Advancing Evidence-Based Practice for Children with Autism: Study and Application of Video Modeling through the Use and Synthesis of Single-Case Design Research

This dissertation document is composed of three separate, but interconnected articles that represent efforts across the research cycle: the first is a review of existing literature on the synthesis of single-case design research in communication sciences and disorders; the second reports results of a novel single-case design study that adds to the existing research literature on behavior modeling interventions for children with autism; and the third is an attempt to translate existing research on video-based behavior modeling into a format accessible to school-based speech-language pathologists serving students with autism. These three articles are tied together by their focus on single-case design research and communication-focused interventions for young children with autism. Through each article, conclusions and recommendations are provided to guide service delivery and future research, with the aim of adding rigor to both the study of autism interventions and the utilization of its findings.Doctor of Philosoph

Barriers to Educator Implementation of a Classroom-Based Intervention for Preschoolers With Autism Spectrum Disorder

There is considerable need for adoptable evidence-based interventions for implementation in public classrooms serving children with autism spectrum disorders (ASD) during the preschool years, an important period in neurodevelopment. Barriers to implementation, including gaps in teacher education, contribute to the research-to-practice gap, and may compromise child outcomes. This qualitative study collected ongoing verbal and written feedback from educators (n = 8) and administrators (n = 3) during their participation in the iterative development phase of a larger project to translate and preliminarily trial an evidence-based intervention, Early Achievements, in public preschool classrooms. Using a grounded theory-based approach, barriers were identified in areas of educator preparedness, engagement, and cohesion, complexity of instructing students with ASD, limited time/resources, and administrator support. Educators and administrators differed in their perspectives. Innovative strategies are presented for enhancing transportability, along with discussion of implications for teacher education practices and related policy

Impact of a Pre-Professional Clinical Education Experience with Adults with Autism Spectrum Disorder: Preparation of Future Speech-Language Pathologists

The purpose of this study was to (1) investigate the impact of a clinical experience with adults with autism spectrum disorder (ASD) on graduate speech-language pathology (SLP) students’ knowledge about ASD, and (2) explore the nature of the clinical experience and its impact on students’ preparation to work with adults with ASD. This study used a mixed-methods design. Quantitative methods were used to identify statistically significant changes in student knowledge about ASD following participation in a clinical experience with adults with ASD. Qualitative methods were used to explore student narratives to uncover details of the clinical experience and its impact. Participants (n=17) were first year SLP master’s students. Results indicate significantly increased knowledge about ASD following participation in the clinical experience with adults with ASD. Coding of themes from student narratives revealed details about key aspects of the experience and its impact. Results point to the positive impact of an immersive, group-based clinical education experience with adults with ASD. Results may guide efforts to create programs to prepare clinicians to serve the growing population of adults with ASD. Next steps include comparison of similar clinical experiences, as well as longitudinal tracking of student outcomes

Developing Feasible and Effective School-Based Interventions for Children With ASD: A Case Study of the Iterative Development Process

Despite an emphasis on identifying evidence-based practices among researchers and using evidence-based practices among professionals in the field of education, there are still problems with uptake and implementation in real-world settings. This lack of diffusion of practices is evident in educational programming for children with autism spectrum disorder (ASD). One solution is to use an iterative process to develop interventions in which researchers work in collaboration with the end users to test and refine interventions. However, there are very few guidelines for developing feasible and effective interventions through these iterative processes. This article provides a description of the iterative process used to develop the Advancing Social-Communication and Play (ASAP) intervention, a supplemental program designed for public preschool classrooms serving students with ASD, and examples of how data from the sequence of iterative design studies shaped the intervention development. The research team offers guidelines for other researchers looking to engage in intervention development using an iterative process in the context of partnerships with end users, including suggestions for planning and executing an intervention development grant

Communicative Gesture Use in Infants With and Without Autism: A Retrospective Home Video Study

Compare gesture use in infants with autism to infants with other developmental disabilities (DD) or typical development (TD)

Genetic Testing to Inform Epilepsy Treatment Management From an International Study of Clinical Practice

IMPORTANCE: It is currently unknown how often and in which ways a genetic diagnosis given to a patient with epilepsy is associated with clinical management and outcomes. OBJECTIVE: To evaluate how genetic diagnoses in patients with epilepsy are associated with clinical management and outcomes. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study of patients referred for multigene panel testing between March 18, 2016, and August 3, 2020, with outcomes reported between May and November 2020. The study setting included a commercial genetic testing laboratory and multicenter clinical practices. Patients with epilepsy, regardless of sociodemographic features, who received a pathogenic/likely pathogenic (P/LP) variant were included in the study. Case report forms were completed by all health care professionals. EXPOSURES: Genetic test results. MAIN OUTCOMES AND MEASURES: Clinical management changes after a genetic diagnosis (ie, 1 P/LP variant in autosomal dominant and X-linked diseases; 2 P/LP variants in autosomal recessive diseases) and subsequent patient outcomes as reported by health care professionals on case report forms. RESULTS: Among 418 patients, median (IQR) age at the time of testing was 4 (1-10) years, with an age range of 0 to 52 years, and 53.8% (n = 225) were female individuals. The mean (SD) time from a genetic test order to case report form completion was 595 (368) days (range, 27-1673 days). A genetic diagnosis was associated with changes in clinical management for 208 patients (49.8%) and usually (81.7% of the time) within 3 months of receiving the result. The most common clinical management changes were the addition of a new medication (78 [21.7%]), the initiation of medication (51 [14.2%]), the referral of a patient to a specialist (48 [13.4%]), vigilance for subclinical or extraneurological disease features (46 [12.8%]), and the cessation of a medication (42 [11.7%]). Among 167 patients with follow-up clinical information available (mean [SD] time, 584 [365] days), 125 (74.9%) reported positive outcomes, 108 (64.7%) reported reduction or elimination of seizures, 37 (22.2%) had decreases in the severity of other clinical signs, and 11 (6.6%) had reduced medication adverse effects. A few patients reported worsening of outcomes, including a decline in their condition (20 [12.0%]), increased seizure frequency (6 [3.6%]), and adverse medication effects (3 [1.8%]). No clinical management changes were reported for 178 patients (42.6%). CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study suggest that genetic testing of individuals with epilepsy may be materially associated with clinical decision-making and improved patient outcomes

Coping strategies used by aging parental caregivers of adults with autism spectrum disorder

Caregiving can be a lifelong responsibility for parents of individuals with autism spectrum disorder (ASD). This study examined coping strategies and barriers experienced by parents of adult children with ASD. The 51 parents who participated in this study were at least 50 years old and had an adult child (18+) with ASD. Semistructured, one-on-one interviews were conducted with parents to understand their experiences of having an adult child with ASD. Using a qualitative, phenomenological approach, thematic analysis revealed seven themes related to parents’ coping strategies or lack thereof. Themes discussed include faith/spirituality, physical activity/fitness, self-focused coping, work, acceptance, reliance on social support, and barriers to coping. Most parents discussed having at least one coping strategy, with some sharing multiple strategies

Social communication supports and services for adults with ASD: Parents’ perceptions of barriers and needs

Adults with autism spectrum disorder (ASD) experience significant social communication challenges that impact key areas of life, including relationship and employment success. Evidence points to great potential for social communication growth in adults with ASD; however, families’ access to supports and services is limited by lack of funding and accessibility. Scant research has been dedicated to unearthing the experiences of adults with ASD and their parents pertaining to social communication supports and services. This qualitative study gathered perceptions from 17 parents through focus groups aimed at determining barriers to and gaps in the system of social communication supports and services for adults with ASD. Using a phenomenological approach, conceptual content analysis was used to examine the parents’ perceptions and determine coding categories. Analyses revealed a number of barriers to effective use of such services and supports, and wishes for changes to facilitate services and supports in this area. Implications for professionals and policymakers are presented

Object play in infants with autism spectrum disorder: A longitudinal retrospective video analysis

Background and aims Early play behaviors may provide important information regarding later-diagnosed developmental delays. Play behaviors of young children with autism spectrum disorder are restricted in diversity, frequency, and complexity. Most autism spectrum disorder research focuses on play in children over 18 months of age. This study examined three groups of infants (later diagnosed with autism spectrum disorder, later diagnosed with other developmental disorders, and typically developing) with the aims of: (1) describing the play behaviors of the three groups of infants at two time points (9–12 months and 15–18 months); (2) examining group differences in four hierarchical levels of play at both time points; (3) comparing groups with respect to the highest level of play achieved; and (4) determining if the highest level of play achieved by infants with autism spectrum disorder and other developmental delays correlated with later developmental outcomes. Methods The current study used longitudinal retrospective video analysis to examine object play behaviors of the three groups of infants (total n = 92) at two time points (time 1: 9–12 months of age, and time 2: 15–18 months of age). Coding of play behaviors was based on existing literature and distribution of data from the current study. Developmental outcomes examined were measured using the Vineland Adaptive Behavior Scales , Childhood Autism Rating Scale , and a non-verbal developmental quotient calculated using visual reception scores from the Mullen Scales for Early Learning . Results Results indicate group differences in play, with infants later diagnosed with autism spectrum disorder showing significantly less sophisticated play than those with typical development. In addition, modest but significant correlations were found between highest level of play achieved at time 1 (9–12 months) and time 2 (15–18 months) and later outcomes for the autism spectrum disorder group. Conclusions and implications Results suggest that examination of infant play behaviors is important for early screening and intervention planning to potentially mitigate effects on later developmental outcomes