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Browsing by Author "Swiezy, Naomi"
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Item A global perspective: Quantitative changes in training participants’ knowledge of autism across selected settings within the United States and Singapore(2023-11) Neal, Tiffany; Nazarloo, Shawn; Deodhar, Aditi; Somasundaram, Manasi; Gandhi, Siddhi; Swiezy, NaomiThe present study aimed to assess and compare the effectiveness of the HANDS in Autism™ Model training curriculum, framework and process specific to changes in autism knowledge via the Autism Knowledge Survey-Revised (AKS-R; HANDS in Autism®, 2005). Additional exploration using the AKS-R, sought to explore differences in the global, Singapore training cohorts specific to their participation in either single-week or multi-week training formats. Results from this preliminary exploration demonstrated statistically significant improvement in autism knowledge across both countries. These findings provide initial evidence as to both the effectiveness and transportability of the HANDS in Autism® Model across participants and countries. While findings are specific to improved autism knowledge, the emerging potential of the Hands in Autism® Model as a comprehensive treatment model will be further discussed.Item Assessing Clinical Global Impressions Severity Scores in an adolescent ASD and DD population across counties(2023-09) Reddy, Enugu Hari Priya; Neal, Tiffany; Deodhar, Aditi; Swiezy, NaomiThe Indiana NeuroDiagnostic Institute (NDI) embodies comprehensive care, stabilization, and transition support for teenagers with autism, across the stages like waitlist, preadmission, admission, discharge, and follow-up, focusing on sustainable community integration and preventing re-admission. The project employs the Clinical Global Impressions (CGI; adapted from Guy, 1976), gauging illness severity and patient progress on a scale of 1 (Normal) to 7 (Extremely ill), assessed preadmission and post-discharge. Most counties initially had high severity scores (7 and 6) but showed a marked shift towards level 5 after leaving the care facility. This positive trend persisted at 1 month, 9 months, and 12 months post-discharge, though data samples were limited. The findings emphasize the enduring benefits of interventions. Factors like individual response variations and external support may have influenced outcomes, warranting further investigation. Overall, the study underscores the effectiveness of tailored interventions for individuals with autism, with potential for broader validation in larger, diverse samples.Item Direct observation in a large-scale randomized trial of parent training in children with autism spectrum disorder and disruptive behavior(Elsevier, 2021) Swiezy, Naomi; Smith, Tristam; Johnson, Cindy R.; Bearss, Karen; Lecavalier, Luc; Drill, Rochelle; Warner, Danielle; Deng, Yanhong; Xu, Yunshan; Dziura, James; Handen, Ben; Scahill, Lawrence; Psychiatry, School of MedicineA direct observation strategy (Standardized Observation Analogue Procedure, SOAP) was used in a large-scale randomized trial of parent training versus parent education in young children with autism spectrum disorder (ASD) and disruptive behavior. The 16-minute SOAP, modified from an earlier version of this same measure, included parentchild interaction to assess child behavior in a clinical laboratory setting. Despite study entry criteria for all child participants requiring moderate levels of disruptive behavior in this project, 126 of 168 children with complete SOAP data at baseline showed no disruptive behavior on this measure. Although the primary purpose of the study was to determine whether the SOAP could detect differences between the two conditions (i.e.,parent training (PT) and parent education (PE)), baseline observation data was not consistent with parent ratings at baseline or subsequent follow up visits, leaving little room to demonstrate improvement with this observation measure. This and the challenging, time-consuming and resource intensive effort involved in using such a measure in a large randomized scale trial, raises fundamental questions about the validity of the SOAP as an outcome measure in such a study. Further consideration related to the feasibility and practicality of using direct observation as a primary measure in larger scale efforts overall are also discussed.Item Effect of Parent Training on Adaptive Behavior in Children With Autism Spectrum Disorder and Disruptive Behavior: Results of a Randomized Trial(Elsevier, 2016-07) Scahill, Lawrence; Bearss, Karen; Lecavalier, Luc; Smith, Tristram; Swiezy, Naomi; Aman, Michael G.; Sukhodolsky, Denis G.; McCracken, Courtney; Minshawi, Noha; Turner, Kylan; Levato, Lynne; Saulnier, Celine; Dziura, James; Johnson, Cynthia; Department of Psychiatry, IU School of MedicineObjective This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior. Methods This was a 24-week, 6-site, randomized trial of parent training versus parent education in 180 children with ASD (aged 3−7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented. Results At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p = .004; effect size = 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p = .11; effect size = 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gains in Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment. Conclusion These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time.Item Enhancing evidence-based practices in educational settings serving students with autism spectrum disorder: A collaborative study of the HANDS in Autism® Model in community classroom settings.(2023-11) Pittala, Venkataramana; Neal, Tiffany; Deodhar, Aditi; Thumu, Mrudhula; Swiezy, NaomiThe collaborative initiative between HANDS in Autism® and school districts focuses on elevating evidence-based practices (EBPs) in educational settings supporting students with autism spectrum disorder (ASD). Training within sites is informed by the HANDS in Autism® Model, a comprehensive module-based training curriculum, framework, and process covering areas such as Environmental Control, Assessment, Goal Setting, Teaching, and Generalization. Module advancement hinges on demonstrating mastery of prior content. This project aims to successively enhance educational team members' application and understanding of evidence-based practices (EBPs) and refine precision of EBP implementation. Ongoing data is collected via Module-Based Rubrics (MBRs), appraising EBP implementation through observed behaviors aligned with each module. A Likert-style rating is used for scoring with a range from 0 (Not Present) to 4 (Fully Present). Preliminary subsample results indicate, that in the initial academic year, a rural Midwest-based middle school location displayed the highest average scores whereas a comparable high school setting consistently demonstrated superior strategy implementation across modules over the 3-year period when contrasted with other educational settings. Furthermore, in subsequent years, both settings surpassed a comparison group (i.e., a rural elementary school) across modules. The project showcases the potential for effective EBP implementation over years using the systematic approach hallmark to the HANDS in Autism® Model. Future plans encompass integration of data analysis to compare school years and sites for comprehensive insights on the influence of implementation on student outcomes. Subsequent steps involve validating trends to inform individual approaches to maximize implementation outcomes based on site characteristics.Item Implementation of the HANDS in Autism® coordinated care continuum: Changes in caregiver-reported patient problem behavior presence and intensity secondary to the implementation of HANDS in Autism® Model across home and school settings following acute inpatient hospitalization(2023-11) Deodhar, Aditi; Neal, Tiffany; Darsanapu, Archana; Swiezy, NaomiThe HANDS in Autism® model focuses on providing follow-up services for adolescents aged 12-18 with autism spectrum disorder (ASD) or developmental disorders (DD), aiding their transition back to community life after acute inpatient hospitalization. This model emphasizes training and community team facilitation for sustainable coordinated care outcomes, targeting primarily families in the home environment while also supporting school and community teams. The study explored changes in patient problem behaviors in both home and school settings, using the Home Situation Questionnaire (HSQ) and School Situation Questionnaire (SSQ) completed by caregivers and school teams. These questionnaires assessed the presence and intensity of problem behaviors before hospital admission and throughout the year after discharge. Preliminary findings show a decrease in problem behaviors’ presence and intensity in both settings post-discharge, with a notable continuous decrease in the home setting over 12 months, underscoring the model's effectiveness in its primary intervention target. However, an increase in problem behavior intensity was observed in the school setting after 12 months, hinting at the potential influence of school personnel/district engagement levels on the intervention's effectiveness in educational environments.Item Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder(Springer Nature, 2017-08) Lecavalier, Luc; Smith, Tristram; Johnson, Cynthia; Bearss, Karen; Swiezy, Naomi; Aman, Michael G.; Sukhodolsky, Denis G.; Deng, Yanhong; Dziura, James; Scahill, Lawrence; Psychiatry, School of MedicineWe conducted a 6 month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3-7 years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p = .05) and a 5.3 point difference between high and low Anxiety groups (p = .04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.Item Predictors of Caregiver Strain for Parents of Children with Autism Spectrum Disorder(Springer, 2021) Bradshaw, Jessica; Gillespie, Scott; McCracken, Courtney; King, Bryan H.; McCracken, James T.; Johnson, Cynthia R.; Lecavalie, Luc; Smith, Tristram; Swiezy, Naomi; Bearss, Karen; Sikich, Linmarie; Donnelly, Craig; Hollande, Eric; McDougle, Christopher J.; Scahill, Lawrence; Pediatrics, School of MedicineParents of children with autism spectrum disorder (ASD) face higher levels of caregiver strain compared to parents of children with other disabilities. This study examined child clinical features that predict high levels of caregiver strain for 374 parents of children with ASD. Caregiver strain was measured using the Caregiver Strain Questionnaire (CGSQ) objective, subjective internalized, and subjective externalized subscales. Confirmatory factor analysis indicated an acceptable fit for the original CGSQ three-factor solution. The strongest child predictors across CGSQ subscales were: disruptive behavior for objective strain, autism severity and disruptive behavior for subjective internalized strain, and oppositional behavior and hyperactivity for subjective externalized strain. Individualized interventions that attend to specific elements of parental strain may reduce strain and improve family wellbeing.Item Unveiling Connections: Exploring Patient Behaviors and Traumatic Brain InjuryMadhuhasa Battula in Autistic Youth at the Indiana NDI Exploratory Project(2023-09) Battula, Madhuhasa; Neal , Tiffany; Deodhar , Aditi; Darsanapu, Archana; Swiezy, NaomiThe Indiana NDI (Neurodevelopmental Institute) Exploratory Project is an initiative that embodies a cooperative effort involving multidisciplinary experts under the auspices of the Indiana Family and Social Services Administration (FSSA), specifically the Division of Mental Health and Addiction (DMHA). In our study, a total of 58 NDI clients were examined. Data was extracted from the RedCap database (Patridge & Bardyn, 2018). This enabled us to assess the potential of various patient behaviors to indicate the presence of Traumatic Brain Injury (TBI) using predictive models, establishing a statistically significant correlation between certain behaviors and the occurrence of TBI. A Heat map exhibiting a positive correlation between patient behaviors and TBI was shown. The data analysis indicates a statistically significant positive correlation between multiple patient behaviors and the presence of traumatic brain injury (TBI), as supported by high model accuracies. This suggests that these patient behaviors may serve as indicators of the presence of TBI and warrant further investigation. Examining the long-term consequences of TBI on behavior is essential to gain a comprehensive understanding of the dynamics involved.