Parent assessments of self-determination importance and performance for students with autism or intellectual disability

Utilizing network analysis to identify core items of quality of life for children with autism spectrum disorder

The purpose of this study was to develop and validate an ultra-short scale called the Quality of Life for Children with Autism Spectrum Disorder 3 (QOLASD-C3) from the full 16-item QOLASD-C scale. We first used network analysis to identify three core items to be retained on the QOLASD-C3 scale. Second, we used Cronbach's alpha and Pearson Product Moment correlations to determine the reliability and validity of the scale. Third, an optimal cut-off score of 6 was identified for the using receiver operating characteristic curve analysis. Finally, we used logistic regression to examine the similarities in the classification status based on demographic characteristics between the quality of life (QOL) status using the QOLASD-C and the QOLASD-C3 scales. Results were similar across the two versions and suggested variations in QOL status based on race/ethnicity, autism spectrum disorder (ASD) severity, and parents' socio-economic status. Implications for research and practice are discussed.

Using a visual support package to facilitate independent leisure engagement and choice-making for individuals with moderate to severe autism in Taiwan

LAY ABSTRACT

Self-determination encompasses various components, including decision-making and independence, making it a complex process. While the importance of self-determination for individuals with autism spectrum disorder has been explored in previous studies, there is limited research focusing on individuals with moderate to severe autism spectrum disorder. Evidence-based practices such as visual activity schedules and video modeling have shown effectiveness in promoting independence among individuals with autism spectrum disorder. To address the need for independence and choice-making among individuals with moderate to severe autism spectrum disorder, this study developed a visual support package incorporating visual activity schedules, video modeling, preference assessments, and prompt procedures. By investigating the intervention's effectiveness in three participants, this study contributes to the existing literature on the use of a visual activity schedule and video modeling in enhancing choice-making and independent leisure engagement. Following the intervention, all participants were able to select three leisure activities, develop their own visual schedules, and complete them. Notably, this study conducted preference assessments to determine participants' preferred leisure activities and did not provide additional reinforcement. Practical implications of this research include incorporating video prompting as needed and adjusting activity engagement time. Future research should explore the long-term effectiveness of the visual support package and its application in developing novel skills or vocational activities for individuals with moderate to severe autism spectrum disorder. This study fills a critical gap in the literature, providing important insights for practices and research in the field of autism spectrum disorder interventions.

Description and predictors of self-determination in males and females with fragile X syndrome on the verge of adulthood

BACKGROUND

Self-determination refers to setting goals and making decisions regarding one's own life with support from others as needed. Research on people with intellectual and developmental disabilities has established the importance of self-determination for quality of life outcomes, such as increased independence and life satisfaction. However, self-determination has not been characterised specifically in fragile X syndrome (FXS), the leading inherited cause of intellectual disability. Relative to youth with other forms of intellectual and developmental disabilities, youth with FXS may face exceptional barriers to the development of self-determined behaviour. In addition to intellectual disability, the FXS behavioural profile is characterised by high rates of autism and anxiety that may further limit opportunities for youth with FXS. The heritable nature of the condition can also yield a distinctive family environment, with siblings and parents also living with fragile X or its associated conditions. Considering these unique challenges, the present study examined self-determination in young adult males and females with FXS and explored whether factors such as language skills, adaptive behaviour and autism traits were associated with self-determination capacity and opportunities.

METHODS

The present study included 9 females and 36 males with FXS between the ages of 17 and 25 years. Caregivers (mothers or fathers) completed the American Institute for Research Self-Determination Assessment, which is a questionnaire that yields three scores: self-determination capacity, opportunities for self-determination at home and opportunities for self-determination at school.

RESULTS

Caregivers endorsed a wide range of self-determination capacity and opportunities, with ratings for opportunities at home and school exceeding ratings of capacity. Better adaptive behaviour skills were associated with more self-determination capacity, and the presence of more autism traits was associated with fewer opportunities at school.

CONCLUSIONS

Results from this study contribute to our understanding of avenues to best support young adults with FXS as they transition to adulthood. Our findings also have implications for practice, such that interventions targeting adaptive behaviours and self-determination may be an effective approach for promoting autonomy and independence for young adults with FXS. Additionally, caregivers and educators should continue to provide opportunities to practise self-determination, regardless of their perception of capacity.

Developing the self-determination of children and young people with intellectual disabilities in schools: A systematic review of the literature

BACKGROUND

Self-determination is associated with lifelong positive outcomes. Students with intellectual disabilities typically have lower self-determination than their peers. Universal basic education access offers schools the opportunity to rectify this disparity. This is the first systematic review investigating the school-based practices that target self-determination development for students with intellectual disabilities.

METHOD

The review follows the PRISMA guidelines, spanning five databases (ProQuest databases, EMBASE, Scopus, Sage Journals, Taylor and Francis Online) from 2006 to 2021.

RESULTS

Across the 18 studies, the most used practice is the SDLMI. Research focuses on United States-based transition-aged students with mild to moderate intellectual disabilities. Social validity tends to be assessed in summative and informal ways. Students are not generally involved in decision-making about practices and individualisation of support.

CONCLUSIONS

Self-determination development for this population can begin before puberty. Future research should critically investigate social validity and holistic integration of student self-determination learning opportunities throughout the pedagogical cycle.

The associations among executive planning, self-determination, and quality of life in adolescents with intellectual disability

BACKGROUND

Skills such as planning and problem solving that are required in self-determination can be cognitively demanding. It has not yet been examined whether executive functions and intelligence are associated with levels of self-determination in individuals with intellectual disability (ID), and how that is related to quality of life (QoL). This study examined the associations among executive functions, intelligence, self-determination, and QoL in adolescents with ID.

METHODS

Seventy-nine adolescents aged between 17 and 20 years with mild ID participated in the study. Executive functions were assessed by experimental tasks. Non-verbal IQ and survey data regarding QoL and self-determination capacity were collected from the participants.

RESULTS

In a regression model with QoL as the dependent variable, only executive planning and self-determination capacity (but not working memory, inhibition and IQ) were significant predictors of QoL. Two mediation models were tested based on the hypotheses, literature and current findings. Model 1 revealed that executive planning had a negative direct effect on QoL when the mediator, self-determination capacity, was held constant. Model 2 indicated that the significant association between self-determination and QoL was not mediated by executive planning.

CONCLUSIONS

The findings highlighted the crucial significance of self-determination, in comparison with executive functions and intelligence, for improving the QoL in adolescents with ID. Importantly, higher executive planning skill was even associated with lower QoL if self-determination was not concurrently strengthened. These findings carry implications for the design of education and intervention programmes aimed at improving QoL of adolescents with ID.

Parenting Styles and Practices in Enhancing Self-Determination of Children With Intellectual and Developmental Disabilities

Parenting styles and practices are crucial in promoting the self-determination of children. The purpose of the current study was to investigate the role of parenting styles and practices in enhancing the self-determination of children with/without intellectual and developmental disabilities (IDD). The present study was carried out with a sample of 243 parents of children with/without IDD in Türkiye (Turkey). The results indicated that an authoritative parenting style and autonomy-supportive parenting practices positively affect the degree of child self-determination, whereas permissive and overprotective parenting practices may limit child opportunities in fostering self-determination. The study results also showed that urbanization, higher income, and higher education level of parents positively impacted the degree of child self-determination. Parents of typically developing children reported higher levels of overall self-determination for their typically developing children when compared with children with intellectual disability and autism spectrum disorder. On the other hand, parents of children with mild disabilities reported a higher level of self-determination than both children with moderate and severe disabilities. The results were discussed within the cultural context of the current sample.

Parental habitus in promoting self-determination of children with/without intellectual and developmental disabilities in Türkiye

BACKGROUND

Enhancing the self-determination of children with intellectual and developmental disabilities (IDD) is a prominent factor in their daily, community, school, or post-school outcomes. Parental practices play a crucial role in promoting self-determination of children with IDD. Families worldwide engage in parenting practices determined by each family's beliefs and values filtered through cultural experiences related to the place of origin, social structure, and living area.

AIMS

This study investigated the impact of parental habitus as structured within social and cultural capital on family ratings of child self-determination in two distinct regions of Turkey (Türkiye). Our assumption is that the gap in terms of social, economic, and cultural capital between different districts of the same country affects parental habitus in fostering their children's self-determination.

METHOD

Researchers collected information from 232 family members regarding the degree of their children's self-determination in two different geographic areas of Türkiye. We used the American Institutes for Research (AIR) Self-Determination Scale - Parent Form (AIR-SDS-PF questionnaire and a socio-demographic form to collect data. We employed the univariate analysis (two-way ANOVA) to identify the main and interactional effect among variables.

RESULTS

Parental habitus depending on where families live, socioeconomic level, and child's disability status was influential in promoting self-determination for their children with IDD and counterparts.

CONCLUSIONS

Regional or micro-cultural differences impacting parental dispositions should be considered in developing or planning self-determination interventions for children with/without IDD in the same country.

Youth and Caregivers' Perspective on Teens Engaged as Mentors (TEAM): An Inclusive Peer Mentoring Program for Autistic Adolescents

Past studies indicate that many autistic youth benefit from support with developing social relationships, exploring leadership opportunities, and engaging in post-secondary education. Teens Engaged as Mentors (TEAM) is an innovative mentoring program that provides socialization and community engagement opportunities in a safe environment for youth with and without autism. This qualitative study explored how participants and their caregivers perceived participation in TEAM. Stakeholder focus groups were conducted annually from 2016 to 2020 with 16 autistic mentees (ages 9-13), 30 autistic and neurotypical mentors (ages 14-21), and 30 caregivers. Participants reported enjoying TEAM because of increased socialization opportunities, which promoted friendships and openness toward others. Caregivers reported growth in their children's social skills and confidence throughout their participation.

Study Protocol for a Randomized Controlled Trial Evaluating the Effectiveness of a Group-Based Self-Determination Enhancement Intervention for Adults with Mild Intellectual Disability and Their Caregivers

Self-determination is regarded as an adult outcome for people with an intellectual disability (ID). However, self-determination curricula are rarely available in Hong Kong. This paper outlines a protocol for an experimental study that examines the effectiveness of a group-based self-determination enhancement intervention for adults with mild ID and their caregivers. A randomized controlled trial with pre-test, post-test and three-month follow-up is proposed. A total of 120 participants will be randomly assigned to three conditions: self-determination enhancement group, self-determination enhancement PLUS group (with caregivers in a parallel group) and leisure activity group as a control condition. Five groups will be organized for each of the three conditions. There will be 10 sessions per group covering the core components of self-determination including self-knowledge, goal setting and attaining goals, self-regulating and adjusting plans. Components for caregivers include understanding how self-determination and REACH responding skills can support their children to exercise self-determination through positive interaction. Self-determination competencies and personal well-being will be measured at three points in time. The proposed study is the first evidence-based local study aimed at examining a culturally tailored self-determination enhancement intervention for people with ID and fills a research gap in existing interventions. If the intervention is demonstrated to be effective, it will provide new knowledge for a group-based intervention and will be used with Chinese-speaking people with ID in different parts of the world. (Trial registration: ClinicalTrials.gov: NCT05167929).

Mothers' and practitioners' insights on the use of digitally-mediated social stories with children on the autism spectrum: A convergent mixed-methods study

BACKGROUND

While end-user interest in digitally-mediated Social Story (SS) intervention for children on the autism spectrum is growing, research on the use of SSs in digital form is currently lacking.

AIMS

This study aimed to investigate how digital-mediation can influence parents' and practitioners' attitudes towards the SS intervention as well as impact their perceived competence in their ability to administer the intervention.

METHODS AND PROCEDURES

This study used a convergent mixed-method design. Nineteen participants (ten practitioners and nine mothers) participated in two focus group sessions. Participants then engaged with a digitally-mediated SS and completed a pre- and post-engagement survey measuring attitude, competence and user experience with the intervention.

OUTCOMES AND RESULTS

The mothers' perceived competence ratings improved after engaging with digitally-mediated SSs. Mothers and practitioners also indicated that digitally-mediated SSs increased their perceived efficiency, while mothers felt it improved their autonomy and further empowered them as end-users.

CONCLUSION AND IMPLICATIONS

Digitally-mediated SS has the potential to effectively address challenges related to intervention implementation whilst also empowering further the end-user.

Self-determination in Male Children with Intellectual Disabilities: Perceptions of Parents from Saudi Arabia

BACKGROUND

Self-determination is essential for improving the quality of life of individuals with disabilities. Prior research has indicated that parents' values and practices are important in supporting the development of self-determination in their children.

AIM

The purpose of the study was to examine Saudi Arabian parents' values and perceptions regarding the importance, performance, and provision of self-determination opportunities to their high school male children with and without intellectual disability.

METHODS

The participants were 133 parents of high school children (76 parents of a child without disabilities and 57 parents of a child with intellectual disabilities, accounting for 57.1% and 42.8%, respectively). Data were collected using a self-report questionnaire. Descriptive statistics and independent samples t-tests were used to understand parents' perceptions of and behaviors related to self-determination.

RESULTS

The results revealed no significant difference in the ratings of the importance of self-determination between the two groups of parents. Parents of children with intellectual disabilities rated their child's self-determination performance lower and provided fewer opportunities to improve their children's self-determination.

CONCLUSION

The results suggested that self-determination skills were valued in Saudi Arabia, highlighting that disability may affect the performance and opportunities to practice self-determination.

Family Role in the Development of Self-Determination for Youth With Intellectual and Developmental Disabilities: A Scoping Review

The development of self-determination is promoted by supportive contexts during adolescence; families are a key part of this context. In adolescent populations, research suggests families can support self-determination in a number of ways, yet less is known about how self-determination is promoted within families of youth with intellectual and developmental disabilities (IDD). To address this knowledge gap, we conducted a scoping review to examine the existing evidence pertaining to the role families of youth with IDD play in supporting the development of self-determination. A review of 24 publications revealed that existing research has focused on understanding family perspectives on self-determination, but there is a lack of studies investigating how families provide supports for self-determination in the home context for youth with IDD. Additionally, little intervention work has focused on supporting families to promote self-determination. Based on the findings, implications for future research and practice are provided.

Identifying School-Based Factors that Predict Employment Outcomes for Transition-Age Youth with Autism Spectrum Disorder

There is a growing need to provide appropriate services to help students with autism spectrum disorder (ASD) transition to employment. Limited research has investigated what aspects of support should be prioritized when preparing youth with ASD for employment. By conducting structural equation modeling using a nationally-representative dataset on high school students receiving special education services (NLTS-2), this study examined the malleable predictors of employment during the transition and developed a model to examine the relationships between predictors and employment outcomes. The findings suggested two pathways for youth with ASD. For youth with higher daily functioning skills (DFS), academic performance mediated the relationship between parent participation and employment. For youth with lower DFS, school-based transition supports was the key mediator.

Non-pharmacological Interventions for Adults with Autism: a Systematic Review of Randomised Controlled Trials

To determine the effects of non-pharmacological randomised controlled trials in adults with autism, a systematic review was conducted across five electronic databases. A total of 3865 abstracts were retrieved, of which 41 articles met all inclusion criteria: randomised controlled trial; non-pharmacological intervention; adults with autism; and English publication. Twenty included studies had strong methodological quality ratings. No meta-analysis could be performed due to heterogeneity between studies. Articles reported on interventions for (1) social functioning and language skills, (2) vocational rehabilitation outcomes, (3) cognitive skills training, and (4) independent living skills. Social functioning was the most studied intervention. PEERS for young adults and Project SEARCH plus ASD support interventions had the strongest evidence. Emerging evidence suggests non-pharmacological interventions could be effective.

Effects of a Justice-Based Partnership Between Employees and Families in Creating Services and Supports to Enhance Quality of Life Outcomes

We propose a justice-based partnership between employees and family members as a means to create services and support systems for people with intellectual disability, enhancing quality of life indicators. More specifically, we examine the links from mutual intergroup justice to three outcomes reported by family members: satisfaction with the center, service quality delivered by employees, and performance focused on the quality of life of people with intellectual disability. We used data from 111 centers. In each center, a group of family members (n = 845) and a group of employees (n = 914) participated. Multilevel modeling revealed that mutual intergroup justice (between employees and family members) has a positive effect on satisfaction with the center, perceptions of functional and relational service quality, and performance based on quality of life.

Differences in Self-Determination Across Disability Categories: Findings From National Longitudinal Transition Study 2012

Researchers have established variability in self-determination scores across disability groups, but most nationally representative research has used data collected over a decade ago from the National Longitudinal Transition Study 2 (NLTS2). To provide an updated analysis of differences in characteristics of self-determination (i.e., autonomy, psychological empowerment, self-realization) across disability groups, this study analyzed data from the recently completed National Longitudinal Transition Study 2012 (NLTS2012). The authors tested measurement equivalence across seven disability groups: high-incidence disabilities (learning disabilities, emotional disturbances, speech or language impairments, and other health impairments), sensory disabilities (visual and hearing impairment), multiple disabilities (multiple disabilities and deaf-blindness), intellectual disability, traumatic brain injury, orthopedic impairments, and autism spectrum disorder (ASD). Students in the multiple disabilities, intellectual disability, and ASD groups showed lower self-determination scores compared with other disability groups. Greater variability was also found in scores among these groups. Implications for assessment research practice, and policy are highlighted.

Validation of the Health-Related Independence for Young Adults with Autism Spectrum Disorder Measure- Caregiver Version

Little is known about Young adults with Autism Spectrum Disorder (YA-ASD) health, healthcare and safety needs. This study describes the validation of a health care transition measure for YA-ASD, the Health-Related Independence (HRI). We collected data from caregivers (n = 490) at five Autism Treatment Network sites and compared the psychometric properties of HRI to the gold standard (STAR_x) and other validated measures. A Confirmatory Factor Analysis and item culling resulted in 30 items addressing six subscales. Content, criterion, and construct validity and internal consistency indicated high validity and reliability for the scale and subscales. HRI is a validated caregiver-report measure of YA-ASD's self-management, safety, and transition skills. This novel measure will be a useful tool in clinics, intervention development, and research.

Student, Educator, and Parent Perspectives of Self-Determination in High School Students with Autism Spectrum Disorder

Self-determination refers to an individual being a causal agent in their daily activities, including the ability to express their own needs, interests, and wants, make choices, and set goals. Self-determination is critical during adolescence and has been linked to positive educational outcomes in individuals with disabilities. Few studies have characterized the measurement of self-determination in adolescents with autism spectrum disorder (ASD). The purpose of the current study was to (a) examine the agreement across the American Institutes for Research Self-Determination Scale (Wolman et al., AIR Self-determination scale and user guide. Palo Alto, CA: American Institute for Research, 1994) student, educator, and parent forms for high school students with ASD, and (b) examine student and family predictors of self-determination. Participants included adolescents with ASD (N = 547, mean chronological age = 16.1 years, SD = 1.4 years), their parents, and educators. Student reports did not correspond to parent or educator reports, and parent and educator reports were in moderate agreement. Adaptive behavior was a significant predictor of self-determination across reporters, highlighting the significance of adaptive behavior skills during high school. In addition to promoting adaptive behavior, supporting family empowerment, and reducing family burden may help to increase self-determination in high school students with ASD. LAY SUMMARY: Self-determination refers to the abilities and opportunities for students to make choices, plans, and set goals. The current study examined self-determination from multiple perspectives in a large, diverse sample of high school students with ASD. Students, parents, and their teachers each completed a questionnaire on self-determination and had little to some agreement across reporters. Providing support to families and help for students to increase independent skills may promote self-determination.

What does success mean for autistic men? A narrative exploration of self-determination

BACKGROUND

Studies involving autistic adults have often focused on negative outcomes and quality of life ratings.

AIMS

This study provides a different viewpoint by examining the perspectives of autistic men who consider themselves to be successful.

METHODS

Data were gathered from 10 men who shared their experiences and perceptions regarding their journey to achieve success. Self-determination theory provided a useful lens for examining the men's narratives and understanding the factors that led to their success.

RESULTS

Analysis of interviews revealed four main themes: (1) being my own self, (2) a competent professional, (3) solving problems in a neurotypical world, and (4) relating and connecting. These themes reflect the men's perception of their own self-determination including their autonomy, competence, and relatedness with others.

CONCLUSIONS

The men's sense of success was derived from their ability to achieve competence in their work, act without help or influence from others and demonstrate a high level of self-awareness and self-reflection. Despite this, many continued to experience difficulty in the social areas of their lives.Implications: These findings suggest that self-determination theory may present an alternative and more positive means of enacting support programs for autistic individuals, and males in particular.

The experience of mothers supporting self-determination of adult sons and daughters with intellectual disability

BACKGROUND

The right of people with disability to be self-determining, to live a life of their choosing, is increasingly recognized and promoted. For adults with intellectual disability, support to enable self-determination may be required. This is often provided by family, yet little is understood about the experience of providing such support.

METHODS

An interpretative phenomenological analysis (IPA) of eight individual, semi-structured interviews with mothers was conducted, to understand the meaning given to their experience of supporting self-determination of their adult son or daughter with intellectual disability.

RESULTS

Three superordinate themes were identified: (a) support context; (b) continuum of support roles; and (c) mother's personal concerns.

CONCLUSION

Mothers of adults with intellectual disability experience an ongoing sense of responsibility to balance competing rights and concerns as they support self-determination. This complex, interdependent relationship results in roles that may facilitate, guide, influence and at times restrict choice and control.

Self-determination in young adults with autism spectrum disorder

This study examined rates of and contributing factors to self-determination among young adults with autism spectrum disorder. Caregivers of young adults with autism spectrum disorder, 16-25 years, from five Autism Treatment Network sites completed surveys about their young adults' transition experiences including the American Institutes for Research Self-Determination measure. Data were analyzed using univariate and multivariate analysis. Caregivers (n = 479) reported their young adults with autism spectrum disorder as having moderate overall self-determination (x = 38; standard deviation = 9.04) with low capacity (x = 15.3; standard deviation = 5.67) and high opportunities at home (x = 23.1; standard deviation = 4.59). Young adults with autism spectrum disorder with intellectual disability or severe autism spectrum disorder symptomology experience significant disparities in overall self-determination compared to those without intellectual disability and less frequent symptom expression and severity. Barring severity indicators, there were few significant predictors of self-determination. Findings show a breakdown in self-determination skill-building. Young adults with autism spectrum disorder with intellectual disability or severe symptomology experienced significant disparities in self-determination. These findings show that current promotion of self-determination is not meeting the needs of young adults with autism spectrum disorder. Future interventions must identify what supports young adults with autism spectrum disorder need to capitalize on these opportunities to be independent and exert autonomy in their daily lives.

Perceptions and understandings of self-determination in the context of relationships between people with intellectual disabilities and social care professionals

This study examines perceptions and understandings of self-determination in the context of relationships between people with intellectual disabilities and social care professionals. We held focus group discussions to explore the views and experiences of 10 residents and 10 professionals at three facilities for people with intellectual disabilities located in Western Switzerland. Participants perceived and understood self-determination in terms of decision-making, social skills, procedures, identity, self-consciousness, autonomy, freedom, barriers, and facilitators. The research process highlighted the shifting and situational nature of the concept, as well as the importance of self-determination for people with intellectual disabilities. The findings also highlight the importance of discussion and reflection on the concept of self-determination and its benefits for people with intellectual disabilities.

The exercise of human rights and citizenship by older adults with an intellectual disability in Ireland

BACKGROUND

The UN Convention on the Rights of Persons with Disabilities (CRPD) provides the benchmark for assessing human rights and citizenship for people with disabilities. This emphasises autonomy, choice, independence, equality and participation for individuals as its fundamental guiding principles.

METHODS

This paper explores the exercise of human rights and citizenship for older adults with intellectual disabilities (ID) in Ireland, including choice-making, advocacy and political participation. Cross-sectional data (n = 701) is drawn from wave 2 of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. Rates of participation are reported, along with bivariate associations across a range of demographic, personal and social variables, while factors associated with level of choice-making and voting are explored.

RESULTS

We found very low rates of choice-making, advocacy and political participation amongst this population. Two factors of choice were explored: key life choice and everyday choice. Some commonalities were identified between the two factors, yet key differences were also noted. Type of residence was the strongest predictor of key life choice yet not significant in everyday choice, while the reverse was true for functioning in activities of daily living. Other factors were also significant in determining choice, including level of ID, contact with family, functional limitation, literacy, age, having friends and respondent type.

CONCLUSIONS

Low rates of participation reported here impinge on the rights of older adults with ID under the principles of the UN CRPD. Choice-making emerged as a multi-factorial phenomenon, with different factors important depending on the type of choice involved. This encourages a nuanced and personalised response from policy and support services to overcome individual challenges to participation as equal citizens. The significance of respondent type also highlights the difficulty of including self-report, supported and proxy participants in ID research.

'It's my home and your work': the views of a filmed vignette describing a challenging everyday situation from the perspective of people with intellectual disabilities

Purpose: Examining everyday challenges in the interactions between people with intellectual disabilities and their staff, as seen from the user’s perspective, is an important perspective in health care research. Involving people with intellectual disabilities as so-called co-researchers is a relatively unexplored research strategy. In this paper, co-researchers participated in all the steps of the research process, from planning to reporting, in addition to the written reporting of the findings. The aim of this study was to explore how people with intellectual disabilities experienced a filmed vignette of an everyday situation. Method: Based on audio-recorded and transcribed individual and focus-group interviews with people with intellectual disabilities, performed by co-researchers with intellectual disabilities together with researchers, qualitative content analysis was used. Results: The analysis reveals three themes: “being emotionally touched”, “being aware of the other”, and “being unclear”. Conclusions: The results are discussed in light of normalization and participation in society with independence and one’s own decision-making. Regarding the care of people with intellectual disabilities, the main finding is the need to focus not only on greater involvement of this population in their own daily lives, but also to teach self-determination skills. Another finding is the importance of involving people with intellectual impairment as co-researchers.

A Pilot Randomized Controlled Trial of the ACCESS Program: A Group Intervention to Improve Social, Adaptive Functioning, Stress Coping, and Self-Determination Outcomes in Young Adults with Autism Spectrum Disorder

The purpose of this pilot randomized controlled trial was to investigate the acceptability and efficacy of the Acquiring Career, Coping, Executive control, Social Skills (ACCESS) Program, a group intervention tailored for young adults with autism spectrum disorder (ASD) to enhance critical skills and beliefs that promote adult functioning, including social and adaptive skills, self-determination skills, and coping self-efficacy. Forty-four adults with ASD (ages 18-38; 13 females) and their caregivers were randomly assigned to treatment or waitlist control. Compared to controls, adults in treatment significantly improved in adaptive and self-determination skills, per caregiver report, and self-reported greater belief in their ability to access social support to cope with stressors. Results provide evidence for the acceptability and efficacy of the ACCESS Program.

Effectiveness of the BOOST-A™ online transition planning program for adolescents on the autism spectrum: a quasi-randomized controlled trial

BACKGROUND

The majority of existing transition planning programs are focused on people with a disability in general and may not meet the specific need of adolescents on the autism spectrum. In addition, these interventions focus on specific skills (e.g. job readiness or self-determination) rather than the overall transition planning process and there are methodological limitations to many of the studies determining their effectiveness. The Better OutcOmes & Successful Transitions for Autism (BOOST-A™) is an online program that supports adolescents on the autism spectrum to prepare for leaving school. This study aimed to determine the effectiveness of the BOOST-A™ in enhancing self-determination.

METHODS

A quasi-randomized controlled trial was conducted with adolescents on the autism spectrum enrolled in years 8 to 11 in Australian schools (N = 94). Participants had to have basic computer skills and the ability to write at a year 5 reading level. Participants were allocated to a control (n = 45) or intervention (n = 49) group and participants were blinded to the trial hypothesis. The intervention group used the BOOST-A™ for 12 months, while the control group participated in regular practice. Outcomes included self-determination, career planning and exploration, quality of life, environmental support and domain specific self-determination. Data were collected from parents and adolescents.

RESULTS

There were no significant differences in overall self-determination between groups. Results indicated significant differences in favor of the intervention group in three areas: opportunity for self-determination at home as reported by parents; career exploration as reported by parents and adolescents; and transition-specific self-determination as reported by parents.

CONCLUSIONS

Results provide preliminary evidence that the BOOST-A™ can enhance some career-readiness outcomes. Lack of significant outcomes related to self-determination at school and career planning may be due to the lack of face-to-face training and parents being the primary contacts in the study. Further research is needed to determine effectiveness of the BOOST-A™ related to post-secondary education and employment. Trial registration #ACTRN12615000119594.

Self-Determination, Intellectual Disability, and Context: A Meta-Analytic Study

The relation between self-determination and intellectual functioning is complex, as other contextual factors may also play significant roles in explaining variability in self-determination. This study used meta-analytic techniques to assess how self-determination measures vary between people with disabilities classified as having intellectual disability (ID) or not, and contextual variables that moderate this relation. The literature search yielded 16 eligible studies, whose variables of interest were coded and analyzed. The results showed that when comparing self-determination measures among disability classification groups, gender, disability label and race/ethnicity were associated with the effect size estimation. These findings empirically support the relevance of personal variables when understanding self-determination levels and their impact in the operational classification of ID.

Quality of Life for Transition-Age Youth with Autism or Intellectual Disability

We examined the subjective health and well-being of 389 transition-age youth with autism or intellectual disability using the parent proxy version of the KIDSCREEN-27. Parents reported well-being of youth with autism and youth with intellectual disability lower than a normative sample in the domains of Physical Well-being, Psychological Well-being, and Social Support and Peers. For both groups of young people, the lowest ratings were reported in Social Support and Peers. Higher ratings of well-being in one or more domains were predicted by minority status, youth character strengths, involvement in community activities, and religious faith. Challenging behaviors, autism, age, and speech as the primary mode of communication were predictive of lower ratings of well-being. We discuss implications for special educators and service providers and offer directions for future research.

Translating Research to Practice for Children With Autism Spectrum Disorder: Part I: Definition, Associated Behaviors, Prevalence, Diagnostic Process, and Interventions

INTRODUCTION

The number of children with autism spectrum disorder (ASD) is rising, along with the potential for challenging behaviors during health care encounters.

METHOD

We present an overview of the emerging science related to ASD diagnosis and interventions for children with ASD.

RESULTS

Emerging science on ASD reveals common associated challenging behaviors, increasing prevalence, emphasis on early diagnosis at 18 to 24 months of age, changes in the diagnostic process with criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, and interventions with medication, education, and behavior management.

DISCUSSION

Family and health care provider preparation strategies facilitate care of children with ASD and their families. Early diagnosis at 18 to 24 months of age and evidence-based interventions contribute to best outcomes for children and families. Health care providers must be aware of the state of the science for diagnosis and best practices to provide family-centered care for this growing population.

Persons with multiple disabilities engage in stimulus choice and postural control with the support of a technology-aided program

Technology-aided programs have been reported to help persons with disabilities develop adaptive responding and control problem behavior/posture. This study assessed one such program in which choice of stimulus events was used as adaptive responding for three adults with multiple disabilities. A computer system presented the participants stimulus samples. For each sample, they could perform a choice response (gaining access to the related stimulus whose length they could extend) or abstain from responding (making the system proceed to the next sample). Once choice responding had strengthened, the program also targeted the participants' problem posture (i.e., head and trunk forward bending). The stimulus exposure gained with a choice response was interrupted if the problem posture occurred. All three participants successfully (a) managed choice responses and access to preferred stimuli and (b) gained postural control (i.e., reducing the problem posture to very low levels). The practical implications of those results are discussed.

A social-ecological analysis of the self-determination literature

This paper uses a social-ecological lens to examine self-determination research, attempting to organize what is known (and unknown) about contextual factors that have the potential to impact the development and expression of self-determined behavior in people with disabilities across multiple ecological systems. Identifying and categorizing the contextual factors that researchers suggest influence self-determination have the potential to allow for the development of a framework that promotes systematic consideration of contextual factors when designing, implementing, and evaluating supports to promote self-determination. Directions for future research and practice are discussed.

Self-determination and choice

Promoting self-determination and choice opportunities for people with intellectual and developmental disabilities has become best practice in the field. This article reviews the research and development activities conducted by the authors over the past several decades and provides a synthesis of the knowledge in the field pertaining to efforts to promote self-determination and choice.

Connecting Youth and Young Adults with Autism Spectrum Disorders to Community Life

Equipping youth with autism spectrum disorders (ASD) to flourish during and after high school is central to the purpose and practice of special education. However, many students with ASD are leaving high school without the preparation and connections needed to engage meaningfully in their communities. This article reviews research-based approaches for connecting adolescents with ASD to life beyond the classroom by describing promising practices for fostering inclusion in postsecondary education and community activities. Recognizing that relationships are at the core of community life, emphasis is placed on fostering social connections as an essential aspect of helping young people with ASD thrive in these settings. We conclude with suggestions for school staff to support the successful transitions of young people with ASD.