A randomised controlled trial of an iPad-based application to complement early behavioural intervention in Autism Spectrum Disorder

Background Technology-based interventions for Autism Spectrum Disorder (ASD) have proliferated, but few have been evaluated within the context of a randomised controlled trial (RCT). This RCT evaluated the efficacy of one technology-based early intervention programme (Therapy Outcomes By You; TOBY) in young children with ASD. Methods TOBY is an app-based learning curriculum designed for children and parents as a complement to early behavioural intervention. Eighty children (16 female) were recruited to this RCT within 12 months of receiving a diagnosis of ASD (M age = 3.38; SD = 0.69) and randomised to receive either treatment-as-usual (community-based intervention, n = 39) or the TOBY therapy (at least 20 min/day) plus treatment-as-usual (n = 41) for a period of 6 months. Outcomes were assessed at 3 and 6 months postbaseline. (Australian New Zealand Clinical Trials Registry: ACTRN12614000738628; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365463). Results Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months, but only 2 min/day during the second 3 months. There was no group difference in scores on the primary outcome, the Autism Treatment Evaluation Checklist, at either the 3- or 6-month follow-up. However, significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes: the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index. Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function, although these decreased in magnitude from the 3- to 6-month follow-up. Conclusions This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD. However, sustained use of the app over the full 6-month period was a challenge for most families.No Full Tex

Randomised controlled trial of an iPad based early intervention for autism:TOBY playpad study protocol

BACKGROUND: Evidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use. METHODS AND DESIGN: Children aged less than 4;3&nbsp;years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group \u27TOBY therapy&thinsp;+&thinsp;therapy as usual\u27 or, the control group \u27therapy as usual\u27 for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad - Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2). DISCUSSION: This trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents\u27 self-efficacy and empowerment in an effort to reduce children\u27s ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents. <br /

De morcegos e caveiras a cruzes e livros: a representação da morte nos cemitérios cariocas do século XIX (estudo de identidade e mobilidade soclais)

Considerando que os espaços destinados aos mortos em uma sociedade refletem especularmente o mundo dos vivos, sendo ambos regidos pela mesma lógica de organização, os cemitérios foram entendidos como um lugar de reprodução simbólica do universo social, e, nessa condição, como um campo privilegiado para a análise do processo de implantação e consolidação dos val-ores burgueses na socieaade carioca do século passado. O presente trabalho, considerando a ruptura do império escravista, na década de 1880, e a emergência de uma república progressivamente capitalista, voltou-se para a verificação de prováveis mudanças no imaginário coletivo sobre a morte, nos cemitérios do Rio de Janeiro, provocadas pelo rompimento aa ordem escravocrata. Uma pesquisa foi conduzida no sentido de se investigar não apenas a natureza dessa mudança, mas sobretudo os mecanismos subjacentes que a determinaram, sendo aqui apresentados os seus resultados