Long-Term Outcomes for a Student with Severely Challenging Behavior in a Special Needs School for Intellectual Disabilities: A School Consultation Case Study.

Self-injurious, stereotyped, and aggressive/destructive behaviors exhibited by individuals with intellectual disabilities and autism spectrum disorders are called challenging behaviors (CBs). Severe CBs often require long-term treatment involving psychosocial approaches based on behavioral interventions and/or medication. A boy with severe CB enrolled in a special needs school, with diagnoses of autism and intellectual disability, was the client of the study. This case report describes the long-term outcomes of eight years of continuous school consultation. The student's severe CB improved with environmental adjustments in the classroom, unified teacher involvement, instruction of leisure and communication skills, and medication. Long-term research on changes in CBs through school consultation is limited, and this case report provides important insights into the development of effective educational programs and curricula for severe CBs in school-aged children.

Developmental trajectories of challenging behaviors reported retrospectively by Japanese parents of adult children with intellectual disabilities.

Introduction: Individuals with intellectual disabilities (ID) are at heightened risk of behavioral problems. Methods: This study investigated differences in the severity of challenging behaviors (CBs) among individuals with IDs at varying life stages. Data were collected from parents' retrospective interviews. Surveys were completed by 47 parents whose child with IDs was 19 years or older and had made use of welfare services for individuals who exhibit CBs. Results: The final study sample consisted of 28 parents. Findings showed that (a) parents gave the lowest total scores for severity of CBs for their adult children when at the pre-school stage compared to other stages (elementary school, junior high school, high school, and post-high school), (b) differences between life stages appear to depend on the type of CB, and (c) the most common CB recorded for children between 0 and 2 years old was extreme hyperactivity, followed by severe sleep disturbances. Conclusions: The results of the study show that domain ratings for stereotypic/restricted behaviors, sleep disturbance problems, feeding problems, and problems with elimination often remain stable throughout the life stages. Moreover, parents frequently reported that CBs often occurred in children aged 0-2 years.

Evaluating outcomes of a community-based parent training program for Japanese children with developmental disabilities: a retrospective pilot study.

Parent training (PT) for parents of children with developmental disabilities (DDs) has recently been recommended in community settings in many countries, including Japan. Research has shown PT could improve parenting skills and mental health in parents as well as improve adaptive skills and reduce behavioral problems in children. Despite evidence concerning the beneficial effects of PT on both parents and children, there is a lack of evidence concerning the potential benefits of PT in real world settings. Moreover, no research has examined whether PT programs implemented in clinical settings have a similar impact on all parents of children with various type of DDs. The present pilot study aimed to examine whether positive changes occur similarly in parental mental health and in the adaptive skills of children with DDs as a result of PT, irrespective of the children's disability type. The study used data from 128 parents who had participated in a PT program in a clinical setting and data concerning 128 children aged 2-17 years with a wide range of DDs, namely autism spectrum disorder, intellectual disability, and other DDs, generated through parental reports and retrospectively assessed the impact of PT on parents and their children. Specifically, changes in parental mental health and the adaptive skills of children were analyzed. The PT program was designed to help parents teach their children adaptive skills at home using applied behavior analytic techniques. The results showed that the parents improved their mental health significantly after completing the PT, irrespective of their child's disability type. During the PT period, almost all the parents were able to implement several instructional tasks targeted toward their children; some children with DDs acquired several adaptive skills. However, these positive changes were not observed in all the parents and their children. These findings suggest that some parents and their children with DDs may benefit from the PT program in a clinical setting. Concurrently, these findings highlight the importance of providing sustained additional support in clinical settings to parents and their children with DDs.

Assessing the Effectiveness of Real-Time Online Parent Training for Parents of Children with Diverse Neurodevelopmental Disorders Residing in the Community.

Background: Parents residing in the community have children with diverse neurodevelopmental disorders. Thus, developing online parent training that is effective for various types of neurodevelopmental disorders, not just for a single one, is essential. This study investigated the effects of real-time online group parent training developed for parents of children with various neurodevelopmental disorders. Methods: Twenty-two parents (two males and 20 females) of children with diagnosed or suspected neurodevelopmental disorders participated. We developed real-time online group parent training based on the Tottori University parent training (TUPT-ON), which can be implemented online as a pilot study. Parenting stress, parenting attitudes, mental health, and children's inappropriate behavior scores were measured before and after the intervention and analyzed using paired t-test. Results: The average participation rate was 75.5%, and the average homework submission rate was 66.6%. The intervention significantly improved parents' quality of life and negative parenting. Moreover, significant improvements were found in the total problems age-standardized scores (T-scores) of the Child Behavior Checkl List in participants' children. In response to five questions about the acceptability of our online group parent training, participants rated most items as four or higher out of five. Conclusion: The implementation of TUPT-ON showed some improvements in children's outcomes and brought about positive changes in parental outcomes across various neurodevelopmental disorders. This result suggests the potential effectiveness of this intervention for different types of neurodevelopmental disorders. TUPT-ON could provide parent training and support for parents dealing with their children's various neurodevelopmental disorders, regardless of location, as long as they have a stable internet connection. However, the lack of a control group and the small sample size of certain diseases warrant caution in interpreting these findings, and a rigorous validation design should be employed and revalidated in the future.

Stress and benefits of video calling for people with autism spectrum disorders.

This study compared stress and the benefits of video calling between individuals with autism spectrum disorder (ASD) proneness and diagnosis and those with typical developmental (TD). Study participants were recruited via the web, and 151 of the 252 participants who responded to a web-based questionnaire were included in the analysis (ASD group:76; TD group:75). The results of the chi-square test suggest that the ASD group may prefer video calling more than the TD group. The results of the analysis using a qualitative methodology (KJ method) suggested that the ASD group was more likely than the TD group to perceive stress due to light stimuli emitted from the screen and the inability to concentrate on a conversation due to visual stimuli. The ASD group perceived the ability to cope with stressful stimuli by operating the device as an benefits of video calling. These findings suggest the importance of creating a communication environment that reduces stress and maximizes the benefits of video calling for people with ASD. Specific support measures include establishing rules in advance that allow the individual to turn the video off or switch to texting.

Online Parent Training for Parents of Children with Autism Spectrum Disorders: Prototype Development of the On-Demand Type.

Background: Parent training (PT) is a promising support for improving parents' mental health, and behavior in children with autism spectrum disorders (ASD). In recent years, there has been an increase in online PT studies. We developed a prototype for the on-demand PT. In this study, we examined changes in the program implementation, accomplishment of homework, parents' mental health, and behavior of children among parents of children with ASD. Methods: This study participated two mothers of children with ASD. The first was the mother of a child aged three years and eight months with ASD and intellectual disability; the second was the mother of a child aged four years and 5 months who had a diagnosis of ASD. An on-demand PT consisting of six sessions was provided online. The program was structured so that the participants watched lecture videos for each session, answered a confirmation test, and submitted homework to advance to the next session. Feedback for the submitted homework and questions was provided via email by the researchers. Results: Both participants watched the program on a schedule for all sessions and submitted all tests and homework assignments. The percentage of correct responses to the tests per session was 100% for both participants. Two of the four target behaviors of the children changed significantly. Pre- and post-questionnaires also showed improvements in the scores of parental depression and parenting stress, as well as overall behavior of the child. Conclusion: The program in this study was developed as a prototype for on-demand PT, and two case studies showed positive results. Although this program was on-demand, changes in parent and child behaviors were confirmed by the scale and actual behavior records. Further demonstration is needed to increase the number of cases and to compare the results between the groups.

Commitment profiles among nurses: combinations of organizational commitment forms and work engagement, psychological distress, and turnover intention.

To clarify the combined effect of the sub-factors of organizational commitment, this study examined the relationships between organizational commitment profiles and work engagement, psychological distress, and turnover intention among nurses. A cross-sectional survey was conducted; 455 nurses (38 men and 417 women) were included in the statistical analysis. We extracted six clusters through k-means cluster analysis and applied a one-way analysis of variance and χ2 test for work engagement, psychological distress, and turnover intention. Consequently, significant differences were found in work engagement and turnover intention (both p<0.05), and no significant difference was found in psychological distress. These results indicate the formation of affective and normative commitment among nurses in working energetically or preventing turnover. Additionally, no negative effects related to increases in continuance commitment were identified in this study.

Long-term outcome of selective mutism: factors influencing the feeling of being cured.

Some long-term outcomes for participants with selective mutism (SM) are elevated rates of phobic disorders, particularly social phobia, persistent communicative problems, and reduced self-esteem. However, data on the long-term outcomes of SM are scarce. In this study, by analyzing interpersonal anxiety, communication skills, and self-esteem among those who experienced SM and felt cured (SM-C-group: 30 females, 6 males, mean age 28.0, SD = 7.42, range 19-47 years), those who experienced SM and did not feel cured (SM-NC-group: 37 females, 4 males, mean age 27.4, SD = 7.24, age range 19-50 years), and those who had not experienced SM (Non-SM-group: 30 females, 30 males, mean age 26.4, SD = 7.62, age range: 20-48 years), we examined the long-term outcomes of SM and the factors that influence the feeling of being cured of SM. Results showed that the SM-C-group and SM-NC-groups had significantly higher interpersonal anxiety and significantly lower communication skills than the Non-SM-group. Moreover, the SM-C-group showed significantly lower interpersonal anxiety and significantly higher communication skills than the SM-NC-group. However, while there was no significant difference in self-esteem between the SM-C and SM-NCgroups, there was a significant difference between the SM-NC and Non-SM groups. The SM-C and SM-NC groups did not differ on the retrospective symptom load (SMQ-J), but did on the Current level of difficulty with speaking. The results of the logistic regression analysis predicted that communication skills and self-esteem did not influence the feeling of being cured of SM, but interpersonal anxiety and Current level of difficulty to speak did. Therefore, it is speculated that the intensity of this interpersonal anxiety and whether people with SM still felt difficulty in talking to others may have affected the feeling of being cured from SM.

Japanese Parents' Experiences with Home-Based Interventions of Applied Behavior Analysis for Young Children with Autism Spectrum Disorders.

This study involved qualitative analyses of the benefits and difficulties of providing home-based Applied Behavior Analysis (ABA) for Japanese parents of young children with autism spectrum disorder (ASD). An open-ended questionnaire survey was administered to 35 parents of children with autism who were implementing home-based ABA. The mean age of the parents was 38.7 years old (SD = 3.80), and the time since initiation of home-based ABA was 25.5 months (SD = 19.58). The mean age of the children with ASD was 64.5 months old (SD = 37.7). Data were analyzed using the KJ method of qualitative analysis. The benefits of implementing home-based ABA were related to growth of the parents themselves and child development. Identified difficulties included balancing work and household responsibilities and psychological problems. These findings were then compared with similar previous studies to discuss support for families implementing in-home ABA programs.

Effectiveness of the internet based parent education program on applied behavior analysis for parents of children with autism spectrum disorder.

BACKGROUND: Parent education (PE) in autism spectrum disorder (ASD) is recognized as an important component of support for families living with ASD. Specifically, the knowledge of how to interact with children based on applied behavior analysis (ABA) is useful for parents. In this study, a short-term, internet based on-demand PE program was conducted for parents of children with ASD to acquire knowledge of ABA and basic teaching techniques. METHODS: Parents of children with ASD were recruited as study participants. They attended on-demand lectures from their homes, performed homework tasks based on lecture content and emailed them to our team. The General Health Questionnaire 30 (GHQ) and Knowledge of Behavioral Principle as Applied to Children (KBPAC) were assessed before and after the program. RESULTS: Of the 25 participants, 21 attended all programs and completed all homework tasks and pre- and post-assessments. However, communication among participants via the bulletin board was low. KBPAC scores increased significantly from pre- to post-program scores, and GHQ subscales regarding anxiety and mood modulation decreased significantly from pre- to post-program scores. Positive results were obtained in the post-questionnaires as well. CONCLUSION: These findings suggest the practical applicability of an online PE program for parents of children with ASD based on ABA.

Parent-Mediated Toilet Training for a Child with Autism Spectrum Disorder through Teleconsultation: A Case Report.

In defecation training, parent-mediated intervention via teleconsultation is helpful because the number of instructions for establishing defecation habits is limited. In the case report of the present study, defecation training was conducted based on gradual target setting and differential reinforcement through teleconsultation via email for a Caucasian 5-year-old boy with autism spectrum disorder (ASD) who lived in Greece. As a result of the intervention, namely the gradual target setting and differential reinforcement, in-bowl defecations increased at home.

The Effect of Nurses' Work-Life Balance on Work Engagement: The Adjustment Effect of Affective Commitment.

BACKGROUND: This study aimed to examine the effects of nurses' work-life balance (WLB), job demands and resources, and organizational attachment on their work engagement (WE). The second aim was to shed light on whether the relationships among WLB, job demands, resources, and WE are modulated by organizational attachment. METHODS: In total, 425 nurses working in a university hospital responded to the questionnaire. The primary statistical analysis method was hierarchical multiple regression with WE as the dependent variable. RESULTS: In the model in which all variables were applied, affective commitment (AC) (ß = 0.41), family-to-work positive spillover (ß = 0.25), and number of children (ß = 0.13) were found to have a significant association with WE. Family-to-work negative spillover (FWNS) and AC had significant interaction effects. The result suggests that when AC was low, WE tended to decline further due to FWNS; however, when AC was high, WE did not change due to the effect of FWNS. CONCLUSION: These results confirmed that to improve nurses' WE, hospital organizations should implement initiatives to facilitate WLB that considers nurses' household roles. Furthermore, high organizational attachment buffered the home's negative influence on work, thereby helping nurses work energetically.

Psychological Preparations Affecting the Emotions of Children with Developmental Disorders Toward Hospitals.

BACKGROUND: The psychological preparation factors associated with positive or negative emotions in pediatric patients with developmental disorders are not well known. We aimed to clarify which psychological preparation factors affect positive (favorable) or negative (fear) emotions toward hospitals in pediatric patients with autism spectrum disorder (ASD) or attention deficit hypertensive disorder (ADHD), using the questionnaires for the patients and guardians. METHODS: The questionnaires were sent by mail via prefectural patient-family groups to pediatric patients (6 to 15 years old; diagnosed with ASD or ADHD) and their guardians living in seven prefectures in Japan. Thereafter, we statistically analyzed the associations between the background factors or psychological preparations and the patients' positive or negative emotions toward the hospital. RESULTS: The questionnaire results of 68 patients (age: 6-15 years; 15 = females; 53 = males) and their guardians indicated the main diagnoses for patients were ASD (n = 54) and ADHD (n = 14). Intellectual disability and hypersensitivity were positively associated with fear experiences in the hospital. In contrast, the staff's explanations during interventions negatively associated with patients' fear experiences. The psychological preparations performed by doctors during the medical checks were positively associated with the patient's positive emotions toward the hospital. CONCLUSION: Regarding the psychological preparations for patients with ASD or ADHD, interpersonal communication with doctors and staff promotes positive emotions and reduces anxiety in the hospital.

Interventions for Students with Problem Behaviors: A Workshop Incorporating Applied Behavior Analysis for Japanese Teachers.

BACKGROUND: We conducted a workshop-style program based on applied behavior analysis (ABA) for Japanese teachers in charge of children with developmental disabilities who had behavioral problems. Additionally, we investigated whether making and implementing behavioral intervention plans (BIPs) for participants, improved students' behavioral problems, and the mental health of participants. METHODS: The participants were 18 Japanese elementary and kindergarten teachers in charge of students with behavioral problems. The workshop comprised eight two-hour sessions of lectures and group discussions related to ABA. Achievement level was evaluated for the development and implementation of the BIP and improvement of behavioral problems. In addition, we analyzed changes in the 30-item General Health Questionnaire (GHQ-30) scores pre- and post-workshop to assess participants' mental health. Fifteen teachers who participated in more than half of the sessions were analyzed. RESULTS: All 15 teachers analyzed were able to perform appropriate functional behavioral assessment (FBA) and make a BIP, and 12 showed improvement in the targeted problem behaviors. Many target behaviors had avoidance functions and many antecedent strategies were behavior contracts. Adaptive behaviors incompatible with problem behaviors were selected as alternative behaviors to problem behaviors. Also, there was no aversive control over the outcome strategy. The average score for "social activity disorder" and "anxiety / caprice" in GHQ30 showed a statistically significant improvement in pre- and post-workshop. CONCLUSION: It was found that appropriate FAB and BIP could be created using "the strategy sheet," in workshops based on the ABA. It was also suggested that the workshop program may in turn improve teachers' mental health. Further study is needed on the effectiveness of the workshop program using intergroup comparison designs for more subjects.

The Telehealth Program for Kindergarten and Nursery Teachers in Charge of Children with Behavioral Problems.

This study provided a telehealth program for kindergarten and nursery teachers in charge of children with, or suspected of having, developmental disabilities. We examined teacher participation, behavior intervention plans (BIP), practice, and improvement of children's behavior. Six sessions of online lectures and two online consultations based on functional behavioral assessments (FBA) were held. All ten teachers conducted the FBA, and seven created the BIP. Additionally, six out of seven teachers recorded their children's problem behaviors, showing improvement in the problem behavior of these children. Moreover, the non-targeted problem behaviors also showed improvement following the intervention.

Reliability and validity of the Japanese version of the Behavior Problem Inventory-Short Form.

BACKGROUND: The Behavior Problems Inventory-Short Form (BPI-S), which assesses behavior problems in individuals with intellectual disabilities (ID), is a shorter version of the BPI-01. This study investigated the reliability and validity of the BPI-S Japanese version (BPI-S-J) for adolescents/adults with ID and behavior problems. METHODS: The test-retest reliability included participants with ID and behavioral problems who were enrolled in welfare services. For test-retest reliability, 42 caregivers independently responded to the BPI-S-J every two weeks. Inter-rater reliability was independently assessed using the BPI-S-J by two caregivers who were familiar with the 42 participants. The participants of the validity assessment were 227 students from special needs schools or patients with ID admitted to medical institutions. The total frequency total score was compared based on the degree of ID. To examine the criterion-related validity, we analyzed the total frequency score, the total score of the Criteria for Determining Severe Problem Behavior (CDSPB) and the total score of the Aberrant Behavior Checklist-Japanese version (ABC-J). RESULTS: The BPI-S-J of test-retest reliability was satisfactory (intra-class correlation; ICC) = 0.954), and the total score significantly (ICC = 0.721) represented good inter-rater reliability. For the validity, the BPI-S-J score of participants who had severe and profound ID was significantly higher than those who had mild and moderate ID. Significant correlations were observed between the BPI-S-J score and CDSPB score (r = 0.499), and the ABC-J score (r = 0.699), indicating adequate criterion-related validity. CONCLUSION: This study showed the utility of the BPI-S-J to assess behavior problems in the Japanese ID population.

Survey of Japanese Welfare Facility Staff and Special School Teachers Facing Difficulties at Work with Persons with Challenging Behaviors.

BACKGROUND: Effective training programs for managing people with challenging behaviors should be established in both welfare and education settings, as it is important that the support system for challenging behaviors covers the entire life span. For consistent support, it is necessary to understand the difficulties and needs of support staff in caring for people with challenging behaviors from infancy through adulthood. The purpose of this study was to gather data from welfare facility staff and special school teachers regarding their difficulties and needs for managing challenging behaviors, and to determine the differences between teachers and staff members. METHODS: We investigated Japanese special school teachers (n = 317) and the staff of welfare facilities for intellectual disabilities (n = 202) regarding their difficulties and needs. The questionnaire comprised 23 items related to the needs and difficulties in responding to challenging behaviors. RESULTS: Three factors were extracted from the analysis of the survey items: "Difficulty in coordination and information sharing with other organizations," "Difficulty in the workplace," and "Difficulty in support and response." The overall trend was that welfare staff have more difficulties and needs than special school teachers. CONCLUSION: It is necessary to emphasize not only how to respond to challenging behavior but also the importance of establishing a collaborative system within the workplace and with other organizations for staff training in light of their perceptions of working conditions.

Consultation on the Functional Assessment of Students with Severe Challenging Behavior in a Japanese Special School for Intellectual Disabilities.

BACKGROUND: It is important to intervene early and treat children and individuals with behavioral disorders. We conducted a functional assessment-based consultation for teachers of several students with severe behavioral disorders and examined the effects of the consultation. METHODS: Eight students with severe behavioral disorders were selected from two special schools for intellectual disabilities in western Japan. An external consultant team conducted a functional assessment-based consultation in cooperation with a team of teachers. Consultations were held once a month, and comprised three to six sessions per student. RESULTS: As a result of the functional assessment, only 8 out of 10 behaviors with some communication function, and 2 with only sensory enhancements were estimated. The Effects of consultations based on functional assessment were presented. It was found that 6 out of 10 target behaviors had obtained high effects. The total score for each behavioral scale showed a statistically significant improvement. CONCLUSION: Although consultations lasted for only six months and occurred from three to six times for each student, scale scores for problem behavior before and after intervention were improved, overall. Each case report suggested that many factors influence the difference in the effects of consultation among individual students. This study is significant in that it provides a model for the consultation system that operates on a short-term basis, and presents a means for small-scale group consultations for students with intellectual disabilities and autism in cooperation with external specialized institutions in special schools in Japan.

Correlation Between Subjective Happiness and Pleasant Activities at Workplace in Nursing Staff for Older Individuals in Japan.

The purpose of this study was to investigate the correlations between nursing staff's mental health, number of years worked, night shifts performed, and pleasant activities at the workplace. One hundred forty-three subjects who had no missing data were analyzed. Questions consisted of basic attributes, subjective happiness scale (SHS), and pleasant activities conducted at the workplace. Denouements of SHS indicated a significant trend for the main effect, with more pleasant activities in the high SHS group than the low SHS group. The interaction was significant, with fewer pleasant activities in participants in the low SHS group who worked the night shift compared with those who worked the night shift regardless of work experience. The outcomes of this study suggest that it is essential to expand the repertoire of pleasant activities at the workplace to increase the subjective happiness of nursing staff for older individuals.

Assessments and Interventions to Address Challenging Behavior in Individuals with Intellectual Disability and Autism Spectrum Disorder in Japan: A Consolidated Review.

Intellectual disability and autism spectrum disorder are neurodevelopmental disorders that emerge during the developmental period. A significant barrier that impedes the social adaptation of individuals with these disorders is the exhibition of problem behaviors, such as self-injurious, stereotyped, and aggressive/destructive behaviors. In recent years, these problem behaviors have been collectively referred to as "challenging behavior," in accordance with the contention that they result from an interaction between the individual and his or her social environment. Evidence-based psychosocial interventions that adopt the functional approach to treating challenging behavior are increasing. However, in order to effectively implement such interventions in educational settings and welfare facilities, it is essential to develop staff training programs and usable psychometric assessments. Accordingly, a brief overview of research studies on challenging behavior that have been conducted in Japan, as well as the various support systems that are available to individuals who exhibit challenging behavior, are presented in this article. The discussion makes it apparent that, in order to improve treatment systems in Japan that are aimed at addressing challenging behavior, it is necessary to establish not only better staff training programs, but also reliable and valid assessments measuring challenging behavior that can be readily used by teachers and parents. On the basis of this discussion, it is proposed that technological advancements must be applied to psychosocial approaches in the study of problem behaviors, in order to develop assessment system using software applications and automatic measurement system of target behaviors using sensing technology.