Predictors of employment for adults with intellectual and developmental disabilities participating in a postsecondary transition program in the United States.

BACKGROUND: Previous research has shown that post-secondary collegiate vocational educational programs often have positive effects on employment outcomes for young adults with intellectual and developmental disabilities. AIMS: Using secondary data of a program in the United States collected over several years, we examined which intervention components of a postsecondary education transition program predicted subsequent employment for young adults with intellectual and developmental disabilities. MATERIALS & METHODS: The sample consisted of 56 individuals that participated in a transition-services collegiate program; Crossing Points, University of Alabama. RESULTS: Results were able to robustly indicate that acquiring job-specific skills was a much better predictor than global measures of intellectual or adaptive behaviour. Additionally, survival curve analyses as an innovative approach to this population showed that there was a positive relation between the number of job-specific training sessions and eventual community employment. DISCUSSION: Results are discussed in relation to a historical parallel movement to expand inclusion of students with intellectual and developmental disabilities in the least restrictive educational setting for primary and secondary public education years. CONCLUSION: In conclusion, the results of the current study suggest positive findings with job-skills training both specific and general.

Introduction to the Special Section: Translating Advanced Quantitative Techniques for Single-Case Experimental Design Data.

The articles in this special section offer strategies to single-case experimental design (SCED) researchers to interpret their outcomes, communicate their results, and compare the results using common, quantitative results. Advancing quantitative methods applied to SCED data will facilitate communication with scientists and other professionals that do not typically interpret graphed data of the dependent variable. Horner and Ferron aptly note that innovative statistical procedures are improving the precision and credibility of SCED research as disseminate our findings to an increasingly diverse audience. This special section promotes the translation of these quantitative methods to encourage their adoption in research using single case experimental designs.

Examining the Relation between Self-reported ASD Symptoms and Sensory Sensitivities from a Community-based Sample of Adults.

Atypical responses to sensory stimuli, termed sensory sensitivities, are a commonly reported symptom for individuals diagnosed with Autism Spectrum Disorder (ASD). In this community-based study of 604 adults, the correlation between sensory sensitivities and ASD symptoms was r = 0.23, p < .001, representing a smaller relation than estimates previously reported in the peer-reviewed research. Additionally, when examining only participants who met or exceeded the ASD screening cutoff score, the relation between sensory sensitivities and ASD symptoms was only slightly larger at r = 0.25, p < .001. Forty-four percentage who met the screening cutoff score for ASD also reported the lowest degree of sensory sensitivities. Finally, just over one-third who met the screening cutoff score for ASD had the highest sensory sensitivities. Sensory sensitivities did not appear to be a consistent feature across adults meeting the ASD screening cutoff score, but a proportion meeting the ASD screening cutoff score also exhibited the most extreme sensory sensitivities.

Examining the correlation between symptoms of obsessive compulsive disorder and autism spectrum disorder in a community-based sample of adults.

We examined the association between obsessive compulsive disorder (OCD) and autism spectrum disorder (ASD) symptoms among a community-based sample of adults (n = 217) that completed an OCD and ASD screening instrument. Approximately 39% of the sample that met the ASD screener cutoff criteria also met the screener cutoff criteria for OCD. The correlation between overall OCD symptoms (i.e., obsessions and compulsions) and ASD symptoms was small but statistically significant for the entire sample of participants. Similarly, obsession and compulsion subscales showed almost identical results for correlation with ASD symptoms (i.e., small but statistically significant) for the entire sample. These results suggest that levels of compulsions and obsessions are equally correlated with ASD symptoms, and neither elevated compulsions nor obsessions differentially predicted the severity of ASD symptoms in a community-based sample of adults. However, when the analysis was restricted to only the participants that met screening criteria cutoff score for ASD, statistically significant results occurred with only elevated compulsions accurately predicting severity of ASD symptoms. These results suggest that compulsive behavior appears to be a good candidate for targeting intervention resources for individuals with characteristics of ASD given the mounting data suggesting that compulsions are more common than obsessions.

Treatment Burst Data Points and Single Case Design Studies: A Bayesian N-of-1 Analysis for Estimating Treatment Effect Size.

Single-case experimental designs (SCED) evaluate treatment effects for each participant, but it is difficult to aggregate and quantify treatment effects across SCED participants receiving the same type of treatment. We applied Bayesian analytic procedures to SCED data aggregated across participants that have previously only been applied to large-N and group design studies of treatment effect sizes. For the current study, we defined transient elevated treatment data points as (1) above the range of the last five baseline sessions during the first three sessions of treatment (i.e., extinction burst); (2) within or above the range of baseline after the first three treatment sessions (i.e., recurrence burst); or (3) thinning phase data points above the last three prethinning treatment data points (i.e., thinning burst). Results indicated that the treatment effect sizes remained large regardless of controlling for transient elevated treatment data points. Finally, we examined the effects of reinforcer schedule thinning on estimates of treatment effect size. Results indicated a moderate negative impact of schedule thinning on treatment effect size with a 16% decrease in effect size. Recommendations for research and practice are provided, and the utility of using Bayesian analysis in single-case experimental designs is discussed.

Renewal of fear and avoidance in humans to escalating threat: Implications for translational research on anxiety disorders.

Exposure-based treatment for threat avoidance in anxiety disorders often results in fear renewal. However, little is known about renewal of avoidance. This multimodal laboratory-based treatment study used an ABA renewal design and an approach-avoidance (AP-AV) task to examine renewal of fear/threat and avoidance in twenty adults. In Context A, 9 visual cues paired with increases in probabilistic money loss (escalating threats) produced increases in ratings of feeling threatened and loss expectancies and skin-conductance responses (SCR). During the AP-AV task, a monetary reinforcer was available concurrently with threats. Approach produced the reinforcer or probabilistic loss, while avoidance prevented loss and forfeited reinforcement. Escalating threat produced increasing avoidance and ratings. In Context B with Pavlovian extinction, threats signaled no money loss and SCR declined. During the AP-AV task, avoidance and ratings also declined. In a return to Context A with Pavlovian threat extinction in effect during the AP-AV task, renewal was observed. Escalating threat was associated with increasing ratings and avoidance in most participants. SCR did not show renewal. These are the first translational findings to highlight renewal of avoidance in humans. Further research should identify individual difference variables and altered neural mechanisms that may confer increased risk of avoidance renewal.

Assessing wandering risk among individuals with Alzheimer's disease and dementia: a pilot study.

BACKGROUND: We examined a screening instrument to assess risk for wandering among individuals with Alzheimer's disease and dementia according to caregiver informants. METHODS: Pilot data were collected on the Risk of Wandering (RoW) screening instrument by 48 responses from an online survey using the Alzheimer's Association Trial Match system. RESULTS: Results indicated acceptable evidence of the internal consistency of scores for the data obtained, α = 0.81. Receiver operating characteristic curve results indicated acceptable evidence of the screening instrument scores' ability to discriminate between individuals who eloped and those who did not wander off, AUC = 0.72, P = 0.003. CONCLUSIONS: A cut-off score for future use is suggested along with directions for future research. The development of a screening instrument would appear to be preferable to restricting the movement of these individuals or unnecessarily invading their privacy through monitoring devices while simultaneously balancing the desire to prevent distress, serious injury, or death.

Telehealth and in-person training outcomes for novice discrete trial training therapists.

The efficacy and efficiency of telehealth and in-person training were compared while teaching seven undergraduate students to implement components of discrete trial training. A multiple-baseline design across skills with elements of multiple probe and delayed multiple baseline combined with an alternating-treatments design was used to evaluate the effects of behavioral skills training (BST) on (a) implementing a multiple stimulus without replacement preference assessment, (b) setting up an instructional context, (c) delivering antecedent prompts, and (d) delivering consequences for accurate and inaccurate responding. Two skills were trained via telehealth and two skills were trained in-person using BST procedures with a mock student. All participants provided high acceptability ratings for both training procedures. Results also showed that telehealth training was as efficacious and efficient as in-person training for all skills across all participants. Five of six participants showed high levels of maintenance of the newly acquired skills; these five also exhibited the skills during a novel instructional task.

Development of an in-vivo metric to aid visual inspection of single-case design data: Do we need to run more sessions?

Comparing visual inspection results of graphed data reveals inconsistencies in the interpretation of the same graph among single-case experimental design (SCED) researchers and practitioners. Although several investigators have disseminated structured criteria and visual inspection aids or strategies, inconsistencies in interpreting graphed data continue to exist even for individuals considered to be experts at interpreting SCED graphs. We propose a fail safe k metric that can be used in conjunction with visual inspection, and it can be used in-vivo after each additional data point is collected within a phase to determine the optimal point in time to shift between phases (e.g., from baseline to treatment). Preliminary proof of concept data are presented to demonstrate the potential utility of the fail safe k metric with a sample of previously published SCED graphs examining the effects on noncontingent reinforcement on occurrences of problem behavior. Results showed that if the value of fail safe k is equal to or less than the number of sessions in the current phase, then the data path may not be stable and more sessions should be run before changing phases. We discuss the results in terms of using the fail safe k as an additional aid for visual inspection of SCED data.

Descriptive analysis and comparison of strategic incremental rehearsal to "Business as Usual" sight-word instruction for an adult nonreader with intellectual disability.

OBJECTIVE: Strategic Incremental Rehearsal (SIR) is an effective method for teaching sight-word acquisition, but has neither been evaluated for use in adults with an intellectual disability, nor directly compared to the ongoing instruction in the natural environment. METHODS: Experimental analysis of sight word acquisition via an alternating treatment design was conducted with a 23-year-old woman with Down syndrome. SIR was compared to the current reading instruction (CRI) in a classroom for young adults with intellectual disabilities. CRI procedures included non-contingent praise, receptive touch prompts ("touch the word bat"), echoic prompts ("say bat"), textual prompts ("read the word"), and pre-determined introduction of new words. SIR procedures included textual prompts on flash cards, contingent praise, corrective feedback, and mastery-based introduction of new words. RESULTS: The results indicated that SIR was associated with more rapid acquisition of sight words than CRI. CONCLUSION: Directions for future research could include systematic comparisons to other procedures, and evaluations of procedural permutations of SIR.

"Watch out!": Effects of instructed threat and avoidance on human free-operant approach-avoidance behavior.

Approach-avoidance paradigms create a competition between appetitive and aversive contingencies and are widely used in nonhuman research on anxiety. Here, we examined how instructions about threat and avoidance impact control by competing contingencies over human approach-avoidance behavior. Additionally, Experiment 1 examined the effects of threat magnitude (money loss amount) and avoidance cost (fixed ratio requirements), whereas Experiment 2 examined the effects of threat information (available, unavailable and inaccurate) on approach-avoidance. During the task, approach responding was modeled by reinforcing responding with money on a FR schedule. By performing an observing response, participants produced an escalating "threat meter". Instructions stated that the threat meter levels displayed the current probability of losing money, when in fact loss only occurred when the level reached the maximum. Instructions also stated pressing an avoidance button lowered the threat level. Overall, instructions produced cycles of approach and avoidance responding with transitions from approach to avoidance when threat was high and transitions back to approach after avoidance reduced threat. Experiment 1 revealed increasing avoidance cost, but not threat magnitude, shifted approach-avoidance transitions to higher threat levels and increased anxiety ratings, but did not influence the frequency of approach-avoidance cycles. Experiment 2 revealed when threat level information was available or absent earnings were high, but earnings decreased when inaccurate threat information was incompatible with contingencies. Our findings build on prior nonhuman and human approach-avoidance research by highlighting how instructed threat and avoidance can impact human AA behavior and self-reported anxiety.

Facial emotion recognition among typically developing young children: A psychometric validation of a subset of NimStim stimuli.

We evaluated the psychometric properties of NimStim taking into account the effects of chronological age on the ability of typically developing young children (aged 2-6 years old) to recognize basic facial expressions (i.e., happy, sad, angry, and fearful). We also examined the psychometric sufficiency of NimStim under race-matched and -mismatched facial emotion stimuli. In the current study, race-matched stimuli referred to when children with African American backgrounds received African American faces to rate their emotions and vice versa for race-mismatched stimuli. Results of the current study represent the first psychometric analysis of reliability and validity for using NimStim pictures depicting happy, sad, angry, and fearful with typically developing children aged 2-6 years old as well as examining race-matched versus -mismatched stimuli. Analyses revealed the psychometric sufficiency of a subset of pictures depicting happy, sad, angry, and fearful from NimStim among young children across race matched and mismatched stimuli.

A meta-analysis of the social communication questionnaire: Screening for autism spectrum disorder.

The current meta-analysis examines the previous research on the utility of the Social Communication Questionnaire as a screening instrument for autism spectrum disorder. Previously published reports have highlighted the inconsistencies between Social Communication Questionnaire-screening results and formal autism spectrum disorder diagnoses. The variations in accuracy resulted in some researchers questioning the validity of the Social Communication Questionnaire. This study systematically examined the accuracy of the Social Communication Questionnaire as a function of the methodological decisions made by researchers screening for autism spectrum disorder over the last 15 years. Findings from this study suggest that the Social Communication Questionnaire is an acceptable screening instrument for autism spectrum disorder (area under the curve = 0.885). Variations in methodological decisions, however, greatly influenced the accuracy of the Social Communication Questionnaire in screening for autism spectrum disorder. Of these methodological variations, using the Current instead of the Lifetime version of the Social Communication Questionnaire resulted in the largest detrimental effect ( d = -3.898), followed by using the Social Communication Questionnaire with individuals younger than 4 years of age ( d = -2.924) and relying upon convenience samples ( d = -4.828 for clinical samples, -2.734 for convenience samples, and -1.422 for community samples). Directions for future research and implications for using the Social Communication Questionnaire to screen for autism spectrum disorder are discussed.

Social Communication Questionnaire scoring procedures for autism spectrum disorder and the prevalence of potential social communication disorder in ASD.

In analyzing data from the National Database for Autism Research, we utilized Mokken scaling techniques as a means of creating a more effective and efficient screening procedure for autism spectrum disorder (ASD) via the Social Communication Questionnaire (SCQ). With a sample of 1,040, approximately 80% (n = 827) of the sample were males while approximately 20% (n = 213) were females. In regard to ethnicity, approximately 68% of the sample were White/Caucasian, while 7% were African American, 16% were Hispanic, 4% were Asian, and 1% were Native American or American Indian. As the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) states that, "individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder," (American Psychiatric Association, 2013, p. 51), the primary labeling difference between the DSM-IV and the DSM-5 would appear to be in identifying social communication disorder as a newly introduced disorder in the DSM-5, which we discuss. Though school psychologists are not dependent on the DSM to the same extent as clinical psychologists to provide services, school psychology is invested in the effective and efficient assessment of ASD. The current study demonstrates how Mokken scaling procedures may be utilized with respect to ASD identification via the SCQ as well as providing information regarding the prevalence of potential social communication disorder as a new disorder and its discrimination with ASD. (PsycINFO Database Record

Attentional Networks in Adolescents with High-functioning Autism: An fMRI Investigation.

BACKGROUND: Attentional deficits in Autism spectrum disorder (ASD) are often noted, but their specific nature remains unclear. OBJECTIVE: The present study used the child Attentional Network Task (Child ANT) in combination with functional magnetic resonance imaging (fMRI) to determine if the consistently cited deficits of orienting attention are truly due to dysfunctions of orienting-based networks. We hypothesized that these observations are, in fact, a reflection of executive dysfunctions. As such, we expected that although ASD adolescents would perform worse on the orienting portion of the Child ANT, the strongest differences in activation between them and the neurotypical (NT) control group would be in areas classically associated with executive functioning (e.g., the frontal gyri and anterior cingulate cortex). METHOD: The brain activity of six high-functioning adolescents with ASD and six NT adolescents was recorded while these individuals performed the three subcomponents of the Child ANT. RESULTS: ASDs were shown to be more accurate than NTs for the alerting, less accurate for the orienting, and similar in accuracy for the executive portions of the Child ANT. fMRI data showed increased bilateral frontal gyri recruitment, areas conventionally associated with executive control, during the orienting task for the ASD group. CONCLUSION: We submit that the increased activations represent neurocorrelates of signal fixation attributable to the subset of executive control responsible for sustained maintenance signals, not the main components of orienting. Therefore, excessive fixation in ASD adolescents is likely due to dysfunctions of executive control and not the orienting subcomponent of the attention network.

Predictors of Elopement Exhibited by School-Aged Children With Special Health Care Needs: Towards the Development of a Screening Instrument for Elopement.

Elopement exhibited by school-aged children with special health care needs is a relatively low frequency problem behavior with the potential for severe negative consequences for the child and family. Using data from the Centers for Disease Control and Prevention (CDC) Survey of Pathways to Diagnosis and Services, our results represent one of the first empirical studies of variables that may be associated with children with special health care needs engaging in elopement. Using data from a nationally representative sample of children with special health care needs, our results revealed two variables that were statistically significant predictors of parent-reported elopement in the past year: (1) the child's chronological age, and (2) the presence of an autism spectrum disorder (ASD) diagnosis. We found that the likelihood of an elopement event was inversely related to age, but positively associated with the presence of an ASD diagnosis. Using parent-response items from the CDC data set, we selected a set of questions to screen for risk of elopement and analyzed their psychometric properties. We discuss the need for future research to validate this screening instrument for school-aged youth with special health care needs. Our study provides an initial psychometric analysis to support a potential screening instrument for elopement events among school-aged youth that needs to be validated by a longitudinal study of its predictive validity.

The tipping point: Value differences and parallel dorsal-ventral frontal circuits gating human approach-avoidance behavior.

Excessive avoidance and diminished approach behavior are both prominent features of anxiety, trauma and stress related disorders. Despite this, little is known about the neuronal mechanisms supporting gating of human approach-avoidance behavior. Here, we used functional magnetic resonance imaging (fMRI) to track dorsal anterior cingulate and medial prefrontal (dACC/dmPFC) activation along an approach-avoidance continuum to assess sensitivity to competing appetitive and aversive contingencies and correspondence with behavior change. Behavioral and fMRI experiments were conducted using a novel approach-avoidance task where a monetary reward appeared in the presence of a conditioned stimulus (CS), or threat, that signaled increasing probability of unconditioned stimulus (US) delivery. Approach produced the reward or probabilistic US, while avoidance prevented US delivery, and across trials, reward remained fixed while the CS threat level varied unpredictably. Increasing the CS threat level (i.e., US probability) produced the desired approach-avoidance transition and inverted U-shaped changes in decision times, electrodermal activity and activation in pregenual ACC, dACC/dmPFC, striatum, anterior insula and inferior frontal regions. Conversely, U-shaped changes in activation were observed in dorsolateral and ventromedial prefrontal cortex and bimodal changes in the orbitofrontal and ventral hippocampus. These new results show parallel dorsal-ventral frontal circuits support gating of human approach-avoidance behavior where dACC/dmPFC signals inversely correlate with value differences between approach and avoidance contingencies while ventral frontal signals correlate with the value of predictable outcomes. Our findings provide an important bridge between basic research on brain mechanisms of value-guided decision-making and value-focused clinical theories of anxiety and related interventions.

Peer reactions to early childhood aggression in a preschool setting: Defenders, encouragers, or neutral bystander.

PURPOSE: The purpose of the current study was to determine if peer reactions to aggression among preschool youth were consistent with those conceptualized in the adolescent bullying literature as defenders, encouragers, and neutral bystanders. RESEARCH DESIGN: Direct observations were used to document patterns for types of peer-directed aggression in early childhood settings to ascertain interaction differences between individuals involved within the bullying dynamic. METHODS AND PROCEDURES: Observations of 50 students in preschool were conducted over 5.5 months. Event recording procedures were used to document aggressive behaviors and reactions from peers and teachers. RESULTS: Results indicated that the majority of aggression was physical. Additionally, peer reactions, as described in the bullying literature for school-aged youth, occurred very infrequently. CONCLUSION: Peer aggression tended to be more physical, suggesting that early childhood educators should attend to these physical interactions, and cultivate a classroom community that emphasizes social supports and appropriate interactions.

Effects associated with on- and off-label stimulant treatment of core autism and ADHD symptoms exhibited by children with autism spectrum disorder.

OBJECTIVE: Families of children with autism spectrum disorder are barraged by different treatment options. Some of these options have the support of empirical evidence while others do not. Stimulant treatments are typically utilized to treat symptoms of ADHD indicating an on-label use of such treatment. METHODS: This study examines the association of stimulant treatment with the on- (symptoms of ADHD) and off- (symptoms of ASD) label symptoms among children with ASD via a non-clinical, population-based sample. RESULTS: Results indicate no significant association of stimulant treatment with a reduction of on- or off-label symptoms among children with ASD. CONCLUSION: Stimulant medications utilized in the treatment of DSM core symptoms of autism spectrum disorder would be considered an off-label use because there is limited evidence to support that stimulants are effective in treating core symptoms of ASD, which is supported by the results of the current study.

Not so bad: avoidance and aversive discounting modulate threat appraisal in anterior cingulate and medial prefrontal cortex.

The dorsal anterior cingulate (adACC) and dorsal medial prefrontal cortex (dmPFC) play a central role in the discrimination and appraisal of threatening stimuli. Yet, little is known about what specific features of threatening situations recruit these regions and how avoidance may modulate appraisal and activation through prevention of aversive events. In this investigation, 30 healthy adults underwent functional neuroimaging while completing an avoidance task in which responses to an Avoidable CS+ threat prevented delivery of an aversive stimulus, but not to an Unavoidable CS+ threat. Extinction testing was also completed where CSs were presented without aversive stimulus delivery and an opportunity to avoid. The Avoidable CS+ relative to the Unavoidable CS+ was associated with reductions in ratings of negative valence, fear, and US expectancy and activation. Greater regional activation was consistently observed to the Unavoidable CS+ during avoidance, which declined during extinction. Individuals exhibiting greater aversive discounting-that is, those more avoidant of immediate monetary loss compared to a larger delayed loss-also displayed greater activation to the Unavoidable CS+, highlighting aversive discounting as a significant individual difference variable. These are the first results linking adACC/dmPFC reactivity to avoidance-based reductions of aversive events and modulation of activation by individual differences in aversive discounting.