Journal of Developmental and Physical Disabilities

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Online ISSN: 1573-3580
Print ISSN: 1056-263X
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The study was aimed to define swallowing related problems of toddlers with Down syndrome (DS) by comparing toddlers with typically developing children (TDC). A total of 127 children (96 DS, 31 TDC), and their mothers included in the study. The presence of chewing disorders, food selectivity, drooling, coughing during swallowing was scored as ‘absent’ or ‘present’. The Pediatric version of the Eating Assessment Tool-10 (PEDI EAT-10) was used to determine dysphagia symptom severity, and the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact of swallowing disorders on caregivers. Mothers of DS reported higher rates of chewing disorders (n = 39, 40.6%), drooling (n = 30, 31.3%) and coughing during swallowing (n = 50, 41.7%) than mothers of TDC (p < 0.01). The mean PEDI-EAT-10 score of children with DS was higher than TDC (p = 0.006). There were significant differences between groups in terms of T-FS-IS. Moderate to strong correlations were detected between PEDI-EAT-10 and total and subscale scores from T-FS-IS (p < 0.001). This prospective study defines swallowing related problems of toddlers with DS. The study results highlight the importance of early investigation of (i) swallowing concerns in children with DS, and (ii) caregivers’ quality of life to define swallowing problems and plan an appropriate swallowing related management program.
 
Sleep onset latency (mins) for autistic participants across baseline, intervention, and follow-up phases
Frequency of night wakings for autistic participants across baseline, intervention, and follow-up phases
Total duration of night wakings (mins) of autistic participants across baseline, interventions, and follow-up phases
Modified Brinley plot showing participant change in SPS scores from baseline to post-treatment
Sleep problems, factors precipitating and maintaining the sleep problem, hypothesized function, and circadian and behavioral interventions used with participants
Sleep problems are prevalent among autistic children and children with Rare Genetic Neurodevelopmental Disorders (RGND). Behavioral interventions are commonly used to treat sleep problems, with most involving extinction. While effective, the occurrence of a response burst (i.e., temporary worsening of the behavior) can result in a temporary increase in parent and child distress, and negatively affect treatment adherence. Thus, it is important to develop less restrictive treatment options. This study used a single case multiple baseline design to investigate the effectiveness and acceptability of less restrictive behavioral interventions (i.e., specifically excluding extinction) for sleep problems in ten autistic children and children with RGND ( M = 7.3 years). Results demonstrated a reduction in sleep disturbance including unwanted bed-sharing, night wakings and sleep onset delay for 3/3, 5/5 and 6/7 children respectively, which were maintained at follow-up. Interventions were rated favorably by parents. The clinical implications of these findings are discussed.
 
Flowchart of Search Strategy
Timeline of Included Studies
of Target Physical Activities Across Studies
Summary of Multi-Component Interventions
Physical activity has many benefits, but many individuals with developmental disabilities fail to exercise regularly. Procedures in which consequences were arranged for exercising, alone or as part of a treatment package, have consistently increased physical activity by members of this population. We review 19 studies that arranged such procedures. Single-component, multi-component, and comparison studies are included. Token reinforcement was the most common intervention strategy, appearing in nine studies. Other strategies included auditory, visual, verbal, and edible reinforcement; goal setting; self-monitoring; and verbal cuing. Physical activities included cycling, walking, running, aerobic and strength training activities, and snowshoeing. One-hundred and forty-two people, ranging from 6-67 years of age, participated in these studies. Over 91% of them responded favorably to the intervention. Unfortunately, only three studies, with a total of eight participants, reported maintenance data. Physical activity returned to near baseline levels for seven of them following termination of treatment. Also unfortunately, evaluation of the quality of the 19 studies using the Methodological Quality Rating Scale revealed that most studies were not methodologically strong. It is heartening that interventions for getting people with developmental disabilities to engage in regular physical activity are available. But more high-quality research is needed. Keywords Exercise · Developmental disabilities · Reinforcement · Physical activity · Leisure · Interventions to promote healthy behaviors Regular physical activity (PA) is an essential component of a healthy lifestyle. The Centers for Disease Control and Prevention (CDC, 2021) recommends that children * Katarina Rotta
 
This study reports on two pilot studies developing a telemedicine parent-delivered social skills intervention (PDSSI) for school-aged children with ASD. Pilot study 1 involved initial development, training, and feasibility testing for six parent–child pairs using in-person training and fidelity monitoring. Findings from study 1 supported the intervention procedures through high satisfaction and parent implementation fidelity. Pilot study 2 tested the intervention with 11 parent–child pairs using telemedicine for parent training, fidelity monitoring, and child outcome testing. Findings from study 2 supported feasibility using telemedicine. Study 2 also provided initial data indicating improvements in child social skills knowledge (d = 1.15), social skills (d = 1.75), and ASD characteristics (d = 0.92). Parents reported improvements in their own empowerment (d = 1.09) and stress (d = 0.44). Some outcomes were assessed and maintained at a 16-week follow-up. Overall, results support ongoing testing of this telemedicine PDSSI.
 
Number of Sessions for Each Conditions (Left) and Structure of Sessions, Including the Duration and the Four Measures of Cortisol (Right)
Level of Mean Value of Cortisol (Left Panels) and Percentage of Time Engaged in Global Stereotypy (Right Panels) Across Three Conditions: Control, Novelty and Unpredictability
Percentage of Time Engaged in Motor Stereotypy (Left Panels) and Vocal Stereotypy (Right Panels) Across Three Conditions: Control, Novelty and Unpredictability
Mean Value of Cortisol (ug/dl) Compared to Percentage of Time Engaged in Global Stereotypy, Motor Stereotypy and Vocal Stereotypy
Several studies have reported conflicting results when assessing associations between stress and repetitive behaviors in individuals with autism spectrum disorder (ASD). Some factors that may have caused these discrepant results include the monitoring of a single broad category for repetitive behaviors, the heterogeneity of the participants, and the use of indirect measures. To address the prior issues, our study explored the relationship between salivary cortisol and direct observation measures of stereotypy in four minimally verbal children with ASD. To this end, we combined an alternating-treatment design with multiple regression analyses to examine the interaction between the two variables. The analyses indicated that the mean value of cortisol was negatively associated with global and motor stereotypy. No significant relation was found between mean value of cortisol and vocal stereotypy. These results highlight the complex relationship between stress and stereotypy and emphasize the relevance of conducting research on a larger scale, which would have a direct impact on our understanding of a core feature of ASD.
 
Past research suggests that children, particularly those with autism spectrum disorder, with general behavioral inflexibility to objects, persons, and environments may be at risk for feeding problems. However, questions remain about whether feeding problems are better predicted by behavioral inflexibility or sensory sensitivity, and whether general or food-specific measures are stronger predictors. The present study compared two types of behavioral inflexibility (general, food-specific) and two types of sensory sensitivity (food touch, temperature) for their association with children’s feeding problems. Participants were 372 children and their parents who completed surveys on their children’s demographics, as well as measures of behavioral inflexibility, sensory sensitivity, and feeding problems. The children, all referred to a feeding clinic were 71.8% male and had a mean age of 71.53 months. For this sample, 33. 7% had autism spectrum disorder (ASD), 28.7% had special needs other than ASD, and 37.5% had no special needs. ANCOVAs examined child demographics (age, weight status, medical problems, gender, special needs status) for their associations with each measure of inflexibility and sensitivity, finding that ASD was associated with more general and food-specific inflexibility, and younger age was associated with more food touch sensitivity. Hierarchical multiple regressions, which controlled for demographics, including ASD diagnosis, compared the four measures of inflexibility and sensitivity as predictors for each feeding problem. These analyses found food-specific behavioral inflexibility was the only significant predictor of all three feeding problems. Results suggest reducing the severity of children’s feeding problems, clinicians focus on increasing behavioral flexibility as it relates to food.
 
Research on Autism Spectrum Disorders (ASD) has found significant disparities in access to services and outcomes in rural communities. Little is known about service providers and families of children with ASD who reside in rural communities. The purpose of this study was to learn and describe the barriers and unmet needs experienced by parents and providers providing support to children with ASD in rural communities through a life course perspective. Eight parents and eight service providers participated in the focus groups from rural counties in Illinois, United States. Parents discussed barriers to accessing and coordinating services, from ASD diagnosis to transition and future planning. Overall themes highlighted the scarcity of qualified professionals trained to work with and serve children and youth with ASD and the resourcefulness caregivers and providers need to fill the gaps in education, health care, transition, and future planning. We present recommendations shared by parents and providers on ways to improve access to services and support for families in rural areas. The current study reports important implications for policy and practice regarding services and support for families of children and youth with ASD residing in rural communities.
 
Hypothetical model
Hypothetical models: the role of different parenting styles in the relations between parental stress and behavior problems
Revised models – the role of authoritative parenting in the relations
Revised models – the role of authoritarian parenting in the relations
Revised model – the role of permissive parenting in relations
Relations between parental stress and children’s behavior problems have been studied, but the role of parenting styles in these relations remains to be clarified. For families of children who are deaf or hard-of-hearing (DHH), exploring the associations among the three factors (i.e., parental stress, parenting styles, and children’s behavior problems) can help provide a more appropriate developmental environment for DHH children. In this study, 100 parents of hearing children and 74 parents of DHH children from Hong Kong and Macau were surveyed to investigate the role of parenting styles in the relations between parental stress and children’s internalizing and externalizing behavior problems. We have several key findings. First, families with DHH children were more likely to engage in permissive parenting, and their children exhibited more externalizing and internalizing behavior problems than their hearing peers. Second, parents who experienced high levels of stress tended to adopt authoritarian and permissive parenting styles, regardless of their children’s hearing status. Third, authoritative parenting was related to fewer externalizing and internalizing problems in DHH children, but such an association was not found in hearing children. However, the relation that authoritarian parenting may contribute to more behavior problems was found in both groups. Implications for family interventions to decrease behavior problems in DHH and hearing children, as well as for future research, are discussed.
 
PRISMA flow-chart
In order to propose intervention methods that can effectively improve the vocational skills of adolescents with autism spectrum disorders, meta-analysis is conducted on 16 research articles in the past twenty years focusing on single-type subjects. The intervention Tau-U effect values of related studies are calculated, and adjustment analysis is made on the subjects’ characteristics, intervention types, intervention methods, intervention environment, dependent variables and the degree of matching between intervention objectives and subject characteristics. The results show that the intervention effect of vocational skills of ASD adolescents is overall significant. In terms of participant characteristics, the intervention effect of high- or medium-functioning ASD adolescents was better than that of low-functioning ASD adolescents. The analysis of intervention types showed statistically significant differences, among which the audio cueing method had the strongest intervention effect, and the frequency of mobile device teaching and behavioral skills training increased significantly. The effect of multi-component interventions is the same as that of single interventions, and it shows a good trend in the past five years and has been widely employed. Vocational skill interventions promote the employment of over 10 million persons with ASD in China, which not only helps achieve their economic independence but also is an important means to improve the social happiness index.
 
FA Results
FCT Delivered through Live Coaching
This study evaluates the effectiveness of a brief functional analysis and functional communication training conducted via telehealth. Three interventionist-child dyads took part in the study including one speech and language pathologist and two school teaching assistants, each working with one child with autism spectrum disorder. Interventionists were trained using didactic training to implement a brief functional analysis as well as synchronous coaching from a BCBA ® to implement functional communication training. A multiple baseline across participants design was utilised to evaluate if interventionists could implement functional communication training to decrease challenging behaviours that included aggression, elopement and disruption. Sessions concluded earlier than planned due to school closures mandated by the COVID-19 outbreak for two of the three participants; however, existing data provide evidence that telehealth is a valid model for enabling clinicians to work in collaboration with school personnel to effectively deliver assessment and intervention procedures remotely via telehealth.
 
Background Physical activities are essential to the quality of life of people with intellectual and developmental disabilities. To promote participation in physical activities, it is critical to identify changeable variables based on the socio-environmental approach. The purpose of this study is to explore the status of physical activity participation and its correlate for people with intellectual and developmental disabilities in South Korea. Methods A total of 416 people with intellectual and developmental disabilities (or their families) completed the Korean national survey. We examined (a) physical activity frequency, duration, types, and facilities; (b) correlates of physical activity participation; and (c) barriers to physical activity participation. Results Slightly over half of the respondents participated in regular physical activity in the past year almost every day for approximately an hour, mainly by walking and jogging. Hierarchical binary logistic regressions revealed positive correlations between physical activity participation and healthy eating habits, reduced depression and suicidal ideas, community outings, direct professional support, and less feelings of discrimination. Conclusions To promote physical activity participation among people with disabilities, personal and socioenvironmental variables should be considered.
 
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication and interaction deficits, as well as restricted and repetitive behaviors. Previous research has examined the role that social deficits play on the development of daily living skills in children with ASD. However, there is a lack of research on this specific relationship. This study was conducted to examine the relationship between social functioning, as measured by the Socialization/Nonverbal Communication factor of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) and daily living skills, as measured by the Daily Living Skills subdomain of the Vineland Adaptive Behavior Scales – 2rd edition (VABS-2) in three groups of children; those who received a diagnosis of ASD, those who received a diagnosis other than ASD, and those who received no diagnosis, resulting in a total of 140 participants. A one-way MANOVA was run to assess for significant differences across groups, and three linear regression were run to evaluate the impact socialization deficits had on daily living skills. Results showed that socialization significantly predicts daily living skills, and that this relationship is most impacted in those who have received a diagnosis other than ASD. Clinical implications of the findings and future directions are discussed.
 
Percent accuracy of solving word problems across all participants
Improving the ability to solve mathematical word problems is one of the most critical issues facing students with developmental disabilities, because it is directly related to their independent living skills. The purpose of this study was to propose a teaching model that implements augmented reality (AR) and video modeling (VM), and to validate its effectiveness, including its immediate, maintenance, and generalization effects on improving the percent accuracy of solving mathematical word problems. The research design of this study adopted single-case multiple probe across students experimental design. The independent variable of this study was the VM with AR teaching model, and the dependent variable was the percent accuracy of the test subjects in solving mathematical word problems. All three test subjects showed an immediate effect, with two showing maintenance and generalization effects. This VM with AR teaching model provides an alternate way for classroom teachers when teach students with developmental disabilities to solve mathematical word problems. This teaching model allows students with developmental disabilities to improve their mathematical word-problem solving skills.
 
Algorithm; Admit and Orient (2-page decision making tool)
A Algorithm to Assess and Take Vital Signs (2-page decision-making tool)
Nurses and other health care providers face daily challenges when delivering care in the acute care settings to adult patients on the autism spectrum (ASD). Secondary to a lack of disability-specific training, health care providers may struggle to establish and maintain a therapeutic rapport with patients diagnosed on the autism spectrum (Bury et al., 2020). The purpose of this paper is to describe the development and pilot testing of decision-making tools to guide healthcare providers as they interact with patients on the autism spectrum using a novel approach. This mixed methods project employed simulation technology and actors portraying patients. It was conducted in two phases. During Phase 1, the decision-making tools were created using video-taped encounters between nursing students (n = 11) and standardized patients (actors) who displayed a range of core characteristics and behavioral features associated with ASD. During Phase 2, we piloted the tools with a convenience sample of 17 nurses. A panel of experts using a modified Delphi technique, 17-item task completion, 22-item behavioral encounter checklists and debriefing sessions, analyzed the 17-recorded simulations. The decision-making tools show promise of being to guide nurses’ efforts to establish and maintain a therapeutic rapport with hospitalized adult patients who are also on the autism spectrum.
 
ELSE Mnemonic Visual Graphic
Percentage of Correct and Independent Responses
Decision-making is the central element of self-determination, requiring targeted, systematic instruction to learn. In this study, researchers developed a multicomponent intervention, “What ELSE about this job?”, to teach job decision-making skills to college students with intellectual and developmental disabilities. The intervention coupled remote audio coaching (RAC) with a mnemonic device, ‘ELSE’, to guide students to make decisions about whether certain jobs would be a good fit for them. The study aimed to investigate the effectiveness of the intervention and determine whether the skills would maintain once the intervention was removed. All students who received the intervention substantially increased their ability to make job decisions. Additionally, all participants maintained the skills upon removal of the intervention, and showed signs of generalizing their skills to novel job coaches and web-based job search apps. Implications and future research are discussed.
 
Performance in non-dominant hand subtest of PPT
Performance in bimanual subtest of PPT
Performance in exercise perception scale
This study was aimed at investigating the effectiveness of assisted therapy (ACT) on manual dexterity in older adults with Down syndrome (DS). Nine older participants with DS, aged 31–52 years old, completed a 30-min stationary cycling session, three times per week for eight weeks of ACT intervention, pedaling at 35% higher than voluntary speed. Another eight older participants with DS, aged 30–51 years old, participated in the voluntary cycling (VC) intervention, pedaling at voluntary speed, as the comparison group. Manual dexterity measured by the Purdue Pegboard Test, and outcome expectations measured by the Exercise Perception Scale, were tested before and after the interventions. After both exercise interventions, the results showed that the non-dominant hand and bimanual subtests of the Purdue Pegboard were significantly improved. The outcome expectations were elevated at marginally statistical level as well. It is speculated that continuous cycling exercise, VC and ACT, may stimulate peripheral sensory input to the motor areas that led to the improvements in manual dexterity and exercise perception. Even though the exact mechanisms are still unknown, the implication of our results showed that VC and ACT can improve manual dexterity in aging DS population.
 
Body diagram presented in the WBC program
Documentation template for recording new student injuries
Average percent implementation integrity recorded in classroom groups
We describe a computer-assisted program for conducting well-body assessments of children with neurodevelopmental disabilities attending a private special education school. Classroom instructors completed daily assessments to detect the presence of bodily injuries and other skin trauma, determine the need for medical treatment, and monitor healing status. Evaluations performed with the classroom instructors revealed that they implemented the program with high integrity and rated several procedural components favorably. Compared to “paper form” data recording, clinicians and supervisors judged the computer-assisted program to track student injuries more thoroughly and record student injuries more accurately. The importance of health monitoring among persons with neurodevelopmental disabilities, advantages of technology-based assessment methods, and practice considerations are discussed.
 
Trial-by-trial data
URP-IR subscale scores
Imitation is a pivotal skill for children with and without disabilities, serving both learning and social interaction functions for young children. Children with autism spectrum disorder (ASD) frequently experience delays in acquiring this skillset, demonstrating challenges in the ability and/or propensity to imitate the actions of others. Current intervention programs frequently use discrete trial teaching (DTT) or contingent imitation to support imitation development in young children with ASD. This study combined contingent imitation with DTT to teach imitation to individuals who had previously struggled with acquiring this skill. A multiple probe design across three preschool children with ASD was conducted within participants’ early learning classrooms. Response to intervention varied across participants, with participants with more advanced imitation skills at study onset demonstrating greater outcomes. Combining contingent imitation with DTT may facilitate the propensity to imitate for individuals who exhibit some appropriate object engagement and are inconsistently imitating others’ actions with objects. However, further research using stronger research design is needed to improve the teaching of imitation to young children with ASD who exhibit challenges with this skillset.
 
The relative contribution of each step in the first hierarchical regression (N = 85) to the variance in QOL. Significant associations are indicated by *
The relative contribution of each step in the second hierarchical regression including participants above the borderline cut-off for the AAC-Q (N = 72) to the variance in QOL. Significant associations are indicated by *
Demographic and clinical characteristics of participants with DCD
Although it is now widely accepted that developmental co-ordination disorder (DCD) persists into adolescence and adulthood, few studies have assessed the concept of Quality of Life (QOL) within the adult DCD population. This is despite a growing recognition that children and adolescents with DCD experience poorer QOL than their typically developed peers. The small body of literature which has examined QOL in adults with DCD has reported that they also report lower levels of QOL as a result of motor coordination deficits. Little research has investigated the factors that result in adults with DCD reporting lower QOL than their typically developed counterparts. The current study explored the relationships between QOL and motor coordination, and QOL and three individual subtypes of avoidance within an adult DCD sample. Eighty-five adults (27 males; 58 females) who reported a diagnosis of, or believe that they have DCD, completed an online questionnaire that consisted of three already established questionnaires in order to measure the concepts of QOL, motor coordination and avoidance, respectively. A hierarchal multiple regression revealed that all three types of avoidance behaviors were significant predictors of QOL scores, while levels of motor coordination did not significantly predict scores of QOL. These results highlight the need for clinicians to develop interventions to help reduce avoidance behavior and social impairment, in order to improve QOL within the DCD adult population.
 
Previous studies have examined the relationship between sleep problems and challenging behaviors in school-aged children and adolescents with autism spectrum disorder (ASD). However, literature has not examined this relationship in the context of toddlers or, more specifically, toddlers with aggression. The present study was conducted to examine the relationship between ASD severity, sleep problems, and aggression in toddlers (aged 24 to 36 months) with a diagnosis of ASD. Sleep problems were measured by the Childhood Sleep Habits Questionnaire (CSHQ; NICHD SECCYD-Wisconsin, 2017) and aggression was measured by part 3 of the Baby and Infant Screen for Children with aUtism Traits (BISCUIT; Matson et al., 2007). A hierarchical multiple regression was conducted with a sample of 28 toddlers and the results indicated sleep problems statistically significantly predicted aggression over and above ASD severity. Implications of these findings and future research directions are discussed.
 
Group comparison of prosocial behavior adjusting for correlates and covariates
Research on siblings of children with developmental and physical disabilities has emphasized negative influences on siblings’ mental health. Yet, such siblings may be more prosocial compared with siblings of children without disabilities, due to care responsibilities and their experiences with their brother’s or sister’s disability. We compared prosocial behavior between siblings of children with autism spectrum disorder (ASD; n=47), physical disabilities (n=42), and siblings of children without disabilities (n=44) using a multi-informant approach (i.e., child-, mother-, and father-report). Prosocial behavior was measured with the Strengths and Difficulties Questionnaire. Drawing on the theoretical and empirical sibling literature, we also examined whether siblings’ internalizing and externalizing difficulties, adjustment to the sibling situation, and communication with parents correlated with siblings’ prosocial behavior. Child-reported internalizing difficulties and mother-child communication significantly correlated with mother-reported prosocial behavior. Child-reported internalizing and externalizing difficulties significantly correlated with father-reported prosocial behavior. No significant correlates with child-reported prosocial behavior was identified. When adjusting for siblings’ internalizing and externalizing difficulties and mother-child communication, siblings of children with physical disabilities scored significantly higher than siblings of children without disabilities on mother- and father-reported prosocial behavior. Siblings of children with ASD scored significantly higher on mother-reported prosocial behavior. We conclude that prosocial behavior may be a relative strength in siblings of children with developmental and physical disabilities, and that siblings’ prosocial behavior may be influenced by type of disability, mental health, and family communication. Interventions targeting siblings’ mental health and family communication may be helpful in promoting siblings’ prosocial behavior.
 
Relationship between the PCA total score and other measures
Relationship between the PAS score and other measures
The present study examined the relationships between the standardized applied behavior analysis (ABA) direct assessment, the PEAK Comprehensive Assessment (PCA), and established assessments commonly used in educational and clinical settings, including the Childhood Autism Rating Scale – Third Edition (CARS-3), the PDD Behavior Inventory (PDDBI), the Vineland Adaptive Behavior Scale – Second Edition (VABS-2), and intelligence, including the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) and the Wechsler Intelligence Scale for Children (WISC-V). Utilizing a sample of 73 children with autism ranging from 3 to 21 years old, the present study found the PCA to be significantly correlated with the established measures. The result suggests evidence of convergent validity of the PCA, and internal consistency among its subtests. Implications of this behavior-analytic standardized assessment were discussed.
 
There is a growing body of evidence supporting the use of telehealth to provide parent training in behaviour analytic interventions and researchers have begun to focus on international demonstrations of this model. The current study assessed the efficacy of a training package focused on naturalistic teaching strategies designed to upskill parents of children with autism spectrum disorder and provide them with ready to use strategies to increase social communication behaviours across verbal operants. Two parent-child dyads were trained to increase mand, tact and intraverbals during play. Parents displayed increases in fidelity for each strategy and viewed the training favourably. Both children showed gains across verbal operants, as captured by a multiple baseline across behaviours design. Supplementary information: The online version contains supplementary material available at 10.1007/s10882-022-09859-4.
 
Histogram of the frequency distribution for Time Elapsed in days
Little research has explored factors effecting the time it takes caregivers to initiate the diagnostic process (e.g., first phone call to a provider) after their infant or toddler received a positive screen for Autism Spectrum Disorder (ASD). The current study investigated the time it takes caregivers of an at-risk sample of toddlers who are enrolled in a statewide early intervention program and screen positive for ASD to initiate the evaluation process. A hierarchical multiple regression was used to identify factors that may affect this timeline. ASD symptom severity and child age were found to predict the length of time between receiving the positive screen and the initiation of the evaluation process; no additional factors (i.e., gender, only child status, younger sibling status, race/ethnicity) were significant. Results indicate that severity of symptoms and child age may be the driving factors for caregivers to initiate the formal evaluation process.
 
Percent of Independent Traveling and Manding. This figure depicts the percentage of independent traveling and manding, across baseline and training for all three participants
An increasing body of literature demonstrates the effectiveness of interventions involving speech-generating devices (SGD) for children with autism with limited vocal speech output abilities. Few studies have evaluated interventions that teach children to “travel” to the device before making requests. The current study evaluated a five-second time delay with physical prompts to teach “traveling” to three preschool aged children with autism, who used the iPad® and application Proloquo2Go™ as a SGD. A multiple stimulus without replacement preference assessment was used to determine preferred items for which the participant would mand (request) for access to, and mand trials were contrived with the tablet-based SGD at a predetermined distance from the participant. The distance between the SGD and participant was then systematically increased from next to the participant, to six feet (1.83 m) away from the participant. Each participant acquired the ability to travel from the location of the SGD, and then to the listener, and to mand for an item using the SGD, to a criterion of 80% independence across three consecutive sessions. This study adds support to the existing literature on the use of interventions involving tablet-based SGDs for children with autism, as well as provides clinicians with a procedure for teaching traveling.
 
Number of IOH demonstrated by participants across low-tech (LT) and high-tech (HT) AAC use
IOH from participants across type of prelinguistic communicative behavior in response to low-tech (LT) and high-tech (HT) AAC use
The purpose of this study was to evaluate the effect of two AAC technologies on indices of happiness for school-age children with multiple disabilities during interactions with their school speech-language pathologists. The study applied a post host secondary analysis of a previously completed single-subject alternating treatment design study including three school-age children with multiple disabilities. The study compared two AAC technology treatment conditions, one high-tech and one low-tech. The secondary analysis revealed that the children displayed more indices of happiness when interacting in the high-tech AAC condition than the low-tech AAC condition. Nonoverlap of all pairs (NAP) calculations estimated a medium or large effect of AAC mode for the participants. This study is limited in scope and by its use of post hoc analysis, but it adds to existing evidence suggesting the benefits of high-tech AAC intervention using personalized color photos, mobile technology, and voice output for school-age children with multiple disabilities. It also shows the potential of indices of happiness to inform clinical decision making for children with multiple disabilities. Future research should continue to evaluate the comparative effects of differing technologies and instructional strategies on indices of happiness to maximize opportunities for communication and language learning.
 
Descriptive table for the categorical sociodemographic variables obtained at the first measure- ment occasion of the study
Summary table of the regression models obtained with the procedure based on a feasible solu- tions algorithm using Bayley's language development scores as dependent variables
Parenting is a key factor for the development of children with intellectual and devel- opmental disabilities. Therefore, early intervention programs should target parenting behaviors to improve children’s developmental outcomes. The present study ana- lyzed the effect of parental behaviors and other family factors on the cognitive and linguistic development of children with an intellectual disability (ID). Participants (n=87, aged between 20 and 47 months) were recruited from several Spanish Early Intervention Centers. The children’s development was assessed with the Bayley Scales of Infant Development (BSID-III) on two occasions. Besides questionnaires including family factors, 10-min mother–child and father-child interactions dur- ing free play were auto-recorded at home. Intensive statistical modeling on the two measurement occasions was used to select relevant predictors as well as their inter- actions. Child cognitive development models, including predictors such as mother’s responsiveness and affection and father’s teaching, had a predictive capacity between 22 and 26%. The language development models, including the mother’s responsive- ness and father’s teaching scores amongst other predictors, yielded adjusted-R2s between 26 and 28%. This study’s findings evidence that parental behaviors during adult–child interaction affect the development of children with intellectual disabili- ties. The study also provides data that can be used to guide early intervention.
 
Parental behavior domains that research in the last decade has related to children's developmental outcomes
Descriptive table for the categorical sociodemographic variables obtained at the first measure- ment occasion of the study
Summary table of the regression models obtained with the procedure based on a feasible solu- tions algorithm using Bayley's language development scores as dependent variables
Parenting is a key factor for the development of children with intellectual and developmental disabilities. Therefore, early intervention programs should target parenting behaviors to improve children’s developmental outcomes. The present study analyzed the effect of parental behaviors and other family factors on the cognitive and linguistic development of children with an intellectual disability (ID). Participants (n = 87, aged between 20 and 47 months) were recruited from several Spanish Early Intervention Centers. The children’s development was assessed with the Bayley Scales of Infant Development (BSID-III) on two occasions. Besides questionnaires including family factors, 10-min mother–child and father-child interactions during free play were auto-recorded at home. Intensive statistical modeling on the two measurement occasions was used to select relevant predictors as well as their interactions. Child cognitive development models, including predictors such as mother’s responsiveness and affection and father’s teaching, had a predictive capacity between 22 and 26%. The language development models, including the mother’s responsiveness and father’s teaching scores amongst other predictors, yielded adjusted-R2s between 26 and 28%. This study’s findings evidence that parental behaviors during adult–child interaction affect the development of children with intellectual disabilities. The study also provides data that can be used to guide early intervention.
 
Caregivers access to different types of technologies
Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed. Supplementary information: The online version contains supplementary material available at 10.1007/s10882-022-09853-w.
 
Problem Behavior, Compliance, and Schedule Selections. BL = baseline; TE = token evaluation
Problem Behavior and Compliance across Maintenance Sessions. Grey markers depict generalization sessions with novel staff or contexts. All sessions were conducted with accumulated exchange-production schedules
Token reinforcement procedures are used to increase appropriate behavior (e.g., completion of instructional tasks) and decrease problem behavior (e.g., aggression) in a wide array of clinical contexts. Token exchange-production schedules, which specify the number of tokens that must be accrued to produce the exchange schedule, are important components of token reinforcement programs. For example, accumulated schedules require learners to “bank up” multiple tokens before they can be exchanged, whereas distributed schedules allow learners to exchange tokens for backup reinforcers after just a single token (or a comparatively smaller range of tokens) is earned. Emerging research suggests that individual preferences for these different arrangements varies and is affected by many variables, including increasing work requirements (e.g., reinforcement schedule thinning). In the current study, we demonstrated that preferences for these schedules was stable across increasing work requirements and demonstrated that non-preferred (accumulated) schedule arrangements may support appropriate behavior and decrease problem behavior, even with very lean token-production schedules. These results have implications for practitioners who use token-based interventions and conduct schedule thinning for escape-maintained behavior.
 
The high prevalence of sleep-related disorders is well documented in individuals with Down syndrome (DS). Given the association between physical activity (PA) and sleep in the typical populations, this study was the pilot study to examine this association through the parental report in this population. The total of forty-three individuals with DS (aged 14–55) participated in the present study. Parents reported on the questionnaires to measure different levels of PA and four factors of sleep-related disorders in adolescents and adults with DS. Our results indicate that age was positively associated with the frequency of “disorders of initiating and maintaining sleep”. In addition, the levels of moderate-to-vigorous PA (MVPA) were negatively associated with the severity of “Features associated with obstructive sleep apnea (OSA)”. Further, the active group had lower parental reports of features associated with OSA compared with the insufficiently active group after controlling for anthropometric measures. Our study suggests moderate-to-vigorous exercise may reduce OSA severity in individuals with DS. Therefore, future support for recreational services should be provided to promote physical leisure activity that may reduce the onset of sleep disorders in this population.
 
This study examined how students with orthopedic impairments experienced strategies identified in the literature to support 'inclusion'. An interpretative phenom-enological analysis research approach was used, and six students with orthopedic impairments (age 10-14 years) served as participants. Data sources were written prompts, semi-structured, audiotaped interviews, and reflective interview notes. Based on thematic data analysis, four themes were constructed: "It's kind of em-barrassing": experiences with support; "I don't want to be different": equipment, activity, and rule modifications; "I like to be a part of the conversation": autonomy and choice in PE; and "I would rather be like the other students": discussing disability. The experiences portrayed through these themes highlighted the differential effects of these explicated strategies, where each strategy contributed to feelings of inclusion, as well as marginalization among participants. As such, the findings indicated that 'inclusive' strategies should not be considered as blanket recommendations ; instead, attempts to promote 'inclusion' of students with disabilities should start with a reflexive look at the unique needs of each individual student.
 
Percentage of Correct Responses for Target and Generalization Scenarios for Video and Picture Interventions Across Conditions for Four Children
Percentage of On-task Behavior in VM and PI Intervention Conditions for Four Children
The purpose of the present study was to investigate the differential effects of video modeling (VM) and picture-based interventions (PI) for teaching children with ASD to recognize emotions in context. The study used an adapted alternating treatments design. One girl and three boys in China, 4.5-5 years old with autism spectrum disorder, participated. Both methods were effective, but three of the four children demonstrated a higher percentage of accurate responses with VM than with PI. All children required less time overall and less time per trial to reach criterion with PI than VM. They required fewer trials to reach criterion with VM, but VM trials were longer. All children displayed longer on-task behavior with VM than with PI. Overall, the two methods can be considered comparable in efficiency, with the choice of one rather than the other depending on learners’ and instructors’ needs, preferences, and contexts.
 
Flow chart for the current study
Mean physical activity scores of the groups in pre-test an post-test
Although the benefits of regular physical activity are clearly expressed, children with Autism Spectrum Disorder (ASD) are less physically active than their typically developing peers. Recent empirical studies have revealed that the level of physical activity of children with ASD has further decreased during the novel coronavirus (COVID-19) pandemic, which has adversely affected the whole world. The aim of this study was to evaluate the potential efficacy of a Zoom-delivered physical activities for children with Autism Spectrum Disorder (ASD). Twenty-two families (parent and child dyads) participated in the study. Families were assigned randomly to an experimental group (n = 11) and a control group (n = 11). Families in the experimental group were engaged in 10 weeks of the Zoom-delivered physical activities. Data were collected using multiple data collection strategies (Personal Information Form- Leisure Time Exercise Questionnaire–Semi-Structured Interview). After the Zoom-delivered physical activities, a significant increase was observed in the physical activity level of children with ASD in the experimental group (F = 95.396, p = 0.000, Ƞ² = 0.834). Parents reported that Zoom-delivered physical activities are a viable and useful intervention to increase the level of physical activity of children with ASD. The findings suggest that Zoom-delivered physical activities merit further investigation as an intervention to increase physical activity in children with ASD.
 
Current developmental disabilities of the children
Severe developmental disability in children affects the life of the child and entire household. We conducted a qualitative study to understand how caregivers manage severe developmental disabilities in children in rural Africa. Families and six children (out of 15 children) who had serious permanent sequelae from a cerebral infection in Handeni, Tanzania, were contacted and invited to a workshop to recount their experience living with severe developmental disabilities. After consent, individual interviews were conducted first through recording of individual digital stories and then through individual semi-structured interviews. Pre-determined key categories were used to analyse the data. Our results showed that developmental disabilities required constant care and reduced the autonomy of the children. Schooling had not been attempted or was halted because of learning problems or inability to meet specialized school costs. Parents were under constant physical, emotional and financial stress. Their occupational earnings decreased. Some families sold their assets to survive. Others began to rely on relatives. Understanding the consequences of developmental disability helps to identify where social support should be focused and improved.
 
Rehabilitation aims to make necessary changes to help individuals achieve maximum life satisfaction. This study focused on Internet competence and use as factors related to life satisfaction for individuals with physical disabilities. Data from the 2016 Information Divide Index of the National Information Society Agency were analyzed. Regression analyses indicated a negative correlation between Internet use related to life services and life satisfaction; however, findings also suggested Internet use has positive effects on life satisfaction for individuals with physical disabilities. Internet use can help improve the life satisfaction of individuals with physical disabilities, and measures to increase competence and use are necessary.
 
Discrimination against Asians and Asian Americans increased during the COVID-19 pandemic. Yet, even prior to the pandemic, little research explored the experiences of Asian American families of children with autism and other developmental disabilities. This brief report summarizes the results of a survey conducted between May and July 2020, in the immediate aftermath of state and local lockdowns due to the pandemic. Twenty-five Asian American caregivers of children with autism and other developmental disabilities completed the survey and reported on the pandemic’s impact on their household. Most of the caregivers were mothers, immigrants, Chinese, raising children with autism, and highly educated. Participants’ primary concerns were the disruption of their children’s educational and therapeutic services. We discuss research limitations and implications.
 
Point prevalence reported on 852 male children and 379 female children who stutter from 3 to 17 years. Legend: Years of age are displayed on the x-axis, while prevalence (in percentages) is displayed on the y-axis. The lower and the upper solid lines represents 95% confidence interval 2.1–3.2%, respectively, for males. The lower and the upper dotted lines represents 95% confidence interval 1.0–1.6%, respectively, for females
Sex ratio (male-to-female) of 1231 children who stutter from 3 to 17 years. Legend: Years of age are displayed on the x-axis, while prevalence (in percentages) is displayed on the y-axis. The lower and the upper interrupted lines represents 95% confidence interval 1.9–2.5, respectively
Stuttering and other developmental disorders are known to affect more male than female children. The present study compared: (1) stuttering prevalence in males and females at discrete ages and (2) prevalence of coexisting developmental disorders in male and female children who stutter (CWS). Data were obtained from the National Health Interview Survey (from 2010 to 2015). The sample comprised 62,450 total children, ages 3 to 17 years. Children in the current sample were those identified by their caregivers as having stuttered in the past 12 months. Rate of stuttering and data on five concomitant disorders (attention deficit hyperactivity disorder—ADHD; autism spectrum disorder; intellectual disability; learning disability; and seizures) were compared between male and female CWS and across three age categories: 3–5, 6–10, and 11–17 years. There were 1231 CWS, 852 males and 379 females, in the sample. Overall prevalence rates were 1.3%, 95% [CI 1.0, 1.6] for females, and 2.6%, 95% [CI 2.1, 3.2] for males, where prevalence rates decreased as age increased. For the total sample, male-to-female ratio was 2.0:1, 95% [CI 1.9, 2.5]. For coexisting developmental disorders, male CWS were at greater odds of having ADHD (OR = 2.32, 95% CI [1.62, 3.31]) and at lower odds than females of experiencing seizures (OR = .370, 95% [CI .214, .638]). Prevalence data at discrete ages revealed a different course of stuttering in early childhood for female and male children. Implications of sex differences, on the presence of ADHD and seizures/epilepsy among CWS, are discussed.
 
Teacher-parent relationships and active family engagement are essential components to positive outcomes for students with disabilities. Latinx students are an increasingly growing student population; however, there are limited studies about the experiences unique to Latinx parents concerning family engagement and home-school partnerships in public schools, and no studies about Catholic schools. To address this gap, focus groups and individual interviews were conducted with five Latina mothers of children with disabilities and five teachers in a Catholic school. The purpose of this study was twofold: 1) identify barriers and facilitators to successful home-school partnerships between Latina mothers with children with disabilities and their teachers in a Catholic setting and 2) examine the role of family engagement in the formation of the home-school partnerships. Constant comparative analysis was used to analyze the data. There were two main findings. First, parents actively engaged in school events and home-school partnerships when opportunities for reciprocal relationships were present. Second, mothers and teachers participated in reciprocal and equitable home-school partnerships fostered through frequent, two-way communication, home-school updates, shared strategies and supports, and mutual respect for one another’s expertise. Implications for research and practice are discussed.
 
Plot of ASD symptoms, comorbid symptoms, and adaptive skills by time. Note. SRS-2 = Social Responsiveness Scale (2nd Ed.); BASC-3 Comorbid Symptoms = Behavior Assessment System for Children (3rd Ed.) Externalizing and Internalizing z-score mean
This study assessed the potential short-term effects of COVID-19 stay-at-home restrictions on ratings of ASD and comorbid symptoms severity and adaptive functioning of 69 youth, ages 8–16 years with ASD without intellectual disability. Parent/caregiver ratings were being collected in fall and spring over approximately two years when the restrictions were imposed four months prior to the final data collection point. Results indicated no significant changes in parent/caregiver ratings of ASD symptom severity, comorbid symptoms severity, social skills, or adaptive behaviors following the stay-at-home restrictions and little variability across the four data collection points. Although findings suggested minimal short-term effects on these symptoms and adaptive skills, ongoing monitoring is needed to assess longer-term impacts.
 
The proposed mediation model
Serial mediation model shows effects of spatial ability, processing speed (ACC) and intelligence on mathematics achievement
Serial mediation model shows effects of spatial ability, processing speed (RT) and intelligence on mathematics achievement
Spatial ability has been shown the positive correlations with the mathematics achievement of typically developing children. However, whether there is a relationship between spatial ability and mathematics achievement in deaf children and the mechanisms that underlie the relationship remain unknown. 256 deaf children in Grades 3 to 9 in two special education schools in China performed a series of cognitive and mathematical tests. After controlling for age and gender, we found that spatial ability, processing speed (both accuracy and reaction time), and intelligence were significantly related to mathematics achievement. Moreover, processing speed and intelligence were found to mediate the relationship between spatial ability and mathematics achievement in deaf children. The mediating effect of intelligence was significantly greater than the serial mediating effect of processing speed (accuracy) and then intelligence; both the mediating effect of processing speed (reaction time) and the mediating effect of intelligence were significantly greater than the serial mediating effect of processing speed (reaction time) and then intelligence. These findings suggest a process through which processing speed can decrease intelligence and identify the mediating effects of processing speed (both accuracy and reaction time) and intelligence in the relationship between spatial ability and mathematics achievement in deaf children.
 
Community integration is preferred by people with intellectual and developmental disabilities; community integration is also associated with positive outcomes. Yet, many people with intellectual and developmental disabilities, especially with higher support needs, remain isolated. This exploratory study examined the relationship between community integration, significant support needs, and emergency department utilization of people with intellectual and developmental disabilities (n = 251) by analyzing secondary Personal Outcome Measures® interview data. We found an interaction between community integration and comprehensive behavior support needs, wherein people with intellectual and developmental disabilities with comprehensive behavior support needs who participated in the life of the community had 78% fewer emergency department visits than those people with comprehensive behavior support needs who did not participate in the community. Not only is community integration preferred by people with intellectual and developmental disabilities, our research suggests it can also produce improved health outcomes for those with comprehensive behavior support needs.
 
Longitudinal plots of subscale scores LS Means. Horizontal axis shows months from the 1st evaluation (0 to 36 months). Error bars show the 95% confidence interval. To facilitate comparison between subscales, all vertical axes ranges have been normalized to show 40% of their corresponding subscale’s maximum available score. A lower score indicates symptom improvement. P-value is marked: *** < 0.0001; ** < 0.001; * < 0.05. A: Receptive Language score. B: Expressive Language score. C: Sociability score. D: Sensory Awareness score. E: Health score
Longitudinal plots of subscale scores LS Means when controlling for the health score. Horizontal axis shows months from the 1st evaluation (0 to 36 months). Error bars show the 95% confidence interval. To facilitate comparison between subscales, all vertical axes ranges have been normalized to show 40% of their corresponding subscale’s maximum available score. A lower score indicates symptom improvement. P-value is marked: *** < 0.0001; ** < 0.001; * < 0.05. A: Receptive Language score. B: Expressive Language score. C: Sociability score. D: Sensory awareness score
Percent evaluations in each time period as a fraction of the number of evaluations at baseline
The effect associated with the presence of seizures in 2 to 5-year-old autistic children was investigated in the largest and the longest observational study to-date. Parents assessed the development of 8461 children quarterly for three years on five orthogonal subscales: combinatorial receptive language, expressive language, sociability, sensory awareness, and health. Seizures were reported in 958 children (11%). In order to investigate the effect of seizures, children with seizures were matched to those with no seizures using propensity score based on age, gender, expressive language, receptive language, sociability, sensory awareness, and health at the 1st evaluation. The number of matched participants was 955 in each group. Children with no seizures developed faster compared to matched children with seizures in all subscales. On an annualized basis, participants with no seizures improved their receptive language 1.5-times faster than those with seizures; expressive language: 1.3-times faster; sociability: 2.3-times faster; sensory awareness: 6.2-times faster; and health: 20.0-times faster. This study confirms a high prevalence of seizures in ASD children and informs on the effect of seizures on children’s longitudinal developmental trajectories.
 
The COVID-19 outbreak affected the daily lives of individuals with Down syndrome, who were considered to have a higher risk of severe infection. While several studies have reported mental health issues in children and/or parents in the general population, no study has focused on people with Down syndrome and their caregivers. This study investigated the disinfection behaviors of individuals with Down syndrome and their caregivers’ stress. A cross-sectional retrospective survey was conducted in October 2020. Caregivers of children and adults with Down syndrome were administered questionnaires including measures for practiced disinfection behavior in children, caregiver’s child-related stress, and psychological distress. About half of the respondents’ children practiced hand hygiene and mask-wearing behaviors, while physical distancing was performed less frequently. Habitual practices in physical distancing are affected by intellectual function. Logistic regression showed that caregivers’ stress was associated with the irritability of individuals with the disorder (adjusted odds ratio [OR] = 8.44, 95% confidence interval [CI] 1.69–42.09) and the burden of infection-prevention behaviors for people with Down syndrome (adjusted OR = 4.26, 95% CI 1.88–9.65). This study showed the characteristics of disinfection behaviors in individuals with Down syndrome and associated factors for serious caregiver stress.
 
Main Categories with Subcategories
Fathers in families with childhood disability have an important role in fostering coping and resilience in children. Insight into men’s thoughts about fathering is necessary to provide family-centered interventions. The purpose of this study was to explore men’s experience of being a father in families with childhood disability. Qualitative interviews were conducted with seven fathers in families with childhood disability. Content analysis was applied to analyze the data. The participants described their thoughts about children’s needs; mastery, secure attachment, clear boundaries, positive emotions, and role models. Creating a father-child unity, being active, playful, fearless, and sometimes restraint was described as fathering behaviors aiming to meet these needs. However, personal, family, and social factors were described as influencing fathers’ behaviors. Fathers’ psychological wellbeing was described to be affected by the childhood disability to different degrees, and emotional triggers related to the disability were described. Participants described using a variety of emotion regulation strategies, but somewhat restraint support seeking behavior. We conclude that the health and social welfare system should involve fathers in the provision of services to children, empower them in their role as fathers, and provide support tailored to their needs.
 
The Duration of Social Interaction Across Three Children with ASD and Their Peers
The Frequency of Social Behaviors for Children with ASD
This study evaluated whether a play-based, teacher-facilitated peer network intervention could improve basic social communication skills of children with autism spectrum disorder (ASD). The study was conducted in a regular classroom, using the principles of peer mediation and an integrated playgroup model. A single-subject multiple baseline design across three participants with ASD and Tau-U were used to determine the size of the effect. The results indicated that basic social communication skills of all three target participants significantly improved from the baseline condition in all three aspects measured: the duration of social interaction, social initiations, and responses to their peers. In the maintenance condition, three target participants retained increased social communication skills yet at lower levels than during the intervention condition. Overall, the results suggested that the intervention package was effective at improving the social abilities of children with ASD and applicable in classrooms. Practices, implications, and recommendations for future research are discussed.
 
Percentage of Independent and Accurate Mands.This figure depicts the percentage of impendent and accurate mands for all three participants, across baseline training, and maintenance
This study evaluated the use of an interrupted chain procedure to establish spontaneous mands (i.e., requests) in three preschool aged children with a diagnosis of autism spectrum disorder. All three participants attended a university based preschool center, which used the methodology of Applied Behavior Analysis. Additionally, all three participants used a high-tech speech-generating device that consisted of an iPad® tablet and application Proloquo2Go™. At this center all three children were exposed to the training procedure that used the interrupted chain procedure to first establish motivation and a five-second time delay with full physical prompts. The results indicated that all three participants acquired the ability to mand for a missing item needed to complete a play activity (i.e., puzzle) to the mastery criteria of three consecutive sessions at or above 80% independent and accurate responding. On average it required the participants five training sessions to reach this criterion. Additionally, maintenance data were collected, and the acquired repertoire was demonstrated to maintain for all three participants. Limitations of the research procedures, clinical implications, and suggestions for future research are also discussed.
 
Pediatrician response type to parent SIB concern * Note: RX = medicine was prescribed
The purpose of this study was to examine the frequency and quality of primary care physician (PCP) recommendations to investigate the management of young children with delays and self-injury (SIB; e.g., head banging) from the time of initial SIB concern to specialty referral as recommended by the American Academy of Pediatrics (AAP). Via a structured electronic health record review, PCP referrals and recommendations were examined for a cohort of 250 children (10–59 months old) with delays and SIB. Only a small portion of cohort charts reviewed (8.0%) received AAP recommended intervention via referral to subspecialty providers by their PCP. Further, only 37.5% received SIB-specific care recommendations. Findings suggest that future targeted education is needed to improve primary care access to AAP recommended intervention for young children with delays and early SIB.
 
Top-cited authors
Kevin Ayres
  • University of Georgia
Linda Mechling
  • University of North Carolina at Wilmington
Jennifer L. Alexander
  • Comprehensive Behavior Change
Peter B Marschik
  • University Medical Center Goettingen / Karolinska Institutet / Medical University of Graz
Elizabeth R. Lorah
  • University of Arkansas