Using fuction-based CBT with parent involvement to treat OCD in two school-age children with high-functioning autism

Obsessive Compulsive Disorder (OCD) involves excessive worry coupled with engaging in rituals that are believed to help alleviate the worry. Pervasive Developmental Disorders (PODs) are characterized by impairments in social interaction, communication, and the presence of repetitive and/or restrictive behaviours (American Psychiatric Association, 2000). Research suggests that as many as 81% of children with a POD also meet criteria for a diagnosis ofOCD. Currently, only a handful of studies have investigated the use of Cognitive Behavioural Therapy (CBT) in treating OCD in children with autism (Reaven & Hepburn, 2003 ; Sze & Wood, 2007; Lehmkuhl, Storch, Bodtish & Geflken, 2008). In these case studies. the use of a multi-modal CBT treatment package was successful in alleviating OCD behaviours. The current study used function-based CBT with parent involvement and behavioural supplements to treat 2 children with POD and OCD. Using a multiple baseline design across behaviours and participants, parents reported that their child 's anxiety was alleviated and these gains were maintained at 6-month follow-up. According to results of the Children 's Yale-Brown Obsessive Compulsive Scale (Goodman, Price, Rasmussen, Riddle, & Rapoport, 1986) from preto post-test, OCD behaviours of the children decreased II"om the severe to the mild range. In addition, the parents rated the family's level of interference related to their child 's OCD as substantially lower. Last, the CBT treatment received high ratings of consumer satisfaction.

Field effectiveness of stimulus equivalence for teaching reading skills to children with autism

Stimulus equivalence involves teaching two conditional discriminations that share one stimulus in common and testing all possible conditional discriminations not taught (Saunders & Green, 1999). Despite considerable research in the laboratory, applied studies of stimulus equivalence have been limited (Vause, Martin, Marion, & Sakko, 2005). This study investigated the field-effectiveness of stimulus equivalence in teaching reading skills to children with Autism. Participants were four children with Autism receiving centre-based intensive behavioural intervention (lBI) treatment. Three of the participants, who already matched pictures to their dictated names, demonstrated six to eight more emergent performances after being taught only to match written words to the same names. One participant struggled with the demands of the study and his participation was discontinued. Results suggest that stimulus equivalence provided an effective and efficient teaching strategy for three of the four participants in this study.

Teaching sexual abuse prevention skills to two children with intellectual disabilities through game play

The current study examined the effectiveness of a sexual abuse prevention program developed locally for children with intellectual disabilities. The program package included a board game with informational storybooks that were designed to be used in a family setting. Additionally, this research sought to determine if parents could be effective at presenting the sexual abuse pr~vention materials to their children. A multiple baseline across behaviours design was used with two participants with a diagnosis of autism. Through role play scenarios as well as verbal knowledge tests, it was determined that the program was effective at teaching the participants the skills presented for self protection. It was also determined that the skills learned were generalized to scenarios that were untrained during the game play. Finally, with additional supports, it was determined that parents were able to effectively teach their children the required skills.

Lived experiences of children with disabilities in various movement programs

This research offered children with disabilities the opportunity to express their voices in the description of their movement experiences. Three children aged 10-13 shared their experiences in school physical education and adapted physical activity. Observations of participants using interactive media activities in an adapted physical activity program were used to supplement interviews. The aim of this research was to discover how future professionals are prepared to design and implement physical activity and physical education programs for children with disabilities. A document analysis of Ontario university course calendars in the fields of physical education and kinesiology, disability studies, and teacher education was utilized. Data from each data context underwent four levels of reduction: 1) content, 2) categorical, 3) thematic, and 4) indigenous typologies. Findings are presented at each level leading to the presentation of indigenous typologies. Typologies of Forbidden-ness and Dichotomous Thinking were identified in the research.

Dyad function-based cognitive behavioural therapy as a treatment for obsessive compulsive disorder in two school aged children with high functioning autism

Children with High-Functioning Autism (HF A) are more vulnerable to developing Obsessive Compulsive Disorder (OCD) than typically developing children and those with Low-Functioning Autism (Gadow et al., 2005). This study used a multiple baseline design across behaviours (Cooper, Heron, & Heward, 2007) to investigate if a two phase function-based Cognitive Behaviour Therapy (CBT) would decrease obsessive compulsive behaviours (OCBs) in two children ages 7 and 9 who met criteria for OCD and HF A. This multimodal treatment package consisted of treatment enhancements to meet the children's cognitive, linguistic, and social challenges associated with their HF A diagnosis, as well as a manual and accompanied children's workbook (Vause, Neil, & Feldman, in progress). In line with previous research conducted on CBT as a treatment for OCD in this population (e.g., Wood et at, 2009), the children in this study experienced clinically significant decreases in their OCBs as a result of receiving the CBT protocol.

I Believe in me, not OCB: Evaluation of Group Function-Based CBT as a Treatment for Obsessive Compulsive Behaviour in Four Children with HFA

Researchers have conceptualized repetitive behaviours in individuals with Autism Spectrum Disorder (ASD) on a continuum oflower-Ievel, motoric, repetitive behaviours and higher-order, repetitive behaviours that include symptoms ofOCD (Hollander, Wang, Braun, & Marsh, 2009). Although obsessional, ritualistic, and stereotyped behaviours are a core feature of ASD, individuals with ASD frequently experience obsessions and compulsions that meet DSM-IV-TR (American Psychiatric Association, 2000) criteria for Obsessive-Compulsive Disorder (OCD). Given the acknowledged difficulty in differentiating between OCD and Autism-related obsessive-compulsive phenomena, the present study uses the term Obsessive Compulsive Behaviour (OCB) to represent both phenomena. This study used a multiple baseline design across behaviours and ABC designs (Cooper, Heron, & Heward, 2007) to investigate if a 9-week Group Function-Based Cognitive Behavioural Therapy (CBT) decreased OCB in four children (ages 7 - 11 years) with High Functioning Autism (HFA). Key treatment components included traditional CBT components (awareness training, cognitive-behavioural skills training, exposure and response prevention) as well as function-based assessment and intervention. Time series data indicated significant decreases in OCBs. Standardized assessments showed decreases in symptom severity, and increases in quality of life for the participants and their families. Issues regarding symptom presentation, assessment, and treatment of a dually diagnosed child are discussed.

Families with Children with Autism, Developmental Delay, and Typical Development: The Relationships of Parenting Self-Efficacy, Parenting Strategies, and Child Problem Behaviour

Parents of children with autism spectrum disorders (ASD) and developmental delays (DD) may experience more child problem behaviours, report lower parenting selfefficacy (PSE), and be more reactive than proactive in their parenting strategies than those who have children with typical development (TD). Differences in PSE and parenting strategies may also influence the extent to which child problem behaviours are experienced by parents who have children with ASD and DD, compared to those who have children with TD. Using a convenience sample of parents of children with ASD (n = 48), DD (n = 51), and TD (n = 72), this study examined group differences on three key variables: PSE, parenting strategies, and child problem behaviour. Results indicated that those in the DD group scored lower on PSE in preventing child problem behaviour than the ASD group. The TD group used fewer reactive strategies than the DD group, and fewer proactive strategies than both the ASD and DD groups. For the overall sample, higher reactive strategies use was found to predict higher ratings of child problem behaviour, while a greater proportion of proactive to reactive strategies use predicted lower ratings of child problem behaviour. PSE was found to moderate DD diagnosis and child problem behaviour. Implications for a behavioural (i.e., parenting strategies) or cognitive (i.e., PSE) approach to parenting are discussed.

Integrating Children with Emotional and Behavioural Disabilities into Community Recreation Programs: A Handbook for Staff

This study examined the process of integrating children with Emotional Behavioural Disorders (EBDs) with their peers into recreation programs. The purpose was to develop a set of recommendations for the development of a handbook to help workers in recreation with the integration process. To this end, a needs assessment was conducted with experienced recreation workers in the form of semistructured interviews. Participants were recruited from two community centers in a large southern Ontario city. Themes were drawn from the analysis of the interview transcripts and combined with findings from the research literature. The results were a set of recommendations on the content and format of a handbook for integrating children with EBDs into recreation programs.

Investigating Changes in Parent Knowledge about Obsessive Compulsive Behaviour Following Group Function-Based Cognitive Behavioural Therapy for Children with High Functioning Autism

This study investigated improvements in parent knowledge of effective intervention strategies following participation in a group function-based CBT treatment (GFbCBT) package for children with comorbid OCD and ASD. Nineteen parents of children ages 7-12 years with High Functioning Autism (HFA) participated in the 9-week treatment program. Key components of treatment included psychoeducation and mapping, cognitive-behavioural skills training, function-based interventions and exposure and response prevention (ERP). Treatment sessions also included direct parent education, which followed a behavioural skills training model (Miltenberger, 2008). Parent knowledge (N = 19) was measured pre and post treatment using a vignette about a child demonstrating obsessive-compulsive behaviour. Results of a one-tailed pairwise t-test indicated statistically significant changes (p=.036) in overall parent knowledge following participation in treatment. Statistically significant changes were also found in parents’ ability to generate ERP and function-based intervention strategies. These results provide preliminary evidence that parents benefit from active involvement in the GFbCBT treatment package.

Cognitive Behavior Therapy for Obsessive-Compulsive Behavior in Children with Autism Spectrum Disorder: A Comparison of Hierarchical Linear Modelling and Visual Analysis

Behavioral researchers commonly use single subject designs to evaluate the effects of a given treatment. Several different methods of data analysis are used, each with their own set of methodological strengths and limitations. Visual inspection is commonly used as a method of analyzing data which assesses the variability, level, and trend both within and between conditions (Cooper, Heron, & Heward, 2007). In an attempt to quantify treatment outcomes, researchers developed two methods for analysing data called Percentage of Non-overlapping Data Points (PND) and Percentage of Data Points Exceeding the Median (PEM). The purpose of the present study is to compare and contrast the use of Hierarchical Linear Modelling (HLM), PND and PEM in single subject research. The present study used 39 behaviours, across 17 participants to compare treatment outcomes of a group cognitive behavioural therapy program, using PND, PEM, and HLM on three response classes of Obsessive Compulsive Behaviour in children with Autism Spectrum Disorder. Findings suggest that PEM and HLM complement each other and both add invaluable information to the overall treatment results. Future research should consider using both PEM and HLM when analysing single subject designs, specifically grouped data with variability.

Exploring the Therapeutic Alliance in Cognitive-Behavior Therapy with Children with Autism Spectrum Disorder: An Interpretative Phenomenological Approach

Abstract The therapeutic alliance (TA) is the most studied process of adult psychotherapeutic change (Zack et al., 2007) and has been found to have a moderate but robust relationship with therapeutic outcome regardless of treatment modality (Horvath, 2001). The TA is loosely described as the extent to which the therapist and the participant connect emotionally and work together towards goals. Conceptualizations of the TA with children have relied on adult models, even though it is widely acknowledged that the pediatric population will rarely willingly commit to therapy, nor readily admit to any challenges that they may be experiencing (Keeley, Geffken, McNamara & Storch, 2011). For children with Autism Spectrum Disorder (ASD) the therapeutic alliance may require an even greater retheorizing considering the communicative and social difficulties of this particular population. Despite this need, research on children with ASD and the therapeutic TA is almost non-existent. In this qualitative study, transcripts from semi-structured interviews with mothers of children with ASD were analyzed using Interpretative Phenomenological Analysis (IPA). IPA closely examines how individual people make sense of their life experiences using a theme-by-theme approach. The three interviewees were mothers whose children were participants in a nine-week Cognitive Behaviour Therapy (CBT) group for obsessive-compulsive behaviours (OCB). A total of four superordinate themes were identified: (i) Centralization and disremembering the TA, (ii) Qualities of the therapist, (iii) TA and the importance of time, and (iv) Signs of a healthy TA. The mothers’ perspectives on the TA suggest that, for them and their children, a strong TA was a required component of the therapy. Implications for clinicians and researchers are discussed.

ARTERIAL STIFFNESS IN CHILDREN WITH AND WITHOUT DEVELOPMENTAL COORDINATION DISORDER

The purpose of this study was to determine whether children with potential developmental coordination disorder (p-DCD) demonstrate increased arterial stiffness and thickness compared to age and school matched controls (mean age 14.7 yrs). We also assessed whether these measures differed by sex. Compliance, distensibility, and intima-media thickness (IMT) were measured at the common carotid artery for 28 children with p-DCD and 47 controls. ECG-R-wave-toe pulse wave velocity (PWV) was also measured for 29 children with p-DCD and 45 controls. We found that compared to controls males with p-DCD had significantly higher PWV (3.8±0.2 vs. 4.1±0.3, p=0.001) and lower distensibility (0.82± 0.19 vs. 0.70± 0.17, p=0.034) while females showed no significant differences (p=0.523 and p=0.123 respectively). As a result, it is apparent that sex differences exist with respect to arterial health within this population and that children with p-DCD may be more likely to develop cardiovascular disease later in life.

Using stimulus equivalence to teach monetary skills to school-age children with autism

The present study evaluated the use of stimulus equivalence in teaching monetary skills to school aged children with autism. An AB within-subject design with periodic probes was used. At pretest, three participants demonstrated relation DA, an auditory-visual relation (matching dictated coin values to printed coin prices). Using a three-choice match-to-sample procedure, with a multi-component intervention package, these participants were taught two trained relations, BA (matching coins to printed prices) and CA (matching coin combinations to printed prices). Two participants achieved positive tests of equivalence, and the third participant demonstrated emergent performances with a symmetric and transitive relation. In addition, two participants were able to show generalization of learned skills with a parent, in a second naturalistic setting. The present research replicates and extends the results of previous studies by demonstrating that stimulus equivalence can be used to teach an adaptive skill to children with autism.

An in-depth analysis of real and perceived barriers to speech and language program participation for children with speech and language delays : a question of barriers to service?

The current study investigated the effects that barriers (both real and perceived) had on participation and completion of speech and language programs for preschool children with communication delays. I compared 36 families of preschool children with an identified communication delay that have completed services (completers) to 13 families that have not completed services (non-completers) prescribed by Speech and Language professionals. Data findings reported were drawn from an interview with the mother, a speech and language assessment of the child, and an extensive package of measures completed by the mother. Children ranged in age from 32 to 71 mos. These data were collected as part of a project funded by the Canadian Language and Literacy Research Networks of Centres of Excellence. Findings suggest that completers and non-completers shared commonalities in a number of parenting characteristics but differed significantly in two areas. Mothers in the noncompleting group were more permissive and had lower maternal education than mothers in the completing families. From a systemic standpoint, families also differed in the number of perceived barriers to treatment experienced during their time with Speech Services Niagara. Mothers in the non-completing group experienced more perceived barriers to treatment than completing mothers. Specifically, these mothers perceived more stressors and obstacles that competed with treatment, perceived more treatment demands and they perceived the relevance of treatment as less important than the completing group. Despite this, the findings suggest that non-completing families were 100% satisfied with services. Contrary to predictions, there were no significant differences in child characterisfics and economic characteristics between completers and non-completers. The findings in this study are considered exploratory and tentative due to the small sample size.

The effectiveness of a multisensory writing program in improving cursive writing ability in children with sensorimotor difficulties

It is estimated that five to ten percent of children experience sensory motor difficulties that result in various learnlng disabilitiies , among them. inabllity to output Information on paper in the appropriate manner (Ayres ,1985). The relationship between sensorimotorabillty and handwriting is well documented in the literature (Freeman,1917; Townsend , 1951; Nlkola-Ll sa, 1987). While much of the literature is inconclusive, there are findings to suggest that muitisensory handwriting programmes are an effective approach to improvlng writing abIlity in these chlldren. For a number of years, Occupational Therapists have been involved in the remediation of handwriting utllizing , amongst other approaches . multisensory programmes. While subjective assessments of effectiveness have been extremerly positive. scientIfic evaluation has been minimal . If further intervention in this area is to occur, it Is essential that the profession be able to justify the existence of such programmes . The purpose of this study was to examine what effects a multlsensory writing prog~am would have on the curslve writing ability of chlldren with sensorimotor dlfficulties. A single case with multiple baselines across be havlours design was used , with the behavlours being cursive writing abilIty of fIve distInct letter groups. The fIve groups were taught in random order, one group every two weeks , In a one-hour session. Repeated measurements of writing speed and qualIty for each letter group were made. This design was repeated over three other cases . Results of the study yielded statistical signifi cance in trend changes In specIfic letter groups for all of the chlldren following interventlon. One child achieved statistical significance In the overall change In quality , while none of the children achieved overall statistical significance In speed score changes . Teacher reports and an assessment of written language prior to and following the program suggest that Intervention may have had a positive effect on self-confidence in written output, and on the maturlty of written expression in some of the cases . Further research in this field is needed to validate the continual use of multisensory writing programmes by Occupational Theraplsts worklng with this specific population and to provide some directlon with regards to the Integration of multlsensory writing programmes within the regular academic remedial programme .