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Using Telepractice in Parent Training in Early Autism
Abstract
There is a growing body of literature indicating that intense early intervention is current best practice for treating children with autism spectrum disorders (ASD). Several studies demonstrate the effectiveness of parents as agents of intervention in the child's home environment. However, this approach requires intense one-on-one supervision by highly trained professionals. Consequently, there is a significant gap between the intensive service requirements for children with ASD and the available resources to provide these services. In the current pilot study, the use of remote technology, telepractice, is evaluated as a tool for coaching parents of two children found to have ASD. Two clinical models of intervention are compared: a traditional model of twice-weekly speech and language therapy sessions (traditional clinical model) and a model where a once-a-week clinical session is followed by a home-based session administered by the parents and remotely supervised and coached by the clinician (clinic/telepractice model). Results suggest that gains obtained in traditional therapy can be maintained and even exceeded in a treatment model that uses telepractice. Parents reported that they perceived telepractice sessions to be as valuable as those delivered directly by the clinician, felt comfortable using the technology, and were willing to continue intervention with their children at home. These preliminary results suggest that use of telepractice holds promise for reducing the demands on available resources of service for this population. A study with a larger population is currently underway including cost-benefit analyses to examine the implications for such a treatment model to its users and to the healthcare system.
... Daugelio autorių (Ciccia, Whitford ir kt., 2011;Molini-Avejonas ir kt., 2015;Neely ir kt., 2017;Chisholm, Psarros, 2018) tyrimai atskleidžia, kad telepraktika yra ne tik efek tyvus mokymosi būdas, bet ir ekonomiškas, ypač laiko ir transporto sąnaudų požiūriu. Pripažįstamas pagalbos, teikiamos natūralioje asmeniui aplinkoje (net ir nuotoliniu būdu), privalumas (WHO, 2010;Baharav, Reiser, 2010;Carey ir kt., 2014). Kiti mokslininkai (Carey ir kt., 2014; Molini-Avejonas ir kt., 2015) akcen tuoja didesnes patekimo pas specifinės patirties ar kompetencijų turintį specialistą, gyvenantį kitame mieste ar šalyje, galimybes. ...
... Research conducted by many authors (Ciccia, Whitford et al., 2011;Molini-Avejonas et al., 2015;Neely et al., 2017;Chisholm & Psarros, 2018) reveals that telepractice is not only an effective way of learning but at the same it is cost-effective and favourable in terms of time and transport costs. The advantage of providing support in the environment that is natural to the person (even remotely) is recognized (WHO, 2010;Baharav & Reiser, 2010;Carey et al., 2014). Other researchers (Carey et al., 2014;Molini-Avejonas et al., 2015) emphasize greater opportunities of availability of a professional with specific experience or competencies, who lives in another city or country. ...
... The scientific research analysis presented by Molini-Avejonas et al. (2015) illustrates the evidence for successful telepractice in the cases of the following disorders: hearing impairments (in identifying a hearing impairment, the availability of the required specialist and cost-effectiveness of services are considered to be an advantage of telepractice); language disorders (it is maintained that the greatest opportunity of telepractice is the availability of the specialist); speech disorders (stuttering and motor speech disorders; i.e., management of dysarthria is considered to be even more successful and cost-effective than the traditional in-person support; voice disorders (the availability of the specialist with specific competencies as well as the ability of monitoring the continuity of support, voice recordings and lower time and financial costs are identified); swallowing disorders (research emphasizes early detection of disorders, early help, more intensive supervision, availability of specialists with specific competencies). Based on the data of the research conducted by Baharav & Reiser (2010), Boisvert et al. (2012), telepractice may also be efficient in providing support to children who have an autism spectrum disorder. The study of Coufal, Parham et al. (2018) did not reveal that speech therapy provided to children with speech sound disorders via telepractice was less efficient than traditional support provided in the room. ...
Straipsnyje analizuojamos logopedų nuomonė ir patirtys, teikiant logopedinę pagalbą telepraktikos būdu COVID-19 situacijos aplinkybėmis. Atlikta kiekybinė ir kokybinė tyrimo duomenų analizė atskleidė šalies logopedų sampratą, taikomas telepraktikos rūšis, šios praktikos taikymo privalumus ir ribotumus, galimybes teikti (ne)tiesioginę pagalbą vaikams, turintiems įvairių kalbėjimo, kalbos ir rijimo sutrikimų, galimybes kokybiškai atlikti profesines logopedo funkcijas per nuotolį. Tyrimas atskleidė, kad telepraktika logopedo darbe, nors kėlusi daug iššūkių dėl poreikio ją taikyti nenumatytomis aplinkybėmis ir tam tinkamai nepasirengus, turi daug privalumų ir gali būti sėkmingai taikoma derinant ją su įprasta, tradicine, fizinio kontakto būdu teikiama pagalba
... Conversely, despite such barriers to feasibility, the acceptability to caregivers is usually high (Baharav & Reiser, 2010;Bearss et al., 2018;Dai et al., 2021;Ingersoll & Berger, 2015;Lau et al., 2022;Montiel-Nava et al., 2022;Pickard et al., 2016;Sengupta et al., 2021a;Tsami et al., 2019;Vismara et al., 2018;Wainer et al., 2021) and, generally, caregivers report high levels of satisfaction (Boisvert & Hall, 2014;Pi et al., 2021;Sutherland et al., 2018). Levels of caregiver involvement are satisfactory and greater in therapist-assisted than in self-directed online programs (Pickard et al., 2016). ...
... Our aim was to explore whether the online delivery method could represent a longer-term response to the needs of families of children with neurodevelopmental disorders, beyond the current health emergency. Overall, virtual CST was found to be feasible and accept to caregiver and facilitators, in line with several previous studies that evaluated the acceptability of online parent training interventions for ASD (Baharav & Reiser, 2010;Bearss et al., 2018;Dai et al., 2021;Ingersoll & Berger, 2015;Lau et al., 2022;Montiel-Nava et al., 2022;Pi et al., 2021;Pickard et al., 2016;Sengupta et al., 2021a;Tsami et al., 2019;Vismara et al., 2018;Wainer et al., 2021). The online adaptation of CST was delivered with high levels of observer-rated competency and integrity, not differently from the in-person CST. ...
... Blended interventions, as suggested in the Hall and Bierman's review (2015), could promote caregivers' engagement and positive outcomes and combine personalization of the intervention, flexibility, and cost-effectiveness. In our study clinicians praised the advantages of the first in-person contact for rapport building, skills assessment and goal-setting as in Ashburner et al (2016), and reported that the remote home visits allowed facilitators to see the child in a naturalistic environment without being intrusive, as previously found (Baharav & Reiser, 2010;Klein et al., 2021), favouring a more active parent participation (Klein et al., 2021;Meadan & Daczewitz, 2015). Similarly, Lau et al. (2022) showed that a hybrid delivery of CST (with virtual group sessions and in-person home visits) received high satisfaction ratings, comparable to both the synchronous online and the asynchronous e-learning delivery, but was reported to be more acceptable and feasible than the other delivery modes in focus groups with parents and facilitators. ...
Feasibility, acceptability and effectiveness data of a virtual adaptation of the WHO Caregiver Skills Training (CST; n = 25) were compared with those of a pilot RCT of CST delivered in person (n = 43) against treatment as usual (TAU; n = 43). Virtual CST was delivered with high levels of integrity, but received lower ratings in some caregiver- and facilitator-rated acceptability and feasibility dimensions. Qualitative analysis identified both benefits (flexibility, convenience, clinical usefulness) and challenges, (technological issues, distraction from family members, emotional distance). Virtual and in-person CST improved significantly more on caregiver competence than TAU; there were no other significant effects. Potential for use of virtual CST as a clinical response in contexts where in-person delivery is not possible is discussed.
... This form of telepractice allows for sharing of information and knowledge in specific topics or areas. 51 Telepractice delivery mode can be synchronous, asynchronous, or a hybrid or a combination of the two. 50 Synchronous telepractice is performed in real-time and communication is interactive, resembling a traditional face-toface experience. ...
... 56,64 Recent database research by Baharav & Reiser confirms that telemedicine can provide access to essential services at reduced costs. 51 Hence, telemedicine consultation provides decision support to the patient's local physician, while raising the physician's degree of familiarity and proficiency in managing more efficiently/capably patient care. 51 Parent-implemented therapies focus on training the parent to be the primary therapy provider, as researchers have shown that parents can be successful interventionists. ...
... 51 Hence, telemedicine consultation provides decision support to the patient's local physician, while raising the physician's degree of familiarity and proficiency in managing more efficiently/capably patient care. 51 Parent-implemented therapies focus on training the parent to be the primary therapy provider, as researchers have shown that parents can be successful interventionists. 65 These therapies have been identified as an appropriate means of participating in their child's intervention and building their ability to promote the development of children with Developmental Disorders (DD). ...
Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.
... A total of 46 studies with telehealth-based intervention were included for quantitative analysis, in which it quantified the obtained results: social interaction (Ferguson et al., 2020;Gudmundsdottir et al., 2019;Ingersoll et al., 2016;Kobak et al., 2011;McGarry et al., 2020;Parsons et al., 2019;Pennefather et al., 2018;Ruble et al., 2013;Stichter et al., 2014;Ura et al., 2021;Voss et al., 2019;Wainer and Ingersoll, 2015), acceptance & engagement (Baharav and Reiser, 2010;Bearss et al., 2018;Hepburn et al., 2016;Ingersoll et al., 2017;Kobak et al., 2011;Lindgren et al., 2020;Lindgren et al., 2016;Little et al., 2018;Machalicek et al., 2016;McCrae et al., 2020;McGarry et al., 2020;Neely et al., 2019;Pennefather et al., 2018;Pickard et al., 2016;Samadi et al., 2020;Simacek et al., 2017;Tsami et al., 2019;Vismara et al., 2013;Vismara et al., 2018;Vismara et al., 2012;Wainer and Ingersoll, 2015), communication & speech (Baharav and Reiser, 2010;Corona et al., 2021;Coufal et al., 2018;Hoffmann et al., 2019;Ingersoll et al., 2017;Ingersoll et al., 2016;Kobak et al., 2011;Neely et al., 2019;Nohelty et al., 2021;Parsons et al., 2019;Pickard et al., 2016;Ruble et al., 2013;Simacek et al., 2017;Tsami et al., 2019;Vismara et al., 2013;Vismara et al., 2018;Wattanawongwan et al., 2022), emotion recognition and control (Voss et al., 2019), daily living skill (A. Craig et al., 2021;Boutain et al., 2020;Gerow et al., 2021;Sivaraman et al., 2021), problem behavior reduction (Hoffmann et al., 2019;Kuravackel et al., 2018;Lindgren et al., 2020;Lindgren et al., 2016;Machalicek et al., 2016;Pennefather et al., 2018;Singh et al., 2021;Suess et al., 2016;Tsami et al., 2019;Wacker et al., 2013), anxiety symptoms reduction (Conaughton et al., 2017;Hepburn et al., 2016), cost reduction(A. ...
... A total of 46 studies with telehealth-based intervention were included for quantitative analysis, in which it quantified the obtained results: social interaction (Ferguson et al., 2020;Gudmundsdottir et al., 2019;Ingersoll et al., 2016;Kobak et al., 2011;McGarry et al., 2020;Parsons et al., 2019;Pennefather et al., 2018;Ruble et al., 2013;Stichter et al., 2014;Ura et al., 2021;Voss et al., 2019;Wainer and Ingersoll, 2015), acceptance & engagement (Baharav and Reiser, 2010;Bearss et al., 2018;Hepburn et al., 2016;Ingersoll et al., 2017;Kobak et al., 2011;Lindgren et al., 2020;Lindgren et al., 2016;Little et al., 2018;Machalicek et al., 2016;McCrae et al., 2020;McGarry et al., 2020;Neely et al., 2019;Pennefather et al., 2018;Pickard et al., 2016;Samadi et al., 2020;Simacek et al., 2017;Tsami et al., 2019;Vismara et al., 2013;Vismara et al., 2018;Vismara et al., 2012;Wainer and Ingersoll, 2015), communication & speech (Baharav and Reiser, 2010;Corona et al., 2021;Coufal et al., 2018;Hoffmann et al., 2019;Ingersoll et al., 2017;Ingersoll et al., 2016;Kobak et al., 2011;Neely et al., 2019;Nohelty et al., 2021;Parsons et al., 2019;Pickard et al., 2016;Ruble et al., 2013;Simacek et al., 2017;Tsami et al., 2019;Vismara et al., 2013;Vismara et al., 2018;Wattanawongwan et al., 2022), emotion recognition and control (Voss et al., 2019), daily living skill (A. Craig et al., 2021;Boutain et al., 2020;Gerow et al., 2021;Sivaraman et al., 2021), problem behavior reduction (Hoffmann et al., 2019;Kuravackel et al., 2018;Lindgren et al., 2020;Lindgren et al., 2016;Machalicek et al., 2016;Pennefather et al., 2018;Singh et al., 2021;Suess et al., 2016;Tsami et al., 2019;Wacker et al., 2013), anxiety symptoms reduction (Conaughton et al., 2017;Hepburn et al., 2016), cost reduction(A. ...
... Twenty-one studies (Baharav and Reiser, 2010;Bearss et al., 2018;Hepburn et al., 2016;Ingersoll et al., 2017;Kobak et al., 2011;Lindgren et al., 2020;Lindgren et al., 2016;Little et al., 2018;Machalicek et al., 2016;McCrae et al., 2020;McGarry et al., 2020;Neely et al., 2019;Pennefather et al., 2018;Pickard et al., 2016;Samadi et al., 2020;Simacek et al., 2017;Tsami et al., 2019;Vismara et al., 2013;Vismara et al., 2018;Vismara et al., 2012;Wainer and Ingersoll, 2015) aimed at discussing the acceptance and engagement of ASD children and their parents were published. A total of 748 parents or guardian of ASD children and adolescents were involved. ...
World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.
... It may include tele-health, video and audio conferencing, chat messaging, wearable and sensor technologies, virtual reality, robotics, and therapeutic games; however, in education, research and implementations primarily focus on the use of video and audio conferencing (Rispoli & Machalicek, 2020). In the literature, ASD of tele-health implementations (Baharav & Reiser, 2010;Barkaia et al., 2017;Lindgren et al., 2016;Meadan et al., 2016;Neely et al., 2016;Schieltz & Wacker, 2020), intellectual disability (Dimitropoulos et al., 2017;Hall et al., 2020;Monlux et al., 2019;Pellegrino & DiGennaro Reed, 2020), low vision (Ihrig, 2016), hearing impairment (Daczewitz, 2015), severe and multiple disability (Simacek et al., 2017), attention deficit and hyperactivity disorder-ADHD (Spencer, Noyes and Biederman, 2019) and individuals with learning difficulties (Hodge et al., 2019) are seen to receive special education services. ...
... Özellikle kırsal kesimde yaşayan özel gereksinimli bireylerin, ailelerin ve uzmanların özel eğitim destek hizmetlerine erişebilmesi tele-sağlık aracılığıyla daha kolay olabilmektedir (Lindgren, vd., 2016;Simacek, vd., 2020;Solomon & Soares, 2020). Ayrıca, alan uzmanı sayısının az olması nedeniyle özel eğitim hizmetlerine erişebilmeyi kolaylaştırma ve bilimsel dayanaklı uygulamalardan yararlanma (Boisvert & Hall, 2014;Lerman, vd., 2020;Rispoli & Machalicek, 2020), sıra bekleme süresinin kısalması (Simacek vd., 2017;Solomon & Soares, 2020) ve ev rutinlerine uygun olması (Baharav, & Reiser, 2010;Wallisch vd., 2019) tele-sağlık uygulamalarının yararları olarak sayılabilir. Son olarak, tele-sağlık uygulamalarının, özel gereksinimli bireylere ihtiyaç duydukları özel eğitim hizmetini sunmada, ebeveynlere aile eğitim hizmetleri yoluyla yöntemleri uygulayabilme becerisi kazandırmada ve uzmanlara mesleki gelişim sağlamada etkili bir yol olduğu pek çok çalışma tarafından ifade edilmektedir (Baharav, & Reiser, 2010;Barkaia, vd., 2017;Benson, vd., 2018;Boisvert & Hall, 2014;Cole, vd., 2019;Lerman, vd., 2020;Lindgren, vd., 2016;Machalicek, vd., 2016;Meadan, vd., 2016;Neely, vd., 2016;Schieltz, vd., 2018;Schiledz & Wacker, 2020;Sivaraman, & Fahmie, 2020;Solomon & Soares, 2020). ...
... Ayrıca, alan uzmanı sayısının az olması nedeniyle özel eğitim hizmetlerine erişebilmeyi kolaylaştırma ve bilimsel dayanaklı uygulamalardan yararlanma (Boisvert & Hall, 2014;Lerman, vd., 2020;Rispoli & Machalicek, 2020), sıra bekleme süresinin kısalması (Simacek vd., 2017;Solomon & Soares, 2020) ve ev rutinlerine uygun olması (Baharav, & Reiser, 2010;Wallisch vd., 2019) tele-sağlık uygulamalarının yararları olarak sayılabilir. Son olarak, tele-sağlık uygulamalarının, özel gereksinimli bireylere ihtiyaç duydukları özel eğitim hizmetini sunmada, ebeveynlere aile eğitim hizmetleri yoluyla yöntemleri uygulayabilme becerisi kazandırmada ve uzmanlara mesleki gelişim sağlamada etkili bir yol olduğu pek çok çalışma tarafından ifade edilmektedir (Baharav, & Reiser, 2010;Barkaia, vd., 2017;Benson, vd., 2018;Boisvert & Hall, 2014;Cole, vd., 2019;Lerman, vd., 2020;Lindgren, vd., 2016;Machalicek, vd., 2016;Meadan, vd., 2016;Neely, vd., 2016;Schieltz, vd., 2018;Schiledz & Wacker, 2020;Sivaraman, & Fahmie, 2020;Solomon & Soares, 2020). ...
Tele-sağlık hem uzun hem de kısa mesafelerde hizmet sağlayıcıları ve / veya alıcılar arasında fiziksel bir ayrımın olduğu durumlarda sağlık hizmetleri sunmak için bilgi ve iletişim teknolojilerinin kullanılması olarak tanımlanmaktadır. Tele-sağlık, sağlık hizmetlerinin tanı, tedavi, önleyici ve iyileştirici yönlerini kapsamakta ve hizmet alıcıları, birincil ve diğer bakıcıları, uzmanları ve eğitimcileri içermektedir. Günümüzde tele-sağlık uygulamalarının en temel yararlarının, ulaşım zorluğunu ortadan kaldırması, maliyetleri düşürmesi ve esnek zaman sağlaması olduğu pek çok araştırmada belirtilmektedir. Özel eğitim genellikle geleneksel ortamlarda yüz yüze yürütülmektedir. Ancak son on yılda, farkındalığın kısmen de olsa artması ve teknolojik engellerin azalması nedeniyle tele-sağlığa olan ilgi ve talep artmıştır. Ancak Covid-19 salgını nedeniyle ani bir şekilde geleneksel eğitim ortamlarında yürütülen özel eğitim hizmetlerinin uzaktan eğitim, özellikle de tele-sağlık uygulamalarına dönüşmesi, alanda çalışan uzmanlar için zorlayıcı olmuştur. 2020 yılı içerisinde yapılmış olan araştırmalar, alan uzmanlarının tele-sağlık yoluyla özel eğitim hizmeti sunma konusunda sınırlı bilgi ve deneyime sahip olduklarını göstermektedir. Dolayısıyla bu çalışmada özel eğitimde tele-sağlık uygulamalarına ilişkin bilgi sunmak amaçlanmaktadır.
... Three studies specifically used parents to implement social communication intervention programs in children with ASD (Baharav & Reiser, 2010;Hao et al., 2021;Meadan et al., 2016). The study by Meadan et al., 2016, adapted the Parent-Implemented Communication Strategies (PiCS) program, which is an in-person treatment, to become an internet-based program (i-PiCS) that was taught remotely with coaching sessions conducted via a telehealth platform. ...
... Hao et al. (2021) found increases in child's number of different words and mean length utterance but did not find significant group differences between outcomes, indicating that the telehealth implementation can be effective. Lastly, the traditional in-person model (2 weekly sessions) was compared to a hybrid model (one in-person followed by one remote session via telehealth with coaching) in the effectiveness of delivering a speech and language intervention; children made communication gains in both (Baharav & Reiser, 2010). Parents also reported high satisfaction with the intervention (Baharav & Reiser, 2010). ...
... Lastly, the traditional in-person model (2 weekly sessions) was compared to a hybrid model (one in-person followed by one remote session via telehealth with coaching) in the effectiveness of delivering a speech and language intervention; children made communication gains in both (Baharav & Reiser, 2010). Parents also reported high satisfaction with the intervention (Baharav & Reiser, 2010). All three studies concluded that parents were satisfied with the social communication intervention they received via telehealth and all three studies demonstrated gains in social communication skills when the intervention was delivered via telehealth; therefore, there is support for the use of telehealth in the implementation of social communication interventions with children with ASD. ...
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
... A number of studies have found the use of in-home parent instruction via telepractice useful with children diagnosed with ASD (Baharav & Reiser, 2010;Bearss et al., 2018;Ingersoll et al., 2017;Vismara et al., 2012). Findings suggest that highquality services can still be maintained in an untraditional manner via distance programming (Baharav & Reiser, 2010). ...
... A number of studies have found the use of in-home parent instruction via telepractice useful with children diagnosed with ASD (Baharav & Reiser, 2010;Bearss et al., 2018;Ingersoll et al., 2017;Vismara et al., 2012). Findings suggest that highquality services can still be maintained in an untraditional manner via distance programming (Baharav & Reiser, 2010). Teaching parents of children with ASD has also been found to improve the quality of life for parents who do not have the resources to provide intensive therapy for their children (Keen et al., 2010). ...
... However, the current study expands prior work relating to child communicative behaviors. This study also affirms the importance of designing interventions for families that are both effective (Baharav & Reiser, 2010) and also acceptable to family members and feasible for them to implement (Boisvert & Hall, 2014;Wainer & Ingersoll, 2013). This is particularly critical during times of disaster; however, such considerations would be particularly beneficial for families that are normally unable to reach high-quality services due to time constraints, geography, or cost (Ingersoll et al., 2017). ...
Individuals with autism spectrum disorder (ASD) have deficits in social and communication skills that can cause problems such as difficulty interacting with others and challenging behaviors. Research has demonstrated the effectiveness of parents as intervention implementers to improve children's communication skills. We evaluated the effects of a telepractice parent coaching communication intervention on communication skills of children with ASD utilizing a multiple probe design across participants. Parents applied strategies learned with their child, targeting communication skills, such as asking opinion-oriented questions or using augmentative and alternative communication to request items. Results indicated improvement in children's communicative behaviors and a significant correlation between parent implementation of intervention elements and children behaviors. Effect size results for the participants indicated strong effects consistent with visually inspected data.
... Parent training results in increased competence and reduced stress in parents (Keen et al. 2010). For children, parent-mediated intervention is related to improved syntactic complexity and vocabulary size (Gengoux et al. 2015), as well as socialization skills (Scahill et al. 2016;Baharav and Reiser 2010). ...
... Conclusions about the efficacy of tele-therapy in parent training for children with ASD are limited, due to the shortage of direct comparisons between on-site and online parent training. Baharav and Reiser (2010) trained two parents by combining in-person and online approaches. In the first phase, parents participated in the traditional face-to-face training for 6 weeks. ...
... Previous studies consistently showed that parent training yielded improved parent fidelity of implementation (e.g., Ingersoll and Wainer 2013), so we predicted the same. Parent training was found to yield improved vocabulary, morphosyntax and responses in children with ASD (e.g., Gengoux et al. 2015;Baharav and Reiser 2010), and we predicted to see progress in children's lexical diversity (i.e., NDW), morphosyntactic complexity (i.e., MLU) and frequency of responses. Findings on children's initiations appear to be less conclusive. ...
Conclusions about the efficacy of tele-therapy for parent-mediated intervention for children with Autism Spectrum Disorders (ASD) are limited, due to the shortage of direct comparisons between tele-therapy and traditional face-to-face therapy. In this study, we implemented a parent training program, which targeted on language facilitating intervention strategies. Fifteen parents of children with ASD participated in person, and 15 participated via online video conferencing. We measured parents' intervention fidelity and children's initiations, responses, lexical diversity and morphosyntactic complexity. Results indicated significant improvements in parents' fidelity and children's lexical diversity and morphosyntactic complexity. No significant differences were detected between the two therapy delivery groups on any outcome measures. Finally, children's progress on morphosyntactic complexity was significantly correlated with parents' improvement on fidelity. 3
... Telepractice is the application of telecommunications technology to deliver services at a distance for the purposes of assessment, intervention, or consultation (Baharav & Reiser, 2010). Telepractice allows for the use of online modules, videoconferencing, and computerized programs to provide effective training to not only interventionists but also parents of individuals with ASD (Neely et al., 2016). ...
... Telepractice allows for the use of online modules, videoconferencing, and computerized programs to provide effective training to not only interventionists but also parents of individuals with ASD (Neely et al., 2016). Research has shown that parents can be effective agents of intervention, but this typically requires one-on-one supervision by a trained professional (Baharav & Reiser, 2010), thus, creating a gap between the requirements for intensive services and the resources available to provide those services for children with ASD (Meadan et al., 2016). ...
The present study aims to increase diversity in autism research and reduce the barriers to support services for children with ASD through a parent-coaching intervention delivered using telepractice. Specifically, the effects of the intervention on communication and affect for both the parent and child with autism were evaluated longitudinally across 8 time points or sessions. Using a quasi-experimental design, without a control group, findings highlight the parent-child dyadic synchrony and responsiveness in affective and communicative competence in the home via a multimodal parenting intervention. Thus, verbal, and affective communication skills are promising targets for future naturalistic intervention strategies with parents or caretakers. Moreover, findings highlight that access to interventions could be increased to diverse and under-represented populations by leveraging telepractice approaches.
... EI best practices includes parent coaching, and research suggests that treatments can be integrated into the child's natural environment (Kronberg et al., 2021;Wallisch et al., 2019). Research has shown that EI, using evidence-based practice, is effective in improving long-term outcomes for children with Autism Spectrum Disorder (ASD) and that telehealth is a promising delivery model for this population (Baharav & Reiser, 2010;Boisvert, et al., 2010;Boisvert, et al., 2012). A single-subject, multiple-baseline design study by Vismara et al. (2012) examined the feasibility and acceptance of telehealth by nine families that each had a child with ASD. ...
... df=1, P<.001, d=4.62) (Vismara et al., 2012). Similarly, the use of telehealth to deliver EI speech language pathology (SLP) services has been found to result in significant increases in behaviors that promote social and communication interactions, with participants showing improvements in all domains measured during home-based sessions facilitated by the parents (Baharav & Reiser, 2010). ...
The COVID-19 pandemic transformed care delivery and influenced telehealth adoption by rehabilitation professionals and their patients. The purpose of this paper is to describe a pediatric health system’s telehealth services pre-pandemic and how those services were scaled during the pandemic. A secondary aim is to provide a roadmap for the operational delivery of telehealth and rehabilitation services, including transition to a hybrid care delivery model. Findings suggested that telehealth can be rapidly scaled to address patient healthcare needs for an early intervention population during a pandemic. Telehealth use during the pandemic helped ensure continuity of care and likely reduced the risk of exposure to patients and staff to the virus. Benefits included enhanced access to care, and savings in time and money for families. Interestingly, as the pandemic declined, the use of telehealth services declined due to patient preference, with many families opting to request a return to in-person care.
... Internet-based parent training interventions have a lot of benefits over traditional interventions, such as overcoming geographical barriers for parents to receive psychoeducation, higher fidelity, greater accessibility, convenience, and reduced time and costs (Aqdassi et al. 2019, Aqdassi et al. 2021, Barak and Grohol 2011, Breitenstein et al. 2014, Hammond et al. 2012, Khanna et al. 2007, Ristkari et al. 2019. Internet-based interventions have already been used to treatment autism spectrum disorder symptoms and its effectiveness has been demonstrated (Ashburner et al. 2016, Baharav and Reiser 2010, Boisvert et al. 2010, Gibson et al. 2010, Hamad et al. 2010, Lindgren et al. 2016, Shire et al. 2020, Speyer et al. 2018, Sutherland et al. 2018, Vismara et al. 2013. For example, Pennefather et al. (2018) reported that after a three-week online training program for sixteen parents of children with autism, parents reported: decreased parental stress, increased relevant knowledge, increase in the child's prosocial behavior, decrease in hyperactive behaviors and high levels of satisfaction with the intervention. ...
... The main finding of this study is that the Internetbased parent training intervention is indeed as effective as face-to-face parent training intervention for children with excessive screen-time and ASD-like symptoms. This is in line with previous studies comparing face-toface interventions with internet-based interventions for children with autism spectrum disorder (Ashburner et al. 2016, Baharav and Reiser 2010, Boisvert et al. 2010, Gibson et al. 2010, Hamad et al. 2010, Lindgren et al. 2016, Shire et al. 2020, Sutherland et al. 2018, Vismara et al. 2013. The within group effect size in the Internet-based group ranged from d ¼ 0.32 to d ¼ 0.86 and in the face-to-face group ranged from d ¼ 0.38 to d ¼ 1.09 for autism symptoms, repetitive behaviors and parental stress. ...
Internet-based intervention approach is one novel strategy to train. However, only a few clinical trials have compared internet-based parent training intervention with an equal face-to-face intervention for children with autism spectrum disorder (ASD)-like symptoms. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for young children with excessive screen-time and ASD-like symptoms. A total of 40 mother–young children with excessive screen-time and ASD-like symptoms dyads were assigned to the Internet-based (n = 20) and to the face-to-face intervention (n = 20). Parents in both groups received intervention that involves 7 sessions (one session per week). Primary outcome measures were the Gilliam autism rating scale - second edition (GARS-2), repetitive behavior scale- revised (RBS-R) and parenting stress index (PSI). The analysis yielded no significant between-group difference for any of the pre- to post-intervention measurements. At post-intervention both intervention conditions revealed significant symptoms changes compared to before the intervention. Also, the parental stress was significant related to the child’s autism symptoms and repetitive behaviors severity. Internet-based parent training intervention for young children with excessive screen-time and ASD-like symptoms and their parents is equally beneficial to regular face-to-face parent training intervention. These findings support the potential for using telehealth to provide research-based parent training interventions to any family that has access to the Internet.
... Internet-based parent training interventions have a lot of benefits over traditional interventions, such as overcoming geographical barriers for parents to receive psychoeducation, higher fidelity, greater accessibility, convenience, and reduced time and costs (Aqdassi et al. 2019, Aqdassi et al. 2021, Barak and Grohol 2011, Breitenstein et al. 2014, Hammond et al. 2012, Khanna et al. 2007, Ristkari et al. 2019. Internet-based interventions have already been used to treatment autism spectrum disorder symptoms and its effectiveness has been demonstrated (Ashburner et al. 2016, Baharav and Reiser 2010, Boisvert et al. 2010, Gibson et al. 2010, Hamad et al. 2010, Lindgren et al. 2016, Shire et al. 2020, Speyer et al. 2018, Sutherland et al. 2018, Vismara et al. 2013. For example, Pennefather et al. (2018) reported that after a three-week online training program for sixteen parents of children with autism, parents reported: decreased parental stress, increased relevant knowledge, increase in the child's prosocial behavior, decrease in hyperactive behaviors and high levels of satisfaction with the intervention. ...
... The main finding of this study is that the Internetbased parent training intervention is indeed as effective as face-to-face parent training intervention for children with excessive screen-time and ASD-like symptoms. This is in line with previous studies comparing face-toface interventions with internet-based interventions for children with autism spectrum disorder (Ashburner et al. 2016, Baharav and Reiser 2010, Boisvert et al. 2010, Gibson et al. 2010, Hamad et al. 2010, Lindgren et al. 2016, Shire et al. 2020, Sutherland et al. 2018, Vismara et al. 2013. The within group effect size in the Internet-based group ranged from d ¼ 0.32 to d ¼ 0.86 and in the face-to-face group ranged from d ¼ 0.38 to d ¼ 1.09 for autism symptoms, repetitive behaviors and parental stress. ...
objectivesInternet-based intervention approach is one novel strategy to train. However, only a few clinical trials have compared internet-based parent training intervention with an equal center-based intervention for children with ASD. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a center-based intervention for young children with Post Digital Nanning Autism Syndrome (PDNAS). MethodsA total of 40 mother–young children with PDNAS dyads were assigned to the internet-based (n=20) and to the center-based intervention (n=20). Parents in both groups received intervention that involves 7 sessions (one session per week). Primary outcome measures were the Gilliam Autism Rating Scale - Second Edition (GARS-2), Repetitive Behavior Scale- Revised (RBS-R) and Parenting Stress Index (PSI). ResultsThe analysis yielded no significant between-group difference for any of the pre- to post-intervention measurements. At post-intervention both intervention conditions revealed significant symptoms changes compared to before the intervention. Also, the parental stress was significant related to the child’s autism symptoms and repetitive behaviors severity.Conclusion: Internet-based parent training intervention for young children with PDNAS and their parents is equally beneficial to regular center-based parent training intervention. These findings support the potential for using telehealth to provide research-based parent training interventions to any family that has access to the Internet.
... Auditory, verbal and visual interactions between a professor and a student is essential in SLP/T assessment, counselling and distance therapeutic sessions and video conferencing is a tool well suited to provide that (D. M. Brennan et al., 2004). Cost savings in money and time for clinicians and parents can be achieved plus the added benefit of easing pressures to the healthcare system as a whole (Baharav & Reiser, 2010). Parents at home while interacting and getting involved in the education of their child can benefit from the use of remote technology in early stages of child learning and development. ...
... As a consequence of internet technology limitations, all are not suited to it (Baharav & Reiser, 2010). Duffy et al (1997) analysed 150 telehealth speech-language consultations as part of study to examine factors such as: the types of communication disorders assessed; recommendations for patient management; and patient outcomes. ...
Speech-Language Pathologists/Therapists have been using a different service delivery model known for almost 40 years as telepractice, so they can meet the growing demand for assessment, intervention, consultancy and also distance learning in their scope of practice. As far as the authors could review the literature highlights a number of benefits for students, teachers, parents and stakeholders, as well as evidence for the delivery of professional services at a distance within the clinical and educational settings. There are few studies regarding the effectiveness of telepractice intervention in this field. To our knowledge, there are no European Portuguese studies. The chapter illustrates up to date international applications of telepractice and distance learning in speech-language therapy services. It has currently increased in order to respond to the world crisis related to COVID-19 in which social self-isolation and personal dislocations are being implemented, forcing this professional to adapt to this new reality.
... Bu uygulamaların en önemli yararı, eğitim imkânlarına ulaşmada zorluk yaşayan aileler için ulaşım sorununu ortadan kaldırması ve buna bağlı olarak maliyetin düşük olmasıdır (Wainer & Ingersoll, 2013). Diğer bir önemli yararı ise esnek zaman olanağı sağlaması nedeniyle ailelerin günlük rutinleri bozulmadan uzmanlara ve eğitim materyallerine ulaşarak eğitim desteği alabilmeleridir (Baharav & Reiser, 2010). Uzaktan aile eğitim uygulamalarının yararlarının yanı sıra internet alt yapısının zorunlu olması, eğitim için bilgisayar ve ekipmanlarına gereksinim duyulması, internet alt yapısının güçlü olması gibi zorunlulukları, uzaktan eğitimin sınırlılıkları olarak ortaya çıkmaktadır (Dinçer, 2006;Kılıç, Karadeniz, & Karataş, 2003). ...
... The most important benefit of these applications is the fact that it eliminates the transportation problems for parents who experience difficulties in accessing education opportunities and therefore incurring lower costs (Wainer & Ingersoll, 2013). Another important benefit is that families could get educational support through the available access to experts and educational materials without altering their daily routines (Baharav & Reiser, 2010). Distance parenting education applications also have disadvantages, such as the requirement for a robust internet infrastructure requirement, computers, and educational equipment. ...
Bu çalışmanın amacı, Otizm Spektrum Bozukluğu (OSB) olan çocuğa
sahip ailelere, çocuklarına iletişim becerilerini kazandırmalarına yardımcı
olacak uzaktan aile eğitim uygulamalarını içeren araştırmalara yönelik
sistematik bir bilgi sunmaktır. Bu amaçla, 2000-2018 yılları arasında yapılan
uzaktan aile eğitim uygulamalarına ilişkin yürütülen araştırmalar alanyazın
üzerinden taranmış ve ulaşılan dokuz çalışma “özetleyici derleme” türünde sunulmuştur.
Ulaşılan araştırmalar; katılımcı özellikleri (yaş, cinsiyet, tanı),
bağımlı-bağımsız değişken, araştırma modeli, kullanılan yazılım programı veya
teknolojik araçlar, aile eğitim uygulama süreci, geçerlik-güvenirlik,
izleme-genelleme, bulgular, etki büyüklüğü ve sonuçlarına ilişkin özellikler
bakımından incelenmişlerdir. Sonuçlar, uygulanan programların hedeflenen
beceriler üzerinde olumlu etkiye sahip olduğunu göstermektedir. Araştırmaların
sunulan bulguları ışığında, katılımcı ebeveynlerin hedeflenen öğretim yöntemini
uygulama becerisini kazandıkları görülmektedir. Katılımcı çocukların ise büyük
oranda hedeflenen iletişim becerilerini sergileyebildikleri belirlenmiştir.
Araştırmalarda uygulanan programların sosyal geçerliklerinin de yüksek olduğu
ifade edilmiştir.
... Included studies focused equally on assessment and intervention, with many finding advantages to delivering services via a technology platform. However, only three studies included participants with ASD and all outcome measures focused on parent feasibility and satisfaction (Baharav & Reiser, 2010;Vismara et al., 2012Vismara et al., , 2013. ...
Background and aims
Due to the COVID-19 pandemic, tele-health has gained popularity for both providing services and delivering assessments to children with disabilities. In this manuscript, we discuss the process of collecting standardized oral language, reading, and writing tele-assessment data with early elementary children with autism spectrum disorder (ASD) and offer preliminary findings related to child and parent engagement and technology issues.
Methods
The data presented are from pretest assessments during an efficacy study examining the electronic delivery of a listening comprehension intervention for children with ASD. Pretest sessions included a battery of standardized language, reading, and writing assessments, conducted over Zoom. The authors operationalized and developed a behavioral codebook of three overarching behavioral categories (parent involvement, child disengagement, and technology issues). Researchers coded videos offline to record frequencies of indicated behaviors across participants and assessment subtests.
Results
Involvement from parents accounted for the highest number of codes. Children showed some disengagement during assessment sessions. Technology issues were minimal. Behavioral categories appeared overall limited but varied across participants and assessments.
Conclusions
Parent involvement behaviors made up approximately two-thirds of the coded behaviors. Child disengagement behaviors made up approximately one-fourth of the coded behaviors, and these behaviors occurred more frequently across many different participants (with lower frequencies but greater coverage across children). Technology problems specific to responding to assessment items were relatively uncommon.
Implications
Clear guidelines including assessment preparation, modification of directions, and guidelines for parents who remain present are among the implications discussed. We also provide practical implications for continued successful adapted tele-assessments for children with ASD.
... 850). The success of telemedicine has since resulted in an expansion of virtual services beyond medicine to other human service fields, resulting in the broader terms "telehealth," "telepractice," and "teletherapy" (Baharav & Reiser, 2010;Cole et al., 2016;Grogan-Johnson et al., 2013). These umbrella terms encompass a variety of approaches, including the delivery of services via phone and teleconferencing. ...
Telehealth is a promising modality for Part C early intervention (EI), services typically implemented face-to-face in home and community settings. Barriers to telehealth in EI reported prior to COVID-19 included lack of training and access to reliable internet. The abrupt telehealth shift at the onset of the pandemic did not permit a phased adoption approach. This mixed-methods study aimed to characterize perspectives of service changes resulting from the telehealth transition. Providers (n = 39) and caregivers (n = 11) completed surveys about perceptions towards the telehealth switch. All providers indicated at least one aspect of services had changed. Approximately half of caregivers reported satisfaction with services decreased and half that satisfaction remained the same. Implications for telehealth in EI beyond the pandemic are discussed.
... Nevertheless, the findings of these studies indicated that participants suggest adding interactive remote coaching sessions to a self-directed eLearning parenting programme, which can be crucial and essential for online parent training programmes, including weekly telephone calls or email correspondence, peer groups, and regularly personalized coaching sessions (60). Given the limited but essential need for interaction with others, research has begun to explore how to use videoconferencing to facilitate remote feedback and support for parents of children with ASD (53,55,(61)(62)(63)(64). ...
Background: Local children with developmental disabilities were deprived of learning opportunities due to recent social and health incidents, resulting in elevating challenging behaviors and familial conflicts. This study explored the acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) in alternative delivery modes under new normal and post COVID-19 period.
Method: CST was delivered via eLearning (EL), videoconferencing (VC), and in-person hybrid (IP) modes to 34 parent-child dyads, being randomly assigned to modes of asynchronous non-interfering EL (n = 9), synchronous with online coaching VC (n = 7), synchronous with in-person coaching IP (n = 9) and Wait-list Control WLC (n = 9). Data from two standardized scales of General Health Questionnaire (GHQ-12) and Strengths and Difficulties Questionnaire (SDQ), and Post-session and Home Visit Feedback Form by Caregivers that included both structured and open-ended questions were collected before and after intervention. Both quantitative and qualitative approaches were used in studying the collected data.
Results: High levels of acceptability and feasibility of the training programme were supported by ratings on comprehensiveness and relevance, agreement with their personal values, duration, and usefulness. IP and VC groups yielded more positive changes than EL and WLC groups with 3, 16, 13, and −3% in General Health Questionnaire (GHQ-12), −13, −15, −6 and 0% in Difficulties-total, and 36.5, 35.5, 5.8 and 2.4% in Prosocial Scale at Strengths and Difficulties Questionnaire (SDQ) for EL, VC, IP, and WLC groups respectively from baseline to 12 weeks after intervention. Results from two standardized scales echoed with qualitative observations that the programme helped improve caregivers' well-being, child's communication, and behaviors across intervention groups.
Conclusions: Current findings revealed that CST delivered in three alternative modes were acceptable and feasible, and yielded positive impacts toward both caregivers and children. In-person coaching, and skill-practicing sessions were effective in mitigating child's challenging behaviors while personal interaction, either face-to-face or virtual, is a significant factor in uplifting caregivers' well-being, whereas the self-learning model was appreciated by the busy caregivers. In clinical practice, needs and goals of families and the constraints of remote interventions at the settings should be balanced.
... Although there is a growing body of literature supporting the effectiveness of in-person social skills interventions (Gates et al., 2017;Hume et al., 2021), research on telehealth administration of social skills interventions is more limited. For example, only a few studies have found that parental instruction provided via telehealth results in increased social communication skills (Akemoglu et al., 2021;Baharav & Reiser, 2010;Hao et al., 2021;Meadan et al., 2016). Additionally, Cihon and colleagues' (2021) investigation of a telehealth administration of the Cool Versus Not Cool intervention found that the three children in the study achieved mastery of the program's seven steps, though only two exhibited generalization of these skills. ...
The COVID-19 pandemic sparked a worldwide transition to providing online services overnight, highlighting the urgent need for empirically supported telehealth interventions. The current study examined the effects of PEERS® for Adolescents Telehealth, an adaptation from the original social skills intervention developed for in-person provision, among 22 autistic adolescents and their caregivers. To evaluate the intervention, caregivers completed questionnaires assessing core autistic features and frequency of get-togethers. Adolescents completed questionnaires measuring social knowledge and frequency of get-togethers. Improvements in social skills knowledge, increased get-togethers, and decreased core autistic symptoms were evident. Preliminary results suggest PEERS® for Adolescents Telehealth improves social competence, as found for the in-person version. Further research exploring the equivalence of telehealth to in-person social skills intervention is recommended.
... For the most part, high-quality family-professional partnerships persevered during telehealth sessions. This finding is consistent with previous studies (Baharav & Reiser, 2010;Gibbs & Toth-Cohen, 2011;Vismara et al., 2012) that telehealth enhanced family-professional partnerships. The findings suggest that participants received support, coaching, and strengths-based information from their providers during telehealth sessions -key components of family-centered practices (DEC of the CEC, 2014). ...
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.
... Studies have shown various types of technology to be user-friendly, successful as a means to coach caregivers about how to conduct in-home interventions, and valuable as a tool to help maintain intervention goals over time (Baharav & Reiser, 2010;Jang et al., 2012;Rooks-Ellis et al., 2020;Vismara et al., 2012). In a study by McDuffie et al. (2016), the researchers used virtually delivered and in-person parent coaching on communication intervention strategies for young boys with Fragile-X syndrome. ...
Early childhood special education (ECSE) professionals were forced to drastically change their methods of providing services as a result of the COVID-19 pandemic. In this qualitative study, we conducted interviews to understand how the COVID-19 pandemic has impacted ECSE professionals both personally and professionally. ECSE rofessionals described challenges as well as unexpected positive outcomes associated with continuing to work in the midst of the COVID-19 pandemic. Professionals also explained the importance of increasing parent interaction through coaching interventions
while engaging in remote service delivery. The findings conclude with professionals’ discussions of how the field may be impacted by the pandemic in the future. Results were discussed in the context of service provision and implications for
supporting professionals who work with young children with disabilities.
... In a systematic review in 2010, eight studies reported favourable outcomes [4] and, similarly, 14 studies in 2018 were positive about the impact of teletherapy [5]. However, both noted the lack of research on direct interventions or assessment provided by clinicians with children and young people with autism. 2 of 11 Teletherapy, as part of the broader terms of telehealth and telepractice, has been used successfully for a range of autism-specific interventions, including speech and language development [6], behaviour support [7][8][9][10], parent-mediated social-communication interventions for young child [11][12][13], and classroom coaching for educators of autistic students [14]. While reviews of the literature on teletherapy have suggested that the platform itself has not been a barrier for successful outcomes [15], the research is still emerging on how practitioners can translate best practice autism support to the online environment [5]. ...
Prior to COVID-19, research into teletherapy models for individuals on the autism spectrum was slowly progressing. Following the onset of COVID-19, teletherapy became a necessity for continuity of services, however, research was still emerging for how to translate best practice autism support to the online environment. The aim of this research was to gain insight into the rapid shift to teletherapy for practitioner and service users and the implications for the broader disability sector. Survey responses were collected from 141 allied health practitioners (speech pathologists, occupational therapists, psychologists, educators, and social workers) from four Australian states and territories. A total of 806 responses were collected from service users following an individual teletherapy session. Five themes were identified during the qualitative analysis; (1) technology—love it or hate it; (2) teletherapy as a “new normal”; (3) short term pain, for long term gain; (4) the shape of service delivery has changed; (5) is teletherapy always an option? Data from the quantitative analysis provided further insights into the first two themes. While COVID-19 has brought forward significant advances in telehealth models of practice, what is needed now is to delve further into what works, for who, and in which context, and explore the potentiality, efficiencies, and scalability of a post-pandemic hybrid approach. This will inform practice guidelines and training, as well as information for service users on what to expect.
... With this strong conviction, virtual mode as an option for service delivery probably has not been much explored. However, there have been several reports in the literature comparing the face-to-face, ICT (virtual), and hybrid modes of service delivery, [22,23] emphasizing that ICT mode is as effective as face-to-face or hybrid mode in the West. In India, a single case study on intervention using Skype for a person with Broca's aphasia was one of the first reported cases of delivering speech and language therapy services through tele-model. ...
With the advancement in science and technology, the information and communication technology (ICT) mode has been put to best use in the
health-care sectors. Unlike health, communication disorders pose special challenges to service delivery. The Discipline of Speech-Language
Pathology and Audiology is an integrated health-care profession which is only about half-a-century old in India. The disproportion in the
ratio of qualified service providers to service receivers is highly prevalent. In view of this, “Telepractice” (The term telepractice is used in
this article to mean tele‑rehabilitation for persons with communication disorders since the service comprises of multifaceted objectives such
as rehabilitation in the Discipline of Speech‑Language Pathology and Audiology) as a means of “reaching the unreached” fits well when
the service delivery is provided across geographic, time, social, and cultural barriers using ICT mode. Telepractice is generally provided
from a remote site using store-and-forward as well as real-time technology using ICT platforms. The platform for telepractice in India is
well set, with a considerable number of people being “digitally literate.” Yet, there are several concerns such as development of professional
skills for telepractice; development and validation of digital resources; empirical studies on face-to-face, virtual, or hybrid service delivery;
revision of code of ethics for telepractice; and mechanism to protect client’s privacy on e-platforms that need to be addressed if telepractice
has to be launched on a large scale in India. Insights gained from the work carried out at the Telecenter for Persons with Communication
Disorders highlight on the advantages of telepractice from client/caregiver’s perspective besides reflections on the prospects and challenges
of telepractice in India.
... Parent responsiveness coaching interventions have employed a range of models, from traditional in-home or clinic-based coaching, to telehealth models, or hybrid interventions that combine the two approaches. An emerging body of research, conducted mostly with mothers, suggests that telehealth parent coaching is effective in improving communication outcomes for children with ASD (Baharav & Reiser, 2010;Berger, Ingersoll, Wainer, Pickard, & Pickard, 2016;Douglas, Kammes, & Nordquist, 2018;Suess et al., 2014;Vismara, McCormick, Gregory, Monlux, & Monlux, 2013). Importantly, telehealth and hybrid approaches are promising coaching delivery models for families with limited access to inperson speech-language intervention services. ...
Parent coaching interventions have been shown to be effective for increasing parent responsiveness and improving communication skills for children with autism spectrum disorder (ASD). However, few interventions have involved fathers. Challenges to father involvement include scheduling limitations, as well as evidence that strategies and activities shown to be effective with mothers may not generalise to fathers. Fathers may benefit from interventions that target strategies, which align with father-child communication and interaction styles. To mitigate barriers to father involvement, this study investigated the effects of a 12-week hybrid intervention program that combined telehealth coaching and in-person father–child aquatics sessions, on a father’s use of responsive communication and play strategies and child communication skills. A single subject, multiple baselines across behaviours experiment was conducted with one dyad (i.e. father, 5-year, 6-monthold child with ASD). Results showed that the participating father was able to quickly learn to use two of the three, targeted responsive strategies (i.e. follow-in comments, followin directives) within the context of parent–child aquatic play. The participating child showed small increases in use of spontaneous single words. Findings of this single subject study have important potential clinical implications for adapting ASD parent coaching programs to more effectively involve fathers.
... Nevertheless, in some studies, clinicians and clients report that telehealth is as effective as traditional in-person delivery (Kocsis & Yellowlees, 2018). Although previously underutilised, telehealth had been emerging as a method of service deliver with children and adolescents in various settings (Olson et al., 2018), for example, mental health (Lingley-Pottie & McGrath, 2008), speech and language therapy (Wales et al., 2017), developmental disabilities (Baharav & Reiser, 2010;Dimitropoulos et al., 2017;Lindgren et al., 2020), and supporting families of children with hearing impairment (Blaiser et al., 2013), but many of these studies predate the COVID-19 pandemic. Many studies report equivalent acceptability and engagement as in-person delivery, minimal behavioural and technological difficulties, positive experiences of building rapport and therapeutic alliance, and increased family engagement (Blaiser et al., 2013;Dimitropoulos et al., 2017;Lindgren et al., 2020;Lingley-Pottie & McGrath, 2008). ...
The COVID-19 pandemic created a major transformation in the delivery of music therapy services worldwide as they moved online. Telehealth research is in its infancy and online work with children and adolescents with visual impairment has yet to be investigated. This survey-based study explored the experiences and perceptions of parents of children and adolescents with visual impairment (n = 11) who engaged in online music therapy. Video playlists were accessed regularly and almost all parents reported positive (2/11) or very positive (8/11) responses and perceived them as beneficial in engaging with their child. Ninety-five percent (10/11) of parents perceived the teleheath programme to be a positive experience for their child, 73% (8/11) observed positive behaviours directly after the sessions, and 82% (9/11) indicated that the programme was a valuable family resource that supported bonding and interaction. Inductive reflexive thematic analysis generated four themes from the qualitative data: (a) positive impacts, (b) interactive family resource, (c) connection to school, and (d) challenges. A discussion of the findings is followed by implications for practice.
... Recent survey data, since the COVID-19 pandemic, has shown keenness from pediatric audiologists and caregivers to engage in, and expand the scope of, remote care practice (Saunders & Roughley 2020). There is also existing evidence for telepractice being used effectively as a tool for coaching parents to supplement face-to-face clinical sessions (Baharav & Reiser 2010;Daczewitz et al. 2020), including use of videos designed specifically with behavior change models in mind to maximize infant hearing aid use (Sindrey et al. 2020). Future work could develop improved remote practice training, using evidencebased BCTs, to support caregivers' hearing aid management needs. ...
Objective:
If the benefits of newborn hearing screening and early intervention are to be fully realized, there is a need to understand the challenges of hearing aid management in infants. The aim was to investigate longitudinal changes in hearing aid use and hearing aid management challenges in very young infants.
Design:
Eighty-one primarily female (99%) caregivers of infant hearing aid users completed a questionnaire about hearing aid management experiences, first when their infants were 3 to 7 months old (1 to 6 months after hearing aid fitting) and again at 7 to 21 months of age. Hearing aid data logging was compared with caregiver reports of daily use for 66 infants.
Results:
The main hearing aid management challenges reported by caregivers were performing listening checks and troubleshooting. These challenges reduced over the approximately 5-month time period but remained a problem with around a quarter of respondents still not confident or unsure about troubleshooting, and around a third not performing a daily listening check. Mean daily hearing aid use, obtained from data logging, declined significantly over time from 6.6 to 5.3 hours. Further analysis revealed reduced hearing aid use was primarily among infants with profound losses (n = 11). Caregivers overestimated daily hours of use at both time points. Caregivers reported difficulty with the infants pulling out their hearing aids, especially at the later time point.
Conclusions:
The findings from this relatively large sample of caregivers of young infants, assessed at two time points, revealed significant challenges in hearing aid management, including highly variable daily hearing aid use. Interventions that use behavior change techniques may be needed to ensure intentions are consistently turned into successful actions, if the benefits of newborn hearing screening and early intervention are to be fully realized.
... Recent survey data, since the COVID-19 pandemic, has shown keenness from pediatric audiologists and caregivers to engage in, and expand the scope of, remote care practice (Saunders & Roughley 2020). There is also existing evidence for telepractice being used effectively as a tool for coaching parents to supplement face-to-face clinical sessions (Baharav & Reiser 2010;Daczewitz et al. 2020), including use of videos designed specifically with behavior change models in mind to maximize infant hearing aid use (Sindrey et al. 2020). Future work could develop improved remote practice training, using evidencebased BCTs, to support caregivers' hearing aid management needs. ...
Objectives:
For children to understand the emotional behavior of others, the first two steps involve emotion encoding and emotion interpreting, according to the Social Information Processing model. Access to daily social interactions is prerequisite to a child acquiring these skills, and barriers to communication such as hearing loss impede this access. Therefore, it could be challenging for children with hearing loss to develop these two skills. The present study aimed to understand the effect of prelingual hearing loss on children's emotion understanding, by examining how they encode and interpret nonverbal emotional cues in dynamic social situations.
Design:
Sixty deaf or hard-of-hearing (DHH) children and 71 typically hearing (TH) children (3-10 years old, mean age 6.2 years, 54% girls) watched videos of prototypical social interactions between a target person and an interaction partner. At the end of each video, the target person did not face the camera, rendering their facial expressions out of view to participants. Afterward, participants were asked to interpret the emotion they thought the target person felt at the end of the video. As participants watched the videos, their encoding patterns were examined by an eye tracker, which measured the amount of time participants spent looking at the target person's head and body and at the interaction partner's head and body. These regions were preselected for analyses because they had been found to provide cues for interpreting people's emotions and intentions.
Results:
When encoding emotional cues, both the DHH and TH children spent more time looking at the head of the target person and at the head of the interaction partner than they spent looking at the body or actions of either person. Yet, compared with the TH children, the DHH children looked at the target person's head for a shorter time (b = -0.03, p = 0.030), and at the target person's body (b = 0.04, p = 0.006) and at the interaction partner's head (b = 0.03, p = 0.048) for a longer time. The DHH children were also less accurate when interpreting emotions than their TH peers (b = -0.13, p = 0.005), and their lower scores were associated with their distinctive encoding pattern.
Conclusions:
The findings suggest that children with limited auditory access to the social environment tend to collect visually observable information to compensate for ambiguous emotional cues in social situations. These children may have developed this strategy to support their daily communication. Yet, to fully benefit from such a strategy, these children may need extra support for gaining better social-emotional knowledge.
... Recent survey data, since the COVID-19 pandemic, has shown keenness from pediatric audiologists and caregivers to engage in, and expand the scope of, remote care practice (Saunders & Roughley 2020). There is also existing evidence for telepractice being used effectively as a tool for coaching parents to supplement face-to-face clinical sessions (Baharav & Reiser 2010;Daczewitz et al. 2020), including use of videos designed specifically with behavior change models in mind to maximize infant hearing aid use (Sindrey et al. 2020). Future work could develop improved remote practice training, using evidencebased BCTs, to support caregivers' hearing aid management needs. ...
Objective:
To compare the cognitive evolution of older adults with severe or profound hearing impairment after cochlear implantation with that of a matched group of older adults with severe hearing impairment who do not receive a cochlear implant (CI).
Design:
In this prospective, longitudinal, controlled, and multicenter study, 24 older CI users were included in the intervention group and 24 adults without a CI in the control group. The control group matched the intervention group in terms of gender, age, formal education, cognitive functioning, and residual hearing. Assessments were made at baseline and 14 months later. Primary outcome measurements included the change in the total score on the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals score and on its subdomain score to assess cognitive evolution in both groups. Secondary outcome measurements included self-reported changes in sound quality (Hearing Implant Sound Quality Index), self-perceived hearing disability (Speech, Spatial, and Qualities of Hearing Scale), states of anxiety and depression (Hospital Anxiety and Depression Scale), and level of negative affectivity and social inhibition (Type D questionnaire).
Results:
Improvements of the overall cognitive functioning (p = 0.05) and the subdomain "Attention" (p = 0.02) were observed after cochlear implantation in the intervention group; their scores were compared to the corresponding scores in the control group. Significant positive effects of cochlear implantation on sound quality and self-perceived hearing outcomes were found in the intervention group. Notably, 20% fewer traits of Type D personalities were measured in the intervention group after cochlear implantation. In the control group, traits of Type D personalities increased by 13%.
Conclusion:
Intervention with a CI improved cognitive functioning (domain Attention in particular) in older adults with severe hearing impairment compared to that of the matched controls with hearing impairment without a CI. However, older CI users did not, in terms of cognition, bridge the performance gap with adults with normal hearing after 1 year of CI use. The fact that experienced, older CI users still present subnormal cognitive functioning may highlight the need for additional cognitive rehabilitation in the long term after implantation.
... Recent survey data, since the COVID-19 pandemic, has shown keenness from pediatric audiologists and caregivers to engage in, and expand the scope of, remote care practice (Saunders & Roughley 2020). There is also existing evidence for telepractice being used effectively as a tool for coaching parents to supplement face-to-face clinical sessions (Baharav & Reiser 2010;Daczewitz et al. 2020), including use of videos designed specifically with behavior change models in mind to maximize infant hearing aid use (Sindrey et al. 2020). Future work could develop improved remote practice training, using evidencebased BCTs, to support caregivers' hearing aid management needs. ...
Objectives:
Effort investment during listening varies as a function of task demand and motivation. Several studies have manipulated both these factors to elicit and measure changes in effort associated with listening. The cardiac pre-ejection period (PEP) is a relatively novel measure in the field of cognitive hearing science. This measure, which reflects sympathetic nervous system activity on the heart, has previously been implemented during a tone discrimination task but not during a speech-in-noise task. Therefore, the primary goal of this study was to explore the influences of signal to noise ratio (SNR) and monetary reward level on PEP reactivity during a speech-in-noise task.
Design:
Thirty-two participants with normal hearing (mean age = 22.22 years, SD = 3.03) were recruited at VU University Medical Center. Participants completed a Dutch speech-in-noise test with a single-interfering-talker masking noise. Six fixed SNRs, selected to span the entire psychometric performance curve, were presented in a block-wise fashion. Participants could earn a low (&OV0556;0.20) or high (&OV0556;5.00) reward by obtaining a score of ≥70% of words correct in each block. The authors analyzed PEP reactivity: the change in PEP measured during the task, relative to the baseline during rest. Two separate methods of PEP analysis were used, one including data from the whole task block and the other including data obtained during presentation of the target sentences only. After each block, participants rated their effort investment, performance, tendency to give up, and the perceived difficulty of the task. They also completed the need for recovery questionnaire and the reading span test, which are indices of additional factors (fatigue and working memory capacity, respectively) that are known to influence listening effort.
Results:
Average sentence perception scores ranged from 2.73 to 91.62%, revealing a significant effect of SNR. In addition, an improvement in performance was elicited by the high, compared to the low reward level. A linear relationship between SNR and PEP reactivity was demonstrated: at the lower SNRs PEP reactivity was the most negative, indicating greater effort investment compared to the higher SNRs. The target stimuli method of PEP analysis was more sensitive to this effect than the block-wise method. Contrary to expectations, no significant impact of reward on PEP reactivity was found in the present dataset. Also, there was no physiological evidence that participants were disengaged, even when performance was poor. A significant correlation between need for recovery scores and average PEP reactivity was demonstrated, indicating that a lower need for recovery was associated with less effort investment.
Conclusions:
This study successfully implemented the measurement of PEP during a standard speech-in-noise test and included two distinct methods of PEP analysis. The results revealed for the first time that PEP reactivity varies linearly with task demand during a speech-in-noise task, although the effect size was small. No effect of reward on PEP was demonstrated. Finally, participants with a higher need for recovery score invested more effort, as shown by average PEP reactivity, than those with a lower need for recovery score.
... Parents and children experiencing the tele-assisted sessions showed the usually demonstrated parent-child interactions at home, especially initiating and sharing play activities. This is in line with the previous literature reporting how effective, acceptable, and usable ubiquitous communication technology is for the parents [27][28][29]. Moreover, as reported by themselves, all parents in the TG spontaneously practiced the learned lessons at home subsequent to the tele-assisted intervention, just as is usually reported by parents following in-person parent coaching sessions. ...
Background:
Telehealth is useful for both autism spectrum disorder (ASD) diagnosis and treatment, but studies with a direct comparison between teletherapy and traditional in-person therapy are limited.
Methods:
This randomized control trial-ISRCTN (International Standard Randomised Controlled Trial Number) primary clinical trial registry ID ISRCTN15312724-was aimed at comparing the effect of a tele-assisted and in-person intervention based on a behavioral intervention protocol for families with children affected by ASDs. Forty-two parents with children with autism (30 months to 10 years old) were randomly assigned to 12 sessions of an applied behavioral analysis (ABA) intervention implemented in an individual and group setting, either with or without the inclusion of tele-assistance. Pre- and postintervention assessments were conducted using the Home Situation Questionnaire (HSQ-ASD) and the Parental Stress Index (PSI/SF).
Results:
Substantial improvements in the perception and management of children's behavior by parents, as well as in the influence of a reduction in parent stress levels on said children's behavior through the use of a tele-assisted intervention, were obtained.
Conclusions:
This randomized controlled trial demonstrates the evidence-based potential for telehealth to improve treatment of ASDs.
... Indeed, research has suggested that technology can facilitate parent training in EI strategies (Vismara et al., 2013). Recently, researchers have proposed the use of hybrid models, wherein families learn to use strategies to support their children's target skills synchronously and asynchronously (Baharav & Reiser, 2010;Wainer & Ingersoll, 2015). Future research should examine families perceptions about such hybrid telehealth models. ...
Using telehealth in early intervention has the potential to increase family and child outcomes as well as to increase access to family-centered services. Yet, little is known about families’ perspectives, including concerns, prior to using telehealth in early intervention. The purpose of this study was to explore families’ perceptions and attitudes toward using telehealth in early intervention. Nine focus groups were conducted with 37 families of children with disabilities. Overall, participants preferred in-person visits (versus telehealth) for early intervention services. However, participants recognized some benefits of telehealth in facilitating communication with early intervention professionals and reaching underserved families. In addition to benefits, participants identified barriers to telehealth including limited access to: technology, the internet and materials. Policymakers and professionals should consider the perspectives, priorities and concerns of families before implementing telehealth in early intervention.
... With this strong conviction, virtual mode as an option for service delivery probably has not been much explored. However, there have been several reports in the literature comparing the face-to-face, ICT (virtual), and hybrid modes of service delivery, [22,23] emphasizing that ICT mode is as effective as face-to-face or hybrid mode in the West. In India, a single case study on intervention using Skype for a person with Broca's aphasia was one of the first reported cases of delivering speech and language therapy services through tele-model. ...
With the advancement in science and technology, the information and communication technology (ICT) mode has been put to best use in the health-care sectors. Unlike health, communication disorders pose special challenges to service delivery. The Discipline of Speech-Language Pathology and Audiology is an integrated health-care profession which is only about half-a-century old in India. The disproportion in the ratio of qualified service providers to service receivers is highly prevalent. In view of this, “Telepractice” (The term telepractice is used in this article to mean tele-rehabilitation for persons with communication disorders since the service comprises of multifaceted objectives such as rehabilitation in the Discipline of Speech-Language Pathology and Audiology) as a means of “reaching the unreached” fits well when the service delivery is provided across geographic, time, social, and cultural barriers using ICT mode. Telepractice is generally provided from a remote site using store-and-forward as well as real-time technology using ICT platforms. The platform for telepractice in India is well set, with a considerable number of people being “digitally literate.” Yet, there are several concerns such as development of professional skills for telepractice; development and validation of digital resources; empirical studies on face-to-face, virtual, or hybrid service delivery; revision of code of ethics for telepractice; and mechanism to protect client's privacy on e-platforms that need to be addressed if telepractice has to be launched on a large scale in India. Insights gained from the work carried out at the Telecenter for Persons with Communication Disorders highlight on the advantages of telepractice from client/caregiver's perspective besides reflections on the prospects and challenges of telepractice in India.
Purpose
There is a clear need for speech-language pathologists, audiologists, and related health care professionals to understand the barriers to hearing health care, so that we may propose possible solutions. Through interview, collaboration, and analysis, the objective was to identify opportunities to enhance support provided for these children.
Method
The authors conducted a review of available literature related to hearing health care disparities. Dr. Matthew Bush, an expert in hearing health care disparities and advocacy, was interviewed on October 12, 2022. Data were extracted and compiled from available literature and the interview including demographics, themes, and available interventions.
Results
The section “Entry Barriers” describes findings in the main categories of Steps, Proximity, Health Care Literacy, and Systemic Inequalities. The “Opportunities for Change” section describes topics from the interview for ongoing discussion in the field.
Conclusions
Ultimately, having this conversation led exactly in a direction that it should—toward further professional development, awareness, and a call to action. To facilitate meaningful change, we are tasked with active discussion, questioning, probing, and improvement. Only through evolution of existing systemic bias and harmful structures can we make meaningful change.
This study aims to develop and identify the effect of SMART-P training on parenting knowledge and children's cognitive development. This research is included as Mix Method research with an ADDIE development model and experimental quantitative research approach. The research method used is explanatory research with a non-equivalent control group design research involving the control and experimental classes. This research is carried out for three weeks, with the stages covering: analysis, design, development, research instrument development, implementation, and evaluation. The population in this study are 714 parents with children aged four years from posyandu/KB in five sub-districts of Malang City, with a research sample of 150 parents with children aged four years and six experts. Data collection techniques in this study used questionnaires and observation checklists. Data analysis in this study used descriptive percentage analysis and SPSS analysis. The results show that 1) SMART-P application is declared valid and acceptable to be implemented as a training medium, 2) a significant effect of parenting knowledge in parents before and after being given parenting training using SMART-P is identified, 3) a significant effect on the development cognitive development of children before and after parents re given care using SMART-P application is identified, 4) a significant difference in the effect of parenting knowledge on parents between the control group and the experimental group is shown, and 5) a significant difference in the effect on children's cognitive development between the control group and the experimental group is slightly identified. Therefore, parenting research using SMART-P needs to be carried out continuously so that parenting knowledge and children's cognitive development can be maximized
The term caregiver encompasses a wide range of individuals such as parents, guardians, grandparents, teachers, or a paid helper who provides direct care services to another individual (Merriam-Webster, Caregiver. https://www.merriam-webster.com/dictionary/caregiver, 2020). For the purposes of this chapter, the definition of caregiver is further defined to specify an informal caregiver (e.g., unpaid family member), rather than a formal caregiver (e.g., paid service provider), and the emphasis is placed on how these caregivers play a significant role in the delivery of interventions. This chapter provides an in-depth review of the comprehensive literature on behavioral parent training, parent training programs, and the use of behavioral skills training to teach caregivers valuable skills, as well as internet-based services. Limitations and barriers of each area are discussed, and solutions or research required to address these confines are examined.KeywordsCaregiverParentCaregiver trainingParent training programsBehavioral parent trainingBehavioral skills trainingTelehealth
Purpose:
The COVID-19 pandemic required most pediatric rehabilitation programs to shift to a virtual delivery format without the benefits of evidence to support this transition. Our study explored families' experiences participating virtually in More Than Words, a program for parents of autistic children, with the goal of generating new evidence to inform both virtual service delivery and program development.
Method:
Twenty-one families who recently completed a virtual More Than Words program participated in a semistructured interview. The interviews were transcribed and analyzed in NVivo using a top-down deductive approach that referenced a modified Dynamic Knowledge Transfer Capacity model.
Results:
Six themes capturing families' experiences with different components of virtual service delivery were identified: (a) experiences participating from home, (b) accessing the More Than Words program, (c) delivery methods and program materials, (d) the speech-language pathologist-caregiver relationship, (e) new skills learned, and (f) virtual program engagement.
Conclusions:
Most participants had a positive experience in the virtual program. Suggested areas for improvement included the time and length of intervention sessions and increasing social connections with other families. Practice considerations related to the importance of childcare during group sessions and having another adult to support the videorecording of parent-child interactions. Clinical implications include suggestions for how clinicians can create a positive virtual experience for families.
Supplemental material:
https://doi.org/10.23641/asha.22177601.
Children with intellectual and developmental disabilities engage in higher rates of challenging behavior (CB) than their typically developing peers. Effective and sustainable intervention and supports designed to reduce CB, as well as promote the development of positive, prosocial behavior, are urgently needed. One approach to targeting CB is providing parents with education and support to serve as the agents of behavior change. The purpose of this study was to examine the effectiveness of a parent education (PE) program focused on the principles of applied behavior analysis delivered using the Project ECHO service delivery model. Results demonstrate positive outcomes in parents' senses of competency and empowerment. In addition, parents identified the intervention as acceptable, suggesting this model as a highly effective and sustainable PE model for this population.
This article examines current technology-aided instruction and intervention (TAII) available for autistic transition-age youth (TAY) and existing policies that may support or hinder the delivery of these interventions. Specifically, we focus on policies that might influence the delivery of TAII to autistic TAY. After a careful review of the literature, we observed that postsecondary policy guiding the delivery of TAII designed to support autistic TAY is lacking. TAII has demonstrated effectiveness, usability, sustainability, and cost-effectiveness, particularly with this population. We suggest possibilities for future policies to support the development, implementation, and evaluation of TAII for autistic TAY.
En la situación de crisis sanitaria que vivimos, los centros de desarrollo infantil y atención temprana (en adelante CDIAT) están adaptando su modalidad de trabajo para seguir ofreciendo intervenciones de calidad a niños, niñas y sus familias. A pesar de que las circunstancias han propiciado el uso de las tecnologías, la teleintervención no es algo nuevo. Desde hace años existen experiencias con demostrada evidencia de que la teleintervención es una modalidad de trabajo complementaria que aporta beneficios similares a las sesiones realizadas bajo el paraguas de las prácticas recomendadas en Atención Temprana (en adelante AT).
Si bien la edición de la guía surge para orientar a los/las profesionales en este momento inusual, su redacción ha sido gracias a la revisión de la literatura publicada desde hace más de una década, así como a las contribuciones de profesionales que, desde distintos lugares del mundo, están implementando sesiones telemáticas.
Los contenidos de esta guía se distribuyen en tres grandes bloques. En primer lugar, se justifica la modalidad de teleintervención como práctica coherente con los principios de la AT y se describen los requisitos y orientaciones para ponerla en práctica. La segunda parte se centra en la colaboración familia-profesional, considerándolas parte activa durante todo el proceso, y el uso de las estrategias de coaching para favorecer su participación. Por último, se recoge cómo evaluar la implementación de la teleintervención, a través de los resultados alcanzados por el/la niño/a, la familia y la modalidad de intervención.
Coordinadores: Margarita Cañadas Pérez. Campus Capacitas UCV; Gabriel Martínez-Rico. Campus Capacitas UCV y Paola de la Mano, Plena inclusión Castilla La Mancha.
Colaboradores:
En la elaboración de la guía han participado:
Stefania Bolsi, ADISLAN, Canarias.
Manuel Pacheco, AEIPI, Asociación Española Intervención Primera Infancia.
Otilia Salvador, AMAFI Castilla La Mancha.
Mar Marín, Grupo AMÁS, Madrid.
Aurora Molina, Grupo AMÁS, Madrid.
Ruth Sastre, Grupo AMÁS, Madrid.
Miriam Jiménez, APACE Talavera, Castilla La Mancha.
Evelia Serrano, APACE Talavera, Castilla La Mancha.
Victoria Pascual, APROSCOM, Baleares.
Montserrat Díaz, ASODEMA, Castilla La Mancha.
Almudena Amador, ASODEMA, Castilla La Mancha.
Carmen Serrano, ASPANA, Castilla La Mancha.
Carolina Izquierdo, ASPRONA, Castilla La Mancha.
Maribel Picazo, ASPRONA, Castilla La Mancha.
Amparo Flox, Fundación FUENTE AGRIA, Castilla la Mancha.
Yolanda Salat, CDIAP L´ESPIGA, Cataluña.
Curra Cañete, Equipo SIDI, Andalucía.
Sofía Reyes, Plena Inclusión Confederación.
María Chavida, Plena Inclusión Castilla León.
Moisés Lamigueiro, Plena Inclusión Galicia (FADEMGA)
Rosabel Esquerdo, Plena Inclusión Comunidad Valenciana
La elaboración y diseño de las ilustraciones las ha realizado Iván Amado Fernández, Centro IRIA, Madrid.
Edita: Plena inclusión España.
Background and Objectives Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which individuals have difficulty in emotional processes related to social cognition and other behavioral patterns. The use of technology in therapeutic and educational interventions for people with ASD - who face ongoing challenges - is increasing. Therefore, to select the interventions more appropriately and ensure their effectiveness, such interventions need to be evaluated. Thus, this study is an attempt to develop a framework for evaluating IT-based interventions in people with ASD. Material and Methods The present study is a descriptive-applied study examining the information technology-based intervention studies in the field of ASD. The search and review of studies continued without any restrictions until an appropriate and complete framework of interventions was obtained. The required data were extracted and collected in a table focusing on the evaluation of ASD interventions. The data were then analyzed to determine an appropriate framework for the objectives of the study. Finally, the evaluation framework was prepared using the one-step Delphi method and sent to 15 experts in the field of autism and health information technology to obtain their views on changing, modifying, approving the framework. Results In the framework developed in this study, two aspects of the interventions including the type of information technology interventions and their outcome are generally presented. . Moreover, the technologies used were presented from three main aspects: evaluation methods, technical evaluation cases, and clinical evaluation cases. Conclusion The results revealed that technology-based interventions in the treatment, education and increasing social interactions of people with ASD can be of tremendous help and bring about significant effects. Therefore, according to experts, the prepared assessment framework of interventions based on information technology leads to identifying the strengths and weaknesses of interventions, improving technologies as well as choosing appropriate interventions and ultimately increasing the quality of life of people with autism spectrum disorder. Extended Abstract Background and Objectives Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which individuals have difficulty in emotional processes related to social cognition and other behavioral patterns. The use of technology in therapeutic and educational interventions for people with ASD - who have ongoing challenges - is increasing. Technology-based interventions have demonstrated a variety of skills for people with autism, including the ability to initiate, maintain or end behavior, recognize emotions, improve functional activities of daily living, learn vocabulary, and reading skills. The unique appeal of electronic technology to children and adolescents with autism has greatly motivated their use in clinical and medical services, education and social communication. Therefore, to select interventions better and ensure their effectiveness, they need to undergo an evaluation. Thus, this study develops a framework for evaluating IT-based interventions in people with ASD. Material and Methods The present study is a descriptive-applied study that examines the information technology-based intervention studies conducted in Iran and the world in the field of ASD. The data were extracted from Databases including Pubmed, Scopus, Science Direct, Embase, Google scholar, SID, Web of Science, Magiran without any time limitation. The search continued until a complete framework of IT-based interventions was obtained. The data collection tool for data extraction was a table containing items with a focus on evaluating interventions in the field of aASD, which examined any type of technology used in the intervention of people with ASD from two perspectives: evaluation method of intervention and technical and clinical cases. The required data were extracted and collected in a table focusing on the evaluation of ASD interventions. In the third step, the extracted data were examined to determine the appropriate framework for the objectives of the study in two aspects, including the type of interventions based on information technology and the outcome of the interventions. Also, based on the objectives of the study, the technologies were evaluated from three main perspectives including evaluation methods, technical evaluation cases, and clinical evaluation cases. Finally, the prepared evaluation framework was sent to 15 experts in the field of autism and health information technology to get their opinions on changing, modifying, or approving the framework. After obtaining the cooperation of these people through the informed consent form, the opinion poll was conducted in 1 stage of Delphi method by e-mail. In general, the results showed that the most common IT-based interventions used in the field of autism included virtual reality, mobile phones, serious games, telemedicine, robots, respectively, wearable technologies, computer technologies, video conferencing and music integration technologies. Each of these technologies was used to achieve specific goals. The most important clinical goal in the interventions of patients with autism is to improve their social interaction. It is also important to improve educational skills and their performance and duties. The use of technology is very valuable and effective in removing barriers to patients’ access to the required health interventions. The least common use of IT-based interventions is to achieve the goal of creating a business for patients. Evaluation of IT-based interventions is very important in order to determine the effectiveness of each and select the appropriate intervention. Various methods are used to evaluate interventions. Based on the findings of the study, observation and interview were found to be the most commonly used assessment method used to evaluate almost all technologies while the least commonly used methods for evaluating interventions were related to the specific method of each. Evaluation of IT-based interventions was conducted from two perspectives, which included the evaluation of the technical cases of the technology used and the evaluation of the clinical cases of technology-based interventions. From the point of view of clinical evaluation, the greatest emphasis of the interventions was related to the improvement of communication skills, and from the aspect of technical evaluation, the greatest emphasis was related to the confidentiality and privacy of individuals. Conclusion According to the results, technology-based interventions in the treatment, education and increasing social interactions of people with ASD can be of enormous help and bring about significant gains. According to experts, the prepared assessment framework of interventions based on information technology can lead to identifying the strengths and weaknesses of interventions, improving technologies as well as choosing appropriate interventions and ultimately increasing the quality of life of people’ with autism spectrum disorder. Therefore, given the effectiveness of information technology-based interventions in the recovery of patients with autism, it is better to increase their use in the treatment of patients. Based on the framework prepared in this study, the evaluation of these interventions was done properly, in fact, different aspects of the evaluation were considered to ensure their correct evaluation. As a result, proper evaluation may lead to improving the quality of the technologies used. In addition, medical professionals can easily select the most appropriate intervention using this framework. Practical implications of research One of the practical consequences of the present study is to increase the precision of the specialists in selecting an intervention based on appropriate technology to treat patients with autism. Therefore, autism specialists would benefit from the use of the framework presented in this study in the selection of the most appropriate technology. Ethical considerations This article has been licensed by the Ethics Committee of Tabriz University of Medical Sciences with ethics code IR.TBZMED.REC.1398.704. Also in the present study, researchers are trustworthy in the use, presentation and publication of scientific materials and all the rights of researchers have been observed. Conflict of interest The authors of this article hereby declare that they have no conflict of interest with each other. Acknowledgement The authors of this article would like to thank all the experts and specialists participating in this research and all the collaborators who contributed in any way tothe implementation of this research.
Purpose
This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice service delivery model.
Method
Four caregivers and children with language delays aged 18–27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver–child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach–Model–Coach–Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words.
Results
There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children.
Conclusion
Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies.
Supplemental Material
https://doi.org/10.23641/asha.14977605
As the need for accessible interventions for autism spectrum disorder (ASD) grows, empirically supported telehealth interventions become increasingly necessary. With the current COVID-19 public health crisis, in-person interventions have become largely infeasible; therefore, it is crucial that providers have information regarding the effectiveness of telehealth interventions. This systematic review evaluates and synthesizes existing group design research on telehealth ASD interventions. Sixteen articles were evaluated on implementer and child-level intervention outcomes as well as factors that promote equitable access to intervention. Findings suggest that telehealth programs are highly acceptable, comparable to face-to-face interventions, and can be an effective method of training implementers in interventions. Recommendations for future research and for maximizing equitable access to telehealth interventions are presented.
The American Speech-Language-Hearing Association (ASHA) developed the National Outcomes Measurement System for aggregating standardized patient outcomes. Outcomes are standardized using Functional Communication Measures (FCM), scales designed to describe communicative function across specific areas of clinical need. This investigation compared in-person and telepractice service delivery for children in elementary school settings who received treatment targeting the FCM categories of either “spoken language production” or “spoken language comprehension.” De-identified cases were secured from ASHA’s NOMS database and the database of a private e-learning provider that implemented the NOMS format. There were minimal significant differences in the median change scores between the traditional and telepractice interventions. These results support comparable treatment outcomes between in-person service delivery and telepractice for treatment of children exhibiting impaired spoken language production or spoken language comprehension in an elementary school setting
Giriş: Erken Çocukluk Özel Eğitimi (EÇÖE); 0-6/8 yaş döneminde gelişimsel yetersizliğe sahip veya gelişimi risk altında olan özel gereksinimli çocuklara ve ailelerine sunulan hizmetler bütünüdür. Kendine özgü çalışma alanı, felsefesi, değerleri, amaçları ve ortaya çıkış nedenleriyle profesyonel alanyazını ve araştırmaları olan bir disiplin alanıdır. Bu çalışmada, EÇÖE’nin temel özelliklerine ve kuramsal temellerine, tarihsel süreç içerisindeki gelişimine, alandaki yasal düzenlemelere, Dünya’da ve Türkiye’de EÇÖE uygulamalarına yönelik güncel gelişmelere, ülkemizdeki çözüm bekleyen sorunlara ve hizmetlerin niteliğini artırabilecek birtakım önerilere yer verilmesi amaçlanmıştır.Tartışma: Ülkemizdeki yasal düzenlemelerin gelişmiş ülkelerle paralellik gösterdiği ve alandaki çalışmaların giderek hız kazandığı gözlense de ülkemize özgü EÇÖE sistem modelinin olmaması, alandaki uzman personel eksikliği, uzmanlar ve kurumlar arası iş birliği, kanıt temelli müdahalelerin uygulamalara yansıması gibi konular halen çözüm beklemektedir. Çalışmanın özellikle ülkemizdeki özel gereksinimli çocuklara ve ailelerine, EÇÖE hizmetleri sunan uzmanlara ve eğitimcilere, bu alanda araştırma yapan araştırmacılara ve yasa geliştiricilere katkılar sunması beklenmektedir.
Pediatric rehabilitation focuses on optimizing function and quality of life of children through a holistic and transdisciplinary patient-centered team approach. This article describes the incorporation of telehealth in pediatric rehabilitation and its growth over the past decade. It also reviews the experience of practitioners using telehealth by necessity during the 2020 COVID-19 pandemic. Evidence suggests many applications where telehealth can appropriately substitute for traditional in-person visits, and there are many potential applications of telehealth to be explored as a means to enhance connectivity of the interdisciplinary rehabilitation team and the outreach to patients in remote and underserved areas.
Purpose
The rollout of individualised disability funding in Australia resulted in an increased demand for services for people with a disability, particularly support for the high percentage of Australians with autism spectrum disorder. Continuing professional development is one way to grow and maintain a skilled workforce; however, face-to-face opportunities can be limited in remote areas of Australia. Technology may provide a low-cost and widely accessible platform for providing education and support for staff in these areas.
Design/methodology/approach
The current study evaluated a novel webinar training and individual online support program for 36 allied health, education and community support staff. Data were collected via a survey on changes in perceived “knowledge and skills” and “confidence” in supporting children with autism, as well as mode of participation, and accessibility of the program.
Findings
Participants reported a significant increase in their “knowledge and skills” and “confidence”, in working with children with autism. This increase was positively related to the number of webinars the participants accessed. The mode of webinar access was predominantly via watching recordings of webinars (asynchronous learning). Synchronous learning via individual online sessions was accessed by a small number of participants, mostly allied health professionals. Workload and scheduling were identified as barriers to engaging in the program. The technology platform was found to be accessible and acceptable.
Originality/value
A predominantly asynchronous mode of delivery was successful, thereby increasing program access and flexibility for remote staff. Technology was not a barrier to accessing the program regardless of remoteness or job role.
Ongoing advances in technology have provided a platform to extend the accessibility of services for children with developmental disabilities across locations, languages and the socioeconomic continuum. Teletherapy, the use of video-conferencing technology to deliver therapy services, is changing the face of healthcare by providing face-to-face interactions among specialists, parents and children. The current literature has demonstrated success in utilizing teletherapy as a modality for speech-language intervention and for social-behavioral management, while research on feeding therapy remains scarce. The current chapter discusses the prevalence of feeding disorders among infants, toddlers and children with developmental disorders. Using evidence from the current literature, a rationale for the utilization of teletherapy as a means of feeding therapy is presented.
The present study used synchronous video conferencing to remotely deliver a behavioral skills training‐based (BST) parent training program to 3 parents of children with autism in the family home. Parents were taught to implement graduated guidance to teach their children several important self‐care skills. Parents did not correctly implement graduated guidance after receiving detailed written instructions only. After parents received the BST parent training package, however, all parents implemented graduated guidance with near‐perfect levels of fidelity, and all children completed the targeted self‐care skills with substantially higher levels of accuracy and independence. Furthermore, parents reported high levels of satisfaction with graduated guidance, the telehealth BST training package, and their children's ability to complete self‐care skills.
Given the increasing number of individuals diagnosed with autism spectrum disorder (ASD), there is a critical need to develop programs that facilitate positive behavior outcomes during the transition to adulthood. Furthermore, many adults with ASD do not have access to intervention programs due to remote locations, lack of qualified personnel, and/or long waitlists. This study, conducted within the context of a combined multiple baseline and changing criterion design, examined the use of videoconferencing (VC) to provide intervention from a remote location. Results showed that following intervention participants were able to independently perform the targeted skills and all targeted skills maintained during follow-up probes. All participants rated the intervention highly and said that they would recommend the intervention to others. These results are discussed in relation to potential avenues to increase access to services for individuals with ASD, particularly in remote and underserved areas, using VC.
This study investigates the effectiveness of relationship-focused intervention on the social and emotional well-being of children with autism spectrum disorders. Relationship-focused intervention is a general approach to developmental intervention that encourages and supports parents to enhance their use of responsive interactive strategies during routine interactions with their children. The sample for this study consisted of 20 young children diagnosed with autism or pervasive developmental disorder and their parents. Parents and children received weekly intervention sessions for 8 to 14 months. These sessions focused on encouraging parents to use a Responsive Teaching curriculum to promote children's socioemotional development. Comparisons of pre- and postassessments indicated that the intervention was successful at encouraging mothers to engage in more responsive interactions with their children. Increases in mothers' responsiveness were associated with significant improvements in children's social interaction, as well as in standardized measures of their social— emotional functioning. These results indicate that relationship-focused intervention holds much promise for enhancing the social—emotional functioning of children with autism spectrum disorders.
To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD).
Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community.
Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group.
This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.
Deficits in attention, communication, imitation, and play skills reduce opportunities for children with autism to learn from natural interactive experiences that occur throughout the day. These developmental delays are already present by the time these children reach the toddler period. The current study provided a brief 12 week, 1 hour per week, individualized parent-child education program to eight toddlers newly diagnosed with autism. Parents learned to implement naturalistic therapeutic techniques from the Early Start Denver Model, which fuses developmental- and relationship-based approaches with Applied Behavior Analysis into their ongoing family routines and parent-child play activities. Results demonstrated that parents acquired the strategies by the fifth to sixth hour and children demonstrated sustained change and growth in social communication behaviors. Findings are discussed in relation to providing parents with the necessary tools to engage, communicate with, and teach their young children with autism beginning immediately after the diagnosis.
Early intervention for children with autism is currently a politically and scientifically complex topic. Randomized controlled trials have demonstrated positive effects in both short-term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysis. Whether such changes lead to significant improvements in terms of greater independence and vocational and social functioning in adulthood is also unknown. Given the few randomized controlled treatment trials that have been carried out, the few models that have been tested, and the large differences in interventions that are being published, it is clear that the field is still very early in the process of determining (a) what kinds of interventions are most efficacious in early autism, (b) what variables moderate and mediate treatment gains and improved outcomes following intervention, and (c) the degree of both short-term and long-term improvements that can reasonably be expected. To examine these current research needs, the empirical studies of comprehensive treatments for young children with autism published since 1998 were reviewed. Lovaas's treatment meet Chambless and colleague's (Chambless et al., 1998; Chambless et al., 1996) criteria for "well-established" and no treatment meets the "probably efficacious" criteria, though three treatments meet criteria for "possibly efficacious" (Chambless & Hollon, 1998). Most studies were either Type 2 or 3 in terms of their methodological rigor based on Nathan and Gorman's (2002) criteria. Implications of these findings are also discussed in relation to practice guidelines as well as critical areas of research that have yet to be answered.
Educating parents of children with autism regarding how to act as treatment providers for their own children is now understood to be an essential component of successful treatment programs. Although most parent education programs have been successful overall in teaching parents to use specific techniques, the programs are often time consuming and costly, and some parents continue to have difficulty learning, then implementing, techniques at home. The current project assessed the addition of a parent education support group to an accelerated parent education program. Both groups of families received individualized parent education for 12 weeks. One group also attended a weekly parent education support group. Both parent mastery of the parent education techniques and the children's language skills were assessed before and after training. Results indicate that inclusion of a parent education support group in a parent education program may increase parent mastery of teaching techniques and success of accelerated programming and, in turn, increase children's language success. Limitations and implications of this clinical research study are discussed.
Advances in the fields of cognitive and affective developmental neuroscience, developmental psychopathology, neurobiology, genetics, and applied behavior analysis have contributed to a more optimistic outcome for individuals with autism spectrum disorder (ASD). These advances have led to new methods for early detection and more effective treatments. For the first time, prevention of ASD is plausible. Prevention will entail detecting infants at risk before the full syndrome is present and implementing treatments designed to alter the course of early behavioral and brain development. This article describes a developmental model of risk, risk processes, symptom emergence, and adaptation in ASD that offers a framework for understanding early brain plasticity in ASD and its role in prevention of the disorder.
Vineland-II: Vineland adaptive rating scales
- S Sparrow
- Cicchetti Dv
- Balla
- Da
Sparrow S, Cicchetti DV, Balla DA. Vineland-II: Vineland adaptive rating scales, 2nd ed. Circle Pines, MN: American Guidance Service, Inc., 2005.
MacArthur communicative developmental inventories Address correspondence to: Eva Baharav
- L Fenson
- Reznick P S D Dale
- Bates E J Hartung
- S Pethick
- Reilly
Fenson L, Dale P, Reznick S, Thal D, Bates E, Hartung J, Pethick S, Reilly J. MacArthur communicative developmental inventories. San Diego, CA: Singular Publishing Group, Inc., 1993. Address correspondence to: Eva Baharav, Ph.D., CCC-SLP Speech-Language–Hearing Clinic