Many autistic individuals experience co-occurring psychiatric conditions and require mental health support. Mental health clinicians report limited knowledge and confidence in working with autistic people. The ECHO Autism: Mental Health program aims to address this gap by providing professional development to clinicians via virtual case-based learning. The current study used a qualitative thematic analysis approach to explore the perspectives of 13 clinicians who completed the ECHO Autism: Mental Health program. Three overarching themes developed from the clinicians' responses: program structure and delivery, perceived challenges, and the impact of participating in the program. Overall, participants highlighted their positive experience in the program, noting the benefits of learning from case discussions and connecting with colleagues who share common clinical needs and difficulties. Some challenges were identified and included time constraints and minor technical issues during the program. The findings can guide future programs to effectively support clinicians in delivering quality care to autistic people.
Adapting and combining evidence-based practices (EBPs) for use in high school special and general education in support of autistic youth can be a daunting process for researchers and practitioners alike. Ensuring the process is informed by autistic voices, is strengths-based, and addresses outcomes identified as priorities for autistic youth can pose additional challenges. This paper provides a description of the activities undertaken to combine two EBPs for use in inclusive high school settings, the Self-Determined Learning Model of Instruction (SDLMI), and Peer Supports. Points where the autistic voice was embedded in the process are highlighted, along with initial feedback from high school teachers and students. Challenges to the EBP adaptation and combination process, as well as barriers to implementation and next steps, are also discussed.
This study explores the integration of augmented reality (AR) technology into supported employment programs to enhance employment outcomes for individuals with intellectual and developmental disabilities (IDD). The research aimed to evaluate the effectiveness of a novel AR-based application functioning as a virtual job coach, providing real-time, context-specific guidance on completing complex job tasks. Employing a single subject multiple probe across participants design, data were collected from four young adults with IDD. The results showed significant improvements in job task performance; participants' accuracy rose from an average of 12% during the baseline phase to 94% with the AR intervention. All participants reached mastery criteria, defined as completing at least 90% of steps correctly and independently across four sessions. The study highlights the potential of AR to improve training efficiency, reduce the demand for in-person job coaching, and broaden employment opportunities for individuals with IDD.
This study explored the demographic and social characteristics of children in understanding their spontaneous social interest toward autistic classmates. Participants were 193 children without disabilities, ages 3 to 6 years, in 16 inclusive preschool/kindergarten classrooms. Teachers and educational aides each nominated socially interested students and rated all students' social interests toward the included classmate. Results indicated that socially interested children were younger, more often boys, had a more advanced social profile (less aggression, more shyness, and more prosocial behaviors), and showed better performance on theory of mind tasks than their peers who were not socially interested in the autistic classmates. Identifying peers without disabilities who show social interest toward the included children can optimize the involvement of peers without disabilities as change agents in inclusive educational environments and promote the social inclusion of autistic students.
Early intervention (EI) can improve developmental outcomes among children with autism spectrum disorder (ASD), but underdiagnosis and undertreatment are common among low-income families and children of racial/ethnic minorities. The Screening and Linkage to Services for Autism (SaLSA) trial (ClinicalTrials.gov Identifier: NCT02374541) demonstrated that autism family navigation (AFN) improved the likelihood that young children at risk for ASD completed a diagnostic evaluation. In a qualitative descriptive study, we recruited parent participants, health care and EI providers and staff, and project personnel from the SaLSA trial to participate in semi-structured interviews on acceptability and feasibility of AFN services for families seen in urban safety-net clinical settings (i.e., where care is provided regardless of ability to pay). Iterative theme analysis was performed. A community focus group was conducted for triangulation to improve validity. Results demonstrated four main themes: (1) “It’s all in a name: the risk of engagement”; (2) “Community partnerships require authentic trust”; (3) “System interactions and interrelationships”; and (4) “What is an autism family navigator: family navigation or clinical role?” This study adds perspectives of interested parties of AFN within an urban underserved population. Recommendations for navigation program content and delivery can inform future modifications to AFN programs in the context of the communities they serve.
Data-based decision-making (DBDM) is crucial for teachers of students with autism or intellectual disability, yet little is known about their engagement in DBDM. We surveyed 77 teachers in the southeastern United States who had worked with students with autism or intellectual disability in self-contained classrooms in the past year. They reported their training and practices in DBDM and the variables they perceived to facilitate and inhibit data collection, graphing, and data-based decision-making. Teachers reported minimal training in DBDM. While some frequently collect data, methods and frequency of data interpretation for instructional decisions vary. Teachers identified time as the biggest barrier to DBDM. Despite recognizing its importance, teachers lack tools to meet accountability standards, highlighting the need for preservice training and ongoing support. Research is warranted on efficient and effective methods for training teachers of students with autism or intellectual disability to engage in DBDM in their classrooms.
In the current study, we described a multitiered study of coaching the coaches via telepractice (CCT) intervention package. The CCT was an intervention program designed to train and coach early intervention service providers (EISPs) so that they can coach parents to use evidence-based naturalistic communication teaching strategies (i.e., modeling, mand-model, and time delay) and reading techniques during shared book reading with their young children with autism. Three participating service providers went through a self-directed training via online modules and were coached via telepractice technologies (videoconferences). Using a single-case multiple-baseline design across participants, we (a) examined EISPs' implementation fidelity (accuracy/quality) of coaching practices, (b) assessed their knowledge on communication strategies and coaching practices, and (c) sought information about their perception on the feasibility and outcomes of the intervention. Visual analysis of the observational data showed a functional relation between the CCT program and EISPs' coaching practices.
Children with autism spectrum disorder and/or with intellectual disabilities (IDD) who experience complex communication needs often benefit from augmentative and alternative communication (AAC) intervention. Given shortages, access to professionals with expertise in AAC instruction can prove difficult. Telepractice may help to connect more specialists to children and practitioners or families who can implement AAC interventions with guidance. As both AAC technology and telehealth rapidly advance, the evidence-base has struggled to keep pace. This systematic review answers questions related to the use of telepractice in intervention for AAC. Data to be reported were gleaned from a comprehensive meta-analysis on AAC and intervention for preschool and school-age children on the autism spectrum and/or with IDD. In the current systematic review, eight studies were identified, representing 22 participants, that met inclusion criteria. Synthesized findings across telepractice methodologies, participant characteristics, intervention parameters, including intervention intensity, and methodological quality are reported.
Given the scarcity of resources across child-serving systems, cost analyses can provide a framework for comparing evidence-based interventions, informing resource allocation, and guiding stakeholders to invest resources. The economic impact of autism is significant. One intervention found to be efficacious is social skills training (SST); however, there are few economic studies of SSTs. This study addresses the dearth of cost analyses of SSTs in the literature. An ingredients method was used, with cost data collected through informant interviews, program budgets, and the E$timator Tool Kit. Results revealed the SST implementation cost was lower than other autism-focused Early Intensive Behavioral Interventions; families bear the largest proportion of costs; and optimizing personnel-heavy interventions like SST may be possible through high-quality, intensive training of lower wage personnel by experienced trainers who also provide ongoing support and supervision.
This study evaluated the effectiveness of video and electronic pictorial presentation modalities in multiple stimulus without replacement (MSWO) job task preference assessments through methods comparison and evaluation of predictive validity. The study was conducted in the school setting with eight transition-age students with ASD and ID. Variations of work task preference assessment, electronic picture-based and video-based MSWO, were compared to an established assessment method, tangible stimulus MSWO. Subsequently, the predictive validity of the assessments was evaluated by observing the task engagement of participants while performing the high- and low-preference work tasks. Results suggest that electronic pictorial and video MSWO assessments of preferences are accurate and effective with some individuals and not as effective as the object modality for others. Findings, limitations, and implications for research and practice are also discussed.
Virtual manipulatives are an evidence-based practice in mathematics for students with autism spectrum disorder (ASD). Yet, to date, most research exploring the effects of the virtual-representational-abstract (VRA) instructional sequence has been conducted in researcher-implemented settings. However, to ensure researchers are able to provide accurate practice recommendations, more research is needed to explore the teacher implementation of this intervention. The purpose of this concurrent multiple probe across participants single-case design study was to examine the effects of a teacher-implemented VRA instructional sequence taught via explicit instruction on the accuracy with which three elementary students with ASD solve addition with regrouping problems. The VRA instructional sequence involved the use of virtual base ten blocks, drawings, and abstract numerical strategies to solve addition with regrouping problems. Researchers found a functional relation between the VRA instructional sequence and student accuracy. All three students were also able to maintain their accuracy after intervention ended. The teacher was able to implement the VRA instructional sequence after only two training sessions with over 97% treatment fidelity.
Best practices in early intervention include empowering parents to embed evidence-based practices within regular routines with their child, such as Naturalistic Developmental Behavioral Interventions (NDBIs). However, very little research has explicitly evaluated intervention approaches that may lead to increased parent self-efficacy for parents of young children with autism. The current study is a mixed-methods evaluation of parent self-reported self-efficacy and perceptions following an NDBI that included strength-based video feedback coaching. We explored (a) parent perceptions of the intervention using a social validity questionnaire and (b) parent self-efficacy using non-parametric Wilcoxon signed-rank test. All parents rated the feasibility and effectiveness of the intervention favorably with strong probability of the parents continuing the intervention in the home. While pre-post results were approaching significance, no statistically significant differences on parent self-efficacy ratings were present (z = -1.841; p = .066). Parent responses to open-ended questions revealed that video feedback allowed parents to observe the successes of their child in ways that were not possible when playing with their child in-the-moment. Parents of young children with autism may find strength-based video feedback coaching a feasible and favorable coaching practice when targeting social communication skills. Implications and future research directions are discussed.
Limited caregiver-mediated naturalistic developmental behavioral interventions' (NDBIs) research exists with the Latine community. To understand the effectiveness of caregiver-mediated NDBI, we must investigate feasibility and effectiveness with marginalized populations to assure family-centered and culturally sensitive care. This study examined the effects of a caregiver-mediated NDBI with three caregiver-child dyads using single-case design (SCD) research informed by a brief priori cultural adaptation. Caregivers demonstrated improved implementation fidelity of NDBI strategies with empowerment-based coaching. We discuss Latine caregiving practices and make recommendations for culturally congruent NDBI caregiver coaching.
Despite an increasing number of young adults with autism pursuing postsecondary education, more research is needed to compare autistic undergraduates to their nonautistic peers. This study surveyed 204 undergraduate students with and without autism. Participants were asked about their perceptions regarding their everyday hindrances and compensatory strategies. Results indicated that procrastination and irregular sleep schedules are significant barriers to academic success for both groups. Autistic students also report challenges related to their diagnosis, such as sensory concerns, difficulties with changes in routine, and apprehension over working with others. Despite these differences, both groups utilize similar compensatory strategies, such as summarizing readings and maintaining routines. Findings emphasize the necessity of interventions targeting procrastination and sleep habits for all students and additional supports provided for autistic students in the areas of socialization, group work, and postsecondary classrooms.
Research suggests some children as early as preschool years exhibit clinically significant levels of internalizing symptoms (i.e., anxiety, somatic, and depressive symptoms), and children with autism spectrum disorder (ASD) are at a heightened risk. The purpose of this study was to examine age differences of internalizing symptoms in a young sample of children with ASD versus typical development (TD). Our sample included 156 children (61 with ASD and 95 with TD) aged 3:0 to 6:11 years and their teachers. A moderation analysis was conducted to assess whether the relation between children's developmental status and internalizing symptoms would vary based on age. Findings indicated that age moderated the relation between diagnostic status and internalizing symptoms. Children with ASD aged 4:9 years and older had significantly higher levels of internalizing symptoms than children with TD. These findings highlight the need for early and targeted intervention for children with ASD with co-occurring internalizing symptoms.
This study examined informant discrepancies for parent and teacher ratings of social skills and behavioral flexibility/regulation of 124 children with autism spectrum disorder (ASD), ages 6 to 11 years. Scores on the Adapted Skillstreaming Checklist (ASC) were examined for mean differences, level of agreement, and moderators of difference scores between informant groups. Results indicated no significant differences between parent and teacher ASC mean scores. Parent and teacher scores were low-to-moderately correlated (intraclass correlation coefficient = .30 and Pearson r = .18) and the Bland-Altman plot and regression analysis revealed no systematic differences in agreement across the range of scores. None of the variables moderated the parent-teacher difference scores. Overall, practitioners should not necessarily anticipate parent-teacher differences when using the ASC for group-level comparisons. However, ratings were less consistent (modest correlations) at the individual child level. Less agreement at the individual child level suggests that practitioners should be prepared to follow-up and clarify the reason(s) for the differences.
The psychological well-being and the quality of life (QoL) of parents of children with autism spectrum disorders (ASD) are adversely affected. A greater need to assess these predictors is recommended to address the Jordanian cultural gap. This study explored the relationships between sociodemographic variables, social support, psychological distress, and QoL among parents of children with and without ASD in Jordan. A descriptive cross-sectional design was used to recruit 160 participants, with 80 participants in each group of parents. Multiple regression analysis was used to build the best-fit predictive model of QoL. Parents of children with ASD reported higher depression, anxiety, and stress levels, and lower social support and QoL than parents of children without ASD. Depression, educational level, and employment status were the only significant predictors of QoL among parents of children with ASD. Interventions should target psychosocial determinants of parental QoL, taking into consideration the cultural context.
Despite the high prevalence of co-occurring anxiety in autistic children, little is known about parental perceptions of anxiety treatment in the context of autism. This study investigated how parents (N = 101) perceived the acceptability, effectiveness, and willingness-to-use four commonly available anxiety treatments for autistic youth: applied behavior analysis (ABA), cognitive-behavioral therapy (CBT), medications (e.g., selective serotonin reuptake inhibitors; SSRIs), and alternative interventions (e.g., specialized diets, nutritional supplements). While all four treatments were perceived favorably, parents rated CBT as more acceptable, more likely to be effective, and more willing-to-use CBT over ABA or alternative interventions. Medication was also rated as likely to be effective over alternative interventions, but not over ABA or CBT. Parent perception ratings did not significantly differ between CBT and medication. Overall, CBT and, to a slightly more limited extent, SSRI medications, may be acceptable and approachable treatment options for autistic youth with co-occurring anxiety.
Measures assessing childhood functioning are often developed in high-income countries and need to be adapted for use in low and middle-income countries where the constructs they measure may not be relevant in their original form. This study describes the framework of cross-cultural adaptation of three measures, viz. Vineland Adaptive Behavior Scales-Third Edition; Communication and Symbolic Behavior Scales-Developmental Profile Caregiver Questionnaire and Child Health Utility-9D, followed in the Communication-centered Parent-mediated treatment for Autism Spectrum disorder in South Asia trial. The primary objective was to adapt these measures using a stepwise process while establishing semantic, idiomatic, conceptual, experiential, and technical equivalence between the original and adapted versions. Resulting items of each measure conveyed the same meaning and intent in both the original and adapted versions. The adapted versions had grammar, punctuation, sentence structure, instructions, layout and format, and mode of administration as they were in the original measures.
Friendships are a critical component of a healthy quality of life and provide numerous benefits for all individuals but can include significant barriers for individuals with neurodevelopmental disabilities (ND). Despite calls for an increase in inclusive educational practices, limited research exists to explore the nature of friendships between children with disabilities and their peers. A qualitative meta-synthesis of studies between 2000 and 2022 was conducted to summarize qualitative research exploring the friendship experiences of children with NDs. Findings from 14 studies noted a number of themes and subthemes related to defining friendship, friendship experiences, barriers to friendship, and facilitators of friendship between children with disabilities and their peers. Implications for policy and practice, limitations, and future research directions are discussed.
