Learning by Doing and Learning by Observing: Training Parents in Saudi Arabia to Implement the Natural Language Paradigm

The present study trained six parents of children with Autism Spectrum Disorder to implement the Natural Language Paradigm in Saudi Arabia. Three of the parents participated in direct training using a Behavioral Skills Training (BST) model involving instructions, modeling, rehearsal, and feedback. As each of the three parents were being trained directly an additional parent observed the training (i.e., there were three trainee-observer dyads). While all of the parents learned from observing other parents being trained directly, only one observer met the predetermined performance criteria after observation alone, with the other two requiring direct training using BST. The parents demonstrated maintenance of their skills at follow-up, and social validity evaluations were strong. In addition, all parents implemented the NLP procedures at mastery criteria in another setting during generalization probes. Implications for further training research are provided.     

Training Educational Staff in Functional Behavioral Assessment: A Systematic Review

Interventions for challenging behavior are more likely to be effective when based on the results of a functional behavioral assessment. Research to date suggests that staff members in educational settings may not have the requisite levels of expertise or support to implement behavioral assessment procedures and design corresponding behavior support plans. The current review sought to examine the nature and effectiveness of Functional Behavioral Assessment (FBA) training described in the literature. Twenty-five studies were examined in relation to type of FBA method used, training procedure, behavioral function and intervention outcome. Training was provided in indirect, observational and experimental functional assessment procedures. Video modeling, lectures, feedback and written protocols were some commonly used training procedures. Interventions derived from results of these assessments were used in twelve studies to treat problem behavior. Social validity and treatment integrity outcomes across all studies are reported. The implications of these findings for research and practice are discussed along with directions for future research.     

Naturalistic Communication Training for Early Intervention Providers and Latinx Parents of Children with Signs of Autism

In this study, researchers implemented a brief training plus coaching program in naturalistic developmental behavioral intervention with three participant triads. Each triad consisted of an early intervention provider, an English-speaking Latinx parent, and that parent’s young child with autism spectrum disorder (ASD) or early signs of ASD who had limited vocal speech. The effects a single training session, plus two researcher coaching sessions were evaluated using a nonconcurrent multiple probes across participants design. Primary dependent variables included (a) the number of completed targeted communication turns between the parent and child and (b) the number of child independent target communication responses (gestures and manual signs) during family-selected routines. Additional measures examined whether parents used strategies taught to them during training, and whether early intervention providers addressed strategies taught via coaching. A social validity measure was used to determine parent and provider views of the training. Due to COVID-19 restrictions, training and post-training sessions were delivered via telehealth for two triads. While data trends and variability differed across triads, following training, all three families increased the number of completed target communication turns and all three children showed higher rates of independent communication responses. Parents and providers implemented strategies taught and reported positive effects of the program. Implications regarding the use of naturalistic intervention methods for Latinx families, the utility of brief training models to meet the needs of under-resourced early intervention programs, and potential uses of telehealth are discussed.

     

Evaluating parent use of functional communication training to replace and enhance prelinguistic behaviours in six children with developmental and physical disabilities

PURPOSE: To evaluate parent use of functional communication training (FCT) to replace and enhance prelinguistic behaviours in six young children with developmental and physical disabilities. METHOD: Initially, the communicative functions of the children's prelinguistic behaviours were assessed by parent interviews. Three communication functions were identified for each child and intervention goals to replace or enhance the child's existing prelinguistic behaviours were developed in consultation with parents. After a baseline phase, parents received training on implementation of FCT. Intervention was staggered across the three communicative functions in a multiple-probe design. RESULTS: Intervention was associated with increases in the replacement communication behaviour. Treatment gains were generally maintained at the monthly follow-ups. CONCLUSION: The results suggest that parents can use FCT to enhance communication skills in children with developmental and physical disabilities.     

Evaluating parent use of functional communication training to replace and enhance prelinguistic behaviours in six children with developmental and physical disabilities

Purpose: To evaluate parent use of functional communication training (FCT) to replace and enhance prelinguistic behaviours in six young children with developmental and physical disabilities. Method: Initially, the communicative functions of the children's prelinguistic behaviours were assessed by parent interviews. Three communication functions were identified for each child and intervention goals to replace or enhance the child's existing prelinguistic behaviours were developed in consultation with parents. After a baseline phase, parents received training on implementation of FCT. Intervention was staggered across the three communicative functions in a multiple-probe design. Results: Intervention was associated with increases in the replacement communication behaviour. Treatment gains were generally maintained at the monthly follow-ups. Conclusion: The results suggest that parents can use FCT to enhance communication skills in children with developmental and physical disabilities.     

Evaluating parent use of functional communication training to replace and enhance prelinguistic behaviours in six children with developmental and physical disabilities

Purpose: To evaluate parent use of functional communication training (FCT) to replace and enhance prelinguistic behaviours in six young children with developmental and physical disabilities. Method: Initially, the communicative functions of the children's prelinguistic behaviours were assessed by parent interviews. Three communication functions were identified for each child and intervention goals to replace or enhance the child's existing prelinguistic behaviours were developed in consultation with parents. After a baseline phase, parents received training on implementation of FCT. Intervention was staggered across the three communicative functions in a multiple-probe design. Results: Intervention was associated with increases in the replacement communication behaviour. Treatment gains were generally maintained at the monthly follow-ups. Conclusion: The results suggest that parents can use FCT to enhance communication skills in children with developmental and physical disabilities.     

Effects of Communication Skills Training on Parents and Young Adolescents From Extreme Family Types

PROBLEM What were the effects of a communication skills training intervention among a sample of young adolescents and parents who scored in the “extreme” range of the Circumplex Model of Family Systems? METHODS Thirty‐seven young adolescents and a parent (intervention group) participated in communication skills training 2 hours/week for 6 weeks. Their responses on measures of satisfaction with the family system and perceptions of communication were compared with those of 47 young adolescents and a parent who scored in the extreme range but did not participate in the training (control group). FINDINGS Fathers and young adolescents demonstrated no change as a result of the program. Mothers who participated in skills training perceived communication with their young adolescent as more open than control mothers, but became increasingly dissatisfied with the family system. CONCLUSION This universal, community‐based, family‐focused intervention may not be indicated for extreme families.     

Treating a Child’s Selective Eating Through Parent Implemented Feeding Intervention in the Home Setting

Although many children with developmental disabilities have food selectivity, few studies have evaluated in-home parent training to address this feeding problem. In the present case, a parent learned to implement a multicomponent feeding intervention with her child through home-based training provided by a consultant. Using a changing criterion evaluation design, the child’s consumption of previously rejected foods increased during the two-phase intervention that combined antecedent and positive reinforcement procedures. The benefits of “natural context” parent training for the treatment of child-feeding problems are discussed.     

Educational Priorities for Individuals with Angelman Syndrome: A Study of Parents’ Perspectives

The priorities of parents of children with intellectual disability should be considered when selecting educational goals. To this end, 77 parents of children with Angelman syndrome (AS) completed a questionnaire that involved rating their child’s abilities and prioritizing educational goals across a range of adaptive and maladaptive domains. A factor analysis was used to determine if parents prioritized the training of skills in which their child showed a major, moderate or minor deficit. Results suggest that skills related to communication, recreation, self-care, motor and academic domains are high priorities. Further, parents of children under the age of 18 indicated that communication skills were a high priority, whereas parents of adults also prioritized daytime activity skills (e.g., swimming and cycling). Training for communication, recreational and ingestion skills was prioritized when children showed emerging skills; training for motor skills was prioritized when children were highly dependent; and training for self-care skills was prioritized when children were more independent in the self-care domain. In terms of behavioral problems, sleep and eating problems were prioritized.     

Parent implemented early intervention for young children with autism spectrum disorder: a systematic review

BACKGROUND: Recent estimates concerning the prevalence of autism spectrum disorder (ASD) suggest that at least one in 200 children is affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children. METHODS: This research review focused on interventions for children aged 1-6 years, and was carried out using systematic methodology: a comprehensive search of psychological, educational and biomedical databases, as well as bibliographies and reference lists of key articles, contact with experts in the field, and hand search of key journals. Only studies which involved a concurrent element of control were included. RESULTS: The review found very few studies that had adequate research design from which to draw conclusions about the effectiveness of parent-implemented early intervention. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression. CONCLUSION: It seems that parent training can successfully contribute to intervention for young children with ASD. However, the review highlights the need for improved research in this area.     

Treatment of behavior disorders by parents and in the home

Children's behavior disorders are particularly stressful on families. Such behavior disorders may result from coercive family interactions and at the same time contribute to family dysfunction. This unfortunate cycle often results in child abuse, later delinquency, and continued use of aggression and violence in later life. Training parents to use effective behavior control procedures can prevent future and more serious behavior problems. Behavioral procedures that have been effectively applied by parents in the home include differential attention, timeout, token economies, daily report card systems, and contingency contracting. Siblings have also been effective in treating behavior disorders as have the behavior disordered children themselves. A variety of parent training programs have been implemented with individuals and groups. Parent training appears to be most effective when provided early in the child's life, when follow-up assistance is provided and gradually reduced, and when parents use self-management procedures to plan, rearrange, and monitor their own parenting environment.     

Fidelity Outcomes for Autism-Focused Interventionists Coached via Telepractice: a Systematic Literature Review

The purpose of this review was to synthesize fidelity features in telepractice studies focused on parent-, educator-, and therapist-directed treatments for individuals with autism spectrum disorder (ASD). A systematic search identified 19 studies for inclusion. Studies were summarized according to participant characteristics, dependent variables, training procedures, implementation fidelity of the intervention, intervention fidelity for the participants, outcomes for the individuals with ASD, generalization and maintenance of fidelity outcomes, study design, and social validity. Results indicate a variety of assessments and interventions were targeted for coaching with a variety of coaching procedures. All of the studies reported that participants were able to implement the assessment or intervention with increased fidelity following the training program. However, results were mixed in four studies in which some participants needed additional training beyond the intervention to meet the authors’ preset performance standards. Implementation fidelity of the training procedures was not well reported. Overall, this developing literature base is best described as limited due to the small number of studies and the variability in procedures.     

Transferring AAC intervention to the home

PURPOSE: To evaluate the acquisition of AAC skills during an initial clinical trial and assess subsequent transfer of the training to the home setting. METHOD: A 12-year-old male with autism was first seen in a clinical setting to establish the use of a voice-output communication device. After learning to use the device to request access to preferred objects in the clinical trial, the intervention was transferred to the home. Follow-up with the parent was conducted via e-mail and telephone. Videotapes were made of initial home-based sessions to enable evaluation of the participant's progress. RESULTS: The programme was successful in teaching the participant to use a portable AAC device to make requests during the clinical trial and then in two home-based activities. CONCLUSION: An initial clinical trial with follow-up support for parents may be an efficient method for beginning AAC intervention and transferring the training procedures to the home setting.     

Parent Education: An Evaluation of STEP on Abusive Parents''Perceptions and Abuse Potential

PROBLEM: To examine the effects of a structured, time-limited parent training group on abusive or potentially abusive parents. METHODS: A pretest-posttest control group design was used with consenting parents (N = 18) to examine the effects of Systematic Training for Effective Parenting (STEP) on abusive parents' perceptions of their children's behaviors and on the parents' potential to physically abuse. The Adlerian Parental Assessment of Child Behavior Scale and the Child Abuse Potential Inventory were used to measure treatment effects. FINDINGS: After participating in STEP, abusive parents had significantly more positive perceptions of their children and were significantly less potentially abusive. Using volunteers, the project cost an average of $100 for each parent. CONCLUSIONS: The research lends empirical support to individual psychology and family systems theory. Future research is indicated using larger samples to examine lay vs. professional leadership of the groups, as well as comparisons of different parenting programs with abusive parents.     

Telephone counseling to implement best parenting practices to prevent adolescent problem behaviors

There is considerable suggestive evidence that parents can protect their adolescents from developing problem behaviors if they implement recommended best parenting practices. These include providing appropriate limits on adolescent free time, maintaining a close personal relationship with the adolescent, and negotiating and providing incentives for positive behavior patterns. However, retention of the study samples has limited conclusions that can be drawn from published studies. This randomized controlled trial recruited and randomized a national population sample of 1036 families to an intensive parenting intervention using telephone counseling or to a no-contact control group. At enrollment, eligible families had an eldest child between the ages of 10-13 years. The intervention included an initial training program using a self-help manual with telephone counselor support. Implementation of best parenting practices was encouraged using quarterly telephone contacts and a family management check-up questionnaire. A computer-assisted structured counseling protocol was used to aid parents who needed additional assistance to implement best practices. This, along with a centralized service, enabled implementation of quality control procedures. Assessment of problem behavior is undertaken with repeated telephone interviews of the target adolescents. The study is powered to test whether the intervention encouraging parents to maintain best parenting practices is associated with a reduction of 25% in the incidence of problem behaviors prior to age 18 years and will be tested through a maximum likelihood framework.     

Longitudinal Analysis of Parent Communication Behaviors and Child Distress during Cancer Port Start Procedures

Background: The roles parents play in supporting their child during painful cancer procedures have been studied as communication strategies versus a broader caring framework and from a cross-sectional versus longitudinal perspective. Objectives: To examine the longitudinal change in parent communication behaviors over repeated cancer port start procedures experienced by their children. Methods: This study used a longitudinal design. Two trained raters coded 104 recorded videos of port starts from 43 children being treated for cancer. This included 25 children with two video-recorded port starts and 18 children with three (T1, T2, T3). The Parent Caring Response Scoring System derived from Swanson's Caring Theory was used to code parent communication behaviors as caring responses during their children's port starts. Three 3- to 5-minute slices (pre–port start, during, and post–port start) were coded for each video. Mixed modeling with generalized estimating equations and Friedman test were used to analyze longitudinal change in parent behaviors. Results: Significant differences were found between T1 versus T3 in eye contact (β = −1.05, p = .02), distance-close-enough-to-touch (β = −0.81, p = .03), nonverbal comforting (β = −1.34, p = .04), and availability (β = −0.92, p = .036), suggesting that more parents used communication behaviors at T3 compared with T1. Parent burdensome or intrusive questions (e.g., Why do you cry? β = −1.11, p = .03) and nonverbal comforting (β = −1.52, p = .047) increased from T2 to T3. The median values of parent communication behaviors overall had no significant changes from T1 to T3. Conclusion: Parents adjusted to use more nonverbal caring behaviors as their child experienced additional port starts. Experimental studies should be designed to help parents use caring behaviors to better support their children during cancer procedures.     

Transferring AAC intervention to the home

Purpose: To evaluate the acquisition of AAC skills during an initial clinical trial and assess subsequent transfer of the training to the home setting. Method: A 12-year-old male with autism was first seen in a clinical setting to establish the use of a voice-output communication device. After learning to use the device to request access to preferred objects in the clinical trial, the intervention was transferred to the home. Follow-up with the parent was conducted via e-mail and telephone. Videotapes were made of initial home-based sessions to enable evaluation of the participant's progress. Results: The programme was successful in teaching the participant to use a portable AAC device to make requests during the clinical trial and then in two home-based activities. Conclusion: An initial clinical trial with follow-up support for parents may be an efficient method for beginning AAC intervention and transferring the training procedures to the home setting.     

Transferring AAC intervention to the home

Purpose: To evaluate the acquisition of AAC skills during an initial clinical trial and assess subsequent transfer of the training to the home setting. Method: A 12-year-old male with autism was first seen in a clinical setting to establish the use of a voice-output communication device. After learning to use the device to request access to preferred objects in the clinical trial, the intervention was transferred to the home. Follow-up with the parent was conducted via e-mail and telephone. Videotapes were made of initial home-based sessions to enable evaluation of the participant's progress. Results: The programme was successful in teaching the participant to use a portable AAC device to make requests during the clinical trial and then in two home-based activities. Conclusion: An initial clinical trial with follow-up support for parents may be an efficient method for beginning AAC intervention and transferring the training procedures to the home setting.     

Parenting stress and parents' willingness to accept treatment in relation to behavioral problems of children with attention-deficit hyperactive disorder

The purpose of this research was to explore parenting stress and parents' willingness to accept treatment in relation to the behavioral problems of children with Attention-Deficit Hyperactive Disorder (ADHD). A total of 100 subjects, either fathers or mothers of children with ADHD, were recruited by convenience sampling from southern Taiwan. The results of this research were: (1) the standardized score for parents' perception of the behavioral problems of their ADHD children was 67.09. (2) The standardized score for parents perception of parenting stress was 62.00. (3) The parents who were most willing to accept treatment were those in the parent training group. (4) The behavioral problems of ADHD children were significantly related to parenting stress (p .001). (5) ADHD children's behavioral problems and parental self-awareness of psychological and emotional problems were the two variables most influential on parenting stress, and recognition of the pathological cause was the most influential factor in willingness to accept treatment. Through this research we also found that the parents hoped that a parent training group would be established. Therefore, nursing personnel can try to develop parent training groups in order to relieve parents' parenting stress.     

The Effect of Group Intervention on the Relationships of Parents with Intellectual Disabilities

Background Parents with intellectual disabilities frequently feel socially excluded and often become dependent on statutory agencies for support. This study aimed to tackle these difficulties by means of a group intervention. Methods Group intervention was provided to 12 parents with borderline or mild intellectual disabilities over 14 weeks. The effects of intervention were evaluated by comparing the intervention group with a borderline or mild intellectual disabilities control parent group (n = 10). Both experimental parent group (EPG) and control parent group (CPG) received home‐based teaching programmes during this period. Parents' self‐concept and perception of the quality of relationship with their children, partners, family members and professionals were assessed (Judson Rating Scale and Behaviour Problem Index) during baseline, post‐intervention and at 27‐week follow‐up. Results The results indicate that self‐concept improved significantly for the EPG with no observable gains made by the CPG. However, the ‘feel good factor’ which came from improvements in parents' self‐concept did not immediately benefit their children. In addition, the quality of relationship between EPG parents and their children, as well as parents' expectations of their children's capabilities did not improve as a result of group intervention. Nonetheless, follow‐up data revealed that group training did result in (i) all of the EPG parents making new friends and (ii) other positive social and practical changes taking place within their families. Single parent status and the accumulative effect of multiple group attendance were identified as important factors affecting parents' perception of themselves and the quality of their relationships. Conclusions The immediate and long‐term benefits of group attendance for parents with intellectual disabilities and secondary benefits for their children are discussed.