scholarly journals Simulation-based education for staff managing aggression and high-risk behaviors in children with autism spectrum disorder in the hospital setting: A pilot and feasibility cluster randomized controlled trial

2021 ◽  
Vol 11 (11) ◽  
pp. 48
Author(s):  
Marijke Jane Mitchell ◽  
Fiona Helen Newall ◽  
Melissa Gaye Heywood ◽  
Jenni Sokol ◽  
Katrina Jane Williams
Keyword(s):  
Intellectual Disability ◽  
Acute Care ◽  
Controlled Trial ◽  
Children With Autism ◽  
Autism Spectrum ◽  
High Risk Behaviors ◽  
Simulation Based ◽  
Training Format ◽  
Behavioral Emergencies ◽  
Cluster Randomized

Background and objective: Aggression and high-risk behaviors, which can result in behavioral emergencies, are common in children with autism and can be magnified in the hospital environment. Children with autism, with or without intellectual disability, have complex communication needs which require a sophisticated level of knowledge, understanding and skill from health care professionals. Pediatric acute care nursing staff are often not trained and lack confidence in managing children with autism. The purpose of this study was to conduct a pilot and feasibility cluster randomized controlled trial (RCT) of simulation-based education for staff in managing behavioral emergencies with autism spectrum disorder (ASD) in the hospital setting.Methods: This study used a mixed method, to explore the acceptability and feasibility of delivering a large-scale cluster RCT and assess trial processes including recruitment, completion rates, contamination, and outcome measures. The simulation-based training format comprised two scenarios involving an adolescent with autism, intellectual disability and aggressive behaviors. Two pediatric wards of similar size and patient complexity were selected to participate in the study and randomized to receive either simulation-based education plus web-based education materials or web-based education materials only.  Results: The RCT design is feasible with recruitment, acceptability and completion rates reaching target. Self-perceived baseline levels of confidence in managing aggression in children were mid-range and lower for children with autism and intellectual disability. Forty to fifty percent of intervention participants rated the training highly in terms of developing skills and knowledge respectively. The mean group score for observer ratings of de-escalation across four simulations was 20 out of a possible 35. Data for ward aggression were not collected.Conclusions: Simulation-based education is an acceptable training format for acute care pediatric nurses. This study is feasible to conduct as a cluster RCT with some modifications to this protocol including assessment of baseline differences in confidence. Observer ratings of de-escalation skills indicated that more than one episode of training may be required for acute care pediatric staff to successfully de-escalate aggressive incidents. As such, we will use repeated simulation scenario exercises for each intervention group in the next trial.

scholarly journals Simulation-Based Education for Staff Managing Aggression and Externalizing Behaviors in Children With Autism Spectrum Disorder in the Hospital Setting: Pilot and Feasibility Study Protocol for a Cluster Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Marijke Jane Mitchell ◽  
Fiona Helen Newall ◽  
Jennifer Sokol ◽  
Katrina Jane Williams
Keyword(s):  
Acute Care ◽  
Nursing Staff ◽  
Externalizing Behaviors ◽  
Controlled Trial ◽  
Hospital Setting ◽  
Autism Spectrum ◽  
Web Based ◽  
Children With Asd ◽  
Simulation Based ◽  
Cluster Randomized

BACKGROUND Children with autism spectrum disorder (ASD) frequently demonstrate aggression and externalizing behaviors in the acute care hospital environment. Pediatric acute care nursing staff are often not trained in managing aggression and, in particular, lack confidence in preventing and managing externalizing behaviors in children with ASD. High-fidelity simulation exercises will be used in this study to provide deliberate practice for acute care pediatric nursing staff in the management of aggressive and externalizing behaviors. OBJECTIVE The purpose of this study is to conduct a pilot and feasibility cluster randomized controlled trial (RCT) to evaluate the effectiveness of simulation-based education for staff in managing aggression and externalizing behaviors of children with ASD in the hospital setting. METHODS This study has a mixed design, with between-group and within-participant comparisons to explore the acceptability and feasibility of delivering a large-scale cluster RCT. The trial process, including recruitment, completion rates, contamination, and completion of outcome measures, will be assessed and reported as percentages. This study will assess the acceptability of the simulation-based training format for two scenarios involving an adolescent with autism, with or without intellectual disability, who displays aggressive and externalizing behaviors and the resulting change in confidence in managing clinical aggression. Two pediatric wards of similar size and patient complexity will be selected to participate in the study; they will be randomized to receive either simulation-based education plus web-based educational materials or the web-based educational materials only. Change in confidence will be assessed using pre- and posttraining surveys for bedside nursing staff exposed to the training and the control group who will receive the web-based training materials. Knowledge retention 3 months posttraining, as well as continued confidence and exposure to clinical aggression, will be assessed via surveys. Changes in confidence and competence will be compared statistically with the chi-square test using before-and-after data to compare the proportion of those who have high confidence between the two arms at baseline and at follow-up. The simulation-based education will be recorded with trained assessors reviewing participants’ abilities to de-escalate aggressive behaviors using a validated tool. This data will be analyzed using mean values and SDs to understand the variation in performance of individuals who undertake the training. Data from each participating ward will be collected during each shift for the duration of the study to assess the number of aggressive incidents and successful de-escalation for patients with ASD. Total change in Code Grey activations will also be assessed, with both datasets analyzed using descriptive statistics. RESULTS This study gained ethical approval from The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) on November 1, 2019 (HREC reference number: 56684). Data collection was completed in February 2020. Data analysis is due to commence with results anticipated by August 2020. CONCLUSIONS We hypothesize that this study is feasible to be conducted as a cluster RCT and that simulation-based training will be acceptable for acute care pediatric nurses. We anticipate that the intervention ward will have increased confidence in managing clinical aggression in children with ASD immediately and up to 3 months posttraining. CLINICALTRIAL Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000139976; http://www.ANZCTR.org.au/ACTRN12620000139976.aspx INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18105

scholarly journals Simulation-Based Education for Staff Managing Aggression and Externalizing Behaviors in Children With Autism Spectrum Disorder in the Hospital Setting: Pilot and Feasibility Study Protocol for a Cluster Randomized Controlled Trial

10.2196/18105 ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. e18105 ◽  
Author(s):  
Marijke Jane Mitchell ◽  
Fiona Helen Newall ◽  
Jennifer Sokol ◽  
Katrina Jane Williams
Keyword(s):  
Acute Care ◽  
Nursing Staff ◽  
Externalizing Behaviors ◽  
Controlled Trial ◽  
Hospital Setting ◽  
Autism Spectrum ◽  
Web Based ◽  
Children With Asd ◽  
Simulation Based ◽  
Cluster Randomized

Background Children with autism spectrum disorder (ASD) frequently demonstrate aggression and externalizing behaviors in the acute care hospital environment. Pediatric acute care nursing staff are often not trained in managing aggression and, in particular, lack confidence in preventing and managing externalizing behaviors in children with ASD. High-fidelity simulation exercises will be used in this study to provide deliberate practice for acute care pediatric nursing staff in the management of aggressive and externalizing behaviors. Objective The purpose of this study is to conduct a pilot and feasibility cluster randomized controlled trial (RCT) to evaluate the effectiveness of simulation-based education for staff in managing aggression and externalizing behaviors of children with ASD in the hospital setting. Methods This study has a mixed design, with between-group and within-participant comparisons to explore the acceptability and feasibility of delivering a large-scale cluster RCT. The trial process, including recruitment, completion rates, contamination, and completion of outcome measures, will be assessed and reported as percentages. This study will assess the acceptability of the simulation-based training format for two scenarios involving an adolescent with autism, with or without intellectual disability, who displays aggressive and externalizing behaviors and the resulting change in confidence in managing clinical aggression. Two pediatric wards of similar size and patient complexity will be selected to participate in the study; they will be randomized to receive either simulation-based education plus web-based educational materials or the web-based educational materials only. Change in confidence will be assessed using pre- and posttraining surveys for bedside nursing staff exposed to the training and the control group who will receive the web-based training materials. Knowledge retention 3 months posttraining, as well as continued confidence and exposure to clinical aggression, will be assessed via surveys. Changes in confidence and competence will be compared statistically with the chi-square test using before-and-after data to compare the proportion of those who have high confidence between the two arms at baseline and at follow-up. The simulation-based education will be recorded with trained assessors reviewing participants’ abilities to de-escalate aggressive behaviors using a validated tool. This data will be analyzed using mean values and SDs to understand the variation in performance of individuals who undertake the training. Data from each participating ward will be collected during each shift for the duration of the study to assess the number of aggressive incidents and successful de-escalation for patients with ASD. Total change in Code Grey activations will also be assessed, with both datasets analyzed using descriptive statistics. Results This study gained ethical approval from The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) on November 1, 2019 (HREC reference number: 56684). Data collection was completed in February 2020. Data analysis is due to commence with results anticipated by August 2020. Conclusions We hypothesize that this study is feasible to be conducted as a cluster RCT and that simulation-based training will be acceptable for acute care pediatric nurses. We anticipate that the intervention ward will have increased confidence in managing clinical aggression in children with ASD immediately and up to 3 months posttraining. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000139976; http://www.ANZCTR.org.au/ACTRN12620000139976.aspx International Registered Report Identifier (IRRID) DERR1-10.2196/18105

scholarly journals Pivotal Response Treatment with and without robot-assistance for children with autism: a randomized controlled trial

2021 ◽  
Author(s):  
Iris van den Berk-Smeekens ◽  
Manon W. P. de Korte ◽  
Martine van Dongen-Boomsma ◽  
Iris J. Oosterling ◽  
Jenny C. den Boer ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Pivotal Response Treatment ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
Children With Asd ◽  
Robot Assistance

AbstractPivotal response treatment (PRT) is a promising intervention focused on improving social communication skills in children with autism spectrum disorder (ASD). Since robots potentially appeal to children with ASD and may contribute to their motivation for social interaction, this exploratory randomized controlled trial (RCT) was conducted comparing PRT (PRT and robot-assisted PRT) with treatment-as-usual (TAU). Seventy-three children (PRT: n = 25; PRT + robot: n = 25; TAU: n = 23) with ASD, aged 3–8 years were assessed at baseline, after 10 and 20 weeks of intervention, and at 3-month follow-up. There were no significant group differences on parent- and teacher-rated general social-communicative skills and blindly rated global functioning directly after treatment. However, at follow-up largest gains were observed in robot-assisted PRT compared to other groups. These results suggest that robot-assistance may contribute to intervention efficacy for children with ASD when using game scenarios for robot-child interaction during multiple sessions combined with motivational components of PRT. This trial is registered at https://www.trialregister.nl/trial/4487; NL4487/NTR4712 (2014-08-01).

Using the Teaching Interactions Procedure to Teach Social Skills to Children With Autism and Intellectual Disability

2016 ◽  
Vol 121 (6) ◽  
pp. 501-519 ◽  
Author(s):  
Aubrey Hui Shyuan Ng ◽  
Kim Schulze ◽  
Eric Rudrud ◽  
Justin B. Leaf
Keyword(s):  
Autism Spectrum Disorder ◽  
Intellectual Disability ◽  
Social Skills ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Multiple Baseline ◽  
Baseline Design ◽  
Teaching Interaction ◽  
Teaching Interaction Procedure

Abstract This study implemented a modified teaching interaction procedure to teach social skills to 4 children diagnosed with autism spectrum disorder with an intellectual disability. A multiple baseline design across social skills and replicated across participants was utilized to evaluate the effects of the modified teaching interaction procedure. The results demonstrated that the teaching interaction procedure resulted in all participants acquiring targeted social skills, maintaining the targeted social skills, and generalizing the targeted social skills.

scholarly journals Lagging skills contribute to challenging behaviors in children with autism spectrum disorder without intellectual disability

Autism ◽  
2017 ◽  
Vol 22 (8) ◽  
pp. 898-906 ◽  
Author(s):  
Brenna B Maddox ◽  
Patrick Cleary ◽  
Emily S Kuschner ◽  
Judith S Miller ◽  
Anna Chelsea Armour ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Emotion Regulation ◽  
Executive Function ◽  
Intellectual Disability ◽  
Social Skills ◽  
Challenging Behaviors ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Environmental Demands

Many children with autism spectrum disorder display challenging behaviors. These behaviors are not limited to those with cognitive and/or language impairments. The Collaborative and Proactive Solutions framework proposes that challenging behaviors result from an incompatibility between environmental demands and a child’s “lagging skills.” The primary Collaborative and Proactive Solutions lagging skills—executive function, emotion regulation, language, and social skills—are often areas of weakness for individuals with autism spectrum disorder. The purpose of this study was to evaluate whether these lagging skills are associated with challenging behaviors in youth with autism spectrum disorder without intellectual disability. Parents of 182 youth with autism spectrum disorder (6–15 years) completed measures of their children’s challenging behaviors, executive function, language, emotion regulation, and social skills. We tested whether the Collaborative and Proactive Solutions lagging skills predicted challenging behaviors using multiple linear regression. The Collaborative and Proactive Solutions lagging skills explained significant variance in participants’ challenging behaviors. The Depression (emotion regulation), Inhibit (executive function), and Sameness (executive function) scales emerged as significant predictors. Impairments in emotion regulation and executive function may contribute substantially to aggressive and oppositional behaviors in school-age youth with autism spectrum disorder without intellectual disability. Treatment for challenging behaviors in this group may consider targeting the incompatibility between environmental demands and a child’s lagging skills.

scholarly journals EEG changes and their relationship with intellectual disability in children with autism spectrum disorders in a tertiary care hospital

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Jannatara Shefa ◽  
Muzharul Mannan ◽  
Shaheen Akhter
Keyword(s):  
Intellectual Disability ◽  
Tertiary Care ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Care Hospital ◽  
Number Of Children ◽  
Eeg Abnormalities ◽  
Eeg Recordings ◽  
Study Participants ◽  
Medical University

Background: Autism in children is frequently associated with Intellectual disability (ID) and epilepsy. It is known that lower IQinfluences epilepsy rates; however, electroencephalographic (EEG) findings in different grades of intellectual functioning are less well studied. Objectives: This study aimed to evaluate the EEG findings and their association with the degrees of ID in children with autism. Methods: Fifty-two children, diagnosed with autism according to the DSM-IV-TR criteria, aged between 2 to 12 years, were included in the study. Participants were recruited from outpatient clinic in the Institute for Paediatric Neurodisorder and Autism (IPNA) in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All of them were subjected to physical and neurological examination. Intelligence quotients (IQ) were measured in all the participants. Psychometric tests Bayley Scales of Infant and Toddler Development, Third edition (BSID III) or Weschler Intelligence Scale for Patients-Revised (WISC-R) were used for evaluating IQ. EEG recordings were done in all the participants. Results: The frequency of EEG abnormalities were observed in 51.9% participants. Among these abnormalities, 36.5% were epileptiform and 15.4% were non-epileptiform. Majority of the focal discharges, in this study were from temporal and frontal ((50% and 40% of focal discharge). Among generalized abnormalities, 89% were symmetrical spike-wave complexes. EEG abnormalities were associated with epilepsy in 66.7% of participants. ID was present in 84.6% and of them, 77% had moderate to severe ID. Mild, moderate or severe ID did not show significant association with EEG abnormalities (p>0.05). However, patients with moderate to severe ID (IQ <50) had a higher rate of EEG abnormalities compared to those without ID or mild ID (81.5% versus 18.5%) (P=0.03). Conclusion: Relatively large number of children with autism and ID had EEG abnormalities and there was a significant association with moderate to severe ID (IQ <50) and EEG abnormalities.

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