Fostering Verbal and Play Interactions in Heritage Language: A Naturalistic Intervention Mediated by Siblings for Autistic Children

Research on sibling-mediated interventions (SMIs) suggests that neurotypical siblings may help bolster language and play development in autistic children (Akers et al., 2018; Celiberti & Harris, 1993; Coe et al., 1991; Glugatch & Machalicek, 2021; Oppenheim-Leaf et al., 2012; Spector & Charlop, 2018), though consideration of culturally and linguistically diverse (CALD) populations is lacking. CALD autistic children often have a heritage language, or home language, other than English that is spoken at home with family members. Evidence suggests that bilingual exposure may be advantageous for language and play of autistic children (Dalmau et al., 2011; Lim & Charlop Seung et al., 2006; Vaughn, 2013). However, studies have not yet explored the role of neurotypical siblings in delivery of heritage language during intervention. The present study examined the effects of a naturalistic intervention mediated by siblings (NIMS) across four sibling dyads. Neurotypical siblings first received training through direct instruction, modeling, and role-play with a bilingual therapist. During intervention, visual prompts were used to encourage neurotypical siblings to deliver instructions, appropriate play phrases, and questions in heritage language during play with the autistic children. Results indicated that appropriate verbalizations of autistic children, social initiations of neurotypical siblings, and interactive play of the sibling dyad increased due to the intervention. Ancillary measures revealed that all dyads reported happiness during the intervention and two dyads improved the quality of the sibling relationship. The implications of the study suggest researchers and practitioners alike should continue to explore neurotypical siblings as change agents for autistic children, particularly when delivering intervention in heritage language

Using Dogs in a Home-Based Intervention with Children with Autism Spectrum Disorders

Humans and dogs have lived among each other in mutually beneficial relationships for thousands of years. In recent years, this human-animal bond has emerged as a catalyst for animal-assisted activities and therapies that may benefit those with disabilities, including children with autism spectrum disorders (ASD). ASD are characterized by qualitative impairments in social interaction and communication and restricted repetitive and stereotyped patterns of behavior, interests, and activities. The nonverbal and nonjudgmental nature of dogs may be non-threatening and easier for children with ASD to decode, which may decrease anxiety and facilitate social bonding. Further, with their roles as social lubricants/transitional objects and natural foci of interest, dogs may facilitate social interaction between children with ASD and other people. Using a single case, multiple baseline design across participants, this study investigated whether multiple semi-structured interactions with dogs would increase social and communicative behaviors and decrease restricted repetitive and stereotyped patterns of behavior in children. Although only two had statistically significant results, all three participants showed responses to intervention in the hypothesized directions. This study supports the position that children with ASD may benefit from participating in animal-assisted activities with dogs

Acceptance and commitment therapy for autism spectrum disorder : evaluation of feasibility, effectiveness, and validity of a novel contextual behavioral treatment

Background: Autism spectrum disorder (ASD) is neurodevelopmental condition, characterized by challenges in reciprocal social behavior, restricted and repetitive behaviors and interests, and sensory hyper- and hyposensitivity. ASD is associated with executive dysfunction, perceived stress, and psychiatric symptoms, reducing quality of life and adaptive functioning. Acceptance and commitment therapy (ACT) has been proven effective for complex and chronic conditions, although not evaluated in ASD. ACT-consistent instruments, such as Action and Acceptance Questionnaire (AAQ) and Cognitive Fusion Questionnaire (CFQ), measuring psychological inflexibility and cognitive fusion, have not been assessed in autistic individuals. Hence, evaluating ACT and the psychometric properties of AAQ and CFQ in autistic individuals is paramount. Aims: The overarching aim was to evaluate the feasibility, preliminary effectiveness, and validity of ACT adapted to ASD. Specifically, the aims were to evaluate (1) the feasibility and preliminary effectiveness of group-delivered ACT for autistic adolescents and young adults in a special school setting (Study I), (2) the feasibility and preliminary effectiveness of group-delivered ACT for autistic adults in a psychiatric outpatient setting (Study II and III), and (3) the psychometric properties of AAQ and CFQ in autistic adults (Study IV). Methods: An adapted ACT protocol (NeuroACT) was evaluated in a quasi-experimental randomized trial (Study I), an open pilot trial (Study II), and a randomized controlled trial (Study III). Study I included 28 ASD adolescents and young adults (13-21 years) utilizing wait-list controls having school classes as usual. Assessments were done at pre, post, and two months follow-up, evaluating self- and teacher-rated stress, self-perceived depression, anxiety, anger, hyperactivity/inattention, prosociality, and conduct and peer problems, analyzed using rmANOV A. Study II included 10 ASD adults (25-65 years), assessing treatment credibility, self- perceived stress and quality of life (primary outcomes), symptoms of depression and anxiety, disability (social; vocational; family), psychological inflexibility, and cognitive fusion at pre, post, and three months follow-up. Data were analyzed using paired t-tests. Study III included 39 ASD adults (21-72 years) randomized to NeuroACT or treatment as usual (TAU), evaluating treatment credibility, self-perceived stress and quality of life (primary outcomes), symptoms of depression and anxiety, sleep problems, disability (social; vocational; family), cognitive and behavioral avoidance, psychological inflexibility, cognitive fusion, autistic core challenges, and executive dysfunction, at pre, post, and six months follow-up, compared to TAU. Data were analyzed using rmANOVA and clinically significant change. Study IV evaluated the construct (convergent and divergent) validity and reliability of AAQ and CFQ in 54 autistic adults (21-72 years) in a psychiatric outpatient setting, using explorative factor analysis and Pearson's correlation coefficient. Results: In Study I, all participants completed NeuroACT, and treatment satisfaction was high. Overall (pre-post-2-month) statistically significant improvements were found in self- and teacher-rated stress, overall psychiatric symptoms, anger, prosocial behavior, and hyperactivity/inattention (d = 0.70-0.81, 95% CI), and a statistical trend for depression (d = 0.67, 95% CI), in NeuroACT compared to wait-list. No statistically significant interaction effect or statistical trend was found in conduct problems, peer relation problems, or anxiety symptoms. In Study II, 90 % completed NeuroACT, and treatment credibility was high (M=7.7/10, SD = .8). Statistically significant improvements or statistical trends were found (pre-post or pre-3-month) in perceived stress and quality of life (primary outcomes), depressive symptoms, social disability, psychological inflexibility, and cognitive fusion (d = 0.27-0.92, 95% CI). Anxiety or work and family-related disability were not statistically significantly improved. In Study III, 85 % completed NeuroACT and treatment credibility was high (M=7.3/10, SD = 2.5). Overall (pre-post-6-month follow-up) statistically significant improvements or statistical trends were observed in perceived stress and quality of life (primary outcomes), depressive symptoms, sleep quality, cognitive and behavioral avoidance, psychological inflexibility, cognitive fusion, and autistic core challenges related to autistic mannerism (i.e., cognitive and behavioral inflexibility) and social motivation (d = 0.57-1.24, 95% CI) in NeuroACT compared to TAU. Between group clinically significant changes were in favor of NeuroACT. No statistically between group significant change or statistical trends were found in breathing problems, fatigue during daytime, awakening difficulties, social, work, or family-related disability, social awareness, social cognition, communication, or executive dysfunction. Dropout rates were higher in NeuroACT compared to TAU. In study IV, parallel analysis indicated a one-factor solution for AAQ and CFQ. Both instruments showed one-facor solion, eplaining 64% of AAQ ariance ( = .92) and 67% of CFQ ariance ( = .93). Statistically significant positive correlations were found between AAQ and CFQ, and measures of psychiatric symptoms and autistic traits, except social awareness, supporting convergent validity. Statistically significant negative correlations were observed between the AAQ and the CFQ, and quality of life, supporting divergent validity. Conclusion: ACT adapted to autism is feasible in autistic adolescents and adults and appears to improve stress and mental health. Also, it may help overcome aspects of autistic core challenges. Common instruments to assess ACT are preliminarily valid and reliable for autistic adults. However, more extensive research is needed to further evaluate ACT in ASD. This thesis adds to the growing awareness and empirical support of contextual behavioral models for autistic individuals

Family Perspectives on the Ontario Autism Intervention Program

The Autism Intervention Program (AIP) in Ontario has been in place providing intensive behavioural intervention (IBI) to children with autism spectrum disorder since 1999 (Perry et al., 2008). This IBI program involves teaching children using applied behaviour analytic (ABA) principles for 25-40 hours per week, in the family home or in an IBI centre. The use of ABA-based methods for teaching skills and decreasing problem behaviour to children with autism has the most evidence to date, and therefore remains in high demand by families within the province. The purpose of the current study was to examine parent perspectives about the Ontario Intensive Behavioural Intervention program for children with autism. A mixed methods design was used to investigate a sample (N=110) of parents who completed the Family Perspectives on IBI Questionnaire (FPIQ) and the Measure of Processes of Care (MPOC) rating scale. In addition, a small focus group (N = 3) was conducted with three parents who had completed the questionnaires. The study investigated parents\u27 overall satisfaction of IBI, and variables that predicted satisfaction. The results of the study indicate that parents were satisfied with their child\u27s outcomes, and they wanted IBI to extend longer, even across the lifespan in some instances. Families felt that the IBI program needed to be evaluated separately with respect to the funding body, and the clinical team. Parents were dissatisfied with the manner in which funding was delivered for the program, how assessment decisions about their children\u27s IBI services were made, and the financial impact that IBI had for many of them. In terms of the clinical team, although some families were dissatisfied with the number and quality of therapists, or the number of meetings with their Supervising Therapist (ST), they were very satisfied with the close relationships they formed with their team, and the individualized clinical goals provided by some teams. An examination of the direct funded option (DFO) vs. the direct service option (DSO) found that the DFO families felt they had more control over their services, but they expressed more dissatisfaction overall

Mother and special education preschool teacher perceptions of the communicative competence of children with severe, multiple disabilities.

Early childhood special education teachers who perceive children's behaviors as communications respond accordingly. Mothers and teachers respond to perceived child behaviors as communications when they contingently respond to those communications. Further support for the development of child communication depends upon the efforts of families and school personnel as individuals recognize child communications and respond in predictable ways. It would seem important that adults in the child's environment agree on the child's communication means and their communicative functions.The combined responses of the participating mothers identified more child communication means than participating teachers. Both groups agreed on the functions of the children's communicative behaviors. Wide variability was found among participant-pair descriptions of specific children's communications. Communication statements found in the children's IEP documents were not generally found to be associated with the child's level of communication as it was perceived by a participant-pair. While some IEP statements addressed the child's perceived communication means and functions, the majority did not.This study asked mothers and preschool special education teachers to describe the communications of young children with severe, multiple disabilities. Each participant-pair completed a survey instrument and participated in a structured interview as they described seven children's communicative behaviors (means) and the function of those communications.Communication development for children begins with the early interactions of mothers and their infants. This developmental process between mothers and their infants is altered when an infant is born with severe disabilities, or encounters some devastating environmental impact early in life. Mother-child interactions are disrupted when the child does not respond to the mother in expected ways. Children with severe, multiple disabilities may exhibit a limited repertoire of behaviors; mothers may be unable to "read" the behaviors as infant communications. Mothers then begin to identify more subtle behaviors as communication and assign them meaning

An exploration of support for children and young people with Tourette Syndrome in schools

This thesis is divided into three parts: a literature review, a major empirical study and a critical appraisal. Part A is a detailed literature review which explores relevant literature related to school support for Children and Young People with Tourette Syndrome. The review begins with an overview of TS, including diagnostic procedures, aetiology and treatment. TS within the context of school is considered through exploration of difficulties CYP with TS face in school and support that may be put in place in school. Additionally, research relating to the role of Educational Psychologists in supporting Tourette Syndrome is explored. Finally, academic and professional rationale along with research questions for the current study are presented. Part B is an empirical study which aims to explore current practices of supporting CYP with TS in mainstream schools and parent’s experiences of this support. The research included 2 components, a questionnaire for school staff and parents and interviews with parents of CYP with TS. A summary of relevant literature is followed by details of methods and measurements for both parts of the research. Findings for both components are presented and discussed in detail, along with consideration of implications of this research. Part C is a critical appraisal of the current research, providing analysis of the research process and decisions made by the researcher. The critical appraisal begins with an overview of contribution that this research makes to the field with consideration to dissemination of findings. The appraisal then discusses decisions made during the research process, including research paradigm, design, recruitment and analysis. Finally, reflections on ethical issues and the researchers position are presented

Being Autistic in a Non-Autistic World: Autistic Adults’ Experiences of Adapting to and Coping Within Predominately Non-Autistic Social Environments

Some autistic individuals modify their innate autistic social behaviour in order to adapt to, cope within, and/or influence the predominately non-autistic social environment; a phenomenon often termed ‘camouflaging’ (Attwood, 2007; Dean et al., 2017; Hull et al., 2017; Lai et al., 2017; Schuck et al., 2019). Camouflaging is one social coping strategy used by autistic people attempting to overcome social challenges within cross-neurotype social interactions and secure employment, develop friendships and romantic relationships, and avoid stigmatisation (Cage & Troxell-Whitman, 2019; Hull et al., 2017). Yet the act of camouflaging is thought to be cognitively effortful and taxing; prone to breakdown under increased social demands and complexity and/or psychological distress; and associated with increased mental health difficulties, misdiagnosis, and identity confusion (e.g., Beck et al., 2020; Cage & Troxell-Whitman, 2019; Cassidy et al., 2018; Hull et al., 2021; Lai et al., 2017; Livingston, Colvert, et al., 2019). Camouflaging research is in infancy; conceptualisations, definitions and measures of camouflaging are still emerging, and much is unknown about relationships between camouflaging and various constructs such as mental health, wellbeing, and the achievement of important social and employment outcomes. This thesis presents a combination of qualitative and quantitative methods to further current understanding of social coping in autistic people by furthering the current conceptualisation of camouflaging including camouflaging behaviours and processes; examining the relationships between camouflaging and social, employment, and mental health outcomes; and exploring social experiences that contrast with camouflaging. The first chapter provides a general introduction to, and overview of, the relevant background research and provides a rationale for the work presented in the thesis. Chapter 2 involves a discussion of methodological considerations involved in the design and analysis of research presented in the thesis. Chapter 3, a systematic review, provides a comprehensive and critical evaluation of the current quantitative camouflaging research base; identifying consistencies in the current evidence as well as issues that require further research. Chapters 4 and 5 describe an interpersonal recall study, using thematic analysis to detail the development, process, and consequences of camouflaging (Chapter 4) and content analysis to describe the behaviours exhibited, altered, or avoided by autistic adults when camouflaging (Chapter 5). Chapter 6, a quantitative cross-sectional study, details associations between camouflaging and social and employment outcomes and indicators of mental health difficulties/psychological distress. Chapter 7 involves a qualitative survey and uses thematic analysis to explore an alternative to camouflaging, specifically autistic adults’ experiences of socialising in ways that feel authentic to them. The final chapter (Chapter 8) provides an overarching discussion of the findings and implications of the thesis with consideration to strengths and limitations

‘Sensory Intelligence’. An exploratory programme evaluation in a secondary school autism resource base

Up to 95% of the autistic population are considered to have atypical sensory modulation which can lead to mal-adaptive strategies for self-regulation. Some argue that atypical and fluctuating sensory profiles could be ‘core’ autistic features underlying behavioural manifestations and poor academic and life-long prognoses. Evidence also suggests that this is more prevalent in the general population than previously thought, resulting in sensory modulation becoming an emerging field in mental health and wellbeing. Despite empirical evidence suggesting that adolescents can be taught adaptive selfregulation strategies, and secondary schools being sensory challenging, school-based interventions with evidence bases to support them, remain sparse in the literature. Barriers include the heterogeneity of autism, austerity, ‘intervention overload’ in schools, and a significant ‘research-practice’ divide undermining effectiveness in messy ‘real-life’ contexts. Little is currently known about what works, for whom and in what context, as a result. Diverse fields, using insights from process rather than product orientated techniques from Implementation Science and Realist evidence bases, are, however, bridging their own research-practice divides with some success. Consequently, the aims of this study were to adopt process-orientated approaches to explore if the ‘Sensory Intelligence’ programme was worthy of further investigation and potentially offered a role for educational psychologists. Using a Case Study approach in an Autism Resource Base attached to a mainstream secondary school, Deductive Thematic Analysis enabled three main themes and ten subthemes to be generated based on interviews with the participants, field notes and individual sensory profiles. The programme was considered ‘definitely viable’ by all three groups despite some tension regarding respective responsibilities. Considerable process issues were identified providing insights for ways forward including the need for detailed implementation planning via a systemic approach. Key roles were also implicated for Educational Psychologists working at individual, group and organisational levels