Behavioral Parent Training via Telehealth for Autistic Children: Further Exploration of Feasibility During the COVID-19 Pandemic.

Objectives: Many autistic children exhibit challenging and disruptive behaviors that can present challenges for both children and their families by interfering with acquisition of adaptive skills and affecting family and peer relationships. Behavioral parent training (BPT) is an evidence-based approach to reducing autistic children's disruptive behavior, but many families face a number of barriers to accessing BPT, such as availability of BPT in their community, and transportation and scheduling challenges. Therefore, we sought to explore the feasibility and promise of effectiveness of adapting an established BPT program to a telehealth format during the COVID-19 pandemic. Methods: A feasibility trial of BPT via telehealth was conducted with fourteen parents of autistic children. Results: Parents and clinicians were able to implement BPT via telehealth with a high degree of fidelity, and parents rated both BPT and the telehealth format favorably. The program also showed promise of effectiveness in reducing autistic children's disruptive behavior, improving their adaptive skills, as well as reducing parents' stress, and improving parents' sense of parenting competence. Conclusions: The findings replicate and extend findings from previous studies, further demonstrating the promise of telehealth as a viable alternative format for delivering BPT. We also explore implications for future research, including the opportunity for more thorough evaluation of the effectiveness of BPT via telehealth.

Effect of Prearrival Orders on Time to Antibiotics for Immunocompromised Oncology Patients Presenting to the Emergency Department With Fever.

OBJECTIVE: Pediatric cancer patients with fever are at risk for invasive bacterial infection. The administration of antibiotics to these patients within the first hour of evaluation is viewed as a quality of care metric with potential to improve outcome. We sought to evaluate the impact of prearrival patient orders on the timeliness of antibiotic administration for this patient population presenting to the emergency department (ED) because of fever. METHODS: A single-site pediatric ED intervention study was performed. Four hundred thirty-nine consecutively referred febrile immunocompromised pediatric oncology patients were included in the study. The intervention used structured monthly messages sent to oncology and emergency medicine providers highlighting specific roles in prehospital communication and in ED-based care emphasizing the use of standardized, prearrival order (PAO) sets. Primary outcome measures were time to antibiotic administration (TTA) and the proportions of patients receiving PAO placement and antibiotics within 60 minutes of ED arrival. Results were analyzed for the preintervention (September 2016-July 2017), intervention (August 2017-February 2018), and postintervention (March-December 2018) periods. RESULTS: Improvements occurred across the study periods in the proportion of patients with PAO placement (preintervention, 68%; intervention, 82%; postintervention, 87%; P = 0.001) as well as in the percentages of patients receiving antibiotics in less than 60 minutes (preintervention, 73%; intervention, 84%; postintervention, 85%; P = 0.02). Median TTA decreased from 48 to 40 minutes ( P = 0.018). Linear regression with TTA as a dependent variable revealed that PAO placement predicted a shorter TTA, decreasing by more than 15 minutes ( B = -15.90; [95% confidence interval, -20.03--11.78]; P < 0.001). CONCLUSIONS: Standardizing elements of prehospital communication and ED-based care using PAO sets resulted in significant improvements in time to antibiotics and in the proportion of febrile immunocompromised oncology patients receiving antibiotics within 60 minutes of ED arrival.

Thinking Small to Think Big: Modular Approach for Autism Programming in Schools (MAAPS).

To date there are no evidence-based comprehensive interventions for use in school settings. There are numerous barriers to delivery of high-quality interventions in schools that have limited the transfer of research-based interventions to school settings. Modular Approach to Autism Programing for Schools (MAAPS) is a framework for implementation of evidence-based interventions in school settings that is designed to address these barriers. The development and initial evaluation of MAAPS was conducted using an implementation-science framework and results indicate that MAAPS is aligned with needs and resources available in schools, that it had excellent social validity, and that there is good evidence that MAAPS is effective for addressing core and associated features of autism in educational settings.

Advances in School-Based Interventions for Students With Autism Spectrum Disorder: Introduction to the Special Issue.

As the diagnosis of autism spectrum disorder has increased, so too has research on interventions to address core and associated features of autism. Although many methodologically rigorous studies on interventions have been reported, their relevance to educators is somewaht unclear. For example, only about 32% of evidence-based strategies identifed in these reviews were conducted in k-12 settings. Current literature also is limited in that, although many studies show that interventions can improve the communication and social interaction skills of individuals with autism, most of this work has been conducted with pre-school children; questions remain about the generality of these findings to school-aged children. Further, there are relatively few studies demonstrating effective interventions for restricted and repetitive behavior and much of this work was conducted in clinical settings. There is a need for studies documenting effective interventions that are feasible in school settings. The purpose of this special issue is two-fold. First, to highlight the need for school-based research with students with autism and second to highlight recent work delineating intervention strategies found to be effective in school settings.

Revised Ion/Substrate Coupling Stoichiometry of GABA Transporters.

The purpose of this review is to highlight recent evidence in support of a 3 Na+: 1 Cl-: 1 GABA coupling stoichiometry for plasma membrane GABA transporters (SLC6A1 , SLC6A11 , SLC6A12 , SLC6A13 ) and how the revised stoichiometry impacts our understanding of the contribution of GABA transporters to GABA homeostasis in synaptic and extrasynaptic regions in the brain under physiological and pathophysiological states. Recently, our laboratory probed the GABA transporter stoichiometry by analyzing the results of six independent measurements, which included the shifts in the thermodynamic transporter reversal potential caused by changes in the extracellular Na+, Cl-, and GABA concentrations, as well as the ratio of charge flux to substrate flux for Na+, Cl-, and GABA under voltage-clamp conditions. The shifts in the transporter reversal potential for a tenfold change in the external concentration of Na+, Cl-, and GABA were 84 ± 4, 30 ± 1, and 29 ± 1 mV, respectively. Charge flux to substrate flux ratios were 0.7 ± 0.1 charges/Na+, 2.0 ± 0.2 charges/Cl-, and 2.1 ± 0.1 charges/GABA. We then compared these experimental results with the predictions of 150 different transporter stoichiometry models, which included 1-5 Na+, 0-5 Cl-, and 1-5 GABA per transport cycle. Only the 3 Na+: 1 Cl-: 1 GABA stoichiometry model correctly predicts the results of all six experimental measurements. Using the revised 3 Na+: 1 Cl-: 1 GABA stoichiometry, we propose that the GABA transporters mediate GABA uptake under most physiological conditions. Transporter-mediated GABA release likely takes place under pathophysiological or extreme physiological conditions.

Recovery and assessment of leukocytes from LR Express filters.

Leukocytes, or white blood cells, are used for a variety of investigational purposes and they offer advantages over laboratory-adapted cell lines. Leukocytes that are typically discarded by blood banks during the collection of red blood cells, platelets, and plasma can often be obtained for research use. However, the available leukocytes are frequently contained within a blood filtration device, such as the Terumo LR Express (TLRE) filter. In this study, procedures were evaluated for the ability to elute viable leukocytes from TLRE filters. The recovered leukocytes were assessed for composition, growth, and functionality. The large majority (>70%) of leukocytes were eluted with a single reverse-elution procedure and the recovered cells contained representative populations of the major leukocyte subsets. Purified T cells exhibited diverse T cell receptor repertoires, characteristic growth upon mitogen stimulation, and CD4+ T cells were able to support HIV-1 propagation. Purified monocytes were able to be differentiated into phenotypically characteristic populations of macrophages and dendritic cells. Overall, TLRE filters offer an attractive source of primary human cells for research and possibly clinical purposes.

Effects of a video feedback parent training program during child welfare visitation.

Behavioral parent training programs have documented efficacy for improving behaviors among parents and their children and are frequently used by child welfare agencies to prevent removal of a child from the parental home or to facilitate reunification. Although an ideal time for parent training might be during supervised visits where parents may practice skills with their children under the guidance and support of a therapist or caseworker, this is not typically the case. Most often, parents within the child welfare system receive parent training in small groups without their children present, and to date, few studies have examined effects of behavioral parent training interventions during supervised visitation. In this study, concurrent multiple baseline across behaviors design was used to examine effects of a behavioral parent training program, Filming Interactions to Nurture Development (FIND), on parental skill acquisition with four mothers who had lost custody of their children but were being considered for reunification. Children emitted little or no problem behaviors during baseline or intervention, so parenting behavior was the primary dependent variable. Results obtained across participants documented a clear functional relation between implementation of the FIND intervention and increases in developmentally supportive parenting behaviors. Results of social validity and contextual fit measures suggest the intervention was perceived by mothers to be positive, feasible, and appropriate within the child welfare context. Practical and conceptual implications, limitations of this study, and directions for future research are discussed.

Evidence for a Revised Ion/Substrate Coupling Stoichiometry of GABA Transporters.

Plasma membrane γ-aminobutyric acid (GABA) transporters (GATs) are electrogenic transport proteins that couple the cotranslocation of Na(+), Cl(-), and GABA across the plasma membrane of neurons and glia. A fundamental property of the transporter that determines its ability to concentrate GABA in cells and, hence, regulate synaptic and extra-synaptic GABA concentrations, is the ion/substrate coupling stoichiometry. Here, we scrutinized the currently accepted 2 Na(+):1 Cl(-):1 GABA stoichiometry because it is inconsistent with the measured net charge translocated per co-substrate (Na(+), Cl(-), and GABA). We expressed GAT1 and GAT3 in Xenopus laevis oocytes and utilized thermodynamic and uptake under voltage-clamp measurements to determine the stoichiometry of the GABA transporters. Voltage-clamped GAT1-expressing oocytes were internally loaded with GABA, and the reversal potential (V rev) of the transporter-mediated current was recorded at different external concentrations of Na(+), Cl(-), or GABA. The shifts in V rev for a tenfold change in the external Na(+), Cl(-), and GABA concentration were 84 ± 4, 30 ± 1, and 29 ± 1 mV, respectively. To determine the net charge translocated per Na(+), Cl(-), and GABA, we measured substrate fluxes under voltage clamp in cells expressing GAT1 or GAT3. Charge flux to substrate flux ratios were 0.7 ± 0.1 charge/Na(+), 2.0 ± 0.2 charges/Cl(-), and 2.1 ± 0.1 charges/GABA. Altogether, our results strongly suggest a 3 Na(+):1 Cl(-):1 GABA coupling stoichiometry for the GABA transporters. The revised stoichiometry has important implications for understanding the contribution of GATs to GABAergic signaling in health and disease.

Functional Analysis With Typically Developing Children: Best Practice or Too Early to Tell?: In Response to.

Hanley (2012) provided a guide to practitioners and researchers in the conduct of functional assessment for problem behavior, citing a body of empirical work to support his view. Much of the work Hanley drew upon was conducted with individuals with developmental delay in hospitals or outpatient clinic settings. In this paper, we argue that the guidelines he put forth are not necessarily applicable to work in schools or with typically developing individuals. We examine the evidence supporting use of functional analysis with typically developing children, emphasizing school-based consultation, and conclude by recommending a tiered assessment approach from least to most intensive based on the needs of the individual child.

Functional consequences of sulfhydryl modification of the γ-aminobutyric acid transporter 1 at a single solvent-exposed cysteine residue.

The aims of this study were to optimize the experimental conditions for labeling extracellularly oriented, solvent-exposed cysteine residues of γ-aminobutyric acid transporter 1 (GAT1) with the membrane-impermeant sulfhydryl reagent [2-(trimethylammonium)ethyl]methanethiosulfonate (MTSET) and to characterize the functional and pharmacological consequences of labeling on transporter steady-state and presteady-state kinetic properties. We expressed human GAT1 in Xenopus laevis oocytes and used radiotracer and electrophysiological methods to assay transporter function before and after sulfhydryl modification with MTSET. In the presence of NaCl, transporter exposure to MTSET (1-2.5 mM for 5-20 min) led to partial inhibition of GAT1-mediated transport, and this loss of function was completely reversed by the reducing reagent dithiothreitol. MTSET treatment had no functional effect on the mutant GAT1 C74A, whereas the membrane-permeant reagents N-ethylmaleimide and tetramethylrhodamine-6-maleimide inhibited GABA transport mediated by GAT1 C74A. Ion replacement experiments indicated that MTSET labeling of GAT1 could be driven to completion when valproate replaced chloride in the labeling buffer, suggesting that valproate induces a GAT1 conformation that significantly increases C74 accessibility to the extracellular fluid. Following partial inhibition by MTSET, there was a proportional reduction in both the presteady-state and steady-state macroscopic signals, and the functional and pharmacological properties of the remaining signals were indistinguishable from those of unlabeled GAT1. Therefore, covalent modification of GAT1 at C74 results in completely nonfunctional as well as electrically silent transporters.

Check-in/check-out: a systematic evaluation and component analysis.

Tier 2 interventions are implemented similarly across students and thus serve as an efficient and cost-effective method of behavior support in school settings. Check-in/check-out is a Tier 2 intervention with documented effectiveness (e.g., Hawken & Horner, 2003; Todd, Campbell, Meyer, & Horner, 2008). Key features of the intervention include brief morning and afternoon meetings with the intervention coordinator, use of a point card on which the teacher monitors student behavior, and teacher feedback at predetermined times. The present study sought to add to the literature by examining the relative contributions of the teacher-feedback components of check-in/check-out via the use of a component analysis. Working with 4 children in a general education setting, we first evaluated the effectiveness of the procedure using reversal designs. Next, we systematically removed teacher-feedback components to assess effects on problem behavior and academic engagement. For 3 of 4 participants, we were able to remove all teacher-feedback sessions and the point card; for the 4th participant, we removed only 2 of 3 teacher-feedback sessions due to time constraints.

Evaluation of stimulus control over a communication response as an intervention for stereotypical responding.

Stereotypical behavior maintained by automatic reinforcement often does not result in harm but may be undesirable in some situations. In the current investigation, participants were 2 individuals who engaged in nonharmful stereotypical responses shown in an analogue functional analysis to be insensitive to social contingencies. After bringing these responses under stimulus control using differential punishment, both participants learned a mand to terminate punishment for stereotypy. We also assessed whether the mand could be brought under stimulus control.

GATMD: γ-aminobutyric acid transporter mutagenesis database.

Since the cloning of the first γ-aminobutyric acid (GABA) transporter (GAT1; SLC6A1) from rat brain in 1990, more than 50 published studies have provided structure-function information on investigator-designed rat and mouse GAT1 mutants. To date, more than 200 of 599 GAT1 residues have been subjected to mutagenesis experiments by substitution with different amino acids, and the resulting transporter functional properties have significantly advanced our understanding of the mechanism of Na+- and Cl⁻-coupled GABA transport by this important member of the neurotransmitter:sodium symporter family. Moreover, many studies have addressed the functional consequences of amino acid deletion or insertion at various positions along the primary sequence. The enormity of this growing body of structure-function information has prompted us to develop GABA Transporter Mutagenesis Database (GATMD), a web-accessible, relational database of manually annotated biochemical, functional and pharmacological data reported on GAT1-the most intensely studied GABA transporter isoform. As of the last update of GATMD, 52 GAT1 mutagenesis papers have yielded 3360 experimental records, which collectively contain a total of ∼100 000 annotated parameters. Database URL: http://physiology.sci.csupomona.edu/GATMD/

Tier II Interventions within the Framework of School-Wide Positive Behavior Support: Essential Features for Design, Implementation, and Maintenance.

To meet the complex social behavioral and academic needs of all students, schools benefit from having available multiple evidence-based interventions of varying intensity. School-wide positive behavior support provides a framework within which a continuum of evidence-based interventions can be implemented in a school. This framework includes three levels or tiers of intervention; Tier I (primary or universal), Tier II (secondary or targeted), and Tier III (tertiary or individualized) supports. In this paper we review the logic behind school-wide positive behavior support and then focus on Tier II interventions, as this level of support has received the least attention in the literature. We delineate the key features of Tier II interventions as implemented within school-wide positive behavior support, provide guidelines for matching Tier II interventions to school and student needs, and describe how schools plan for implementation and maintenance of selected interventions.

Permanent Genetic Resources added to Molecular Ecology Resources Database 1 December 2009-31 January 2010.

This article documents the addition of 220 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Allanblackia floribunda, Amblyraja radiata, Bactrocera cucurbitae, Brachycaudus helichrysi, Calopogonium mucunoides, Dissodactylus primitivus, Elodea canadensis, Ephydatia fluviatilis, Galapaganus howdenae howdenae, Hoplostethus atlanticus, Ischnura elegans, Larimichthys polyactis, Opheodrys vernalis, Pelteobagrus fulvidraco, Phragmidium violaceum, Pistacia vera, and Thunnus thynnus. These loci were cross-tested on the following species: Allanblackia gabonensis, Allanblackia stanerana, Neoceratitis cyanescens, Dacus ciliatus, Dacus demmerezi, Bactrocera zonata, Ceratitis capitata, Ceratitis rosa, Ceratits catoirii, Dacus punctatifrons, Ephydatia mülleri, Spongilla lacustris, Geodia cydonium, Axinella sp., Ischnura graellsii, Ischnura ramburii, Ischnura pumilio, Pistacia integerrima and Pistacia terebinthus.

PERMANENT GENETIC RESOURCES: Development of polymorphic microsatellite loci for the endangered Topeka shiner, Notropis topeka.

We have developed a set of eight polymorphic microsatellite markers for the endangered Topeka shiner, Notropis topeka. Allelic diversity at each of these loci was assessed in a single isolated population from eastern South Dakota, USA. The allelic diversity ranged from four to 15 alleles. These are the first microsatellite markers to be reported for this species. These markers are being used in a more thorough study of the population structure throughout the remaining range of this species.

Discriminative control of punished stereotyped behavior in humans.

The purpose of this experiment was to establish discriminative control of responding by an antecedent stimulus using differential punishment because the results of past studies on this topic have been mixed. Three adults with mental retardation who exhibited stereotypy not maintained by social consequences (i.e., automatic reinforcement) participated. For each subject, stereotypy occurred frequently in the presence of a stimulus correlated with nonpunishment of stereotypy and rarely, if ever, in the presence of a stimulus correlated with punishment of stereotypy. Latency measures showed that the antecedent stimulus correlated with punishment served as the discriminative stimulus for the suppression of stereotypy. These results are important insofar as they show that discriminative control by an antecedent stimulus develops with punishment, and because it sometimes may be desirable to establish such control of socially inappropriate behavior.

Use of the structured descriptive assessment with typically developing children.

To date, only a limited number of studies have focused on functional assessment with typically developing populations. The most commonly reported method of functional assessment with this population seems to be descriptive assessment; however, the methods used in the descriptive assessment often are unclear. This is unfortunate as researchers and practitioners often are left with little guidance as to how to conduct a functional assessment with typically developing children. The purpose of this study was to determine whether the structured descriptive assessment (SDA) might be used with typically developing children. Four children with problem behavior participated in the study, and hypotheses about functional relations were developed for all children. Furthermore, efficacious interventions were developed and implemented for 2 children based on the results of the SDA.

Applying behavior analysis to school violence and discipline problems: Schoolwide positive behavior support.

School discipline is a growing concern in the United States. Educators frequently are faced with discipline problems ranging from infrequent but extreme problems (e.g., shootings) to less severe problems that occur at high frequency (e.g., bullying, insubordination, tardiness, and fighting). Unfortunately, teachers report feeling ill prepared to deal effectively with discipline problems in schools. Further, research suggests that many commonly used strategies, such as suspension, expulsion, and other reactive strategies, are not effective for ameliorating discipline problems and may, in fact, make the situation worse. The principles and technology of behavior analysis have been demonstrated to be extremely effective for decreasing problem behavior and increasing social skills exhibited by school children. Recently, these principles and techniques have been applied at the level of the entire school, in a movement termed schoolwide positive behavior support. In this paper we review the tenets of schoolwide positive behavior support, demonstrating the relation between this technology and applied behavior analysis.

Effects of familiar versus unfamiliar therapists on responding in the analog functional analysis.

The analog functional analysis involves the manipulation of pre-determined antecedent and consequent events and typically is conducted by trained experimenters. Inclusion of idiosyncratic variables in the analog functional analysis may affect responding. Inclusion of caregivers is one potential antecedent that may affect problem behavior. The purpose of this study was to evaluate the effects of including caregivers in the analog. Four individuals with developmental disabilities and their caregivers served as participants. For 3 of 4 participants, different patterns of responding were observed when caregivers versus experimenters conducted the functional analysis.