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Helping people with intellectual and visual disabilities engage in activity and mobility is considered crucially important to promote constructive occupation and a basic form of physical exercise (i.e., objectives that are essential for the individuals’ wellbeing and in line with their rights). This study assessed two new programs aimed at helping eight participants with intellectual and visual disabilities (four in each program) to independently move through specific indoor destinations, collect and transport objects, and access stimulation events (e.g., music) with the support of technology systems involving a smartphone linked to mini cameras and speakers. The second program was more advanced than the first and (a) required the participants to discriminate the objects used and transport two (rather than one) of them before any stimulation event, and (b) included telephone calls to and stories from preferred communication partners among the stimulation events. Each program was implemented using a single-case research design (i.e., a non-concurrent multiple baseline design across participants). The results showed that both programs were effective in enabling the participants to collect, transport, and put away objects and access stimulation independently during 20-min sessions. Based on the results, both programs might be considered useful tools to help people with intellectual and visual disabilities manage independent activity and mobility.

Parents are often expected to be the primary implementers of intervention for their young children with autism spectrum disorder (ASD). The provision of a few hours a week of intervention by a trained therapist, in addition to parent-implemented intervention, could increase child outcomes compared to parent-implemented intervention in isolation. This study evaluated the effects of a 12-week parent coaching program based on the Early Start Denver Model (ESDM) followed by 12-weeks of therapist-delivered ESDM intervention for four children with ASD. The effects of these interventions on child participation, functional utterances, and imitation were evaluated using a multiple probe across participants design. Children's participation improved during both interventions. Children generally showed greater improvements in imitation with the therapist than with their parents but showed minimal improvements in functional utterances. This suggests there may be some benefit to low-intensity therapy in addition to parent coaching, but more research is needed.

Families of autistic children from underserved populations participate in support services at lower rates than other families. To better understand possible reasons for this inequity, we reviewed qualitative studies examining parent-reported barriers and facilitators to accessing and participating in support services. A systematic search identified 18 articles that met inclusion criteria. Resulting thematic analysis located three themes: (a) support service accessibility, (b) diversity of support services, and (c) community. Parents reported that financial pressures, geographic location, and service flexibility influenced their ability to obtain support services. Implications for service delivery and areas for future research are discussed.

BackgroundPeople with intellectual and sensory or sensory-motor disabilities tend to have problems performing multistep tasks. To alleviate their problems, technological solutions have been developed that provide task-step instructions. Instructions are generally delivered at people’s request (eg, as they touch an area of a computer or tablet screen) or automatically, at preset intervals. ObjectiveThis study carried out a preliminary assessment of a new tablet-based technology system that presented task-step instructions when participants with intellectual and sensory disabilities walked close to the tablet (ie, did not require participants to perform fine motor responses on the tablet screen). MethodsThe system entailed a tablet and a wireless camera and was programmed to present instructions when participants approached the tablet, that is, when the camera positioned in front of the tablet detected them. Two instructions were available for each task step. One instruction concerned the object(s) that the participants were to collect, and the other instruction concerned the “where” and “how” the object(s) collected would need to be used. For 3 of the six participants, the two instructions were presented in succession, with the second instruction presented once the required object(s) had been collected. For the other 3 participants, the two instructions were presented simultaneously. Instructions consisted of pictorial representations combined with brief verbal phrases. The impact of the system was assessed for each of the 2 groups of participants using a nonconcurrent multiple baseline design across individuals. ResultsAll participants were successful in using the system. Their mean frequency of correct task steps was close to or above 11.5 for tasks including 12 steps. Their level of correct performance tended to be much lower during the baseline phase when they were to receive the task-step instructions from a regular tablet through scrolling responses. ConclusionsThe findings, which need to be interpreted with caution given the preliminary nature of the study, suggest that the new tablet-based technology system might be useful for helping people with intellectual and sensory disabilities perform multistep tasks.

We surveyed New Zealand parents of autistic children to identify their perceived barriers and facilitators to accessing support services, including the influence of a family's level of financial resourcing. A total of 173 completed surveys were analysed. Service pathway factors were the greatest barrier experienced by participants, whereas facilitators related to providers tended to be most helpful. Lower family income was associated with a higher number of reported barriers. Both lower family income and having a child who identified their gender as non-binary were predictive of rating the extent of barriers higher. Parents of younger or of non-speaking autistic children on average reported a greater number of facilitators. Implications of these results for support service delivery and potential areas for future research are discussed.

Due to loss of spoken language and resulting complex communication needs, people with Rett syndrome are obvious candidates for communication intervention. To advance evidence-based practice and guide future research efforts, we identified and summarized 16 communication intervention studies published since a previous 2009 review on this topic. Studies were summarized in terms of (a) participants, (b) dependent variables related to communication, (c) intervention characteristics, (d) outcomes, and (e) certainty of evidence. Across the 16 studies, intervention was provided to a total of 100 participants from 3 to 47 years of age. Half of the studies used systematic instruction to teach aided AAC. Other interventions and associated technologies included music therapy, eye tracking technology, and transcranial stimulation. Positive outcomes (e.g., using AAC devices to make requests and/or initiate social-communication interactions) were reported in 13 of the studies. These 16 new studies provide additional guidance on how to enhance the communicative functioning of people with Rett syndrome. Future research directions are highlighted.

Objectives: The present study evaluated a new smartphone-based program to help 12 participants with intellectual disability plus visual and motor impairments to self-regulate their stimulation input (thus avoiding their dependence on staff) through simple non-verbal responses. Method: Nonconcurrent multiple baseline designs across participants were used to assess the effects of the program. The technology used for the program involved a Samsung J4 Plus smartphone with Android 9.0 operating system, two voice recording devices, smart-plugs, and a mini speaker. The smartphone was provided with a Google account and Internet connection, which allowed the participants to access Google Assistant and Google Play Music. The participants could make requests for two different types of stimulation (e.g. songs and familiar voices or noises) by activating via hand pressure the two voice recording devices. The verbal request messages emitted by the devices were recognized by the Google Assistant, which led the smartphone to deliver the related stimulation. Results: During the baseline sessions (without the support of the voice recording devices), the participants failed to access any stimulation. During the intervention and post-intervention phases (with the support of the voice recording devices), all participants managed to access the types of stimulation available independently. The mean frequency of responses (i.e. activations of both voice recording devices) per session ranged between about 8 and 14. Conclusion: The new smartphone-based program can be viewed as a useful resource to enable individuals like the participants of this study to access preferred stimulation independently.

The Early Start Denver Model (ESDM) is a promising early intervention for promoting improved social, cognitive, and communication outcomes for young children with autism spectrum disorder (ASD). However, most studies evaluating group-based delivery of this program have used 15-25 h per week of intervention in specialized ESDM preschools with low child-teacher ratios. Thus, the positive results from such studies might not be obtained when this intervention model is evaluated in more typical inclusive preschool settings. In this study, a low-intensity version of the ESDM was delivered to three young children with ASD in their regular inclusive preschool by a certified therapist who did not typically work at any of the preschools. The intervention procedures were implemented for 3 h per week over an 8- to 10-week period. Data were gathered on children's levels of participation, imitation, and communication from weekly 10-min video recordings. The effects of the intervention were evaluated using a multiple probe across participants design with 3 weekly follow-up probes, 3 weeks after the intervention ended. All participants showed improvement in active participation, imitation and either intentional vocalizations or spontaneous functional utterances. These results were generally maintained at follow-up. This low-intensity version of the ESDM would seem effective for use in real-world preschool environments.

ObjectiveThis study aimed to help six participants with intellectual disability combined with sensory and motor impairments to make verbal requests through the use of a technology system involving cardboard chips and a smartphone.MethodThe participants were divided into two groups of three based on whether they did or did not have visual skills. Each group was exposed to the intervention with the technology system according to a non-concurrent multiple baseline across participants design. During the 20 min intervention sessions, the participants were provided with a smartphone and nine cardboard chips each of which had a picture or object (i.e., a mini object replica or raised object contour) and several radio frequency identification tags attached to it. To make a request, the participants were to bring a cardboard chip in contact with the smartphone. This read the tags attached to the cardboard and verbalized the request related to that cardboard.ResultsDuring the baseline (without cardboard chips and smartphone), the participants’ mean frequency of independent requests (all non-verbal requests) varied between zero and near 1.5 per session. During the intervention (with cardboard chips and smartphone), the participants’ mean frequency of independent requests (all verbal requests) varied between over 4.5 and about 10 per session.ConclusionThe results suggest that the system might be useful to help participants like the ones included in this study to make verbal requests with simple responses.

PurposeLamb-Shaffer syndrome (LAMSHF) is a neurodevelopmental disorder described in just over two dozen patients with heterozygous genetic alterations involving SOX5, a gene encoding a transcription factor regulating cell fate and differentiation in neurogenesis and other discrete developmental processes. The genetic alterations described so far are mainly microdeletions. The present study was aimed at increasing our understanding of LAMSHF, its clinical and genetic spectrum, and the pathophysiological mechanisms involved.MethodsClinical and genetic data were collected through GeneMatcher and clinical or genetic networks for 41 novel patients harboring various types ofSOX5 alterations. Functional consequences of selected substitutions were investigated.ResultsMicrodeletions and truncating variants occurred throughout SOX5. In contrast, most missense variants clustered in the pivotal SOX-specific high-mobility-group domain. The latter variants prevented SOX5 from binding DNA and promoting transactivation in vitro, whereas missense variants located outside the high-mobility-group domain did not. Clinical manifestations and severity varied among patients. No clear genotype-phenotype correlations were found, except that missense variants outside the high-mobility-group domain were generally better tolerated.ConclusionsThis study extends the clinical and genetic spectrum associated with LAMSHF and consolidates evidence that SOX5 haploinsufficiency leads to variable degrees of intellectual disability, language delay, and other clinical features.

Immigrants have poorer health outcomes due in part to limited access to health care. Children with autism spectrum disorder (ASD) who have immigrant parents are diagnosed at a later age and those whose parents have limited English proficiency receive fewer hours of services. What contributes to these health care and support services disparities? This review examined eight qualitative studies published between 2010 and 2020 that explored barriers experienced by immigrant parents of children with ASD with regard to accessing diagnostic and/or intervention services. Key barriers included long wait times, language barriers, and limited health literacy. Recommendations for practice and future research are discussed.

This study examined the effectiveness of Self-Regulated Strategy Development (SRSD) to improve students' ability to write expository essays after reading social studies text. Third-grade general education teachers (N = 14) were randomly assigned by clusters to SRSD or a business as usual control condition. One hundred and eighty consented students participated in the full study. Teachers in the SRSD condition participated in 12 h of practice-based professional development (PBPD) before implementing the SRSD intervention. They also received 30-min biweekly coaching sessions across the 16 weeks of the study. Initially, teachers provided SRSD strategy instruction in TIDE ("Topic Sentence, Important Details, Explain Details, Ending") for planning and writing expository essays. Then, teachers spent an additional 8 weeks teaching students to use TIDE for creading, planning, and writing expository essays using social studies text. Multilevel random effects models indicated SRSD students included more genre elements in their expository essays (ES[subscript g] = 1.07) and produced essays of higher holistic quality (ES[subscript g] = 0.72) than control students when writing an expository essay using a source text. Students in the SRSD condition also included more genre elements when writing an expository essay drawing content from memory (ES[subscript g] = 1.09), and outperformed control students on a norm-referenced writing measure (ES[subscript g] = 0.79). Findings support implementation of the SRSD intervention in general education classrooms within content-areas and underscore future directions for combining writing, reading, and social studies instruction.

Summary: In behavioral research and clinical practice video data has rarely been shared or pooled across sites due to ethical concerns of confidentiality, although the need of shared large-scaled datasets remains increasing. This demand is even more imperative when data-heavy computer-based approaches are involved. To share data while abiding by privacy protection rules, a critical question arises whether efforts at data de-identification reduce data utility? We addressed this question by showcasing an established and video-based diagnostic tool for detecting neurological deficits. We demonstrated for the first time that, for analyzing infant neuromotor functions, pseudonymization by face-blurring video recordings is a viable approach. The redaction did not affect classification accuracy for either human assessors or artificial intelligence methods, suggesting an adequate and easy-to-apply solution for sharing behavioral video data. Our work shall encourage more innovative solutions to share and merge stand-alone video datasets into large data pools to advance science and public health.

BackgroundPeople with motor, visual, and intellectual disabilities may have serious problems in independently accessing various forms of functional daily occupation and communication. ObjectiveThe study was aimed at developing and assessing new, low-cost technology-aided programs to help people with motor or visual-motor and intellectual disabilities independently engage in functional forms of occupation and communication with distant partners. MethodsTwo programs were set up using a smartphone interfaced with a 2-switch device and a tablet interfaced with 2 pressure sensors, respectively. Single-subject research designs were used to assess (1) the first program with 2 participants who were blind, had moderate hand control, and were interested in communicating with distant partners through voice messages; and (2) the second program with 2 participants who possessed functional vision, had no or poor hand control, and were interested in communicating with their partners through video calls. Both programs also supported 2 forms of occupational engagement, that is, choosing and accessing preferred leisure events consisting of songs and music videos, and listening to brief stories about relevant daily topics and answering questions related to those stories. ResultsDuring the baseline phase (when only a conventional smartphone or tablet was available), 2 participants managed sporadic access to leisure or leisure and communication events. The other 2 participants did not show any independent leisure or communication engagement. During the intervention (when the technology-aided programs were used), all participants managed to independently engage in multiple leisure and communication events throughout the sessions and to listen to stories and answer story-related questions. ConclusionsThe findings, which need to be interpreted with caution given the nature of the study and the small number of participants, seem to suggest that the new programs may be viable tools for helping people with motor or visual-motor and intellectual disabilities independently access leisure, communication, and other forms of functional engagement.

People with severe/profound and multiple disabilities may receive insufficient stimulation and correspondingly show low levels of happiness (satisfaction). Various stimulation strategies have been proposed to address this situation. This study aimed to extend the assessment of two of those strategies (i.e., self-regulated and staff-regulated stimulation strategies) with 12 participants who were exposed to each strategy. During intervention sessions with self-regulated stimulation, the participants sat at a desk and received stimulation if they pushed a panel in front of them thus activating a smartphone's proximity sensor. During intervention sessions with staff-regulated stimulation, they sat at a desk and received stimulation independent of any response. All participants showed increases in indices of satisfaction with self-regulated stimulation. Nine of them also showed such increases with staff-regulated stimulation. The participants' level of satisfaction during self-regulated stimulation sessions was frequently higher than that observed during staff-regulated stimulation sessions. Staff personnel interviewed about the two strategies provided higher scores for self-regulated stimulation. The self-regulated stimulation strategy may be considered preferable to the staff-regulated stimulation strategy because of its impact on participants' satisfaction and active responding.

Parents are the logical intervention agents for young children with autism spectrum disorder (ASD). The early start Denver model (ESDM) is a promising early intervention approach for children with ASD that can be implemented by parents. This study evaluated the effects of training parents in the use of the ESDM. We used a non-concurrent multiple probe across participants design to evaluate the effects of providing five mothers of young children with ASD with one hour per week of training for 12 weeks. Outcome measures included mothers use of the ESDM techniques and measures of the children's levels of engagement and imitation, and expressive language skills. Maintenance of outcomes after one month was also assessed. Results showed four of the five mothers increased the percentage of ESDM techniques that they were using usually or consistently. Four of the five children showed some improvement on at least one of the child outcome measures. This suggests mixed results for supporting parents in the use of the ESDM. Implications and future research directions are discussed.

Helping people with intellectual and visual disabilities engage in activity and mobility is considered crucially important to promote constructive occupation and a basic form of physical exercise (i.e., objectives that are essential for the individuals' wellbeing and in line with their rights). This study assessed two new programs aimed at helping eight participants with intellectual and visual disabilities (four in each program) to independently move through specific indoor destinations, collect and transport objects, and access stimulation events (e.g., music) with the support of technology systems involving a smartphone linked to mini cameras and speakers. The second program was more advanced than the first and (a) required the participants to discriminate the objects used and transport two (rather than one) of them before any stimulation event, and (b) included telephone calls to and stories from preferred communication partners among the stimulation events. Each program was implemented using a single-case research design (i.e., a non-concurrent multiple baseline design across participants). The results showed that both programs were effective in enabling the participants to collect, transport, and put away objects and access stimulation independently during 20-min sessions. Based on the results, both programs might be considered useful tools to help people with intellectual and visual disabilities manage independent activity and mobility. [ABSTRACT FROM AUTHOR]

The study assessed a new interactive technology system for helping six people with intellectual and visual disabilities exercise relevant physical responses embedded within a fairly straightforward activity (i.e., placing objects in containers). Activity responses consisted of the participants taking objects from the floor or a low shelf and placing those objects in a container high up in front of them (thus bending their body and legs and stretching their arms and hands). The technology involved a portable computer, a webcam, and three mini speakers whose basic functions included monitoring the participants’ responses, delivering preferred stimulation contingent on the responses and verbal encouragements/prompts for lack of responses, and assisting in data recording. The study was conducted following a non-concurrent multiple baseline design across participants. During baseline (i.e., when the system was used only for data recording), the participants’ mean frequency of responses per session varied between zero and nearly 12. During intervention (i.e., when the system was fully working), the participants’ mean frequency of responses per session increased to between about 34 and 59. Mean session duration varied between nearly 10 and over 14 min. The new system may be a valuable tool for supporting relevant physical activity engagement in people with intellectual and multiple disabilities.

Purpose: Children with autism spectrum disorder (ASD) and complex communication needs are increasingly taught to use tablet-based speech-generating devices (SGDs). An important issue in designing such interventions is the selection of an appropriate format for displaying vocabulary. The purpose of this study was to determine (a) whether young children with ASD can be taught to use different SGD vocabulary display formats and (b) whether there are differences across the formats on a range of secondary measures (e.g., preference and generalization). Method: Five preschoolers with ASD (and prior experience with simpler aided augmentative and alternative communication) were taught to use grid and visual scene display SGDs during a play-based intervention. Acquisition of functional responding was assessed using a single-case experimental design. Secondary variables included error types, antecedents for communication, preference, and generalization. Results: All participants increased their use of functional target vocabulary using both the grid and the simple visual scene display. Of the five participants, three showed similar performance with both formats, whereas two had slightly higher rates of functional responding with the grid. Individualized differences across participants and formats were apparent across secondary variables (e.g., preference, error types, generalization). Conclusions: Both simple grid and visual scene displays may be viable options when teaching functional use of SGDs to children with ASD who have prior aided augmentative and alternative communication experience. Analyzing secondary variables beyond device acquisition (e.g., generalization, preference) may have implications for individualizing intervention.

Issues with sleep onset and maintenance are common among many children and adolescents with developmental disabilities. A lack of experienced practitioners, financial cost, and practical issues associated with providing parent coaching in the family home during evenings pose a number of barriers to successful sleep intervention. Telehealth interventions represent a potential approach for facilitation of the delivery of treatments for sleep problems in children and adolescents that may alleviate some of the challenges of delivering services equitably and in a timely manner. In the present review, we systematically searched for, summarized, and appraised the quality of ten studies that have used telehealth interventions for the treatment of sleep problems in children and adolescents. The majority of studies used Web-based platforms to deliver content as part of a multi-component intervention. For children, interventions were parent mediated; however, adolescents engaged directly in the intervention process, which typically included cognitive behavioral therapy for insomnia. Each of the studies reported positive overall treatment effects though only five of the studies met criteria that reflected strong methodological rigor, thus limiting the strength of the conclusions. This review identifies current telehealth practices and areas for future research.

Contemporary parent-implemented early intervention programs for children with autism spectrum disorder usually incorporate a range of techniques with different theoretical underpinnings. While research suggests that parents often learn to implement interventions with an acceptable degree of overall fidelity, there is limited research into parent use of individual intervention techniques. This study included five mothers of young children with autism spectrum disorder who participated in a 12-week parent training program based on the Early Start Denver Model. Ten-minute play samples were coded for the mothers' use of 18 specific Early Start Denver Model techniques before, during, and 1 month after the training program. The correlation between the mothers' use of each Early Start Denver Model technique and their child's level of engagement and expressive language was also calculated. Results suggest that all mothers increased the number of techniques that they were using from baseline to parent training. Some Early Start Denver Model techniques were moderately or strongly correlated with both child engagement and expressive language. There was considerable variation in outcomes across all mother--child dyads. These preliminary results have implications for how parents are trained/coached to implement interventions for young children with autism spectrum disorder.

Objectives: This study assessed a new technology-aided program to support independent leisure and communication engagement with people with intellectual and motor or sensory-motor disabilities. Methods: Six adults participated. The program relied on the use of a Samsung Galaxy Tab S2 LTE tablet with Android 6.0 Operating System, a NANO SIM card, and the WhatsApp Messenger and MacroDroid applications. The participants were presented with leisure and communication (i.e. text messaging) alternatives, and, based on their choices, with series of steps allowing them to access leisure events or send messages. Results: During baseline, the participants were unable to access leisure events or send messages. During intervention and post-intervention phases, they used the program successfully and spent large percentages of the session time independently engaged in leisure and messaging. Conclusions: A program based on readily available technology may be functional to support leisure and communication in people like the participants of this study.

There is a need for research that evaluates the effectiveness of early intervention when delivered in inclusive preschools. In this study, 3 regular preschool teachers were trained to use the Early Start Denver Model with a child with autism spectrum disorder who attended an inclusive preschool. Each teacher worked with 1 child. Teachers received eleven 60-min coaching sessions based on an adapted version of the Early Start Denver Model's parent coaching program. A multiple baseline across participants design was used to evaluate effectiveness in terms of teachers' use of the early intervention techniques and children's levels of participation, imitation, and communication. Data were collected via weekly 10-min video recordings, with 3 follow-up probes conducted 11 weeks following intervention. Teachers improved in their use of early intervention techniques, and children demonstrated improved levels of active participation, but results for child imitation and communication were mixed. Positive results were generally maintained at follow-up. This study provides preliminary support for the effectiveness and feasibility of using a modified coaching program to train preschool teachers to use early intervention techniques from the Early Start Denver Model.

Children with autism spectrum disorder (ASD) who have limited speech are often taught to communicate using a speech-generating device (SGD). We evaluated procedures for teaching a mand for information (i.e., "Where" is [item]?) using an interrupted behavior chain procedure. In Experiment 1, all participants (3 children with ASD who communicated using an SGD) acquired the target mand but transfer to a novel stimulus did not occur. In the second experiment, 2 participants were taught to approach alternative communication partners when the first partner did not provide the information. The second experiment also included procedures to test whether the responses were under the control of appropriate motivating operations (MOs). Generalization across communication partners occurred with both participants, but transfer across behavior chains with only 1 participant. The results of both experiments suggest that teaching multiple behavior chains and evaluating MO control may be necessary to establish generalized manding for information.

Objectives: Data indicate that some developmentally and behaviorally based early intervention programs can lead to a range of improvements in children with autism spectrum disorder. However, many such programs call for a fairly intensive amount of intervention. The objective of this preliminary study was to evaluate the effectiveness of a low-intensity therapist delivered intervention for young children with autism spectrum disorder. Methods: The study evaluated the outcomes of 3 hours per week of therapist-delivered early start Denver model intervention (ESDM) over a 12-week period for four preschool-aged boys with autism spectrum disorder. The effects of intervention on communication, imitation, and engagement were evaluated using a non-concurrent multiple probe across participants design. Results: Following the intervention, all four children showed increases in imitation, engagement, and either functional utterances or intentional vocalizations. These results were maintained after 4 weeks and mostly generalized to each child's mother. Conclusion: These preliminary results suggest that low-intensity therapist delivered ESDM intervention may be of some benefit to children with autism spectrum disorder.

Early intervention is widely recommended for young children with autism spectrum disorder, but the effectiveness of interventions when implemented in inclusive preschool settings needs to be considered. To this end, we identified 16 studies that provided early intervention to children with autism spectrum disorder who were attending inclusive preschools. Effectiveness studies, that is, studies evaluating interventions that were implemented under real-world conditions, were targeted, provided they met the pre-determined inclusion criteria. Included studies were summarized in terms of (a) participant characteristics, (b) intervention procedures, (c) procedures for training teachers, (d) study design, (e) outcomes, (f) study quality, and (g) social validity. A range of intervention procedures were implemented, and positive outcomes for children and/or teachers were reported in most studies. However, methodological limitations were identified for most of the included studies, indicating the need for additional higher-quality research. Still, the present review suggests that teachers may be able to effectively deliver early intervention to young children with autism spectrum disorder in inclusive preschool settings.