a psychosocial intervention for children with attention deficit hyperactivity disorder

BACKGROUND/AIM

Designing psychosocial interventions that parents perceive as appropriate is essential to enhancing their engagement with the intervention and their long-term use of the intervention strategies. The aim of this study was to explore the long-term appropriateness of a play-based psychosocial intervention for children with Attention Deficit Hyperactivity Disorder (ADHD) from the perspectives of parents.

METHODS

Semi-structured phone interviews were conducted with 14 parents of children with ADHD who participated in a randomised controlled trial of the play-based intervention 1 year earlier.

RESULTS

Thematic analysis led to the development of three core-themes: (i) Everybody needs a parenting handbook, (ii) No one thing you are dealing with, and (iii) A different approach: Reframing.

DISCUSSION

The core-themes related back to a definition of intervention appropriateness that acknowledges the intervention as important/relevant, beneficial, socially and ecologically valid and promotes sustainable change, indicating parents perceived the intervention as appropriate. The core-themes also resembled aspects of the process of family adaptation. Findings highlight the importance of designing interventions that are appropriate from parents' perspectives to enhance their long-term engagement and use of the intervention strategies as well as outcomes for their child in the long term.

The use of video-modelling as a method for improving the social play skills of children with attention deficit hyperactivity disorder (ADHD) and their playmates

Introduction

We investigated child outcomes and mothers' perspectives following technology-based intervention sessions aimed at improving children's social play skills.

Method

Participants in this multiple case study included five children with attention deficit hyperactivity disorder, their mothers and five typically developing playmates, who had completed a parent-delivered play-based intervention 18 months previously. The initial intervention included the use of a technology-based interactive DVD at home and clinic-based sessions involving video-modelling. In this study, children received two additional technology-based clinic sessions involving video-modelling. Children's social play skills were measured pre- to post-intervention using the Test of Playfulness. Trends in scores were descriptively analysed by case. Mothers' perspectives were explored through semi-structured interviews; data were descriptively analysed by group and case.

Results

Two children with attention deficit hyperactivity disorder showed an increase in their social play skills, and three a decrease in skills. Of the playmates, three showed consistent social play skills, one an increase and one a decrease. Qualitative findings suggest parents felt better able to support their child. Parents also suggested next steps for the intervention were necessary as their child continued to develop.

Conclusion

Additional intervention support using technology after initial intervention may need to be adapted to different developmental stages and for use across different contexts.

A Randomised Controlled Trial of a Play-Based Intervention to Improve the Social Play Skills of Children with Attention Deficit Hyperactivity Disorder (ADHD)

There is a need for effective interventions to address the social difficulties of children with ADHD. This randomised controlled trial examined the effectiveness of a play-based intervention for improving the social play skills of children with ADHD in peer-to-peer interactions. Children with ADHD (5 to 11 years) were randomised to an intervention-first (n = 15) or waitlist control-first group (n = 14). Participants allocated to the control-first group received the intervention after a 10-week wait period. Children invited a typically-developing playmate and parents of children with ADHD participated. The intervention involved: six clinic play-sessions, weekly home-modules and a one-month home follow up. The Test of Playfulness (ToP) was scored by a blinded rater. Parent reported treatment adherence was used to assess treatment fidelity. Between group statistics were used to compare the change of the intervention-first (10-week intervention period) and control-first (10-week wait period) groups. Once all children had received the intervention, repeated measures ANOVA, post hoc Least Significance Difference tests and Cohen’s-d were used to measure effect. Changes in ToP social items were analysed using Friedman’s ANOVA. Linear regression analyses were used to identify variables that predicted change. The control-first group did not change during the wait period. The change in the intervention-first group was significantly greater than the change in the control-first group (during the wait period). When the data from the two groups were combined, the mean ToP scores of the children with ADHD (n = 29) improved significantly following the intervention, with a large effect from pre to post intervention and from pre intervention to follow up. Children maintained treatment gains at follow up. All ToP social items improved significantly following the intervention. The findings support the use of play involving parent and peer mediated components to enhance the social play skills of children with ADHD.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000973617

Evaluating the pragmatic language skills of children with ADHD and typically developing playmates following a pilot parent-delivered play-based intervention

BACKGROUND/AIM

Children with attention deficit hyperactivity disorder (ADHD) often present with pragmatic language deficits and difficulties with peer-peer friendships. Parents and typically developing peers (TDPs) may be able to assist via parent and peer-mediated intervention approaches when adequately supported by trained adult facilitators. This study investigated whether a parent-delivered play-based intervention supported by occupational therapists and speech language pathologists was feasible and improved the pragmatic language skills of children with ADHD and their TDPs.

METHODS

Nine children with ADHD paired with nine TDPs (mean age = 8.2 years) participated. The seven-week intervention was delivered by parents of children with ADHD at their home and consisted of weekly assigned home-based modules, supported play-dates between the pairs of children and supplemented by three clinic visits. Parent adherence to intervention activity was monitored on a weekly basis. Blinded ratings of observed peer-peer play interactions were used to detect changes in pragmatic language from pre-post intervention and one month follow-up using the Pragmatic Observation Measure (POM).

RESULTS

All parents reported completing the seven weekly home-based modules and attended all clinic visits. Significant improvements in observed pragmatic language skills were found from pre-follow-up for both the ADHD and TDP children and pre-post for the ADHD children.

CONCLUSION

The preliminary findings suggest that using parents to facilitate their child's pragmatic language skills was a feasible intervention approach with parents acting as agents of change to improve the pragmatic language of their children. This exploratory study identifies the need for further large-scale research to address the pragmatic language skills of children with ADHD using parent-delivery in a play-based, peer-peer context.