Video-Based Training in Recognizing Exemplars of Autism Spectrum Disorder Diagnostic Criteria.

Autism Spectrum Disorder (ASD) is an increasingly common neurodevelopmental disorder with long-term and pervasive effects. Despite the benefits of early diagnosis, research suggests that training in recognizing the behavioral markers of ASD and the fundamentals of ASD diagnosis are not routinely provided to prospective child clinicians. As a means to train students in recognizing exemplars of behavior consistent with ASD diagnostic criteria, we created a video library of brief clips of children and adults with and without ASD who varied on multiple dimensions (e.g., sex, ethnicity, language skills, developmental level). Using clips from the library, we developed a brief training program to instruct students on diagnostic criteria for ASD and how to recognize examples of these behaviors in children. A randomized experimental trial compared the impact of the video-based training program delivered via the Internet to conventional graduate-level textbook training. Although both textbook and video-based training groups improved in their identification of ASD behaviors, the video-based training group significantly outperformed the textbook-based training group at posttest. The creation of a video library that can be incorporated into remote access training is a promising means of allowing students to view a range of presentations of a disorder even when direct access to a diverse set of clients may be difficult.

GoFAR: improving attention, behavior and adaptive functioning in children with fetal alcohol spectrum disorders: Brief report.

OBJECTIVE: This brief report describes the GoFAR intervention designed to improve attention, behavior, and adaptive functioning in children with FASD, ages 5 to 10 years. METHODS: Thirty children were randomized to one of three conditions: GoFAR; FACELAND, and CONTROL; 25 completed the interventions. Over 10 sessions children and caregivers learned a metacognitive strategy (FAR) designed to improve cognitive control of behavior and adaptive functioning and practiced it during behavior analog therapy. Attention, behavior problems, and adaptive skills were measured pre- and post-intervention. RESULTS: From pre- to post-testing the GoFAR intervention group improved on the Test of Variables of Attention (TOVA). Both intervention groups improved in Daily Living Skills. CONCLUSION: This pilot study demonstrated that children with FASD and their caregivers benefit from a focused intervention designed to improve effortful control of behavior. The study suggests the need for a larger clinical trial to evaluate the intervention's effectiveness.

Improving FASD Children's Self-Regulation: Piloting Phase 1 of the GoFAR Intervention.

The initial parent training component of GoFAR, an intervention designed to improve the self-regulation and adaptive living skills of children with Fetal Alcohol Spectrum Disorders, was piloted in a small, randomized clinical trial of 28 participants assigned to either a time-lapsed control group or one of two parent training groups who differed on whether the child's computerized instruction was congruent or incongruent with the parent instruction. Parental compliance and achievement of therapy goals were indicators of improvement in the child's self-regulation skills. Children who received computerized instruction consistent with the parent training demonstrated greater self-regulation improvements than those receiving incongruent computerized instruction.

A metacognitive strategy for reducing disruptive behavior in children with fetal alcohol spectrum disorders: GoFAR pilot.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) are often characterized by disruptive behavior problems and there are few effective interventions available. GoFAR is a novel, 3-part intervention designed to improve self-regulation and adaptive living skills of children with FASD by improving metacognitive control of emotions and arousal. METHODS: The intervention has 3 components: (i) GoFAR: a "serious game" designed to teach a metacognitive control strategy in a computer game environment; (ii) parent training on child behavioral regulation; and (iii) Behavior Analog Therapy (BAT) sessions, a practical application of the metacognitive learning methodology by parent and child in the context of learning adaptive skills. The learning strategy (FAR) teaches the child to Focus and make a plan, Act out the plan, and Reflect back on the plan. Thirty families were randomized to 3 groups: (i) GoFAR (n = 10); (ii) FACELAND (n = 10); or (iii) CONTROL (n = 10). The 2 intervention groups, GoFAR and FACELAND, used computer games to instruct children. Both groups also received 5 sessions of parent training followed by 5 sessions of joint parent/child therapy (BAT). Assessment of disruptive behavior, including frequency of temper tantrums, frustration tolerance, impulsivity, destructiveness, aggression, and maintaining attention were carried out before enrollment at Mid-Treatment, when game play and parent training were completed, and finally, after completing the BAT sessions. RESULTS: Parental report of disruptive behavior overall was significantly reduced in the GoFAR group after the first components, game play and parent training, and after the BAT sessions in the FACELAND group with no changes in the CONTROL group over time. CONCLUSIONS: The GoFAR(®) game was well received by children and effective in teaching the required skills. Mastering the FAR metacognitive strategy was associated with a reduction in disruptive behaviors in children with FASD suggesting that effective interventions can improve outcomes for this high-risk group.

Community translation of the Math Interactive Learning Experience Program for children with FASD.

The Math Interactive Learning Experience (MILE), a program designed to address academic and behavioral problems found in children with Fetal Alcohol Spectrum Disorders (FASD), was found to be effective in a randomized clinical trials with results that persisted at a 6-month follow-up. The current study evaluated the effectiveness of a community translation, in partnership with several community sites in the metropolitan Atlanta area. A total of 60 participants were randomly assigned to one of the three treatment groups: the MILE program administered at a specialty care center (Center MILE) or in the community (Community MILE), or to parent math instruction only (Parent Instruction). This study evaluated instructor satisfaction with the training program, knowledge related to FASD and the MILE program, adherence to the MILE teaching methodology, participant math outcomes, and parents' satisfaction with their treatment experience. Instructors reported a high degree of satisfaction with the overall training and mean site fidelity ratings were positively correlated with change in math performance. Those in the MILE intervention groups demonstrated more positive gains in math skills than those in the Parent Instruction group but did not differ from each other. Parents in the Parent Instruction group reported less satisfaction with their intervention than those assigned to the Center MILE group but satisfaction ratings did not differ between those in the MILE intervention groups. These results indicate that the community translation and the MILE instructor training program developed as part of this process were well-received and effective in producing positive treatment outcomes.

JobTIPS: a transition to employment program for individuals with autism spectrum disorders.

This study evaluated the effectiveness of an internet accessed training program that included Theory of Mind-based guidance, video models, visual supports, and virtual reality practice sessions in teaching appropriate job interview skills to individuals with high functioning Autism Spectrum Disorders. In a randomized study, twenty-two youth, ages 16-19, were evaluated during two employment interviews. Half received a training intervention following the initial interview and the half who served as a contrast group did not. Their performance pre and post intervention was assessed by four independent raters using a scale that included evaluation of both Content and Delivery. Results suggest that youth who completed the JobTIPS employment program demonstrated significantly more effective verbal content skills than those who did not.

Comparing the Effectiveness of On-Line versus In-Person Caregiver Education and Training for Behavioral Regulation in Families of Children with FASD.

Different formats for delivering parent education designed to improve the functioning of children with FASD were evaluated. Participants were randomly assigned to a treatment condition: (1) Community Standard/Informational Packet, (2) Group Workshops, and (3) Internet Training. Overall satisfaction was high for all formats but the Workshop group received higher ratings on usefulness, understandability, amount, overall satisfaction, and willingness to recommend than did the Community group and higher ratings than did the Internet group on amount of information and overall satisfaction. All three groups improved in their knowledge of behavioral learning principles but only the Internet and Workshop groups made significant gains in knowledge of FAS and advocacy. Improved behavior was only found in the Workshop and Community conditions. The results suggest all forms of parent education have some benefits but the child's degree of alcohol-related impairment, severity of behavioral symptoms, and overall goals of the intervention may influence optimal choice.

Games that "work": using computer games to teach alcohol-affected children about fire and street safety.

Unintentional injuries are a leading cause of death and disability for children. Those with developmental disabilities, including children affected by prenatal alcohol exposure, are at highest risk for injuries. Although teaching safety skills is recommended to prevent injury, cognitive limitations and behavioral problems characteristic of children with fetal alcohol spectrum disorder make teaching these skills challenging for parents and teachers. In the current study, 32 children, ages 4-10, diagnosed with fetal alcohol syndrome (FAS) and partial FAS, learned fire and street safety through computer games that employed "virtual worlds" to teach recommended safety skills. Children were pretested on verbal knowledge of four safety elements for both fire and street safety conditions and then randomly assigned to one condition. After playing the game until mastery, children were retested verbally and asked to "generalize" their newly acquired skills in a behavioral context. They were retested after 1 week follow-up. Children showed significantly better knowledge of the game to which they were exposed, immediately and at follow-up, and the majority (72%) was able to generalize all four steps within a behavioral setting. Results suggested that this is a highly effective method for teaching safety skills to high-risk children who have learning difficulties.

An Evolution of Virtual Reality Training Designs for Children With Autism and Fetal Alcohol Spectrum Disorders.

This article describes an evolution of training programs to use first-person interaction in virtual reality (VR) situations to teach safety skills to children with autism spectrum disorder (ASD) and fetal alcohol spectrum disorder (FASD). Multiple VR programs for children aged 2 to 9 were built and tested between 1992 and 2007. Based on these results, a learning design evolved that uses practice in virtual space with guidance and correction by an animated character, strategic limitations on allowed actions to force correct patterning, and customization of worlds and responses to simplify user controls. This article describes program evolution by comparing design details and results as variations in behavioral responses between disorders, differences in skill set complexity between different safety skills being taught, and improved technology required changes in the virtual training methodology. A series of research projects are summarized in which the VR programs proved effective for teaching children with ASD and FASD new skills in the virtual space and, where measured, most children generalized the actions to the real world.

Case study: using a virtual reality computer game to teach fire safety skills to children diagnosed with fetal alcohol syndrome.

OBJECTIVE: To assess the effectiveness of a computer-based virtual reality (VR) game in teaching five children diagnosed with fetal alcohol syndrome (FAS) fire safety skills and to generalize these skills to a real world simulation. METHOD: Children participated in a study by using a multiple baseline, multiple probe design. Before the game, no child could correctly describe what actions to take during a home fire. A computerized game allowed them to learn the recommended safety steps in a virtual world. Skill learning and real-world generalization were tested immediately after the intervention and at 1-week post-test. RESULTS: All children reached 100% accuracy on the computer intervention, defined as successfully completing each of the safety steps. At the 1-week follow-up, all the children were able to perform the steps correctly in a real world simulation. CONCLUSIONS: The results suggest that this method of intervention warrants further study as an educational delivery system for children with FAS.

The challenge of using virtual reality in telerehabilitation.

Continuing advances in virtual reality (VR) technology along with concomitant system cost reductions have supported the development of more useful and accessible VR systems that can uniquely target a wide range of physical, psychological, and cognitive rehabilitation concerns and research questions. VR offers the potential to deliver systematic human testing, training, and treatment environments that allow for the precise control of complex dynamic three-dimensional stimulus presentations, within which sophisticated interaction, behavioral tracking, and performance recording is possible. The next step in this evolution will allow for Internet accessibility to libraries of VR scenarios as a likely form of distribution and use. VR applications that are Internet deliverable could open up new possibilities for home-based therapy and rehabilitation. If executed thoughtfully, they could increase client involvement, enhance outcomes and reduce costs. However, before this vision can be achieved, a number of significant challenges will need to be addressed and solved. This article will first present three fictional case vignettes that illustrate the ways that VR telerehabilitation might be implemented with varying degrees of success in the future. We then describe a system that is currently being used to deliver virtual worlds over the Internet for training safety skills to children with learning disabilities. From these illustrative fictional and reality-based applications, we will then briefly discuss the technical, practical, and user-based challenges for implementing VR telerehabilitation, along with views regarding the future of this emerging clinical application.