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Abstract: Objectives The potential role of neuroinflammation in adult attention deficit hyperactivity disorder (ADHD) patients has been investigated with peripheral hemogram-related inflammatory markers. Systemic immune inflammation index (SII) is defined as a new index that has been developed for the balance of inflammatory and immune status. Methods Our study was based on a prospective routine complete blood count(CBC) analysis of 74 Adult ADHD patients and 70 healthy participants. The DSM-5-Clinician version and Barratt impulsivity scale-11 were used to evaluate the participants. Results There was no statistical difference in the comparison of the SII ratios, platelet distribution width (PDW), and plateretritis (PCT) (p>0.05 for each) in a group of a young adults with ADHD and in a comparison control group. These inflammatory indicators were found to be similar between patients newly diagnosed with ADHD (n=40) and patients using methylphenidate (n=34) (p>0.05 for each). The relationship between ADHD clinical symptoms and severity and inflammation was evaluated. A significant negative correlation was observed between attention deficit scores and PCT (r=−0.301, p=0.009). A positive significant correlation was found between hyperactivity scores and SII (r=0.247, p=0.034). A significant positive correlation was found between Barrat motor scores and PDW(r=241, p=0.038). In the regression analysis, the PCT variable changed the attention deficit variable (β=.33, t(70)= −2.703, p=.009, pr2= .094) predicted negatively and significantly. Conclusions We demonstrated the association of SII, which is independently associated with adverse outcomes in many diseases, and the severity of hyperactivity symptoms in adult ADHD. The fact that PCT predicts attention deficit negatively and decisively shows the importance of inflammatory assessments specific to clinical presentations. The critical importance of platelets in inflammatory processes in ADHD has been demonstrated once again with inflammatory markers such as SII, PLT, and PDW, which can be accessed by an easily applicable complete blood count method. PubDate: 2022-05-11
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Abstract: Objectives The COVID-19 pandemic and the resulting social changes have made unprecedented changes in our lifetime with unknown repercussions on children with autism spectrum disorders. We sought to assess the effect of the COVID-19 pandemic and resulting social changes on boys with autism spectrum disorder. Methods We conducted a survey using the CRISIS-AFAR questionnaire of caregivers of a population of boys (n = 40) with moderate to severe autism spectrum disorder for changes in environment and behavior before and after the pandemic. Results We found several interesting findings, including an increase in self-injurious behaviors after the start of the pandemic, but not in the level of hyperactivity, anxiety, or aggressive behavior, or amount and frequency of stereotypies/repetitive behaviors in the children before and after the start of the pandemic. There was an increased difficulty in adjusting to new daily routines after the pandemic, as well as increased difficulty falling asleep. Conclusions The study showed that a majority of boys with moderate/severe autism in our study were negatively affected by the pandemic across several domains. Additionally, this study highlights the need for educational and mental health resources to be prepared for similar events in the future. PubDate: 2022-05-06
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Abstract: Objective The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. Methods A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. Results There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. Conclusions The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions. PubDate: 2022-05-02
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Abstract: Objectives A disproportionate number of individuals with autism spectrum are unable to transition into independent living during adulthood, compromising the ability to experience autonomy and exert self-determination. Over the past 30 years, there has been an increasing trend to incorporate technology into educational and behavioral interventions, including those to target daily living skills. Methods In order to inform practice and identify needs for future research, we conducted a systematic review of peer-reviewed published research evaluating the effectiveness of an intervention incorporating electronic technology to improve daily living skills among adults with autism spectrum. We extracted data regarding participants, daily living skills targeted, intervention characteristics, and outcomes. Additionally, we evaluated each case against What Works Clearinghouse single-case design standards. Results Through a systematic database search and ancillary searches, we identified 27 studies with 49 participants. Interventions supported by electronic technology were most commonly used to improve meal preparation and housekeeping tasks. Across most applications, technology was utilized within the antecedent portion of an intervention, most commonly used with video modeling or video prompting interventions. Surprisingly, few studies took place in the participants’ place of residence. Conclusions Evidence suggests there is great potential for incorporating technology into daily living skill interventions; however, more research is warranted to realize the full benefits of this approach. PubDate: 2022-04-25
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Abstract: Objectives Research involving the use of augmentative and alternative communication (AAC) applications on mobile technology devices for children with autism spectrum disorder (ASD) needs to expand beyond teaching simple requesting skills. Children’s abilities to create multi-symbol AAC messages is one skill that can be further explored. Methods Two preschool-aged males with ASD were taught to use an AAC application to create two-symbol messages (e.g., possessor-entity, agent-action) to label play-based stimuli. Both participants had prior experience using AAC applications to request. For each participant, we implemented a multiple probes across targets design. We used matrix training to introduce different combinations of the two-word targets. Targeted responses were taught during play using an embedded instruction approach that involved modeling, time delay, and prompting. Results Both participants rapidly acquired possessor-entity targets. Results for agent-action responses were mixed. One participant showed gradual improvement with these targets, and the other showed variable performance. Conclusions This pilot study provides evidence that while children with ASD can increase their use of multi-symbol AAC messages in play contexts, some communicative targets may be more easily acquired. Factors such as motivation and prior symbol knowledge may have influenced responding. More research is needed to continue to establish effective methods for teaching advanced AAC skills to children with ASD. PubDate: 2022-04-25
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Abstract: Objectives This paper describes and integrates self-determination and mindfulness research in intellectual and developmental disability, with a focus on how both approaches shift the focus to intervening from the “inside out” rather than from the “outside in.” Methods A targeted overview of self-determination and mindfulness research in intellectual and developmental disabilities is provided. Parallels and areas of divergence are described, with implications derived for the integration of the two approaches to promote positive outcomes for people with intellectual and developmental disabilities. Results There is a synergistic relationship between self-determination and mindfulness-based interventions. Promoting internal resources, self-awareness, and emotion regulation through mindfulness may provide the foundation on which to build specific self-determination skills. Conclusions There is a need for ongoing work to develop and test, in partnership with disabled people, the impacts and outcomes of integrated approaches to promoting mindfulness and self-determination. This will require changes across multiple levels, and issues related to diversity and equity must be at the forefront. PubDate: 2022-04-20
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Abstract: Objectives Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by stereotyped behavior and poor social interaction. Although the etiology of this illness is unknown, research clearly shows that it has a genetic foundation due to complicated inheritance. It affects about 52 million individuals worldwide. Several risk factors for autism converge into possible pathways for other neurodevelopmental diseases, with onsets occurring at various stages of development. Methods In the study’s literature review, the genes included were identified in articles published over the previous 30 years in databases such as the web of sciences, PubMed, Google Scholar, Embase, and other databases. Candidate genes associated with ASD are CHD8, SHANK3, SLC6A4, RELN, DISC1, and ITGB3. Results Several prenatal risk factors cause neurological vulnerability, which increases the probability of autism and other neurodevelopmental problems. Genomic research has allowed tremendous progress in discovering ASD risk genes during the last decade. Recent technological advancements have demonstrated that certain genetic mutations and modifications may serve as useful biological markers, risk indicators, and therapeutic targets for illnesses. Conclusions In large cohorts, high-throughput next-generation sequencing uncovers a varied and complicated genetic landscape of new risk genes. More studies are needed to understand better the environmental variables that play a crucial role in disease development. Currently, there is less clinical data to support the function of ASD. However, the prevailing research facts for many researched ASD new candidate genes support their links and identify ASD etiologic processes for establishing an early diagnostic marker. PubDate: 2022-04-07
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Abstract: Objectives The purpose of this theoretical analysis of current research on ADHD is to provide an account integrating executive functional profiles with its broader structural neurodevelopmental profile. Methods Comparative theoretical analyses between executive functional deficit disorder models of ADHD and results from default mode network fMRI data. This was followed by an analysis of the temporal profile of ADHD and phase synchronous neural assemblies. Results Comparative analyses suggest disparities within executive functional deficit disorder models and discontinuities between executive functional and structural profiles of ADHD. Analysis of the temporal signature of ADHD provides a potential avenue for integrating different profiles by means of anchoring executive functions within inherent diachronic neurocognitive organization. Conclusions The analyses provided suggest that executive functional deficits in ADHD arise from much broader idiosyncrasies, rooted within the inherent diachronic organization of neurocognitive function, and whose challenges must be understood in conjunction with socio cultural environmental factors. PubDate: 2022-03-14
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Abstract: Objectives Previous reviews highlight the similarities in teaching healthcare and hygiene routines to individuals with and without intellectual and developmental disabilities. Additionally, similar interventions are used when interfering behaviors occur. Although these routines are topographically distinct, there are enough similarities to suggest effective procedures for one routine may be used to inform another. This scooping review aims to identify effective teaching and intervention procedures for healthcare and hygiene routines specifically for individuals with intellectual and developmental disabilities. We also evaluated the extent to which functional analyses were conducted; a dimension not included in previous reviews. Methods Eligible articles targeted compliance or tolerance within the context of a defined healthcare or hygiene routine as a dependent variable and used an experimental design with a demonstration of experimental control. Articles were identified through PsycINFO, PubMed, and Academic Search Premier databases. Additionally, a hand search of five related journals was conducted. Data were collected on dependent variables, functional analyses, baseline contingencies, teaching procedures, and additional experimental components. Results A total of 52 articles met inclusion criteria. Most experiments produced positive outcomes. The findings show all experiments involved a treatment package with multiple components. The most common teaching procedures were graduated exposure and DRA. A lack of functional analyses and social validity was noted. Conclusions Component analyses are needed to identify the most effective and efficient procedures. Pyramidal training to teach medical professionals how to provide preventative pyramidal training should be explored. PubDate: 2022-03-14
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Abstract: Objective This study sought to document the necessary adaptations to early childhood education program policies, procedures, and funding allocations to fully implement the Pyramid Model framework with fidelity. Methods An administrative interview including both quantitative and qualitative data was developed for the purposes of the research. Ten program directors and administrative staff from 6 CSEFEL and TACSEI demonstration site programs in 4 states across the USA participated. Results Quantitative results revealed that program administrators reported either altering (70.44%) or creating (60.52%) a new policy, procedure, or budget item for a majority of all interview item categories to fully implement the Pyramid Model. Across interview items, more than half of demonstration programs (69%) reported altering or creating a program policy, procedure, or budget item. Over half of programs (58%) also reported that these policies, procedures, or related budget items were documented in writing. Qualitative results suggested that program administrators viewed (1) program alterations reflecting alignment specifically with Pyramid Model practices; (2) intra-program collaboration and collaboration between program staff and stakeholders; and (3) written documentation of program policies, procedures, or budget items as highly important for fully implementing the Pyramid Model with fidelity. Conclusions Results provide detailed information regarding specific ways that administrators adapted program policies, procedures, and related budget items to fully implement the Pyramid Model with fidelity. These findings can prove useful for administrators aiming to successfully implement the Pyramid Model framework in their early childhood programs to support children with developmental disabilities and typically developing children. PubDate: 2022-03-09 DOI: 10.1007/s41252-022-00247-9
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Abstract: Objectives The study assessed a smartphone-based technology system, which was designed to support functional occupation and mobility in people with severe to profound intellectual disability and visual impairment. Methods The technology system provided (a) verbal orientation cues to guide the participants to a desk with two containers (and two groups of 10 objects that were to be transported to two different destinations), (b) verbal instructions to take the objects (one at a time), (c) verbal orientation cues to reach the destinations where the objects taken had to be transported, (d) instructions to put away the objects at the destinations, and (e) praise and brief periods of preferred stimulation. Seven participants were involved in the study, which was carried out according to a nonconcurrent multiple baseline across participants design. Results During the baseline (when the technology system was not available), the participants produced few or no correct responses (i.e., failed to collect, transport, and deposit objects at the right destinations). During the intervention phase (i.e., with the support of the technology system), their mean frequency of correct responses per session was between close to 19 and close to 20 (out of a maximum possible of 20) and their mean session duration varied between about 16 and 29 min. Conclusions The data suggest that the technology system used in this study may be a viable resource to support activity and mobility in people with intellectual and visual disabilities. PubDate: 2022-03-09 DOI: 10.1007/s41252-022-00250-0
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Abstract: Objectives This paper provides an overview of the literature on assessing and teaching safety skills to children and adults with intellectual or developmental disabilities across different safety skills and discusses recommendations for practice in teaching safety skills. Methods We reviewed studies evaluating safety skills training with individuals with autism and other developmental disabilities. We evaluated procedures for teaching safety skills for social threats (abduction and sexual abuse lures) and physical threats (guns and poisons). We conclude with recommendations for practice based on this research. Results Active learning approaches consisting of behavioral skills training with added intervention components such as in situ training, prompting, and stimulus control strategies are the most effective interventions for teaching and promoting the generalization of safety skills for social and physical safety threats. In addition, limited research shows video modeling was effective for social threats but not for safety threats. Conclusions Children and adults with intellectual or developmental disabilities are at a higher risk of being injured or victimized than their typically developing peers. Teaching individuals with disabilities how to respond when safety threats are present can decrease the likelihood that they will be injured or victimized. This paper summarizes literature showing active learning approaches are most effective and provides recommendations for practitioners to conduct safety skills training. PubDate: 2022-03-07 DOI: 10.1007/s41252-022-00248-8
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Abstract: Objectives Sleep problems in children on the autism spectrum may be affected by core diagnostic characteristics, including stereotypy (restricted and repetitive behaviors). Little is known about the nature of sleep-related stereotypy and its role within sleep disturbance. This study aimed to improve our understanding of the types of sleep-related stereotypy, its potential role within sleep difficulties, and how parents manage night-time stereotypy, in children on the autism spectrum. Methods This qualitative study used thematic analysis to analyze clinical assessment reports obtained from 21 parents of children on the autism spectrum referred for behavioral sleep intervention. Five themes, including the types of stereotypy, timing within sleep problems, stereotypy as sleep-interfering, stereotypy as sleep-conducive, and parent-responses, were identified. A clinical case study illustrates the potential role of vocal stereotypy within night wakings, through functional assessment and treatment of sleep problems in a child on the autism spectrum. Results Stereotypy included vocal and motor behaviors and repetitive manipulation of objects. Parents perceived stereotypy as both problematic and as beneficial to sleep, which may differentially affect behavioral treatment. Parent responses to stereotypy were varied and included co-sleeping. The case study highlights the complexity of the sleep and stereotypy relationship and the difficulty in treating automatically maintained behavior in the sleep context. Conclusion The function that stereotypy serves in relation to sleep disturbance is unclear and may differ across and within children. It is important we seek to better understand the specific ways that stereotypy may affect sleep, and vice versa, to improve clinical management of sleep problems in children on the autism spectrum. PubDate: 2022-03-04 DOI: 10.1007/s41252-022-00246-w
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Abstract: Objectives Hope is reliably associated with positive outcomes in youth; however, prior literature has yet to explore hope in neurodiverse individuals. As adolescents with neurodevelopmental differences (ND) display distinct neurocognitive profiles and are at risk for poor psychosocial outcomes, it is essential to understand how this marginalized group may vary in their own subjective ratings of hope, and how hope may relate to positive adjustment in this population. Further investigation of relational determinants, such as family characteristics and peer relationships, is also warranted to increase understanding of how various dimensions of social support relate to hope for different populations. Methods The current study assessed group differences in hope for ND adolescents on the autism spectrum and/or with intellectual disabilities, as compared to neurotypical (NT) adolescents. Additionally, correlates and predictors of hope were clarified across neurodiverse groups. Participants included 185 adolescents (NT: n = 96; ND: n = 89) and their mothers as part of a larger longitudinal study. Results Results indicated that adolescents with ND reported significantly lower hope than NT peers, t(183) = 3.31, p = .001, with autistic adolescents at highest risk. Regardless of neurodevelopmental status, greater hope was associated with fewer internalizing symptoms (F(1,178) = 12.35, p = .001) and higher quality of life (F(1,179) = 57.05, p < .001). Furthermore, maternal scaffolding and adolescent social skills were predictive of higher hope across groups. Conclusions Findings underscore the importance of hope in adolescence for all youth and highlight avenues for intervention. PubDate: 2022-03-04 DOI: 10.1007/s41252-022-00242-0
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Abstract: Objectives Direct support professionals (DSPs) play a critical role in health-related outcomes for individuals with intellectual and developmental disabilities (IDD) who reside in congregate living settings. Large behavioral healthcare organizations often rely on staff to function as peer trainers for newly hired DSPs. Organizations should adopt empirically supported training techniques to prepare peer trainers for their role and develop systems to ensure ongoing integrity of the training system. The purpose of this program description is to summarize consultation activities that attempted to create these systems. Methods Staff members were trained to function as peer trainers, an assessment was conducted to determine the barriers to training in the natural environment, and a systems-level intervention informed by the assessment was implemented to improve peer trainer integrity. Results The assessment revealed peer trainers were often unaware when they were expected to train and did not receive feedback or programmed consequences for training newly hired DSPs. A systems-level intervention containing a prompt (reminder) about upcoming training and feedback plus a monetary incentive produced improvements in trainer integrity. Conclusions A systems-level intervention based on an assessment can improve peer trainer integrity. Ensuring peer trainer integrity increases the likelihood that newly hired DSPs will implement health-related protocols with individuals with IDD. PubDate: 2022-03-02 DOI: 10.1007/s41252-022-00245-x
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Abstract: Objectives Individuals diagnosed with autism spectrum disorder (ASD) often have increased levels of stress, leading to dysregulated production of cortisol. Participation in activity with a mindfulness component may reduce levels of stress and cortisol in children. The purpose of this study was to examine the feasibility and preliminary effects of a community-based judo program on cortisol levels in youth with ASD. Methods Seventeen participants completed the judo program. Twelve were included in the final analysis. Participants were split into age groups: children (n = 5; 8–12 years) and adolescents (n = 7; 13–17 years). A standardized protocol was developed through a collaboration between researchers and families of participants to collect the salivary cortisol samples. Changes in acute (before/after one judo session) and chronic (week 1/week 10) salivary cortisol levels between age groups were assessed using repeated measures. Results No significant chronic × age (F(1,10) = .046, p = .456, ηp2 = .057) or acute × age (F(1, 10) = 4.38, p = .057, ηp2 = .316) interactions were noted. A trend existed indicating that cortisol levels were decreased acutely for adolescents as shown by a large effect size (Cohen’s d = 1.2) vs children (Cohen’s d = .01). Out of 17 participants, 12 (71%) provided all 4 cortisol samples with only 2 (10%) participants refusing to provide any samples. Conclusions The cortisol collection protocol was feasible in a community setting of youth with ASD. Future studies should recruit larger samples of children to better explore the efficacy of judo and other physical activity on subjective and objective measures of stress in a larger sample of this population. PubDate: 2022-01-25 DOI: 10.1007/s41252-022-00237-x
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Abstract: Objectives Clinical governance has been receiving increasing attention around the world over the years in various settings. Studies show that having good clinical governance in organizations has several benefits. This study aimed to explore the capacity of disability support organizations in Singapore to achieve clinical governance and understand the barriers and enablers to use evidence-based practice. Methods Seventy-nine allied health professionals (AHPs) aged between 21 and 30 years who were working in four disability organizations in Singapore completed an online questionnaire that was distributed by the National Council of Social Service (NCSS). Results For the majority of 60-item CGCQ, very few AHPs chose the extreme-scale points (i.e., agree or disagree strongly) as most gave neutral responses. The results delve into the specific clinical governance areas of planned and integrated quality improvement, proactive risk management, the climate of blame and punishment working with colleagues, training and development opportunities, and organizational learning, which organizations need to work on. Although AHPs may have access to certain support and resources, it is not necessarily that they find these areas most useful, most influential, or with the least barriers. Results identify this specific support and resources. There was a mismatch between accessibility, usefulness, influence, and hindrance of support and resources when adopting new assessments or interventions. Conclusions Clinical governance climate within disability service organizations from the perspective of AHPs working within disability service organizations may not be dire, but it is necessary to improve specific areas and provide proper support in order to maintain quality standards. The findings emphasize the importance of having high-quality standards of care and service in which clinical governance can flourish. Implications for research and development at the organizational level are discussed. PubDate: 2022-01-20 DOI: 10.1007/s41252-022-00241-1
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Abstract: Objectives Animal-assisted therapy with dogs is regularly used in children with behavioural and developmental disorders. Aims of this systematic review were threefold: to analyse the methodological quality of studies on dog-assisted therapy (DAT) for children with behavioural and developmental disorders, to determine to which extent the studies on DAT adhere to the quality criteria developed by the International Association of Human Animal Interaction Organisation (IAHAIO) and to describe the characteristics of the participants, the intervention and the outcomes. Method Three databases (i.e. PsycInfo, MedLine and Eric) were searched, and 14 studies on DAT were included. The Joanna Briggs Institute checklist (JBIC) and the quality criteria developed by the IAHAIO were used during data extraction. Characteristics of the participants, the intervention, the therapy dogs and the outcomes of the studies were summarised. Results Six of the 14 included studies reported significant outcomes of DAT, whereof six in the social domain and two in the psychological domain. However, scores on the JBIC indicated low to moderate methodological quality and only three of the included studies adhered to the IAHAIO quality criteria. Conclusions DAT is a promising intervention for children with behavioural and developmental disorders, especially for children with autism spectrum disorder. A clear description of the therapy’s components, the role of the therapy dog and analysis of the treatment integrity and procedural fidelity would improve the methodological quality of the studies and the field of dog-assisted interventions. PubDate: 2022-01-14 DOI: 10.1007/s41252-022-00239-9
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Abstract: Objectives There is limited research evaluating parent perceptions of early intervention. The current study aimed to examine parent experiences of Early Start Denver Model (ESDM) parent coaching and therapist-delivered ESDM (low-intensity therapy). Methods Parents of children with autism participated in semi-structured interviews and data was analyzed using qualitative content analysis. Results Perceived facilitators included the accommodation of parents’ needs, the delivery of the coaching, the home-based setting, and the professional’s personal characteristics and relationship with the family. Perceived barriers included the structure of the low-intensity therapy and difficulty in observing therapy sessions. Parents generally preferred the parent coaching to the low-intensity therapy due to the importance of helping their own child. Conclusions These results emphasize the importance of including parents in the provision of early intervention. PubDate: 2022-01-08 DOI: 10.1007/s41252-021-00233-7
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Abstract: Objectives We examined problematic eating behaviors among a sample of young autistic adults to better understand the purported relationship between autism and eating disorders. We hypothesized that autistic participants would score higher on measures of problematic eating behavior compared to a non-autistic comparison group, but that autistic participants would not report elevated levels of weight and shape concern. We also conducted an exploratory analysis to examine the extent to which each autism diagnostic criterion was associated with problematic eating behavior. Methods Seventy-four autistic and 40 non-autistic young adults aged between 18 and 25 years completed an online survey consisting of the Eating Disorder Examination Questionnaire (EDE-Q), Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS), autism spectrum quotient (AQ), and Autism Eating Behavior Questionnaire. Results Autistic individuals self-reported higher levels of problematic eating behavior than non-autistic individuals as measured using the EDE-Q, NIAS, and Autism Eating Behavior Questionnaire; however, contrary to expectations, weight and shape concern were also elevated. Autism diagnostic criteria explained a combined 19.2% of the variance in EDE-Q global score and 19.0% of the variance in NIAS total score; however, individually, only diagnostic criterion B4 (sensory sensitivities) was significantly associated with EDE-Q global score, and only diagnostic criterion B3 (restricted interests) was significantly associated with NIAS total score. Conclusions These results suggest that autistic individuals may experience autism-focused eating behaviors in conjunction with, rather than instead of, typical eating disorder cognitions. PubDate: 2022-01-03 DOI: 10.1007/s41252-021-00231-9
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