Dr Laura Roche

Sleep disturbances have frequently been associated with trauma and post-traumatic stress disorder (PTSD). Effective treatments for sleep disturbances are therefore likely to be indicated for individuals who have experienced trauma. With the aim of advancing evidence-based practice in this area, this review focuses on studies evaluating behavioral treatments for sleep disturbances among civilians who have experienced trauma. Seventeen studies were identified that met inclusion criteria. Data were extracted from each study on (a) the type of sleep disturbance experienced, (b) assessments used, (c) treatment procedures, (d) outcome measures, and (e) main findings. Research quality was also evaluated. The results of these 17 treatment studies were generally positive, but ratings of the strength of the research varied from strong to weak. Overall, this review finds evidence to support the use of behavioral treatments for sleep disturbances resulting from experiences of trauma. The implications of these findings for clinical practice are discussed.

In recent years, a shift in focus has seen researchers seek to identify the priorities and preferences of key stakeholders to shape the direction of future research for those on the autism spectrum. The process of synthesising the views, knowledge and expertise of key stakeholders with either a lived or shared experience of autism is invaluable and can inform future research to ensure that it is meaningful and has the greatest impact. A number of studies have reported on the research priorities of groups within the autism community, but to date, these studies stand alone and priorities have not been considered collectively. This systematic review identified seven studies that reported on key stakeholders¿ priorities for autism research. Studies were synthesised according to (a) the target participant group and method of recruitment, (b) the methodology used to elucidate the viewpoint of stakeholders, (c) the country of stakeholders and (d) commonly identified priorities. Common features across studies note the importance of prioritising initiatives that will result in real-world changes in the lives of the autism community and more research across the lifespan. There is an identified need for more diverse stakeholder voices to influence the identification of priorities for future research foci. Continued inclusion of the autistic and autism communities in priority-setting research is imperative for achieving significant outcomes in autism research and to progress the field in an effective and socio-ethical way. Lay abstract: It has become very important in autism research to ask the autistic community about what kinds of research they think should be done in order to improve the lives of people with autism. Many studies have reported on research goals from people within the autism community, such as parents of people on the autism spectrum, and practitioners and clinicians who support people on the autism spectrum. So far, the research goals from all of these studies have not been considered together, which is important so that all autism research can be working towards the same goals. We reviewed seven studies that looked at the priorities for autism research from key people within the autism community. Each of the reviewed studies are described according to (a) the types of people involved in the study, (b) the way the research goals from each group of people were identified, (c) the country where they were from and (d) the most common research goals from across all of the studies. Within these seven studies, research that will lead to real-world changes in the daily lives of the autism community and a greater focus on skill training for people with autism across their lives were found to be very important. From this review, we found that it is also very important to include a range of different people from the autism community when deciding what autism research goals should be focused on so that future research can be more helpful for the autism community.

Objectives: Angelman syndrome (AS) and is typically diagnosed in children under the age of three based upon early behavioural concerns identified by parents, or genetic links with other family members. For some families however, the pathway to diagnosis is not so clear, particularly when children demonstrate differential characteristics, commonly seen for those with UBE3A pathogenic variants (ubiquitin protein ligase EA3), imprinting defects or uniparental disomy (patUPD) etiology. The aim of this paper is to explore parent¿s experiences of the pathway to diagnosis involving 394 children with formal diagnoses of AS. Methods: Data from the Global Angelman Syndrome Registry on the age of formal diagnosis, the process involved in formal diagnosis, professionals involved in the diagnosis, the number of tests taken and the prevalence of misdiagnoses were compared across deletion and non-deletion (UBE3A pathogenic variant, imprinting and patUPD) etiologies. Results: Compared to those with deletion etiology, individuals with non-deletions are more likely to (a) receive a diagnosis later in childhood (i.e., past the age of 3 years old), (b) have a greater number of professionals and tests involved and (c) to be misdiagnosed with global developmental delay. Conclusions: The methods identified for formal diagnoses mirrored the current advances in technology and accessibility. The benefit of using parental report from registries to understand the diagnostic process and promote early and accurate diagnosis of AS is discussed.

Purpose of Review: Neonates present with a number of primitive reflexes that typically dissipate in later infancy. Persistence of such reflexes past infancy could indicate some type of developmental problem or compromised neurology and therefore might be predictably associated with various types of developmental disorders. The present review sought to summarize key studies investigating the persistence of primitive reflexes in individuals with cerebral palsy, attention-deficit/hyperactivity disorder, autism spectrum disorder, and other developmental disorders. Recent Findings: Several studies have shown persistence of primitive reflexes in children with cerebral palsy, attention-deficit/hyperactivity disorder, and autism spectrum disorder. Persistence of primitive reflexes varies in relation to the type and severity of symptoms in cases of cerebral palsy and attention-deficit/hyperactivity disorder and with the presence of comorbid intellectual disability in children with autism spectrum disorder. Primitive reflexes have also been shown to persist in adults with Down syndrome. Summary: Assessing primitive reflexes may be useful for advancing the understanding and early detection of developmental disorders. Additional research should seek to clarify the relation between the persistence of primitive reflexes and the type and severity of developmental disorders, as well as seeking to identify possible reflex phenotypes. Persistence of primitive reflexes might signal some type of developmental or neurological problem and may negatively impact motor development and learning. Evidence-based interventions to address the persistence of primitive reflexes are lacking, and the development of these should be a research priority.

Purpose of Brief Review: 22q11.2 deletion syndrome (22q11.2DS) is a micro-deletion disorder with a heterogenous complex presentation including significant communication difficulties. This brief review discusses the communication profile and potential approaches to enhancing communication skills for these learners. Recent Findings: The communication profile of 22q11.2DS has been described in several studies identifying early assessment, monitoring, and on-going language interventions as best practice for those with 22q11.2DS. However, few studies have reported on empirical findings of specific interventions to enhance the communicative skills of learners with 22q11.2DS. Summary: The distinct communication profile of individuals with 22q11.2DS offers researchers and practitioners an opportunity to develop tailored interventions to support effective communication skills for learners with 22q11.2DS. This review recommends that, in addition to existing interventions, augmentative and alternative communication (AAC) should be evaluated to (a) support early expressive communication for children and (b) support socio-communication strategies for older learners with 22q11.2DS.

Autism spectrum disorder is characterized by social and communication impairment, but some children appear to have relative strength in areas such as reading printed words. The present study involved two children with limited expressive communication skills, but relatively stronger reading ability. Based on this existing strength, we evaluated a textual prompting procedure for teaching the children to produce multiword spoken requests. The effect of providing textual prompts on production of multiword requests was evaluated in an ABAB design. The results showed that multiword requests increased when textual prompts were provided and decreased when the prompts were removed. In subsequent phases, the textual prompts were successfully faded by gradually making the printed text lighter and lighter until eventually the prompts were eliminated altogether. We conclude that identification of children¿s strengths may assist in identifying effective prompting procedures that could then be used in teaching functional communication skills.

Background: Responding to one's own name (RtN) has been reported as atypical in children with developmental disorders, yet comparative studies on RtN across syndromes are rare. Aims: We aim to (a) overview the literature on RtN in different developmental disorders during the first 24 months of life, and (b) report comparative data on RtN across syndromes. Methods and procedures: In Part 1, a literature search, focusing on RtN in children during the first 24 months of life with developmental disorders, identified 23 relevant studies. In Part 2, RtN was assessed utilizing retrospective video analysis for infants later diagnosed with ASD, RTT, or FXS, and typically developing peers. Outcomes and results: Given a variety of methodologies and instruments applied to assess RtN, 21/23 studies identified RtN as atypical in infants with a developmental disorder. We observed four different developmental trajectories of RtN in ASD, RTT, PSV, and FXS from 9 to 24 months of age. Between-group differences became more distinctive with age. Conclusions and implications: RtN may be a potential parameter of interest in a comprehensive early detection model characterising age-specific neurofunctional biomarkers associated with specific disorders, and contribute to early identification.

The study described in this article sought to enhance the social interaction skills of 3 preschool children using video modeling. All children had been assessed as having difficulties in their interactions with peers. Two were above average on internalizing problems and the third was above average on externalizing problems. The study used a delayed multiple probe across participants¿ design and was situated in a preschool setting. Videos were individualized for each participant based on age, gender, ethnicity, and individual needs. The models demonstrated appropriate play behavior with peers. Positive outcomes were achieved for 2 participants. The findings suggest that although the social interaction skills of preschool children can be enhanced in their natural environment through the use of video modeling; video modeling alone might not be sufficient for addressing the needs of children with externalizing problems.

Purpose of Review: Substantial research exists focusing on the various aspects and domains of early human development. However, there is a clear blind spot in early postnatal development when dealing with neurodevelopmental disorders, especially those that manifest themselves clinically only in late infancy or even in childhood. Recent Findings: This early developmental period may represent an important timeframe to study these disorders but has historically received far less research attention. We believe that only a comprehensive interdisciplinary approach will enable us to detect and delineate specific parameters for specific neurodevelopmental disorders at a very early age to improve early detection/diagnosis, enable prospective studies and eventually facilitate randomised trials of early intervention. Summary: In this article, we propose a dynamic framework for characterising neurofunctional biomarkers associated with specific disorders in the development of infants and children. We have named this automated detection ¿Fingerprint Model¿, suggesting one possible approach to accurately and early identify neurodevelopmental disorders.

iPads® have been successfully used as speech-generating devices (SGD) for children with ASD and limited speech, but little research has investigated the use of iPads to enhance academic skills, such as picture/word matching. In the present study, a student with ASD received intervention to teach picture and word matching using an iPad-based SGD as the response mode. A multiple baseline across matching tasks design was used to evaluate the effects of a graduated guidance prompting procedure and differential reinforcement on correct matching across four matching tasks (i.e., picture to picture, word to picture, picture to word, and word to word). With intervention, the student showed increased correct matching across all four combinations, suggesting that picture and word matching with an iPad-based SGD can be successfully taught using graduated guidance and differential reinforcement. This approach might have relevance for teaching a range of academic/literacy skills to students with ASD who present with limited or no speech.

We reviewed 18 studies reporting on the use of microswitch technology to enable self-determined responding in children with profound and multiple disabilities. Identified studies that met pre-determined inclusion criteria were summarized in terms of (a) participants, (b) experimental design, (c) microswitches and procedures used, and (d) main results. The 18 studies formed three groups based on whether the microswitch technology was primarily intended to enable the child to (a) access preferred stimuli (7 studies), (b) choose between stimuli (6 studies), or (c) recruit attention/initiate social interaction (5 studies). The results of these studies were consistently positive and support the use of microswitch technology in educational programs for children with profound and multiple disabilities as a means to impact their environment and interact with others. Implications for delivery of augmentative and alternative communication intervention to children with profound and multiple disabilities are discussed.

Background: Children with neurodevelopmental disorders often present with little or no speech. Augmentative and alternative communication (AAC) aims to promote functional communication using non-speech modes, but it might also influence natural speech production. Method: To investigate this possibility, we provided AAC intervention to two boys with neurodevelopmental disorders and severe communication impairment. Intervention focused on teaching the boys to use a tablet computer-based speech-generating device (SGD) to request preferred stimuli. During SGD intervention, both boys began to utter relevant single words. In an effort to induce more speech, and investigate the relation between SGD availability and natural speech production, the SGD was removed during some requesting opportunities. Results: With intervention, both participants learned to use the SGD to request preferred stimuli. After learning to use the SGD, both participants began to respond more frequently with natural speech when the SGD was removed. Conclusion: The results suggest that a rehabilitation program involving initial SGD intervention, followed by subsequent withdrawal of the SGD, might increase the frequency of natural speech production in some children with neurodevelopmental disorders. This effect could be an example of response generalization.

We reviewed nine studies evaluating the use of tangible symbols in AAC interventions for 129 individuals with developmental disabilities. Studies were summarized in terms of participants, tangible symbols used, communication functions/skills targeted for intervention, intervention procedures, evaluation designs, and main findings. Tangible symbols mainly consisted of three-dimensional whole objects or partial objects. Symbols were taught as requests for preferred objects/activities in five studies with additional communication functions (e.g., naming, choice making, protesting) also taught in three studies. One study focused on naming activities. With intervention, 54% (n = 70) of the participants, who ranged from 3 to 20 years of age, learned to use tangible symbols to communicate. However, these findings must be interpreted with caution due to pre-experimental or quasi-experimental designs in five of the nine studies. Overall, tangible symbols appear promising, but additional studies are needed to establish their relative merits as a communication mode for people with developmental disabilities. © 2014 International Society for Augmentative and Alternative Communication.

The present study involved comparing the acquisition of multi-step requesting and social communication across three AAC options: manual signing (MS), picture exchange (PE), and speech-generating devices (SGDs). Preference for each option was also assessed. The participants were two children with autism spectrum disorders (ASD) who had previously been taught to use each option to request preferred items. Intervention was implemented in an alternating-treatments design. During baseline, participants demonstrated low levels of correct communicative responding. With intervention, both participants learned the target responses (two-and three-step requesting responses, greetings, answering questions, and social etiquette responses) to varying levels of proficiency with each communication option. One participant demonstrated a preference for using the SGD and the other preferred PE. The importance of examining preferences for using one AAC option over others is discussed. © 2013 International Society for Augmentative and Alternative Communication.

We evaluated a set of instructional procedures for teaching two nonverbal boys with autism spectrum disorders (ASD) to request the continuation of toy play using an iPad®-based speech-generating device (SGD). The effects of the instructional procedures were evaluated in a multiple baseline across participants design. Instruction focused on teaching the boys to select a TOY PLAY symbol from the iPad® screen when their toy play was briefly interrupted. The instructional procedures included behavior chain interruption, time delay, graduated guidance, and differential reinforcement. Results showed that both boys learned to use the SGD to request and maintained this skill without prompting. SGD-based requesting also generalized to other objects/activities. Acquisition of SGD-based requesting was associated with decreases in reaching and aggressive behavior. Results suggest that systematic instruction with the iPad®-based SGD effectively replaced reaching and aggression with socially acceptable communication. © 2013 Published by Elsevier Ltd.