This document summarizes a study that used longitudinal analysis to identify predictors of outcomes for children with autism undergoing intensive behavioral intervention (IBI). Twenty-four children received on average two years of IBI and were assessed every six months using standardized tests. Multilevel modeling found that total intervention time, pre-intervention functioning, and age best predicted improvement in language, daily living skills, cognitive, and motor abilities over time. The results suggest that longitudinal analysis is a promising method for identifying reliable predictors of IBI outcomes.
ProcedureASD children92 children recruited 16 Funded mu.docxstilliegeorgiana
Procedure
ASD children
92 children recruited
16 Funded multidisciplinary centers
Using DSM-IV-TR
8 children with Dx. at HR for ASD
5 treatment centers used ABA
6 treatment centers used Imitation & TAU
7 children dropped out
85 children, ages 22-75 months
5 treatment centers TAU
Characteristics investigated
Age
Autism severity
Time elapsed
Maternal & paternal
Gender
IQ
Education
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).
Children divided into 3 intervention groups.
1
Results
Based on 3 interventions
ABA - Applied Behavior Analysis
JA- Joint attention
TAU- Treatment as usual.
Study was analyzed based on comparison of treatment between intervention groups.
Using 2 repeated MANOVA Analysis
Results from questionnaires were analyzed differently.
Descriptive statistics for pre & post measurement in the different intervention groups of all dependent variables.
Test results revealed no interaction between intervention group & time, which means that the progress children made, was not different in the 3 intervention groups.
There was an effect of time irrespective of intervention group.
Time
Intervention group
There was no stastical difference in intervention groups and the various intervention measures carried out.
2
Individual variabilityProgressAge Outcomes% of Progress 1Measurement of interventions22- 75 monthsImitation, Pretend Play, language abilities & adaptive behavior. All three intervention groups (ABA, TAU, & JA)Good progress> 6 months in AE 3 or 4 outcomes.26% Moderate to good progress3-5 months in AE3 outcomes7%Mixed progressNormal development plan1-2 outcomes34%Limited to moderate progress3-5 months1-2 outcomes14%Limited progressNo progress or deterioratedNot ˃ 2 months, 19%
This is a simplified table of how the results were presented. For the various interventions they employed, there had to be measurements. They classified progress into categories of good to little progress (5 categories). Then, defined the ages that would signify if a child has undergone improvement or not, depending on how good they perform in different outcomes like Imitation, pretend play etc. Then analyze the total progress percentages of all three interventions.
3
Predicting Outcomes
1. No difference in average scores for different intervention groups.
Used global progress categories over multiple regression analysis.
This enables better analysis of outcomes.
Predictors: Age, IQ-category, autism severity & treatment intensity & number of months in intervention.
2. Significant difference in education types in intervention groups.
3. Found that children in different types of education progressed differently
regular education,
regular education with support,
special education and not in school yet.
4. Merging of progress, intervention groups & analyzing of continuous predictors to ensure enough observations.
5. Age was omitted as a factor.
6. Education type & IQ were the only ...
Autistic Learning & Behavioural Difficulties Inventory: Validation of the Scr...iosrjce
The triad of impairments in communication, social interaction, and imagination is often used in
autism screening tools. In this paper, the authors have proposed an alternative by examining autistic learning
and behavioural challenges in cognitive, conative, affective and sensory processes. The alternative pinpoints the
specific needs and strengths for informing decisions on selecting appropriate autism treatment strategies to
follow up. They trialled the use of the Autistic Learning and Behavioural Difficulties Inventory (ALBDI) on 53
participants and validated it on the Gilliam Autism Rating Scale-Second Edition (GARS-2). Findings of their
study suggested that ALBDI is a useful measure where its total autistic learning and behavioural difficulties
scores correlated significantly with the GARS-2 total standard scores of its subtests and its Autism Index with
Pearson correlation coefficients r = .800 (p<.01)><.01) respectively. ALBDI is included in the
Appendix.
Research review of Treatments for Autism in patients residing in psychiatric ...Jacob Stotler
Review of Evidence-based practice and research conducted on effective treatments with patients with Autism Spectrum Disorder (ASD) in patients residing in psychiatric facilities.
1
4
Discrete Trial Training (DTT) effect on children with ASD
Introduction
Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual.
According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017).
The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder i ...
A Study on Level of Mental Health Problems of Adolescentijtsrd
Mental health problems are very common among adolescent. This may be due to the fact that attending family members to a challenging time for many traditional and non traditional among adolescent. Adolescent after completing high school are typically younger, depend on parents for financial support, and do not work or work part time. Thus, in addition to stress related to academic load, these adolescent may have to face the task of taking on more adult like responsibilities without having yet mastered the skills and cognitive maturity of adulthood. Descriptive research design and simple random sampling technique was adopted for the study. A sample size of 60 was collected using interview scheduled. This study concludes that 58 of the respondents are having good level of mental health, 24 of the respondents are having moderate level of mental health and the remaining 18 of the respondents are having poor level of mental health. Ms. Elakkiya S | L. Jerlin Jeci "A Study on Level of Mental Health Problems of Adolescent" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd56206.pdf Paper URL: https://www.ijtsrd.com.com/medicine/other/56206/a-study-on-level-of-mental-health-problems-of-adolescent/ms-elakkiya-s
ProcedureASD children92 children recruited 16 Funded mu.docxstilliegeorgiana
Procedure
ASD children
92 children recruited
16 Funded multidisciplinary centers
Using DSM-IV-TR
8 children with Dx. at HR for ASD
5 treatment centers used ABA
6 treatment centers used Imitation & TAU
7 children dropped out
85 children, ages 22-75 months
5 treatment centers TAU
Characteristics investigated
Age
Autism severity
Time elapsed
Maternal & paternal
Gender
IQ
Education
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).
Children divided into 3 intervention groups.
1
Results
Based on 3 interventions
ABA - Applied Behavior Analysis
JA- Joint attention
TAU- Treatment as usual.
Study was analyzed based on comparison of treatment between intervention groups.
Using 2 repeated MANOVA Analysis
Results from questionnaires were analyzed differently.
Descriptive statistics for pre & post measurement in the different intervention groups of all dependent variables.
Test results revealed no interaction between intervention group & time, which means that the progress children made, was not different in the 3 intervention groups.
There was an effect of time irrespective of intervention group.
Time
Intervention group
There was no stastical difference in intervention groups and the various intervention measures carried out.
2
Individual variabilityProgressAge Outcomes% of Progress 1Measurement of interventions22- 75 monthsImitation, Pretend Play, language abilities & adaptive behavior. All three intervention groups (ABA, TAU, & JA)Good progress> 6 months in AE 3 or 4 outcomes.26% Moderate to good progress3-5 months in AE3 outcomes7%Mixed progressNormal development plan1-2 outcomes34%Limited to moderate progress3-5 months1-2 outcomes14%Limited progressNo progress or deterioratedNot ˃ 2 months, 19%
This is a simplified table of how the results were presented. For the various interventions they employed, there had to be measurements. They classified progress into categories of good to little progress (5 categories). Then, defined the ages that would signify if a child has undergone improvement or not, depending on how good they perform in different outcomes like Imitation, pretend play etc. Then analyze the total progress percentages of all three interventions.
3
Predicting Outcomes
1. No difference in average scores for different intervention groups.
Used global progress categories over multiple regression analysis.
This enables better analysis of outcomes.
Predictors: Age, IQ-category, autism severity & treatment intensity & number of months in intervention.
2. Significant difference in education types in intervention groups.
3. Found that children in different types of education progressed differently
regular education,
regular education with support,
special education and not in school yet.
4. Merging of progress, intervention groups & analyzing of continuous predictors to ensure enough observations.
5. Age was omitted as a factor.
6. Education type & IQ were the only ...
Autistic Learning & Behavioural Difficulties Inventory: Validation of the Scr...iosrjce
The triad of impairments in communication, social interaction, and imagination is often used in
autism screening tools. In this paper, the authors have proposed an alternative by examining autistic learning
and behavioural challenges in cognitive, conative, affective and sensory processes. The alternative pinpoints the
specific needs and strengths for informing decisions on selecting appropriate autism treatment strategies to
follow up. They trialled the use of the Autistic Learning and Behavioural Difficulties Inventory (ALBDI) on 53
participants and validated it on the Gilliam Autism Rating Scale-Second Edition (GARS-2). Findings of their
study suggested that ALBDI is a useful measure where its total autistic learning and behavioural difficulties
scores correlated significantly with the GARS-2 total standard scores of its subtests and its Autism Index with
Pearson correlation coefficients r = .800 (p<.01)><.01) respectively. ALBDI is included in the
Appendix.
Research review of Treatments for Autism in patients residing in psychiatric ...Jacob Stotler
Review of Evidence-based practice and research conducted on effective treatments with patients with Autism Spectrum Disorder (ASD) in patients residing in psychiatric facilities.
1
4
Discrete Trial Training (DTT) effect on children with ASD
Introduction
Autism Spectrum Disorder (ASD) is a condition that affects the development of an individual affecting their behaviour and the ability to communicate (Autism Spectrum Disorder, 2021). In most cases, this disorder exhibits its symptoms within the initial two years of an individual, despite its diagnosis being plausible for individuals of all ages. Persons diagnosed with this disorder often have repetitive behaviours and restricted interests, find it difficult to partake in social interactions and communication with others, and show other symptoms that may impede the individual's ability to perform well in school, work and several other aspects of life ("Autism Spectrum Disorder, 2021). The individuals diagnosed with the disorder will, in some cases, be reliant on their families and individuals close to them for help and support. Despite the disorder's potency as a life-long condition, some services and treatments are provided, helping an individual diagnosed with the condition improve the quality of their life. It is also important to note that the disorder has several different variations; hence, the spectrum of different characteristics, unique to every diagnosed individual.
According to studies conducted, one in fifty-four children is diagnosed with the disorder in the United States, occurring in children of all racial backgrounds and socioeconomic groups ("Data and Statistics on Autism Spectrum Disorder | CDC," 2021). According to the same report, the disease is four times more likely to occur in boys than in girls. Between 2009 to 2017, the number of children aged between 3-17 years diagnosed with development disorders, inclusive of ASD, increased from 16.2% to 17.8%. (Ünlü et al., 2018). In the use of discrete trial training (DTT), children are taught a plethora of skills, which include academic, language, and social skills, necessary to facilitate their development. In the treatment of ASD, options are limited. However, early diagnosis, coupled with behaviour interventions, is considered to have the best outcomes in managing the disorder's symptoms (Masi et al., 2017).
The prevalence of ASD in children has been noted to rise significantly in the population (Masi et al., 2017; "Data and Statistics on Autism Spectrum Disorder | CDC," 2021), affecting a larger portion of the population. This number of affected individuals is projected to rise even higher in the coming years, a problem in society that needs to be addressed. In the treatment of the disorder, drug interventions, while widely used, have failed to prove their efficiency in improving or managing symptoms in most cases (Masi et al., 2017). The treatment options for the disorder are also very limited. The use of drug interventions, early diagnosis, and early behavioural interventions is very expensive and inaccessible to many individuals affected by the condition. Identifying the disorder i ...
A Study on Level of Mental Health Problems of Adolescentijtsrd
Mental health problems are very common among adolescent. This may be due to the fact that attending family members to a challenging time for many traditional and non traditional among adolescent. Adolescent after completing high school are typically younger, depend on parents for financial support, and do not work or work part time. Thus, in addition to stress related to academic load, these adolescent may have to face the task of taking on more adult like responsibilities without having yet mastered the skills and cognitive maturity of adulthood. Descriptive research design and simple random sampling technique was adopted for the study. A sample size of 60 was collected using interview scheduled. This study concludes that 58 of the respondents are having good level of mental health, 24 of the respondents are having moderate level of mental health and the remaining 18 of the respondents are having poor level of mental health. Ms. Elakkiya S | L. Jerlin Jeci "A Study on Level of Mental Health Problems of Adolescent" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-2 , April 2023, URL: https://www.ijtsrd.com.com/papers/ijtsrd56206.pdf Paper URL: https://www.ijtsrd.com.com/medicine/other/56206/a-study-on-level-of-mental-health-problems-of-adolescent/ms-elakkiya-s
Application of Applied Behavior Analysis to Mental Health Issu.docxarmitageclaire49
Application of Applied Behavior Analysis to Mental Health Issues
Mark T. Harvey
Florida Institute of Technology
James K. Luiselli
The May Institute, Inc.
Stephen E. Wong
Florida International University
The theoretical and conceptual basis for behavior analysis emerged from the fields of
experimental psychology, physiology, and philosophy, effectively melding theory with
scientific rigor. Behavior analysis has since expanded from controlled laboratories into
applied settings, including hospitals, clinics, schools, family homes, and communities.
Much of the early research in applied behavior analysis (ABA) included participants
with mental health disorders and developmental disabilities. ABA research for persons
with developmental disabilities is vibrant and expansive; however, there is a paucity of
recent research in behavior analytic assessment and treatment for persons with mental
health diagnoses. This article describes how ABA technology can advance mental
health services for children and adults utilizing a multidisciplinary approach to link
professionals from psychology, psychiatry, and other associated disciplines to optimize
patient outcomes. Discussion focuses on historic applications of behavior analysis,
opportunities, and barriers in the mental health field, and ways in which ABA can
contribute to a multidisciplinary treatment approach.
Keywords: applied behavior analysis, functional behavior assessment, functional analysis, con-
tingency management, acceptance and commitment therapy
The etiology of mental illness is believed to
be a complex interaction between genetics,
physiology, neurobiology, and environmental
factors that lead to psychological, physiologi-
cal, and/or behavioral changes. When these de-
viations differ significantly from societal norms
and interfere with one’s ability to function in
daily life, the person may be diagnosed with a
mental disorder (American Psychiatric Associ-
ation, 2000). Often a licensed physician, psy-
chiatrist, or psychologist assesses an individual,
diagnoses a mental disorder, and then desig-
nates a treatment plan for that individual. Al-
though an interdisciplinary approach, wherein
representatives from various disciplines such as
medicine, psychiatry, clinical psychology, neu-
roscience, education, social work, and behavior
analysis convene to devise a treatment plan
would be preferable, the logistics and resources
required limit this practice to select clinical
facilities. We posit that behavior analysis,
which includes refined techniques for teaching
and motivating adaptive behavior, should be an
integral part of a multidisciplinary approach to
mental health services. Combining technologies
derived from behavior analysis and other disci-
plines could broaden our understanding of men-
tal disorders, expand the range of available in-
terventions, and improve therapeutic outcomes
and client satisfaction.
This article briefly examines early applied be-
havior analysis (ABA) resear.
Dietary paterrns of autistic chidren - Copy.pptxArif Majeed
Autism is a complex developmental and non-curable neurobiological condition that typically appears during the first three years of life. (Christensen et al., 2016).
Although the onset of symptoms for most children occurs during late infancy some may not display any symptoms until they are of 2 years after a period of comparative growth.
It effects brain function predominantly in the areas of social interaction and communication skills that results in varying degrees of difficult socialization, verbal and nonverbal communications, repetitive and problematic behavior.
The challenging manners of these children disrupt the food choices which in turn affect nutritional status and growth. Irritabilities and anxiety can be associated with introduction of new food.(K. Barnhill et al., 2017).
Autism is prevalent worldwide with male are effected almost five times more than female.(Salih,et.al,2017). In Honk Kong 1 in 27 and in Norway 1 in 196, whereas in Pakistan 1 in every 50 children can be autistic. There are approximately 350,000 autistic children in Pakistan however, the actual number remains hidden due to underreporting, misdiagnosis and social causes.
Regular nutritional screening and evaluation of Autistic children is an important clinical deliberation as they may have numerous risk factors that seem to intensify the occurrence of nutrient insufficiencies.
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
“A Study on Mental Health Problems of Adolescent” with Special Reference to C...ijtsrd
Mental health problems are very worldwide among adolescent. This may be due to the truth that attending family members to a difficult time for many traditional and non traditional among adolescent. Adolescent after effecting high school are typically younger, depend on parents for financial support, and do not work or work part time. Thus, in addition to stress related to academic load, these adolescent may have to face the task of taking on more adult like responsibilities lacking having yet mastered the skills and cognitive maturity of adulthood. Stress, life events, past experiences and genetics all play a part in determining our mental health. Student life exposes individuals to risk factors affecting mental health including financial worries, periods of transition, substance use, parental pressure, culture shock and disconnection from previous supports. Descriptive research design and simple random sampling technique was adopted for the study. A sample size of 60 people was collected using planned interviews. In this study conclude that 61 of the respondents had good mental health, 24 had moderate mental health, and the remaining 15 respondents had poor mental health. Dr. R. Revathi Priya | Ms. Vaishnavi. A "“A Study on Mental Health Problems of Adolescent” with Special Reference to Coimbatore Districts" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-5 , October 2023, URL: https://www.ijtsrd.com/papers/ijtsrd59900.pdf Paper Url: https://www.ijtsrd.com/medicine/other/59900/“a-study-on-mental-health-problems-of-adolescent”-with-special-reference-to-coimbatore-districts/dr-r-revathi-priya
Emotional intelligence-as-an-evolutive-factor-on-adult-with-adhdRosa Vera Garcia
ADHD adults exhibit deficits in emotion recognition, regulation, and expression. Emotional intelligence (EI) correlates with better life performance and is considered a skill that can be learned and developed. The aim of this study was to assess EI development as ability in ADHD adults, considering the effect of comorbid psychiatric disorders and previous diagnosis of ADHD. Method: Participants (n = 116) were distributed in four groups attending to current comorbidities and previous ADHD diagnosis, and administered the Mayer–Salovey–Caruso Emotional Intelligence Test version 2.0 to assess their EI level. Results: ADHD adults with comorbidity with no previous diagnosis had lower EI development than healthy controls and the rest of ADHD groups. In addition, ADHD severity in childhood or in adulthood did not influence the current EI level. Conclusion: EI development as a therapeutic approach could be of use in ADHD patients with comorbidities.
Impacts of Mentor’s Strategic Communication on Adjustment Problems among Adol...Arun Varghese
ABSTRACT Introduction: Adolescence is the period of rapid changes in physical and mental state. Rapid storm of physiological changes brigs a great deal of stress and adjustment difficulties. It represents one of the critical transitions in the life span with a wide range of adjustment and mental health problems. The present study is aimed to assess the impact of Mentor’s Strategic Communication on adjustment problems among adolescents. Methodology: A quasi experimental non-equivalent control group design was chosen to assess the impact of Mentor’s Strategic Communication by using Self developed Adjustment Inventory among 60 adolescents (30 each experimental and control group) with mild and moderate adjustment problems at selected schools, Kerala. The Samples were selected based on simple random sampling. Appropriate descriptive & inferential statistics was applied to compute the results. Results: Finding reveals that out of 30 students, 70% reported moderate adjustment problems while 30% were in mild adjustment issues in experimental group. There was a significant difference for adjustment problems among experimental and control group after Mentor’s strategic communication (p<0.001). Further, number of siblings (p<0.032) and education status of father (p<0.008) found significant association to adjustment problems among schools going adolescents. Conclusion: The results of the study revealed that majority of adolescents face adjustment problems and Mentor’s strategic communication had significant impact on improvement in adjustment problems. A planned and timely infusion of mentorship strategy may help them to deal with their day to day adjustment problems and help them to focus in studies in a better way. Keywords: Adolescence, Adjustment problems, coping, stress, behavioural problems
Assist with first annotated bibliography. Assist with f.docxnormanibarber20063
Assist with first
annotated bibliography
.
Assist with first
annotated bibliography
.
(Thesis topic: Psychotherapy)
. Each submission must also include a brief critique of the source (e.g., how could the study be improved, criticism of the author(s) assertions, ideas for future studies, etc.).
summary of the article, including the purpose/hypothesis of the study, a statement about the participants and methods utilized in the study, results and implications for future research, as well as the methodological limitations/critique of the study.
.
Assistance needed with SQL commandsI need assistance with the quer.docxnormanibarber20063
Assistance needed with SQL commands
I need assistance with the query commands assigned to an assignment. I have the databases properly created and do not need assistance with the commands associated with creating the databases. Here is the complete assignment. I have attached the database information.
The structure of the movies database is as follows:
Director (
DIRNUB
, DIRNAME, DIRBORN, YR-DIRDIED)
STAR (
STARNUB
, STARNAME, BIRTHPLACE, STARBORN, YR-STARDIED)
MOVIE (
MVNUB
, MVTITLE, YRMDE, MVTYPE, CRIT, MPAA, NOMINATIONS, AWRD,
DIRNUB
)
MOVSTAR (
MVNUB
,
STARNUB
, AMTPAID)
MEMBER (
MMBNUB
, MMBNAME, MMBADD, MMBCITY, MMBST, NUMRENT, BONUS, JOINDATE)
TAPE (
TAPENUM,
MVNUB, PURDATE, TMSRNT,
MMBNUB
)
Create Video Store database as discussed in the class. Make sure to correct column widths/types before creating tables. Use SQL to form queries to produce the following reports
:
** List the names and numbers of directors whose names begin with the alphabet ‘K’.
List the tape no, movie title, and the membership number and name of members, who are currently borrowing tapes numbered below 20. Arrange the report in descending order by tape number.
List the names and respective numbers of stars and directors who have worked together.
** List the tape numbers for movies of movie type: ‘HORROR’.
List the name of the director who has received the maximum number of total awards considering all his/her movies: AWRD.
** List the names of all members who have not borrowed any movie currently.
List the movie type and number of tapes for each type in the database.
** For each movie list total how many times it has been rented: TMSRNT.
Report the total times rented (TMSRNT) for each movie type.
The database administrator discovers that the name of director whose number is 7 in the database should be spelt as ‘JOHNNY FORD’. Make corrections to the data.
Delete the movie number 14 and all its tapes. Print both tables to verify.
List all tape numbers and their movie titles, and indicate the member number and member name if the tape is currently rented out.
13. List all tape numbers, and also indicate the member’s city if a tape is currently rented out by a member.
14. Who is the youngest director?
How many movies did he/she direct?
15. Grant access to me (joshi) to your movstar table for select and update.
16. Create a unique index on movstar table.
17. For each movie type list the average age of movies given the current year is 2011.
18. ** Create a view MEMB_TAPES that includes the currently rented movies and the members who are renting them, include movie type.
19. ** Use the view MEMB_TAPES to find all currently rented “COMEDY” type movies and members who are renting them.
20. ** List all tape numbers, along with movie name and member name if rented out (leave member name blank if not rented out).
.
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Application of Applied Behavior Analysis to Mental Health Issu.docxarmitageclaire49
Application of Applied Behavior Analysis to Mental Health Issues
Mark T. Harvey
Florida Institute of Technology
James K. Luiselli
The May Institute, Inc.
Stephen E. Wong
Florida International University
The theoretical and conceptual basis for behavior analysis emerged from the fields of
experimental psychology, physiology, and philosophy, effectively melding theory with
scientific rigor. Behavior analysis has since expanded from controlled laboratories into
applied settings, including hospitals, clinics, schools, family homes, and communities.
Much of the early research in applied behavior analysis (ABA) included participants
with mental health disorders and developmental disabilities. ABA research for persons
with developmental disabilities is vibrant and expansive; however, there is a paucity of
recent research in behavior analytic assessment and treatment for persons with mental
health diagnoses. This article describes how ABA technology can advance mental
health services for children and adults utilizing a multidisciplinary approach to link
professionals from psychology, psychiatry, and other associated disciplines to optimize
patient outcomes. Discussion focuses on historic applications of behavior analysis,
opportunities, and barriers in the mental health field, and ways in which ABA can
contribute to a multidisciplinary treatment approach.
Keywords: applied behavior analysis, functional behavior assessment, functional analysis, con-
tingency management, acceptance and commitment therapy
The etiology of mental illness is believed to
be a complex interaction between genetics,
physiology, neurobiology, and environmental
factors that lead to psychological, physiologi-
cal, and/or behavioral changes. When these de-
viations differ significantly from societal norms
and interfere with one’s ability to function in
daily life, the person may be diagnosed with a
mental disorder (American Psychiatric Associ-
ation, 2000). Often a licensed physician, psy-
chiatrist, or psychologist assesses an individual,
diagnoses a mental disorder, and then desig-
nates a treatment plan for that individual. Al-
though an interdisciplinary approach, wherein
representatives from various disciplines such as
medicine, psychiatry, clinical psychology, neu-
roscience, education, social work, and behavior
analysis convene to devise a treatment plan
would be preferable, the logistics and resources
required limit this practice to select clinical
facilities. We posit that behavior analysis,
which includes refined techniques for teaching
and motivating adaptive behavior, should be an
integral part of a multidisciplinary approach to
mental health services. Combining technologies
derived from behavior analysis and other disci-
plines could broaden our understanding of men-
tal disorders, expand the range of available in-
terventions, and improve therapeutic outcomes
and client satisfaction.
This article briefly examines early applied be-
havior analysis (ABA) resear.
Dietary paterrns of autistic chidren - Copy.pptxArif Majeed
Autism is a complex developmental and non-curable neurobiological condition that typically appears during the first three years of life. (Christensen et al., 2016).
Although the onset of symptoms for most children occurs during late infancy some may not display any symptoms until they are of 2 years after a period of comparative growth.
It effects brain function predominantly in the areas of social interaction and communication skills that results in varying degrees of difficult socialization, verbal and nonverbal communications, repetitive and problematic behavior.
The challenging manners of these children disrupt the food choices which in turn affect nutritional status and growth. Irritabilities and anxiety can be associated with introduction of new food.(K. Barnhill et al., 2017).
Autism is prevalent worldwide with male are effected almost five times more than female.(Salih,et.al,2017). In Honk Kong 1 in 27 and in Norway 1 in 196, whereas in Pakistan 1 in every 50 children can be autistic. There are approximately 350,000 autistic children in Pakistan however, the actual number remains hidden due to underreporting, misdiagnosis and social causes.
Regular nutritional screening and evaluation of Autistic children is an important clinical deliberation as they may have numerous risk factors that seem to intensify the occurrence of nutrient insufficiencies.
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
“A Study on Mental Health Problems of Adolescent” with Special Reference to C...ijtsrd
Mental health problems are very worldwide among adolescent. This may be due to the truth that attending family members to a difficult time for many traditional and non traditional among adolescent. Adolescent after effecting high school are typically younger, depend on parents for financial support, and do not work or work part time. Thus, in addition to stress related to academic load, these adolescent may have to face the task of taking on more adult like responsibilities lacking having yet mastered the skills and cognitive maturity of adulthood. Stress, life events, past experiences and genetics all play a part in determining our mental health. Student life exposes individuals to risk factors affecting mental health including financial worries, periods of transition, substance use, parental pressure, culture shock and disconnection from previous supports. Descriptive research design and simple random sampling technique was adopted for the study. A sample size of 60 people was collected using planned interviews. In this study conclude that 61 of the respondents had good mental health, 24 had moderate mental health, and the remaining 15 respondents had poor mental health. Dr. R. Revathi Priya | Ms. Vaishnavi. A "“A Study on Mental Health Problems of Adolescent” with Special Reference to Coimbatore Districts" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-5 , October 2023, URL: https://www.ijtsrd.com/papers/ijtsrd59900.pdf Paper Url: https://www.ijtsrd.com/medicine/other/59900/“a-study-on-mental-health-problems-of-adolescent”-with-special-reference-to-coimbatore-districts/dr-r-revathi-priya
Emotional intelligence-as-an-evolutive-factor-on-adult-with-adhdRosa Vera Garcia
ADHD adults exhibit deficits in emotion recognition, regulation, and expression. Emotional intelligence (EI) correlates with better life performance and is considered a skill that can be learned and developed. The aim of this study was to assess EI development as ability in ADHD adults, considering the effect of comorbid psychiatric disorders and previous diagnosis of ADHD. Method: Participants (n = 116) were distributed in four groups attending to current comorbidities and previous ADHD diagnosis, and administered the Mayer–Salovey–Caruso Emotional Intelligence Test version 2.0 to assess their EI level. Results: ADHD adults with comorbidity with no previous diagnosis had lower EI development than healthy controls and the rest of ADHD groups. In addition, ADHD severity in childhood or in adulthood did not influence the current EI level. Conclusion: EI development as a therapeutic approach could be of use in ADHD patients with comorbidities.
Impacts of Mentor’s Strategic Communication on Adjustment Problems among Adol...Arun Varghese
ABSTRACT Introduction: Adolescence is the period of rapid changes in physical and mental state. Rapid storm of physiological changes brigs a great deal of stress and adjustment difficulties. It represents one of the critical transitions in the life span with a wide range of adjustment and mental health problems. The present study is aimed to assess the impact of Mentor’s Strategic Communication on adjustment problems among adolescents. Methodology: A quasi experimental non-equivalent control group design was chosen to assess the impact of Mentor’s Strategic Communication by using Self developed Adjustment Inventory among 60 adolescents (30 each experimental and control group) with mild and moderate adjustment problems at selected schools, Kerala. The Samples were selected based on simple random sampling. Appropriate descriptive & inferential statistics was applied to compute the results. Results: Finding reveals that out of 30 students, 70% reported moderate adjustment problems while 30% were in mild adjustment issues in experimental group. There was a significant difference for adjustment problems among experimental and control group after Mentor’s strategic communication (p<0.001). Further, number of siblings (p<0.032) and education status of father (p<0.008) found significant association to adjustment problems among schools going adolescents. Conclusion: The results of the study revealed that majority of adolescents face adjustment problems and Mentor’s strategic communication had significant impact on improvement in adjustment problems. A planned and timely infusion of mentorship strategy may help them to deal with their day to day adjustment problems and help them to focus in studies in a better way. Keywords: Adolescence, Adjustment problems, coping, stress, behavioural problems
Assist with first annotated bibliography. Assist with f.docxnormanibarber20063
Assist with first
annotated bibliography
.
Assist with first
annotated bibliography
.
(Thesis topic: Psychotherapy)
. Each submission must also include a brief critique of the source (e.g., how could the study be improved, criticism of the author(s) assertions, ideas for future studies, etc.).
summary of the article, including the purpose/hypothesis of the study, a statement about the participants and methods utilized in the study, results and implications for future research, as well as the methodological limitations/critique of the study.
.
Assistance needed with SQL commandsI need assistance with the quer.docxnormanibarber20063
Assistance needed with SQL commands
I need assistance with the query commands assigned to an assignment. I have the databases properly created and do not need assistance with the commands associated with creating the databases. Here is the complete assignment. I have attached the database information.
The structure of the movies database is as follows:
Director (
DIRNUB
, DIRNAME, DIRBORN, YR-DIRDIED)
STAR (
STARNUB
, STARNAME, BIRTHPLACE, STARBORN, YR-STARDIED)
MOVIE (
MVNUB
, MVTITLE, YRMDE, MVTYPE, CRIT, MPAA, NOMINATIONS, AWRD,
DIRNUB
)
MOVSTAR (
MVNUB
,
STARNUB
, AMTPAID)
MEMBER (
MMBNUB
, MMBNAME, MMBADD, MMBCITY, MMBST, NUMRENT, BONUS, JOINDATE)
TAPE (
TAPENUM,
MVNUB, PURDATE, TMSRNT,
MMBNUB
)
Create Video Store database as discussed in the class. Make sure to correct column widths/types before creating tables. Use SQL to form queries to produce the following reports
:
** List the names and numbers of directors whose names begin with the alphabet ‘K’.
List the tape no, movie title, and the membership number and name of members, who are currently borrowing tapes numbered below 20. Arrange the report in descending order by tape number.
List the names and respective numbers of stars and directors who have worked together.
** List the tape numbers for movies of movie type: ‘HORROR’.
List the name of the director who has received the maximum number of total awards considering all his/her movies: AWRD.
** List the names of all members who have not borrowed any movie currently.
List the movie type and number of tapes for each type in the database.
** For each movie list total how many times it has been rented: TMSRNT.
Report the total times rented (TMSRNT) for each movie type.
The database administrator discovers that the name of director whose number is 7 in the database should be spelt as ‘JOHNNY FORD’. Make corrections to the data.
Delete the movie number 14 and all its tapes. Print both tables to verify.
List all tape numbers and their movie titles, and indicate the member number and member name if the tape is currently rented out.
13. List all tape numbers, and also indicate the member’s city if a tape is currently rented out by a member.
14. Who is the youngest director?
How many movies did he/she direct?
15. Grant access to me (joshi) to your movstar table for select and update.
16. Create a unique index on movstar table.
17. For each movie type list the average age of movies given the current year is 2011.
18. ** Create a view MEMB_TAPES that includes the currently rented movies and the members who are renting them, include movie type.
19. ** Use the view MEMB_TAPES to find all currently rented “COMEDY” type movies and members who are renting them.
20. ** List all tape numbers, along with movie name and member name if rented out (leave member name blank if not rented out).
.
assingment Assignment Agenda Comparison Grid and Fact Sheet or .docxnormanibarber20063
assingment
Assignment: Agenda Comparison Grid and Fact Sheet or Talking Points Brief
It may seem to you that healthcare has been a national topic of debate among political leaders for as long as you can remember.
Healthcare has been a policy item and a topic of debate not only in recent times but as far back as the administration of the second U.S. president, John Adams. In 1798, Adams signed legislation requiring that 20 cents per month of a sailor’s paycheck be set aside for covering their medical bills. This represented the first major piece of U.S. healthcare legislation, and the topic of healthcare has been woven into presidential agendas and political debate ever since.
As a healthcare professional, you may be called upon to provide expertise, guidance and/or opinions on healthcare matters as they are debated for inclusion into new policy. You may also be involved in planning new organizational policy and responses to changes in legislation. For all of these reasons you should be prepared to speak to national healthcare issues making the news.
In this Assignment, you will analyze recent presidential healthcare agendas. You also will prepare a fact sheet to communicate the importance of a healthcare issue and the impact on this issue of recent or proposed policy.
To Prepare:
Review the agenda priorities of the
current/sitting U.S. president and the two previous presidential administrations.
Select an issue related to healthcare that was addressed by each of the last three U.S. presidential administrations.
Reflect on the focus of their respective agendas, including the allocation of financial resources for addressing the healthcare issue you selected.
Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.
The Assignment: (1- to 2-page Comparison Grid, 1-Page Analysis, and 1-page Fact Sheet)
Part 1: Agenda Comparison Grid
Use the Agenda Comparison Grid Template found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the two previous presidential administrations and their agendas related to the public health concern you selected. Be sure to address the following:
Identify and provide a brief description of the population health concern you selected and the factors that contribute to it.
Describe the administrative agenda focus related to the issue you selected.
Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.
Explain how each of the presidential administrations approached the issue.
Part 2: Agenda Comparison Grid Analysis
Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:
Which administrative agency would most likely be respons.
Assimilate the lessons learned from the dream sequences in Defense o.docxnormanibarber20063
Assimilate the lessons learned from the dream sequences in Defense of Duffer's Drift.
The Lieutenant's dream sequences help him understand his tactical problem and make decisions when faced with a new problem. The Lieutenant had virtually no knowledge of the terrain, the weather, civilians, enemy, etc. If an intelligence section had been made available to the Lieutenant, how might have he used such a staff to help him avoid the painful (and deadly) consequences of poor decision making in his dream sequences?
.
Assignmnt-500 words with 2 referencesRecognizing the fa.docxnormanibarber20063
Assignmnt:-
500 words with 2 references
Recognizing the fact usernames passwords are the weakest link in an organization’s security system because username and password are shareable, and most passwords and usernames are vulnerable and ready to be cracked with a variety of methods using adopting a record number of devices and platforms connected to the Internet of Things daily and at an alarming rate.
Provide the all-inclusive and systematic narratives of the impact of physical biometric operations on the current and future generation.
500 words with 2 references
Discussion:-
Discussion
Effective and efficient use of biometric technology will play a key role in automating method of identifying living persons based on individual physiological and behavioral characteristics.
Provide the comprehensive narratives on the advantages and disadvantages of a physical biometric system?
.
Assignmnt-700 words with 3 referencesToday, there is a crisi.docxnormanibarber20063
Assignmnt-700 words with 3 references
Today, there is a crisis about organizations’ inability to resolve the age-old problem of how to control the abuse of trust and confidence given to authorized officials to freely logon onto the organization’s system, Many such officials , turn around to betray the organization by committing cybercrimes. Vulnerability stems from interactions and communications among several system components and categorized as deficiency, weakness and security cavity on
network data center.
To what extent do internal threats constitute a key factor against any organization’s ability to battle insider threats caused by people who abuse assigned privilege?
What is the most effective mechanism for organizations to combat internal threats?
Why should disgruntled employees must be trained on the danger of throwing wastepaper and electronic media in a bin within and outside the facility?
Discussion:
400 words with 2 references
Per Fennelly (2017-182), “Why do Employees steal?” employee stealing is a multiple part operation.
Most organizations are often intolerant and impatient to verify employee’s identity and background and establish trust due to the time-consuming nature of daily assignments.
Most organizations often ignore to establish and adopt on-board ecological waste management action plans to deal with discarded materials, shredded left-over documents and magnetic media and placing fragments in isolated location.
Nonetheless, organizations must learn to support and train employers who are assigned to work and protect the organization data center, facilities and resources. Large segments of any organizations’ facility managers are often none-aggressive and choose short cuts in discharging assigned services by posting passwords on the screen and leaving confidential documents lying out on the table and uploading same document to associates, husbands, loved ones and competitors. Most authorized users within the organization are often the puniest linkage in any security operation.
Per Fennelly (2017-182), “Why do Employees steal?”
employee stealing is a multiple part operation.
Disgruntled employees can install sniffers on organizations’ data file server via polite phone calls
They can gain required user identification and password to access the organization’s secured data center.
Most organization retain an employee on the same salary for twenty years and they pay new a newly hired employee the salary of the actively existing employee.
Most organizations often ignore to establish and adopt on-board ecological waste management action plans to deal with discarded materials, shredded left-over documents and magnetic media and placing fragments in isolated location.
.
Assignment For Paper #2, you will pick two poems on a similar th.docxnormanibarber20063
Assignment:
For Paper #2, you will pick two poems on a similar theme to
compare and contrast
. Your paper will explain how the poems use some of the poetic devices we’ve been discussing to express distinct attitudes towards their common subject. It will point out the
similarities and differences
in the ways the two poems do
this
. Therefore, you will need to compare and contrast the general tones of the poems as well as how they use poetic devices to create those tones. Poetic devices you might want to consider include diction, imagery, figurative language, sound (including rhyme, alliteration, assonance, rhythm, and meter), and form.
Your
audience
for this paper is other students in the class who have read these poems. You can assume that your reader has the poems in front of him or her, so you don’t need to quote the whole poem, though a brief paraphrase might be useful. You will need to quote specific lines, phrases, or words in order to point out specific features of the poems. Your
purpose
is to help your reader see the
differences and similarities
in the two poems and, consequently, to better understand how each one works to create its particular effects or meanings.
Your paper should be
800 – 1000 words long, typed and double-spaced, with 1” margins all around
.
Use of secondary sources (other than our own textbook) is not allowed
for this assignment. If you have questions about the poem, ask other students or the instructor.
Here are some
suggested topics
:
1. Compare and contrast the ways Whitman’s “To a Locomotive in
Winter
” (p. 504) and Dickinson’s “I like to see it lap the Miles” (p. 504-05) represent their common subject: a locomotive. What claims does each poem make about the locomotive? What tone or attitude is taken towards the locomotive? How does each poem use specific poetic devices to create its tone?
2. Compare and contrast the ways Lovelace’s “To
Lucasta
” (p. 521) and Owens’ “
Dulce
et
Decorum
Est
” (p. 521-22) represent their common subject: war. What claims does each poem make about war? What tone or attitude is taken towards war? How does each poem use specific poetic devices to create its tone?
3. Compare and contrast the ways
any two
love poems in our reading represent their common subject. What claims does each poem make about love? What tone or attitude is taken towards love? How does each poem use specific poetic devices to create its tone? (Please check the two poems you pick with the instructor before proceeding.)
4. Compare and contrast the ways
any two
of the following poems represent God:
·
Donne’s “Batter my Heart, Three-
Personed
God” (p. 531),
·
Hopkins’ “God’s Grandeur” (p. 624),
·
Herbert’s “Easter Wings” (p. 676),
·
Blake’s “The
Tyger
” (p. 824-25).
What claims does each poem make about God? What tone or attitude is taken towards God? How does each poem use specific poetic devices to create its tone?
5. Compare and contrast the ways.
Assignment Write an essay comparingcontrasting two thingspeople.docxnormanibarber20063
Assignment:
Write an essay comparing/contrasting two things/people/places/ideas, etc. This should not simply be a list of their similarities and differences, but a cohesive essay written in paragraph form with a thesis, introduction, body, and conclusion.
Remember, a compare/contrast thesis can be formulated in one of the following ways:
1) One thing is better than another
2) Two things that seem to be similar are actually different
3) Two things that seem different are actually similar
Parameters:
*Typed
*Double-Spaced
*Times New Roman
*12 Point Font
*1 Inch Margin
*3 pages (not even a word shorter)
*2 outside sources
.
Assignment Travel Journal to Points of Interest from the Early Midd.docxnormanibarber20063
Assignment :Travel Journal to Points of Interest from the Early Middle Ages, Romanesque, and Gothic World
Travel Journal to Points of Interest from the Early Middle Ages, Romanesque, and Gothic World
Travel was one of the social characteristics that helped shape the Early Middle Ages and the Romanesque period—either to the Middle East to fight in the Crusades or throughout Europe as part of extensive pilgrimages.
For this assignment, put yourself in the place of a person living during this time who traveled extensively throughout Europe by selecting six pieces of art or architecture that you found personally to be the most interesting and important examples that date from this period in history. You should have 2 examples from each of the time periods specific to the Middle Ages: two examples from the Early Middle ages, two that represent the Romanesque, and two that represent Gothic art.
Your objects need to date between 400 CE and 1300 CE—the time span that encompasses the Early Middle Ages, Romanesque, and Gothic periods.
You are going to create a travel journal and itinerary for other students who will travel with you to your points of interest. Create a PowerPoint presentation of seven slides, including an introduction, your five destinations, and a conclusion. On each slide, include the image of the artwork or architecture, and the following information about the image:
Its location
Its name
The period of time it was created
Three interesting points about the artwork/building
What people viewing the image could learn about the Early Middle Ages, the Romanesque period, or Gothic art and architecture.
Why you selected this image
THIS MUST BE FOLLOWED
Assignment 2 Grading Criteria
Maximum Points
Selected two images representative of the early Middle Ages style, from between 400 CE and 1000 CE.
10
Provided location, name, and period of time created for the early Middle Ages images.
12
Explained why you selected each early Middle Ages image, and offered three interesting points about each image and what people could learn from viewing each image.
15
Selected two images representative of the Romanesque style, from between 1000 CE and 1100 CE.
10
Provided location, name, and period of time created for the Romanesque style images.
12
Explained why you selected each Romanesque style image, and offered three interesting points about each image and what people could learn from viewing each image.
15
Selected two images representative of the Gothic style, from between 1100 CE and 1300 CE.
10
Provided location, name, and period of time created for the Gothic style images.
12
Explained why you selected each Gothic style image, and offered three interesting points about each image and what people could learn from viewing each image.
15
The PowerPoint presentation meets length requirements and contains correct spelling and grammar.
.
Assignment What are the factors that influence the selection of .docxnormanibarber20063
Assignment
What are the factors that influence the selection of access control software and/ or hardware? Discuss all aspects of access control systems.
DQ requirement:
initial posting to be between 200-to-300 words.
All initial posts must contain a properly formatted in-text citation and scholarly reference.
Reply post 100-to-150 words.
No plagarism
.
Assignment Write a research paper that contains the following.docxnormanibarber20063
Assignment:
Write a research paper that contains the following:
Discuss the visual assets such as charts, interactive controls, and annotations that will occupy space in your work.
Discuss the best way to use space in terms of position, size, and shape of every visible property.
Data representation techniques that display overlapping connections also introduce the need to contemplate value sorting in the z-dimension, discuss which connections will be above and which will be below and why. Show example using any chart or diagram of your choice.
Your research paper should be at least 3 pages (800 words) excluding cover page and reference page. It should be double-spaced, have at least 2 APA references, and typed in Times New Roman 12 font. Include a cover page and a table of content.
.
Assignment Talk to friends, family, potential beneficiaries abou.docxnormanibarber20063
Assignment
Talk to friends, family, potential beneficiaries about your idea. Do they agree that you deeply understand what the proposed beneficiaries are doing currently to manage/endure their problem? Explain. What are your proposed beneficiaries doing currently to manage/endure their problem? How would you get buy-in from others to sign on to your proposed Beneficiary Experience table (reference Chapter 4)? Include research to support your social entrepreneurship idea.
Minimum 2 pages
Minimum 2 scholarly sources
APA formatted
.
Assignment The objective of assignment is to provide a Power .docxnormanibarber20063
Assignment:
The objective of assignment is to provide a
Power Point Presentation
about
all vaccines including the Flu vaccine in the pediatric population
. Your primary goal as a
Family Nurse Practitioner
is to educate parents about the importance of vaccination and understanding their beliefs and preference by being cultural sensitive in regards this controversial topic. This is an individual presentation and must include
a minimum of 8 slides with a maximum of 10 slides
.
This presentation must include a “Voice Presentation”. Please, this part includes
as a note in each slide
, so I can read it. Thank you.
and the following headings:
*Voice attached in all slides. Please use notes, so I can read it.
ALL REFERENCES FROM USA and within 5 years.
1.
Introduction
(Clearly identifies the topic and Establishes goals and objectives of presentation)
2.
Clinical Guidelines Evidence Based Practice per CDC
– (Presents an insightful and through analysis of the issue (s) identified. Excellent Clinical guidelines)
3.
Population and Risk Factors
(The population is identified and addressed as well the topic(s) and issue(s)
4.
Body and Content
: (Makes appropriate and powerful connections between the issue(s) identified and the concept(s) studied. Very creative and Supports the information with strong arguments and evidence.
5.
Education
– (Presents detailed, realistic, and appropriate recommendations and education including parents/patients)
6.
Conclusion
. Excellent Conclusion clearly supported by the information presented
.
Assignment During the on-ground, residency portion of Skill.docxnormanibarber20063
Assignment:
During the on-ground, residency portion of Skills Lab II, you will have attended sessions covering topics relevant to advanced clinical social work practice. During Skills Lab II, you join with a group of three to four students to present a clinical case. You will create your own case—this case will be a situation you have faced in practice or one you create. During the presentation, you and each group member are expected to demonstrate knowledge, awareness, and skills appropriate to a concentration-year master’s student.
The presentation should include the following:
· The identification of the individual/family or group with background information including:
o Presenting problem or concern
o History of the presenting problem
o Social history
o Family history
o Previous interventions
· Your assessment of the client/family/group
· Your engagement of the client/family/group
o Specify the specific social work practice skills that were or would be used in your engagement.
This is the right up about this project
Tiffany, a 17-year-old African American female resides in Huston Texas with her mother (48 years old) and 2 brothers (20 years old and 10 years old). Tiffany was raised by her mother. Her father went to prison for selling drugs when Tiffany was 5 years old. Tiffany has been having trouble sleeping, her grades have dropped, she is no longer interested in sports or her after school club activities. Tiffany is also afraid to go outside and she does not want to leave her mother’s side. Tiffany reports she gets nervous and has heart palpitations when she sees a police car or hears police sirens. Tiffany’s mother is concerned about the sudden change of behavior in her daughter and thus, took her in to see a therapist.
Tiffany was very active in school. She had good grades, active in sports and after school clubs. The teachers spoke very highly of Tiffany, however, expressed concerns to her mother when they noticed a change in her grades. Additionally, the school staff noticed Tiffany withdrawing from her friends appeared to be isolating herself from others. Tiffany and her family were active within their church community. Tiffany and her family live in a low-income community. Tiffany’s mother does work full time, however, she still receives SNAP and Medicaid services. They also live in Section 8 housing. Tiffany lives in a community with a high crime rate. She often witnesses and hears stories of police brutality. Tiffany’s mother had to explain to her children how to respond to a police officer with they are ever stopped. Tiffany’s other brother has a history of police involvement.
.
Assignment PurposeThe first part of this assignment will assist.docxnormanibarber20063
Assignment Purpose:
The first part of this assignment will assist you in identifying a topic which you will work with for subsequent activities in the course. The second part of the assignment helps you articulate what constitutes plagiarism.
Part 1:
In this course you will be using a variety of resources and research tools. This activity will guide you in formulating a topic to use for later assignments in this course.
1. What is something you are curious about? What is something you see out in the world that you want to know more about? Perhaps think of health, business, or socio-cultural issues. Write it here:
_______________________________________________________________________
(Need help selecting a topic? Review the Research Topic Starting Points for EN 104, EN 106, EN 111, and EN 116 guide from the Herzing University Library. Browse some of the resources linked there for generating topic ideas. http://herzing.libguides.com/research_topic_starting_points)
2. Create a Mind Map for your topic in the Credo Reference Database available through the Herzing University Library. You can access the link to that database and view a brief tutorial in the Research Topics Starting Points guide at http://herzing.libguides.com/research_topic_starting_pointsIf you need assistance using this tool, contact the Herzing University Librarians using the contact information in that guide. You might need to play around with how you word your topic.
Did the Mind Map help you narrow your topic? Describe your experience with the Mind Map feature and indicate your narrowed topic:
3. Write at least three research questions related to your topic and circle or somehow indicate the one you are most interested in answering:
4. Create a thesis statement for your research project. Be sure it meets the characteristics of a “strong” thesis statement as described in the reading for this unit.
Characteristics of a Strong Thesis Statement
· Answers the research question and is adequate for the assignment.
· Takes a position – doesn’t just state facts.
· It is specific and provable.
· It passes the “so what?” test.
Include your thesis statement here:
Part 2:
The following paragraph is from this source:Spiranec, S., &Mihaela, B. Z. (2010). Information literacy 2.0: Hype or discourse refinement? Journal of Documentation, 66(1), 140-153. doi:http://dx.doi.org.prx-herzing.lirn.net/10.1108/00220411011016407
Web 2.0 is currently changing what it means to be an information literate person or community…. The erosion did not begin with Web 2.0 but had started considerably earlier and became evident with the first web document without an identifiable author or indication of origin. Generally, this erosion comes naturally with the advancement towards electronic environments. In the era of print culture the information context was based on textual permanence, unity and identifiable authorship, and was therefore stable. The appearance of Web 1.0 has already undermined .
Assignment PowerPoint Based on what you have learned so .docxnormanibarber20063
Assignment:
PowerPoint:
Based on what you have learned so far in this course, create a PowerPoint presentation that addresses each of the following points. Be sure to completely answer all the questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least four (4) citations throughout your presentation. Make sure to reference the citations using the APA writing style for the presentation. Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements.
Title Slide (1 slide)
At each stage of development, culture can have a distinct impact on basic aspects of life. Based on your reading thus far, describe how cultural influences impact development throughout the lifespan. Include the following aspects of life:
Cognition (2-3 slides)
Acceptance of cultural traditions (2-3 slides)
Biological health (2-3 slides)
Personality(2-3 slides)
Relationships (2-3 slides)
References (1 slide)
Each slide should have a graphic and very few words. In a separate Word file, create a script to use when giving this presentation (about 50 words per content slide - 500 words total). Submit both files to the dropbox.
.
Assignment In essay format, please answer the following quest.docxnormanibarber20063
Assignment: In essay format, please answer the following questions:
On your second In-Class Assignment, which was on John Stuart Mill's freedom of thought and discussion, you were asked to provide your own opinion on any moral issue.
1) Your task is to write an essay
DEFENDING
the
the OPPOSITE opinion.
2) Please structure your essay in the following format: (SEE ATTACHED FILE FOR MORE DETAILS ON WHAT EACH OF THESE MEAN)
I. Introduction/Thesis Statement
II. Body - Include at least two reasons why one would support this position
III. Counter-Argument - What is the argument against that position?
IV. Reply to Counter-Argument - Why could the counter-argument be wrong?
V. Conclusion
.
Assignment Name:
Unit 2 Discussion Board
Deliverable Length:
150-500 words (not including references) 2 Peer Responses
Details:
The Discussion Board (DB) is part of the core of online learning. Classroom discussion in an online environment requires the active participation of students and the instructor to create robust interaction and dialogue. Every student is expected to create an original response to the open-ended DB question as well as engage in dialogue by responding to posts created by others throughout the week. At the end of each unit, DB participation will be assessed based on both level of engagement and the quality of the contribution to the discussion.
At a minimum, each student will be expected to post an original and thoughtful response to the DB question and contribute to the weekly dialogue by responding to at least two other posts from students. The first contribution must be posted before midnight (Central Time) on Wednesday of each week. Two additional responses are required after Wednesday of each week. Students are highly encouraged to engage on the Discussion Board early and often, as that is the primary way the university tracks class attendance and participation.
The purpose of the Discussion Board is to allow students to learn through sharing ideas and experiences as they relate to course content and the DB question. Because it is not possible to engage in two-way dialogue after a conversation has ended, no posts to the DB will be accepted after the end of each unit.
A. Questions for weekly discussions and conversations (not part of the required Discussion Board assignment)
These questions can serve as the starting point for your discussions during the week. They are “thought starters,” so that you can explore some ideas associated with the discussion board and unit topics. Answers are not required, and should not be submitted with your required assignment. Answers are not graded.
1. What images do we use today that originated from creations by early civilizations for religious ceremonies?
2. What historical art images do we use today, from creations by early civilizations, for cultural celebrations?
B. Required Discussion Board assignment.
From the list below, choose one Greek work of art and one Roman work of art and
compare and contrast
them according to the criteria listed:
Greek Art
Roman Art
The
Doryphoros
(Polykleitos, 450 BCE)
Augustus of Primaporta
(c. 20 BCE)
The Laocoon Group
(1
st
Century, CE)
Marcus Agrippa with Imperial Family
(South frieze from the Ara Pacis, 13-9 CE)
Nike of Samothrace
(c. 190 BCE)
She-Wolf
(c. 500 BCE)
The Temple of Athena
(427–424 BCE)
The Colosseum
(72–80 CE)
The Parthenon
(447–438 BCE)
The Arch of Constantine
(313 CE)
Answer the following list of questions in a comparative essay to evaluate your choices. Be sure to introduce the works you have chosen.
What is the FORM of the work?
Is it a two-dimensional or three-dimensional work of art?
What materials are us.
Assignment In essay format, please answer the following questions.docxnormanibarber20063
Assignment: In essay format, please answer the following questions:
1) Briefly summarize Stirner's Egoism.
2) Look at some contemporary moral issues in the news, either current or past, and apply his Egoist theory to the issue. How would he view the issue?
3) Do you agree with the way Stirner would view the issue? Why or why not?
All together, the answers must total up to about 500-700 words. Assignments
MUST
have the following format: Name, Class, and Essay Subject & Date in the upper left hand corner.
Double Spaced
, 12pt Times New Roman or Arial font. If you use outside sources, it must include a works cited page.
.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
2. Gualberto Buela-Casal
ORIGINAL ARTICLE
Prediction of treatment outcomes and longitudinal analysis in
children with autism undergoing intensive behavioral
intervention
Javier Virues-Ortega*,a, Víctor Rodríguezb, C.T. Yua
aUniversity of Manitoba and St. Amant Research Centre,
Canada
bFundación Planeta Imaginario, Spain
Received September 4, 2012; accepted March 18, 2013
*Corresponding author at: University of Manitoba, Psychology
Department, P518 Duff Roblin Bldg., 190 Dysart Road,
MB R3T Winnipeg, Manitoba, Canada.
E-mail address: [email protected] (J. Virues-Ortega).
Abstract Outcome prediction is an important component of
treatment planning and prognosis.
However, reliable predictors of intensive behavioral
intervention (IBI) have not been clearly
established. IBI is an evidence-based approach to the systematic
teaching of academic, social,
verbal, and daily living skills to individuals with autism
spectrum disorder. Incorporating
longitudinal analysis to IBI outcome studies may help to
identify outcome predictors of clinical
value. Twenty-four children with autism underwent on average
two years of IBI and completed
language, daily living skills, cognitive, and motor assessments
(Early Learning Accomplishment
4. clínico. En el presente estudio se
evaluaron las habilidades verbales, cognitivas y de la vida
diaria (Early Learning Accomplish-
ment Profile y Learning Accomplishment Profile-Diagnostic, 3ª
ed.) de 24 niños con trastorno del
espectro autista en un programa de intervención conductual
intensiva. Las evaluaciones se rea-
lizaron cada seis meses y durante un periodo medio de
intervención de dos años. Mediante
PALABRAS CLAVE
Autismo;
predictor
Análisis aplicado
de la conducta;
Cuasi-experimento
(serie temporal
interrumpida con
un grupo)
92 J. Virues-Ortega et al.
Autism spectrum disorder (ASD) is a pervasive developmental
disorder that affects 1 to 2.5% of children (Baio, 2012). A
number of comprehensive psychosocial interventions for
people with ASD have been developed for which preliminary
evidence exists. These include the Early Start Denver model
(ESDM, Dawson et al., 2010), the Treatment and Education
of Autistic and Related Communication Handicapped
Children (TEACCH, Welterlin, Turner-Brown, Harris, Mesibov,
& Delmolino, 2012), and intensive behavioral intervention
based on the UCLA Young Autism Project model and applied
behavior analysis (IBI, Lovaas, 1987). Although there is no
single approach to treatment for all individuals with ASD,
5. IBI based on applied behavior analysis is among the few
approaches to treatment that have been tested extensively
using clinical trial methodology (Rogers & Vismara, 2008;
Virués-Ortega, 2010; Wetherby & Woods, 2006).
Applied behavior analysis is devoted to the experimental
study of socially significant behavior as a function of
environmental and social variables, and is the branch of
experimental psychology that supports the conceptual
framework of IBI (Luiselli, Russo, Christian, & Wilczynski,
2008). IBI is a comprehensive and evidence-based approach
to the systematic teaching of behavioral, verbal, cognitive,
and social repertoires to individuals diagnosed with ASD
(Howlin, Magiati, & Charman, 2009). Treatment typically
involves over 20 weekly hours of one-to-one teaching
incorporating multiple learning trails and specific programs
for targeted behavioral goals. Teachers program hundreds
of learning trials per day featuring discrimination training,
prompting, generalization, and other reinforcement-based
procedures known to facilitate the acquisition of new skills
in individuals with and without disabilities (Miltenberger,
2011). The IBI curriculum integrates complex sequences of
programs from basic attending or vocalizing skills, up to
complex verbal, social, and problem-solving skills (Lovaas,
2002).
Over 20 independent trials have been conducted which
jointly suggest that IBI has moderate to large effects on
daily living skills, cognitive functioning, language, and
social behavior (Foxx, 2008; Remington et al., 2007; Virués-
Ortega, 2010). The field of IBI has shown a considerable
growth as suggested by the increasing number of service
providers and certified professionals (Shook & Johnston,
2011).
Parents of children undergoing IBI and other evidence-
6. based interventions frequently want to know whether their
child will be able to attend school without special support,
what areas of behavioral functioning - whether motor,
social or cognitive - are likely to improve as a consequence
of treatment, and what intervention intensity and duration
may be optimal for their child. Until recently, outcome
research had been of little assistance to respond to these
and other questions pertaining to the longitudinal
progression of children undergoing treatment.
While the evidence available strongly suggests that some
individuals benefit significantly from IBI and other
approaches to treatment, participant and intervention
characteristics associated with greater intervention effects
are not well understood. The wider literature of treatment
outcomes in ASD has examined a range of mediating and
moderating factors that could, potentially, be established
as clinically valuable predictors. These include pre-
intervention IQ, treatment duration and intensity, family
characteristics, age at intervention onset, social initiation
skills, and structural dismorphologies of the central nervous
system. The scant literature available on these factors
have been reviewed by Rogers and Vismara (2008) who
concluded that “The current intervention research focus on
main effects models provides little information about who
does well in which treatments and why” (pp. 28-29).
Age, pre-intervention functioning, and intervention
intensity have been examined in the narrower literature of
IBI outcome predictors. Studies that have examined the
role of age at the onset of IBI have shown that the earlier
the intervention, the greater the intervention effect. For
instance, Granpeesheh, Dixon, Tarbox, Kaplan, and Wilke
(2009) found that children below seven years at treatment
onset mastered more behavioral objectives every month
7. than children who started IBI intervention above that age.
The studies that have examined pre-intervention
functioning as a predictor of treatment outcome have not
always been consistent in their findings. Perry et al. (2008)
examined progress of children with ASD that received IBI
services by comparing standardized assessments at the
beginning and end of the service. Children were classified
as having either higher, intermediate, or lower functioning
at intake based on their Vineland Adaptive Behavior
Composite score. The higher functioning group made
substantial gains (∼20 IQ increments) relative to the other
two groups. By contrast, Ben-Itzchak, Lahat, Burgin, and
Zachor (2008) reported that pre-intervention IQ (normal,
borderline, low) did not predict the IQ gains after a year of
IBI in a group of 81 young children with ASD and
developmental disabilities.
More evidence has been accrued on the effects of
intervention intensity. However, findings remain
inconsistent. Taking IQ as a prototypical outcome (Table 1),
Makrygianni and Reed (2010) in a correlational study did
not find any effects of intensity – similar results were found
by Sheinkopf and Siegel (1998). Virués-Ortega (2010)
análisis multinivel se examinaron posibles predictores
longitudinales incluyendo sexo, edad,
intensidad y duración de la intervención, tiempo total de
intervención y nivel de funcionamien-
to previo a la intervención. Los resultados indicaron que el
tiempo total de intervención, el
funcionamiento previo y la edad causaban los mayores
incrementos en bondad de ajuste de los
modelos longitudinales. El análisis longitudinal es una
estrategia analítica prometedora en la
identificación de predictores fiables de la efectividad de la
9. first year of treatment, but not during the second.
IBI operates through a package of systematic teaching
strategies which are expected to provide the individual
with an increasing set of cognitive and behavioral resources
that will in turn offset, to various extents, the behavioral
excesses and deficits that are characteristic of ASD and
other developmental disabilities. Being a training-based
and goal-directed approach to intervention, IBI may lead to
some degree of behavioral gains for as long as the
intervention is in place. Longitudinal analysis of IBI may
help to identify distinct treatment gain itineraries across
subjects and tie those to specific predictors. For instance,
it may be possible that individuals starting at a higher pre-
intervention level of functioning benefit more from IBI but
reach an asymptote (ceiling) sooner than individuals that
start at a lower level of functioning. The longitudinal
predictors of IBI effects shall be greatly informative, albeit,
they have been rarely explored in the literature. There are
several longitudinal analyses that feature patterns of
change in individuals with ASD (Dietz, Swinkels, Buitelaar,
van Daalen & van Engeland, 2007; Jonsdottir et al., 2007;
Magiati, Moss, Charman, & Howlin, 2011). Nonetheless,
these analyses are constrained by the number of longitudinal
assessments (three or less); the number of treatment
outcomes (e.g., Dietz et al. only reported IQ); and the data
analysis strategy (e.g., no multilevel analyses).
This article describes growth patterns of motor, cognitive,
verbal, daily-living, and social skills in a sample of children
with ASD admitted into a home-based IBI program managed
by trained behavior analysts and delivering 20 to 40 weekly
hours of intervention. We used the children’s performance
in standardized assessments conducted periodically to
longitudinally create curves charting the rates and
10. asymptotes of various behavioral repertoires. Subsequent
analyses were conducted to test the impact of several
personal and intervention-related predictors on the
longitudinal growth of IBI outcomes. The present analysis
may help to enhance the prognostic information available
to families and clinicians by determining the extent to
which specific client- and treatment-related variables more
closely predict treatment outcome over the duration of the
intervention.
Method
Participants
Twenty-four children diagnosed with ASD (Age: Mean =
50.05 months, SD = 28.3; Gender: 21 boys and 3 girls)
admitted to the IBI program of Fundación Planeta
Imaginario (Barcelona, Spain) participated in the study.
An a priori power analysis indicated that a total sample
size of 15 was required to detect large effects (Cohen
effect size = 1). Therefore, our sample would suffice to
identify moderate to large effect sizes. A priori power
analysis assumptions were based on the pooled effect
size of 20 trials on IBI using IQ reported by Virués-Ortega
(2010) (Pooled effect size = 1.19). Participants were
recruited consecutively and were not excluded based on
their age or pre-intervention functioning at the time of
referral. All participants received a diagnosis of ASD from
an external medical consultant based on the diagnostic
criteria of the Diagnostic and Statistical Manual of Mental
Disorders, 4th edition text revised. Diagnosis was
supported by standardized assessments of autism
including either the Autism Diagnostic Interview-Revised
(ADI-R) or the Autism Diagnostic Observation Schedule-
Generic (ADOS-G) (Le Couteur, Haden, Hammal, &
McConachie, 2008). Further personal characteristics are
11. presented in Table 2.
Table 1 Effect of treatment intensity on IQ in intensive
behavioral intervention outcome studies.
Study Sample Intensity range Analysis Effect
sizea (h/week) size
Makrygianni & Reed (2010) 86 15-30 Correlational (Pearson r)
.22
Sheinkopf & Siegel (1998) 11 21-32 Correlational (Pearson r)
−.06
Virués-Ortega (2010) 340 12-45 Meta-regression .01
Note. Effects reported as Cohen d effect sizes. a Sample size of
the intervention group.
*All effect sizes were non-significant, p > .05.
94 J. Virues-Ortega et al.
Instruments
Fine and gross motor, cognitive, language, self-care and
social skills were assessed by means of the Early Learning
Accomplishment Profile (E-LAP; Glover, Priminger, &
Sanford, 1988; Peisner-Feinberg & Hardin, 2001) and the
Learning Accomplishment Profile-Diagnostic, 3rd edition,
(LAP-D; Hardin, Peisner-Feinberg, & Weeks, 2005). The
E-LAP and LAP-D scores are developmental age values
expressed in months. The score range is 0 to 36 for the
E-LAP and 36 to 72 for the LAP-D. If a participant achieved
the upper limit of the score range of E-LAP, the assessment
would be repeated with the LAP-D, which would then
continue to be used as the means of standardized assessment
12. every 6-month period until treatment was discontinued. In
order to control for potential ceiling effects in our data, if
a participant reached the LAP-D ceiling, assessment could
be repeated one additional time to inform maintenance
(provided that the individual would continue to receive
services through the program for the next six-month
period).
Both the E-LAP and the LAP-D have a high level of
inter-rater reliability, internal consistency, and
convergent validity with IQ (Fleming, 2000; Hardin et al.,
2005; Long, Blackman, Farrell, Smolkin, & Conaway,
2005; Peisner-Feinberg & Hardin, 2001). The test-retest
reliability of both instruments is reportedly excellent,
ranging between .93 and .99 (Peisner-Feinberg & Hardin,
2001, Hardin et al., 2005). Practice effects were unlikely,
as exposure to materials and tasks during the assessment
was minimal (few trials); and prompting, reinforcement,
and correction strategies were not present during the
assessment. The Spanish version of the E-LAP and the
LAP-D materials were used in the present study. The
LAP-D was validated in a representative sample of
Spanish-speaking children (Hardin et al., 2005). No
Spanish validation of the E-LAP is currently available.
Nonetheless, test scoring is performance-based - there
are no standard scores.
Both instruments have been used frequently as
standardized assessments in intervention studies with
individuals with ASD (e.g., Ganz, Simpson & Corbin-
Newsome, 2008). Moreover, the construct validity of E-LAP
and LAP-D is supported by items screening all diagnostic
areas of ASD (e.g., “initiates on play activities,” “responds
correctly when asked to show a toy,” “inflexible and rigid
in behavior”), items informing non-pathognomonic clinical
13. features of autism (e.g., motor functioning), and items
covering developmentally relevant skills (e.g., matching
skills). In summary, the E-LAP and LAP-D were considered
adequate for the present analysis due to their likely
resilience to practice effects; excellent stability; excellent
convergent validity with intellectual assessment measures;
and relevance to the clinical, adaptive, and behavioral
features of ASD.
Procedure
Participants were admitted consecutively to an IBI program
within the period May 2006 through January 2011. This
program was an official international replication site of the
UCLA Young Autism Project model and affiliated with the
Lovaas Institute (2011). At the onset of intervention,
participants received an average of 31.87 weekly hours (SD
= 10.11, range 15 -47.30) of home-based systematic
teaching following the UCLA young autism model of service
delivery and curriculum (Lovaas, 2002). Average treatment
duration was 21.87 months (SD = 14.38, range 5.33-58.57).
In keeping with all IBI bonafide programs, in addition to the
hours of formal intervention, incidental teaching and
practice goals were operating during most waking hours
(parents and caregivers acted as active co-therapists).
One-to-one teaching was delivered by trained tutors that
were supervised on a weekly basis by licensed psychologists
Table 2 Characteristics of the study sample.
Pre-test Post-test
(N=24) (N= 24)
Age in months, M±SD 51.91±27.31 69.46±27.26
Gender (male:female) 23:1
Ethnicity (% Caucasian) 100%
14. Social class,a % high 100%
IQ,b M±SD 74.50±13.98 91.50±16.86
Skills mastered in selected areas,c M±SD
Attending (max. 19) 13.04±4.34 19.16±3.05
Imitation (max. 27) 7.84±8.41 19.92±7.24
Matching (max. 13) 6.02±7.48 13.08±6.08
Basic labeling (max. 13) 12.44±5.33 31.21±19.88
Independent play (max. 15) 3.76±4.76 11.72±6.00
Interaction with peers/adults (max. 25) 2.28±3.82 11.60±9.06
Note. aEstimated by parental education and professional
background. bWechsler Preschool and Primary Scale of
Intelligence, 3rd ed.;
Bailey Scales of Infant Development, and Merrill-Palmer Scales
of Mental Tests. cNumber of skills mastered by area (Lovaas
Institute
Midwest, 2010).
M = mean; SD = stardard deviation.
Prediction of treatment outcomes and longitudinal analysis in
children 95
with a background in behavior analysis. Parents received
weekly or bi-weekly progress updates, and supervision and
specific routines that required their involvement in order
to ensure the consistency of the interventions across
contexts and caregivers. Intervention was individualized
and comprehensive; and targeted motor, behavioral, daily-
living, verbal, cognitive, and social skills. Goals were
informed by a standardized curriculum composed of over
850 skills organized in 45 broad clinical areas (e.g., reading,
self-control skills). These goals are informed by
developmental sequences of typically developing children
(Luiselli et al., 2008) and include skills that are instrumental
15. for the acquisition of more complex repertoires (e.g.,
matching skills, imitation). Teaching sessions were delivered
via one-to-one teaching with gradual transition to group
activities and natural contexts. Transition to natural social
contexts was emphasized after mastery in one-to-one
teaching format. Decision-making in terms of hour allocation
and treatment discontinuation weighted a number of
factors including availability of school support, progress
achieved, family priorities, and treatment costs. Typically,
individuals that showed a persistent asymptote in their
learning achievements or that became independent at
school were assigned a reduced number of hours in
preparation of service discontinuation (for details on the
IBI curriculum see Lovaas, 2002). The current program was
in line with the guidelines for responsible conduct published
by the Behavior Analyst Certification Board (2010).
All participants underwent standardized assessments
with the E-LAP or the LAP-D prior to the intervention and
approximately every six months into the program (average
data points per participant 3.8, range 2-6). The selection,
administration, and correction of instruments followed the
guidelines by Jurado and Pueyo (2012).The research
assistants conducting the standardized assessments were
not involved in the administration of treatment and were
not familiar with the hypotheses of the study.
Data analysis
Figure 1 shows the individual growth trajectories of
participants for the eight E-LAP and LAP-D outcomes. Visual
inspection of the data plots over time suggests that
trajectories accelerated away from the start point shortly
after the intervention commenced while progression
decelerated as the individual approached a personal or
16. scale ceiling. Therefore, individual trajectories did not
follow a linear progression but rather an exponential
negative growth. Exponential negative trajectories are
composed formally of a negatively accelerated curve,
Figure 1 Trajectories of Early Learning Accomplishment Profile
and Learning Accomplishment Profile-Diagnostic scores over
time.
Fitted exponential negative curves (solid black line) were
obtained for individuals above (dotted grey lines) and below
(solid grey
lines) the median of pre-intervention functioning at baseline in
each domain.
Gross Motor Fine Motor Pre-writing Cognitive
Receptive
80
80
60
60
40
40
20
20
0
17. 0
0 20 40 60 0 20 40 60 0 20 40 60 0 20 40 60
Expressive Self-care Social
Intervention Time (Months)
Sc
al
e
sc
or
es
Sc
al
e
sc
or
es
96 J. Virues-Ortega et al.
ending in an upper asymptote. According to the formal
attributes of the data we selected a multilevel regression
model based on the following exponential negative
function:
Yij = αi – (αi – π0i) e –π TIMEij
18. Where αi represents the upper asymptote, π0i represents
the lower end of the trajectory, and π1i represents the
slope of the curve. Figure 2 illustrates different exponential
negative patterns of change over time for various parameter
values.
Multilevel models provide two distinct levels of analysis:
level-1 and level-2. The structural parts of the level-1
submodel contain two level-1 parameters and one within-
person variance component (εij). The first parameter, known
as intercept (π0i), represents the initial status of an
individual i in the population. The second parameter, known
as slope (π1i), represents the rate of change for the
individual i in the population by unit of time. Therefore,
level-1 establishes individual change overtime. By contrast,
the parameters at level-2 do not represent individual
variation, but average level of the outcome in the
population. Specifically, the parameters at level-2 represent
the average outcome level in the population corresponding
to the intercept and slope values at level-1. At level-2, the
pattern of change is not examined in terms of time, as is
the case at level-1, but rather, in terms of a predictor. In
summary, there are four parameters at level-2: γ00 is the
population average of level-1 intercept with level-2
predictor value of 0, γ01 is the population average difference
in level-1 intercept for a 1-unit variation in the predictor,
γ10 is the population average of the level-1 slope when the
predictor equals 0, and finally, γ11 is the population average
difference when the predictor equals 1. γ00 and γ10 are
baseline parameters while γ01 and γ11 estimate the association
of the predictor with the initial status and the rate of
change of the longitudinal progression, respectively. The
model also provides a residual variance value for the
intercept (σ02), the slope (σ12), and the covariance among
19. these two (σ01). For multilevel models incorporating two
predictors we will also report γ12 and γ12, which represents
the population’s average variation in the outcome level for
a one-unit increment in the predictors 1 and 2 (level-1),
respectively (for more details in multilevel analysis refer to
Singer & Willet, 2003). The estimation of the predictor
coefficients at level-2 is presented formally below:
π0i = ϒ00 + ϒ01 (PREDICTORi – PREDICTOR) + ξ0i
π0i = ϒ10 + ϒ11 (PREDICTORi – PREDICTOR) + ξ1i
According to this model, individual growth parameters
(π0i, π1i) across children will be a function of population
average values (γ00, γ10), and population variance components
(ξ0i, ξ1i) represented by residual variances (σ02, σ12) and
covariance (σ01).
We estimated a series of multilevel models using different
sets of predictors in order to select models that would
maximize goodness-of-fit for a given outcome when
compared with an unconditional baseline model (model
with no predictors). This was accomplished in two sequential
multilevel analyses. In the first sets of models we examined
the impact of time-based predictors (intervention duration
in weeks, total hours of intervention - weekly hours of
interventions multiplied by weeks of intervention - and age
in months). We would then select the model incorporating
the single time-based predictor with best goodness-of-fit
for each of the eight outcomes under analysis. Subsequently,
we calculated a new set of two-predictor models
incorporating the predictor previously selected and a
specific personal factor that, when added, resulted in
further increases in goodness-of-fit. The personal factors
examined for each of the eight outcomes were age (if not
selected in the preceding step), gender, and pre-intervention
functioning. Two levels of pre-intervention functioning
20. were established using the median value at baseline as cut-
off point. The rationale for selecting these predictors is
twofold: a) they are all common individual/treatment
characteristics readily accessible to the clinician, and b)
they have been examined in previous IBI studies although
not in the context of a longitudinal analysis. Longitudinal
predictors that changed overtime (intervention duration,
total intervention duration, age) were re-calculated each
time an individual was assessed.
The Akaike information criterion (AIC) and the Bayesian
information criterion (BIC) were computed as goodness-of-
fit parameters for all one- and two-predictor models. Lower
AIC and BIC values are indicative of better fitting. The best
100
75
50
25
0
E(Y)
Time
0 2 4 6 8 10
α = 100
π1 = .3
π1 = .2
21. π1 = .1
π0 = 15
Figure 2 Exponential patterns of change based on different
parameter values.
Prediction of treatment outcomes and longitudinal analysis in
children 97
fitting two-predictor model was selected for each outcome
and was fully reported. All analyses were conducted with
STATA version 11 (STATA Corporation, College Station, TX)
and its GLAMM program for multi-level analysis. A .05 level
of significance was used throughout. Results have been
reported according to the guidelines by Hartley (2012).
By comparing the goodness-of-fit of one- and two-
predictor models with an unconditional model, we aimed
to establish which factors would better explain the
longitudinal variation in our data. This analysis will help to
determine prominent trajectories of intervention outcomes
based on specific predictors. This strategy also serves the
purpose of suggesting causality in the absence of a control
group, similar to the way in which dose-response relations
inform causation (see a discussion relevant to this point in
Arjas and Parner, 2004). Namely, the causation inference
would be supported if intervention intensity (e.g., total
intervention hours at each time of assessment) is indeed
superior in its ability to increase the fit of the model
relative to an arbitrary time-dependent predictor
(individuals’ age).
22. Results
The examination of the goodness-of-fit parameters of
multilevel regression models showed that one-predictor
and two-predictor models had a superior fit than
unconditional models for every domain of the E-LAP and
the LAP-D. AIC and BIC goodness-of-fit parameters of all
models are reported in Table 3. Total intervention time
(hours per week multiplied by weeks of intervention) was
the single predictor with the highest favorable impact on
goodness-of-fit for all E-LAP and LAP-D outcomes. Other
time-based predictors including individuals’ age and
intervention duration in months had a positive impact in
the model’s fit, but did so to a lesser extent than total
intervention time in all eight outcomes.
Further improvements in goodness-of-fit were achieved
in two-predictor models. Keeping total intervention time as
the first factor, we examined the fit of regression models
incorporating age, gender, or pre-intervention level as a
second predictor. Age was the second most efficient
predictor in terms of improving fit of the regression models
for gross motor function, receptive language, self-care,
and social behavior; while pre-intervention level was the
second most efficient predictor for regression models using
fine motor function, prewriting, cognitive, and expressive
language (Table 3). The regression models of domains
assessing motor, daily living, and social skills (gross motor
function, fine motor function, self-care and social behavior)
achieved better fitting than regression models of language-
related domains (prewriting, receptive language, expressive
language, cognitive).
Table 4 presents the best fitting two-predictor multilevel
model for each E-LAP and LAP-D outcome. Both predictors
23. were statistically significant (p < .001) for every outcome.
Rate of change attributable to total intervention time in
hours (γ11) ranged from .004 to .009 (outcome average
increase by predictor unit). Coefficient magnitudes for age
in months (γ12) as a predictor ranged from .391 to .514.
Finally, coefficients for the dichotomous variable pre-
Table 3 Goodness-of-fit parameters of all one- and two-
predictor multilevel models of change for Early Learning
Accomplishment Profile and Learning Accomplishment Profile-
Diagnostic scores.
Goodness-of-fit (AIC, BIC)
GMF FMF PWR COG RLG ELG SFC SBH
Unconditional model 761.56 774.54 761.31 774.29 809.53
822.50 782.89 795.87
800.47 813.44 761.91 774.88 755.07 768.05 747.29 760.26
One-predictor models
Intervention duration 715.86 721.17 779.29 746.27 763.16
732.19 706.67 706.42
731.43 736.70 794.86 761.84 778.73 747.77 722.24 721.99
Total intervention time 693.33 691.12 744.67 720.03 737.42
712.48 677.15 688.53
708.59 706.38 759.93 735.29 752.68 727.74 692.41 703.79
Age 716.29 731.43 776.85 761.27 769.47 740.37 708.01 721.45
731.86 747 792.42 776.84 785.03 755.94 723.58 737.02
Two-predictor models
Age 664.01 673.20 727.92 710.50 724.67 702.71 651.35 676.02
681.81 691 745.72 728.30 742.47 720.52 669.16 693.82
Gender 691.93 690.19 745.08 719.15 735.78 711.83 675.18
687.74
709.73 707.99 762.88 736.95 753.59 729.63 692.99 705.55
Pre-intervention level 675.54 661.39 715.56 705.10 726.15
698.89 661.74 676.27
24. 693.35 679.20 733.36 722.90 743.96 716.70 679.55 694.07
Note. AIC = Akaike information criterion; BIC = Bayesian
information criterion; COG = Cognitive; ELG = Expressive
language; FMF = Fine
motor function; GMF = Gross motor function; PWR =
Prewriting; RLG = Receptive language; SBH = Social behavior;
SFC = Self-care.
Intercept constant; slope is established as the intervention
duration in months. Level-2 and level-3 best fitting models by
outcome are
highlighted.
98 J. Virues-Ortega et al.
intervention level (γ12) ranged from 22.971 to 35.669. Figure
1 portrays fitted curves based on an exponential negative
growth of subsamples above and below the median value of
pre-intervention level for each of the eight standardized
outcomes.
Discussion
Multilevel regression analyses based on an exponential
negative growth trajectory indicated that total intervention
duration in hours was the single predictor with the highest
contribution to the model fit for all outcomes when
compared with unconditional models. This finding suggests
that a subtle characteristic of the intervention – a
combination of both treatment intensity (weekly hours)
and treatment duration (total weeks of treatment) –
optimizes the fitting of individual trajectories to a specific
mathematical function for the duration of the intervention
and across a range of standardized outcomes. Improvements
25. in model fitting caused by duration alone did not improve
goodness-of-fit to the extent achieved by total intervention
time as a single predictor (Table 3). Therefore, our data
suggest that both intensity and duration, as represented by
total intervention time, remained important factors of
intervention gains regardless of pre-intervention functioning
or age. Finally, total intervention time remained significant
(p < .001) in all final two-predictor multilevel models (Table
4). When used in one-predictor models, pre-intervention
functioning was inferior to total intervention time in terms
of improving goodness-of-fit for all outcomes.
We tested the impact of pre-intervention functioning in
the goodness-of-fit of multilevel models incorporating two
predictors. Including pre-intervention level as a second
predictor, improved goodness-of-fit for all outcomes in the
two-predictor models (Table 3). For four of the eight
standardized outcomes examined (fine motor, pre-writing,
cognitive, expressive language), pre-intervention level was
the personal characteristic (above age and gender) that
generated the greatest improvement in model fit. Pre-
intervention level was a significant factor (p < .001) in the
final two-predictor models for fine motor, pre-writing,
cognitive and expressive language domains (Table 4).
Interestingly, these outcomes involved more complex
cognitive abilities relative to the remainder of E-LAP and
LAP-D outcomes (e.g., fine vs. gross motor; expressive vs.
receptive language; cognitive vs. self-care).
Our results suggest that individuals starting intervention
at a lower level in a given outcome were more likely to
follow an asymptotical growth as opposed to individuals
that initiated treatment with a higher level of performance
(cf. fitted curves on Fig. 1). The visual inspection of the
individual longitudinal trajectories in our sample suggests
26. that pre-intervention level is a plausible predictor of
individuals’ performance over the course of the intervention
to the extent that a bimodal pattern seems obvious in most
of the outcomes (e.g., Cognitive, Social). Bimodal
trajectories in our dataset are consistent with the distinction
between most and least positive responders to IBI discussed
by Remington et al. (2007). The visual examination of
individual trajectories on Figure 1 suggests that the pre-
intervention median is an acceptable cut-off point as
attested by the predictors significance and fit gains in
models that incorporated this factor. A more sophisticated
strategy to determine the cut-off point would have required
asymmetrical assignment of participants above and below
the cut-off points, which may have harmed statistical
power and increase the potential for type II error. Therefore,
future analyses would benefit from samples sizes larger
than ours.
Learning processes have been found to accommodate
well to exponential negative or logistic patterns of change
(e.g., Hicklin, 1976). The possibility remains, however, that
non-linear patterns of growth found in the present study
may have been caused by measurement-dependent factors,
like inadequate scaling assumptions or excessive ceiling
Table 4 Multilevel models for Early Learning Accomplishment
Profile and Learning Accomplishment Profile-Diagnostic scores
change over the duration of intensive behavioral intervention.
Goodness-of-fit (AIC, BIC)
GMF FMF PWR COG RLG ELG SFC SBH
Fixed effects
Intercept (γ00) 7.44 13.91** 10.97* 8.87 −3.00 5.46 -4.45 .52
Intervention, hours (γ11) .00** .01** .01** .01** .01** .01**
27. .01** .01**
Age, months (γ12) .51** – – – .51** – .57** .39**
Pre-intervention levela (γ12) – 28.43** 35.67** 24.27** –
22.97** – –
Variance components
Level-1: Within-person (σε2) 25.32 23.32 47.64 32.91 47.79
28.39 16.54 18.90
Level-2: Intercept (σ02) 89.91 60.71 158.79 123.89 204.10
122.62 155.74 159.19
Level-2: Slope (σ12) .07 .19 .25 .33 4.37 .40 .10 .32
Level-2: Covariance (σ01) .46 2.37 -4.16 2.76 .11 .98 2.81 3.92
Note. COG = Cognitive; ELG = Expressive language; FMF =
Fine motor function; GMF = Gross motor function; PWR =
Prewriting; RLG =
Receptive language; SBH = Social behavior; SFC = Self-care.
Goodness-of-fit parameters and domain abbreviations in Table
3. *p < .01;
**p < .001. aPre-intervention levels above and below the
median at pre-test.
Prediction of treatment outcomes and longitudinal analysis in
children 99
effects in the psychometric instrument used to establish
treatment outcomes. These potential shortcomings,
however, may have had little impact on the validity of the
predictors, which is independent from the specific shape of
the longitudinal growth.
The contributions of our study are primarily methodological
and to a lesser extent practical. As discussed in our
28. introduction, the literature on the effect of intensity and
other predictors on the outcome of IBI have yielded
inconsistent results. This inconsistency may be explained,
at least to some extent, by non-linear variations of the
predictor and the outcome overtime. Therefore, longitudinal
studies may enhance our ability to examine outcome
predictors with sufficient statistical power. Our results
provide evidence in this direction being the first study to
use this methodology in the context of IBI intervention.
In terms of the applied relevance of our findings, future
longitudinal studies expanding the present analysis could
eventually provide the basis for evidence-informed clinical
decision-making. Namely, clinicians could combine various
predictors available at the beginning of the intervention
(e.g., pre-intervention functioning in an specific area, age,
expected treatment intensity and duration) to estimate the
progress of the client over the next years, which could in
turn inform the decision-making of family, caregivers and
health decision-makers in terms of treatment planning and
resource allocation.
In summary, the present analysis helps to identify the
general features of the longitudinal progression of children
with autism undergoing IBI. Our results suggest that
increased intervention time, lower age at intervention
onset, and higher pre-intervention functioning might be
associated with greater IBI outcomes for intervention
programs of up to four years in duration. The present study
provides the methodological basis for predictor identification
in the longitudinal analysis of IBI.
References
Arjas, E., & Parner, J. (2004). Causal reasoning from
longitudinal
29. data. Scandinavian Journal of Statistics, 31, 171-187.
Baio, J. (2012). Prevalence of autism spectrum disorders:
Autism
and Developmental Disabilities Monitoring Network, 14 sites,
United States, 2008. MMWR Surveillance Summaries,
61(SS03),
1-19.
Behavior Analyst Certification Board (2010). BACB Guidelines
for
responsible conduct for behavior analysts. Available from:
http://www.bacb.com/index.php?page=57 [retrieved 23 Jan
2013].
Ben-Itzchak, E., Lahat, E., Burgin, E., & Zachor, A. D. (2008).
Cognitive, behavior and intervention in young children with
autism. Research in Developmental Disabilities, 29, 447-458.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J.,
Greenson,
J., Donaldson, A., & Varley, J. (2010). Randomized, controlled
trial of an intervention for toddlers with autism: The Early Start
Denver model. Pediatrics, 125, 17-23.
Dietz, C., Swinkels, S. H., Buitelaar, J. K., van Daalen, E., &
van
Engeland, H. (2007). Stability and change of IQ scores in
preschool children diagnosed with autistic spectrum disorder.
European Child & Adolescent Psychiatry, 16, 405-410.
Fleming, J.A. (2000). An examination of inter-rater reliability
of
the E-LAP. Baltimore: Johns Hopkins University.
Foxx, R.M. (2008). Applied behavior analysis treatment of
30. autism.
Child and Adolescent Psychiatric Clinics of North America, 17,
821-834.
Ganz, J. B., Simpson, R. L., & Corbin-Newsome, J. (2008). The
impact of the picture exchange communication system on
requesting and speech development in preschoolers with autism
spectrum disorders and similar characteristics. Research in
Autism Spectrum Disorders, 2, 157-169.
Glover, M. E., Priminger, J. L. & Sanford, A. R. (1988). Early
learning
accomplishments profile. Winston-Salem, NC: Kaplan.
Granpeesheh, D., Dixon, D. R., Tarbox, J., Kaplan, A. M., &
Wilke,
A. E. (2009). The effects of age and treatment intensity on
behavioral intervention outcomes for children with autism
spectrum disorders. Research in Autism Spectrum Disorders, 3,
1014-1022.
Hardin, B. J., Peisner-Feinberg, E. S., & Weeks, S. W. (2005).
The
Learning Accomplishment Profile-Diagnostic (LAP-D), third
edition. Lewisville, NC: Kaplan Early Learning.
Hartley, J. (2012). New ways of making academic articles easier
to
read. International Journal of Clinical and Health Psychology,
12, 143-160.
Hicklin, W. J. (1976). A model for mastery learning based on
dynamic equilibrium theory. Journal of Mathematical
Psychology, 13, 79-88.
Howlin, P., Magiati, I., & Charman, T. (2009). Systematic
31. review of
early intensive behavioral interventions for children with
autism. American Journal on Intellectual and Developmental
Disabilities,114, 23-41.
Jónsdóttir, S. L., Saemundsen, E., Asmundsdóttir, G.,
Hjartardóttir,
S., Asgeirsdóttir, B. B., Smáradóttir, H. H., Sigurdardóttir, S.,
&
Smaári, J. (2007). Follow-up of children diagnosed with
pervasive developmental disorders. Journal of Autism and
Developmental Disorders, 37, 1361-1374.
Jurado, M. A., & Pueyo, R. (2012). Doing and reporting a
neuropsychological assessment. International Journal of
Clinical and Health Psychology, 12, 123-141.
Le Couteur, A., Haden, G., Hammal, D., & McConachie, H.
(2008).
Diagnosing autism spectrum disorders in pre-school children
using two standardised assessment instruments: The ADI-R and
the ADOS. Journal of Autism and Developmental Disorders, 38,
362-372.
Long, C. E., Blackman, J. A., Farrell, W. J., Smolkin, M. E. &
Conaway, M. R. (2005). A comparison of developmental versus
functional assessment in the rehabilitation of young children.
Pediatric Rehabilitation, 8, 151-161.
Lovaas, O. I. (1987). Behavioral treatment and normal
educational
and intellectual functioning in young autistic children. Journal
of Consulting and Clinical Psychology, 55, 3-9.
Lovaas, O. I. (2002). Teaching developmentally disable
children:
32. The ME Book. Austin, TX: Pro-ed.
Lovaas Institute (2011). NIMH Replication Sites. Available
from:
http://www.lovaas.com/contact.php [retrieved 1 Sep 2012].
Lovaas Institute Midwest (2010). Matrix curriculum and clinical
goal areas. Minneapolis, MN: Author.
Luiselli, J. K., Russo, D. C., Christian, W. P., & Wilczynski, S.
M.
(2008). Effective practices for children with autism. New York:
Oxford University Press.
Magiati, I., Moss, J., Charman, T., & Howlin, P. (2011).
Patterns of
change in children with autism spectrum disorders who received
community based comprehensive interventions in their pre-
school years: A seven year follow-up study. Research in Autism
Spectrum Disorders, 5, 1016-1027.
Makrygianni, M. K., & Reed, P. (2010). Factors impacting on
the
outcomes of Greek intervention programmes for children with
autistic spectrum disorders. Research in Autism Spectrum
Disorders, 4, 697-708.
Miltenberger, R. G. (2011). Behavior modification: Principles
and
procedures (5th ed.). Belmont, CA: Cengage.
100 J. Virues-Ortega et al.
Peisner-Feinberg, E. S., & Hardin, B. J. (2001). The early
33. learning
accomplishment profile edition examiner’s manual and
technical report. New York: Kaplan.
Perry, A., Cummings, A., Geier, J. D., Freeman, N. L., Hughes,
S.,
LaRose, L., Managan, T., Reitzel, J. A., & Williams, J. (2008).
Effectiveness of intensive behavioral intervention in a large,
community-based program. Research in Autism Spectrum
Disorders, 2, 621-642.
Reed, P., Osborne, L. A., & Corness, M. (2007). Relative
effectiveness
of different home-based behavioral approaches to early
teaching intervention. Journal of Autism and Developmental
Disorders, 37, 1815-1821.
Remington, B., Hastings, R. P., Kovshoff, H., degli Espinosa,
F.,
Jahr, E., Brown, T., Alsford, P., Lemaic, M., & Ward, N.
(2007).
Early intensive behavioral intervention. American Journal on
Mental Retardation, 112, 418-438.
Rogers, S. J., & Vismara, L. A. (2008). Evidence-based
comprehensive
treatments for early autism. Journal of Clinical Child and
Adolescent Psychology,37, 8-38.
Sheinkopf, S. J., & Siegel, B. (1998). Home-based behavioral
treatment of young children with autism. Journal of Autism
and Developmental Disorders, 28, 15-23.
Shook, G. L., & Johnston, J. M. (2011). Training and
professional
certification. In W. W. Fisher, C. C. Piazza, & H. S. Roane
34. (Eds.),
Handbook of applied behavior analysis (pp. 498-510). New
York: Guilford Press.
Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data
analysis. New York: Oxford University Press.
Virués-Ortega, J. (2010). Applied behavior analytic intervention
for autism in early childhood. Clinical Psychology Review, 30,
387-399.
Welterlin, A., Turner-Brown, L. M., Harris, S., Mesibov, G., &
Delmolino,
L. (2012). The home TEACCHing program for toddlers with
autism.
Journal of Autism and Developmental Disorders, 42, 1827-1835.
Wetherby, A. M., & Woods, J. J. (2006). Early social
interaction
project for children with autism spectrum disorders beginning
in the second year of life: A preliminary study. Topics in Early
Childhood Special Education, 26, 67-82.
O R I G I N A L P A P E R
Savant Syndrome: Realities, Myths and Misconceptions
Darold A. Treffert
Published online: 6 August 2013
� Springer Science+Business Media New York 2013
35. Abstract It was 126 years ago that Down first described
savant syndrome as a specific condition and 70 years ago
that Kanner first described Early Infantile Autism. While as
many as one in ten autistic persons have savant abilities,
such special skills occur in other CNS conditions as well
such that approximately 50 % of cases of savant syndrome
have autism as the underlying developmental disability and
50 % are associated with other disabilities. This paper sorts
out realities from myths and misconceptions about both
savant syndrome and autism spectrum disorders (ASD) that
have developed through the years. The reality is that low
IQ is not necessarily an accompaniment of savant syn-
drome; in some cases IQ can be superior. Also, savants can
be creative, rather than just duplicative, and the skills
increase over time on a continuum from duplication, to
improvisation to creation, rather than diminishing or sud-
denly disappearing. Genius and prodigy exist separate from
savant syndrome and not all such highly gifted persons
36. have Asperger’s Disorder. This paper also emphasizes the
critical importance of separating ‘autistic-like’ symptoms
from ASD especially in children when the savant ability
presents as hyperlexia (children who read early) or as
Einstein syndrome (children who speak late), or have
impaired vision (Blindisms) because prognosis and out-
come are very different when that careful distinction is
made. In those cases the term ‘outgrowing autism’ might
be mistakenly applied when in fact the child did not have
ASD in the first place.
Keywords Savant syndrome � Autism � Autism
spectrum disorder � Hyperlexia � Einstein syndrome
Realities
Savant Syndrome Defined
Savant syndrome is a rare but spectacular condition in
which persons with developmental disabilities, including
but not limited to autism, or other CNS disorders or disease
have some spectacular ‘islands of genius’ that stand in
jarring juxtaposition to overall limitations. (Treffert 2010)
37. The condition can be present from birth and evident in
early childhood (congenital) or develop later in life after
CNS injury or disease (acquired). It affects males 4–6 times
more frequently than females. Typically the skills occur in
five general areas—music, art, calendar calculating,
mathematics or mechanical/visual-spatial skills. Other
skills occur less frequently including language (polyglot),
unusual sensory discrimination, athletics or outstanding
knowledge in specific fields such as neurophysiology, sta-
tistics, navigation or computers, for example. Skills are
usually single skills, but multiple skills can occur as well.
Whatever the skill it is always associated with massive
memory of a habit or procedural type—very narrow but
exceedingly deep within the confines of the special skill. In
some cases massive memory is the special skill.
Savant Syndrome is Not a New Disorder (Nor is
Autism)
It is over 200 years ago since the first case of savant syn-
38. drome appeared in a scientific journal in Germany (Moritz
1783). And it is 126 years since Dr. J. Langdon Down first
D. A. Treffert (&)
Agnesian HealthCare, 430 East Division Street, Fond du Lac,
WI 54935, USA
e-mail: [email protected]
123
J Autism Dev Disord (2014) 44:564–571
DOI 10.1007/s10803-013-1906-8
described savant syndrome as a distinct condition. (Down
1887). In his 1887 lectures Down described ten cases of
savant syndrome, including a boy who had memorized The
Rise and Fall of the Roman Empire verbatim and could
recite it backward or forward. Interestingly, in those same
lectures Down described a form of mental retardation later
named Down’s syndrome, and he described as well a form
of ‘‘developmental retardation’’ that unmistakably con-
sisted of cases of what we now would term early onset and
39. late onset autistic disorder. (Treffert 2006) And in Kanner’s
description of early infantile autism cases in 1944 there are
several individuals who would now be considered cases of
savant syndrome.
Down coined the term ‘idiot savant’. He did not intend
that term be degrading or insulting. At the time ‘idiot’ was
an accepted scientific word for persons with an IQ below
25 and ‘savant’ was derived from the French word savoir,
meaning ‘to know’. Because of its pejorative connotation, a
1988 paper suggested it was time to discard that archaic
term and substitute ‘savant syndrome’ instead. (Treffert
1988) Then in 1989 the movie Rain Man made the term
‘‘autistic savant’’ household words.
Not All Savants are Autistic, and Not All Autistic
Persons are Savants
Rain Man was a marvelous movie. It was accurately and
sensitively done. Yet some persons came away from the
movie assuming that, like Raymond Babbitt, all savants are
40. autistic. Not so. Approximately one in ten persons with
autism has savant skills; so nine out of ten do not.
Approximately 1 out of 1,400 persons with mental retar-
dation or CNS deficits other than autism do have savant
skills so such abilities are not limited to autistic disorder.
(Saloviita 2000) Hence not all autistic persons are savants,
and not all savants are autistic.
Savant Skills Represent a Spectrum of Abilities
While admittedly a subjective scale at this point, savant
skills lie on a spectrum of abilities. Most common are
splinter skill savants who have obsessive preoccupation
with and memorization of music & sports trivia, birthdays,
license plate numbers, historical facts, train or bus sched-
ules, navigation abilities, or maps for example. Talented
savants are those in whom musical, art or other special
abilities are more conspicuous not only in contrast to
individual limitations, but also in contrast to peer group
abilities whether disabled or not. And prodigious savant is
41. an extremely high threshold term reserved for those
extraordinarily rare individuals in whom the special skill is
so outstanding that were it to be seen in a non-impaired
person such a person would be termed a ‘‘prodigy’’ or
‘‘genius’’.
The Acquired Savant: ‘‘Accidental Genius’’
In 1923 Minogue reported a case in which musical genius
appeared in a three-year old child following meningitis. In
1980 Brink described the case of Mr. Z who demonstrated
savant mechanical skills and traits at age nine after a bullet
wound to the left brain produced muteness, deafness and
left sided paralysis, but precipitated the newly surfaced
savant skills. Dorman in 1991 published a case in which an
8 year old boy began to show exceptional calendar calcu-
lating skills following a left hemispherectomy.
But it was Miller’s reports on 12 individuals with fronto-
temporal dementia who developed exceptional savant art
and musical skills that really brought the ‘acquired savant’
42. to prominent attention. (Miller et al. 1996, 1998, 2000)
Miller had done SPECT imaging on these 12 patients, and
he also did SPECT imaging on a 9 year old autistic, artistic
savant. In these instances there was left anterior temporal
dysfunction and evidence of what Kapur called ‘‘para-
doxical functional facilitation’’–dysfunction in one area of
the brain which uncovered, or facilitated ‘paradoxical’
function in some other area of still intact brain capacity
(Kapur 1996).
Since that time there have been numerous reports of
what might be called ‘‘acquired savant syndrome’’ fol-
lowing a cerebral insult from stroke, a blow to the head,
dementia or other CNS disease or injury accompanied by
the emergence of savant skills, sometimes at a prodigious
level (Treffert 2010). In most of these cases there was some
sort of ‘trade-off’ of cognitive or other abilities for the new
found savant skills. Yet in other cases, more aptly called
‘accidental genius’ (following being struck by lightning in
43. one instance) there has been no trade off at all with the
emergence of new found skills. These instances raise many
interesting questions about dormant capacity within us all,
and raise the even more challenging question of how to tap
those buried abilities without enduring some CNS catas-
trophe. These cases of acquired savant syndrome are pre-
sented in much more detail on the savant syndrome web
site at www.savantsyndrome.com.
The Most Important Question of All: How do They
do It?
There have been many theories put forth to try to explain
savant syndrome ranging from early heredity theories to
present day Quantum theory. (Treffert 2010). Some of the
neuropsychological theories such as weak central coher-
ence, mind blindedness are interesting as they apply to the
autistic savant. But 50 % of savants are not autistic. The
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44. http://www.savantsyndrome.com
role of heredity is no doubt a contributor and the search for
a savant ‘gene’ is underway, one study finding such a gene,
but another not confirming that finding. Compensatory
learning, reinforcement and repetition-compulsion may
also play a role, but then, if those dynamics produce savant
syndrome, why wouldn’t that apply to all persons with
autism or other CNS limitations?
The theory I favor is that what I have come to call the
‘‘three R’s’’ and reflects the process Kapur termed ‘‘para-
doxical functional facilitation’’ in 1996 in which one area
of the brain in released from the inhibiting influence of
some other brain area. In the case of savants, both con-
genital and acquired, there is brain damage in one area,
frequently the left hemisphere, with recruitment of still
intact brain tissue in another area of the brain, rewiring of
circuitry to that new area, and release of dormant capacity,
45. through a disinhibiting process, of information and skills
already stored in that newly recruited area.
It is genetic memory—the genetic transfer of knowledge
and skills—that accounts for the already stored dormant
capacity tapped by the recruitment, rewiring and release. I
address genetic memory much more fully in Islands of
Genius as well, and on the savant syndrome web site at
www.savantsyndrome.com. Genetic memory is based on
the fact that some savants, particularly those severely
limited in other ways, clearly ‘‘know things they never
learned’’. The only possible way to know things one never
learned—sometimes at complex levels—is for that
knowledge to be factory installed, genetically transmitted.
But there is one other important element that contributes
to the ‘‘how do they do it?’’ question. That is the role of the
family or other caregivers, teachers or mentors in first
discovering the special gift in the savant, then tenderly
nurturing and encouraging that gift, and supporting and
46. reinforcing it by praise coupled with copious unconditional
love.
Some Mysteries Remain
There are many scientific mysteries still about savant
syndrome. But two are especially intriguing. First is the
conspicuous regularity in which the triad of mental
impairment (often from autism) ? impaired vision ?
musical genius occurs. Savant syndrome is rare but the
frequency of this triad is very conspicuous and dispropor-
tionate throughout the history of savant cases combining
blindness and mental disability with prodigious musical
skills. The first of such persons was Thomas Bethune,
better known as ‘‘Blind Tom’’, who was born in 1850 and
gave his first public piano concert at age 8. From then on he
became an international celebrity and was the most cele-
brated black concert artist of the nineteenth century. His
repertoire was in the thousands of pieces including many of
his own compositions, the first of which he created at age
47. five.
Since that time a number of such cases with this triad are
glaringly over-represented in savant syndrome, in itself a
rare condition. Leslie Lemke in the United States, Derek,
Paravicini in the United Kingdom and Hikari Oe in Japan
are present day representatives of this amazing combina-
tion of ability and disability. In addition to those examples,
a number of other such cases are documented in detail in
Islands of Genius. The savant syndrome web site provides
further video evidence and documentation of this extraor-
dinary triad of mental impairment ? blindness ? musical
genius.
A second mystery is the why calendar calculating, an
obscure skill in neurotypical persons, is seemingly almost
universally present in persons with savant syndrome. This
ability is a clear example of how savants, sometimes
severely impaired, innately ‘‘know things they never
learned’’. Yes, there are formulas for calendar calculating.
48. And yes, if any person puts his or her mind to it, he or she
can learn (laboriously) how to calendar calculate. But
savants seem to have this algorithm or formula ‘uncon-
sciously’ inscribed or inculcated in their brain and in most
such individuals there simply has not been any ‘study’ of
the calendar nor the ‘learning’ of any formula. Why cal-
endar calculating? And why is that so prominent in savant
syndrome but generally not seen in other brain diseases or
disorders? Some imaging studies are underway with cal-
endar calculating savants, comparing them to neurotypical
‘expert’ calendar calculators and control groups.
Myths and Misconceptions
Savants are Not ‘Creative’
Some observers, while extolling the eidetic-like ability and
memory of savants, point out that in contrast to such
astonishing imitative ability, savants, as a group are not
very creative. In fact I was one of those observers who
wrote just that in the original 1988 version of Extraordi-
49. nary People:Understanding Savant Syndrome. I raised the
question there ‘‘Is the savant creative?’’ I answered it this
way: ‘‘In my experience, not very’’.
I was wrong and have corrected that perception in my
later writings. What changed my mind? Some additional
years of observation. There is always a tremendous
advantage in having a longitudinal view of a patient and his
or her ‘natural history’ of illness or disorder, compared to a
one-time, snapshot consultation. And now, having the
opportunity to observe the ‘natural history’ of how the
savant skills emerge and develop over many years, I have
noted predictable and replicable sequence of steps that
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http://www.savantsyndrome.com
progresses from imitation, to improvisation, to creation in
savant syndrome. Let me expand on that, using Leslie
Lemke as an example.
50. Leslie Lemke’s ability to store and replicate music, even
after only a single hearing, was spectacular. Indeed at age
14 he was able to play back Tchaikovsky’s First Piano
concerto flawlessly having heard it for the first time as a
theme song to a television movie.
Over time, however, Leslie began to show improvisa-
tional skills in a addition to replication abilities. For
example at a 1989 concert a young girl came up to the
stage in the challenge portion of the concert and played
‘‘Mississippi Hotdog’’. Leslie listened and then, when
asked, dutifully played back the piece exactly as he had
heard it. But toward the end of the piece he began to look a
bit restless, and seemed more excited and more eager to
play. After the initial playback of Mississippi Hotdog was
completed, flawlessly as usual, Leslie then launched into a
5 min improvisation which could be called ‘‘Variations on
a Theme of Mississippi Hotdog.’’ He changed pitch,
changed tempo and demonstrated convincingly that he
51. does indeed have innate access to the ‘rules of music’,
confirmed by a number of professional musicians who have
observed him.
Adding to the improvisation skill now is creation and
composing of entirely new pieces. One such song he calls
‘‘Down Home on the Farm in Arpin’’, and another he
names ‘‘Bird Song’’. In that latter piece he duplicates, by
whistling softly as he plays his new tune, the bird songs he
hears as he sits for hours outside his farm home.
That same sequence from replication to improvisation to
creation occurs in other savants whether musicians or
artists. The artists begin their ‘career’ with striking replicas
of what they have seen and stored, usually requiring no
model or constant reference piece. Then some improvisa-
tion begins to appear—a telephone pole deleted here, or a
new tree there—slightly different from the original. Then
comes creation of entirely new pieces, maybe now free-
form or in an entirely different art style.
52. So the savant can be creative. Some savants prefer to
stay with replication, but many have gone beyond literal
copying, as stunning as that can be, to improvisation and
then creation of something entirely new.
These clinical impressions regarding creativity in the
savant have been bolstered by several formal research
projects. A 1987 study by Hermelin, O’Connor and Lee
looked at musical inventiveness in five musical savants
compared to six non-savant children who had musical
training over a period of 2 years but who had not been
exposed to compositional or improvisational instruction.
Five tasks were used to grade for ‘‘musical inventiveness’’.
On those tests the savant group was superior to the control
group. Similarly, on tests of musical competence—timing,
balance and complexity—the savants (with a mean IQ of
59) were also superior to the control group.
Hermelin and her co-workers indicated this study was
consistent with earlier findings—that a series of separate
53. intelligences, of which music is but one, exist in each
person rather than a single, consistent intelligence that
permeates all the skills and abilities of each person. With
respect to music, they concluded that savants were able to
show some creativity and improvisation in addition to
mimicry.
Hermelin et al. (1989) conducted a study of improvi-
sations by Leslie Lemke compared to a professional, non-
savant musician after each had heard the same musical
pieces, one lyric (Grieg) and one a-tonal (Bartok). Leslie’s
improvisations were described as ‘‘virtuoso embellish-
ments with a considerable degree of musical inventiveness
and pianistic virtuosity.’’ That study concluded that ‘‘both
subjects’ attempts at improvisation show a high degree of
generative musical ability, and what distinguishes them
from each other is not so much a differential degree of
musicianship but rather their own, different musical pref-
erences as well as their respective personality characteris-
54. tics.’’ In improvisational style on the Bartok, a-tonal piece,
both musicians resembled each other as well.
In summary, savants can be creative. Most savants travel
along a route of first replication, then improvisation, and
finally creation. As we learn more about the brain from the
study of savants, we may also learn much more about talent
and creativity itself through the unique window into the
brain and special skills savant syndrome provides.
The ‘‘Nadia’’ Effect and the ‘‘Dreaded Trade-Off’’
In 1977 Dr. Lorna Selfe described the case of Nadia, a
prolific childhood artist, whose special abilities disap-
peared after she was sent away to school to increase lan-
guage acquisition, socialization abilities and daily living
skills. With the publication of Dr. Selfe’s 2011 book—
Nadia Revisited—we now have the benefit of long term
follow-up on Nadia. Selfe describes the loss of skills this
way: ‘‘In the years following my first study, and throughout
her school days, Nadia was given intensive help with lan-
55. guage development and her ability to communicate
improved with the production of two/three word sentences.
She also started to draw like an infant so that, for a period,
two styles coexisted and sometimes on the same piece of
paper. Gradually and inexorably she lost the ability to draw
realistically. Unlike some savant artists such as Stephen
Wiltshire, who has maintained the strength of his drawing
ability, Nadia’s ability appeared to peter out. She is now
middle-aged and lives in a specialist care home but for
many years she has simply refused to draw.’’ But, in spite
of the loss of art skills, Selfe points out, importantly, that
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even though now Nadia is not interested in art and is totally
dependent on others in that supervised setting there is also
the ‘‘optimistic story of the love and care of the family that
raised her and of the people who now care for Nadia. She is
56. in the safe and competent hands of dedicated staff who
devote themselves to the care of people who are unable to
look after themselves.’’
We don’t seem to know exactly what did happen with
Nadia and why those special skills disappeared. But what I
do know is that in the many, many savants with whom I
have worked, or know about, such a ‘‘dreaded trade-off’’,
or loss of skills, does not occur as the savant gets older or
when exposed to more formal education and training. To
the contrary, in my experience vigorously ‘‘training the
talent’’, whatever that special skill is, leads, in and of itself,
to increased language, social and daily living skills without
any ‘‘dreaded trade-off’’ of special skills. So Nadia’s
experience is the exception, not the rule.
Putting aside the fear of a ‘‘dreaded trade-off’’ is
important because parents, teachers or therapists are
sometimes reluctant to venture forth with more formal
education or training efforts lest the ‘‘Nadia’’ effect occur.
57. The good news is that such a fear is, in my experience,
unfounded and should not prevent presenting the savant
with more formal education and training within his or her
area of specialty, as well as in a more general educational
sense. That being the case, parents and teachers can con-
tinue not only to applaud and reinforce the special skills as
they surface, but can confidently add teaching and training
in a more formal sense as well without fear of loss of talent,
ingenuity or enthusiasm on the part of the savant.
Savant Syndrome is Always Associated with Low IQ
Perhaps stemming from Down’s original description
regarding low IQ and the presence of savant skills, a
misconception continues that low IQ is a necessary
accompaniment of savant syndrome. That in fact is not the
case. While it is true that most savants have measured IQ’s
between 50 and 70, in some instances IQ can be as high as
125, or even higher. Thus an IQ level above 70 does not
‘disqualify’ someone from having savant syndrome.
58. One reason that many savants, or many autistic persons,
have IQ scores below 70 is that IQ measurement depends
so heavily on verbal scales, and many autistic individuals,
including those with savant syndrome, have language
(verbal) deficits as an intrinsic part of the underlying
disorder.
A second reason for low IQ scores among savants is the
fact that IQ tests measure only one facet of ‘‘intelligence’’,
something termed ‘‘IQ’’. Savants tend to do poorly on that
particular measure of ‘‘intelligence’’. But savants point out
forcefully that there are multiple forms of ‘‘intelligence’’
and IQ measures only one such ‘‘intelligence’’. IQ tests do
measure something defined as ‘‘IQ’’. But IQ tests fail to
measure some of the other forms of ‘‘intelligence’’ that
savants possess in greater or lesser measure as well. Some
of the savants are profoundly disabled in capacities as
measured by IQ, but yet they are astoundingly ‘intelligent’
within their ‘‘island of genius’’.
59. There is much debate among psychologists regarding
single v. multiple intelligence theories. But savant syn-
drome, with sometimes extraordinary ability co-existing
with profound disability in the same individual argues
forcefully for the concept of multiple intelligence. And the
fact of multiple intelligences has profound implications not
just for better understanding and approaching savant syn-
drome, but also for implementing more effective, individ-
ualized and targeted education efforts for all segments of
the population.
Thirdly, in all developmental disabilities, and savant
syndrome, one has to make a distinction between ‘‘actual
retardation’’, as classified by IQ scores, from ‘‘functional
retardation’’—instances in which persons with presumably
normal or high IQ (if it could be accurately measured)
function at levels more consistent with sub-normal IQ. In
such instances, either the language and verbal deficits, or
behavioral traits and symptoms, prevent accurate mea-
60. surement of ‘‘IQ’’. These individuals, whether savants or
not, ‘‘function’’ as if ‘‘retarded’’, but their abilities in cer-
tain other areas of function belie a below average IQ score.
That is termed ‘‘functional retardation.’’
Leslie Lemke provides an example of how misleading
IQ levels can be as a single measure of intelligence. Leslie
has a measured IQ of 58 on the WAIS-R test, based solely
on verbal scores; performance tests were not done because
such testing relies heavily on vision, and Leslie is blind.
Other tests were carried out as well including the 4th edi-
tion of the Stanford-Binet; the Tactual Performance Test;
the American Association for Mental Deficiency Adaptive
Behavioral Scale; and the Animal List Selective Remind-
ing Test. By looking at the scores on these tests as a whole,
the neuropsychologist concluded Leslie was functioning in
the moderately retarded range of intelligence, defined as an
IQ level between 35 and 55.
Yet a videotape of one of Leslie’s concerts challenges
61. the accuracy of such a low level of intelligence figures. At
this particular concert Leslie was asked to play a piece he
had never heard before with the other pianist, rather than
waiting for the piece to conclude and then play it back after
hearing it as he usually does. The other pianist began
playing. Leslie waited about 3 seconds and then did indeed
play the piece with the other pianist, separated only by
those 3 seconds. In that three second delay Leslie was
taking in what he heard, processing it, and simultaneously
outputting the music as he played along with the other
568 J Autism Dev Disord (2014) 44:564–571
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pianist. Leslie was parallel processing, just as some very
intelligent, but rare, interpreters are able to translate what a
speaker is saying into another language simultaneously,
rather than having the speaker pause from time to time
while the interpreter ‘catches up’.
62. Leslie was parallel processing. That would not be pos-
sible if the IQ level of 35–55 was an accurate barometer of
his over-all intelligence. He exceeds that level by far with
the parallel processing of music which signals that more
than a single ‘intelligence’ was at work during that com-
plex performance.
In summary, measured IQ levels in savants can range
from sub-normal to exceptional and low IQ is not a pre-
requisite to being classified as a ‘savant’. While many
savants have measured IQ levels below 70, some have
measured IQ’s above normal which can range as high as
125 or above. In assessing IQ scores, one has to differen-
tiate’actual’ retardation from ‘functional’ retardation
All ‘‘Geniuses’’ and ‘‘Prodigies’’, Past and Present are
Really ‘‘Aspies’’
With increased interest in autism and Asperger’s, and
especially with the visibility given to the extraordinary skills
seen in savant syndrome, it seems popular these days to
63. apply the diagnosis of Asperger’s disorder particularly to
anyone considered to be a ‘genius’ or ‘prodigy’ past or
present. Names such as Einstein, Rembrandt, Mozart,
Jefferson and many others are bandied about in such dis-
cussions. It is difficult enough to make accurate diagnoses of
autism or Asperger’s disorder in real life, with face-to-face
interviews and comprehensive testing, let alone trying to
apply post-mortem diagnoses, sight unseen. Retrospective
medical diagnoses are always problematical and suspect.
And then there are present-day prodigies and geniuses.
Some, outrageously bright, but not autistic children, have
composed multiple symphonies by age seven, or have
mastered instruments, sometimes multiple instruments, by
age three. Others show astonishing artistic, mathematical,
prose or poetry skills well beyond their years. If children,
we call them prodigies. They are neither autistic, nor
Aspergers. If adults, we call them geniuses. They also are
neither Asperger’s nor autistic. Prodigies and geniuses
64. have special, spectacular abilities in absence of any
underlying disability. Typically, rather than there being
simply one ‘‘island’’of genius as is often the case with
savants, whatever the skills of the prodigy or genius, they
are associated with a high measured IQ in all areas of
functioning.
In short, not every gifted child, nor every ‘absent
minded professor’, has Asperger’s disorder. Instead,
‘‘prodigy’’ and ‘‘genius’’ do exist as independent conditions
separate from any underlying disability or disorder The
temptation to classify all prodigies and geniuses as having
autism or Asperger’s seems to be part of the disease de jour
phenomenon quite rampant these days and needs to be
resisted in favor of careful analysis lest continued ‘diag-
nosis creep’ deletes all meaningful classification, all the
disorders lose their specificity, and the ‘spectrum’ engulfs
us all.
The beginning of wisdom is to call things by their right
65. name. Asperger’s, autism, and savant syndrome surely do
exist. But so do the categories of ‘‘normal’’, ‘‘gifted’’,
‘‘prodigy’’ and ‘‘genius’’. The important thing is to know
the difference lest every parent of a gifted child for
example, whether mildly gifted or profoundly gifted, fear
their child is autistic.
‘‘Outgrowing’’ Autism: Separating ‘Autistic-Like’
Traits from Autistic Disorder in Children Who Read
Early, Speak Late, or are Blind
I get many ‘‘I’ve got a son or daughter who……..’’ emails
from the savant syndrome web site in which parents describe
various accelerated skills in their children and inquire whe-
ther those might be forms of savant syndrome, and if so, how
should those special skills, and that child, be approached
educationally and otherwise. Among those many inquiries
are children who read early (hyperlexia) or speak late
(Einstein Syndrome). Often children in both those groups are
automatically, and mistakenly, assumed to be autistic when
66. in fact they only have ‘autistic-like’ behaviors and traits with
very different causes and outcomes than Autistic Disorder.
They tend to ‘outgrow’ their autism (their choice of terms),
which was not autism in the first place.
Based on a number of such cases brought to my atten-
tion separating ‘‘autistic-like’’ behaviors and traits from
‘‘Autistic Disorder’’ in children who read early, or speak
late, or who are blind, is a critical differential diagnosis
with vast causal, treatment and outcome ramifications.
Hyperlexia I, II and III
Some neurotypical children simply read early. They may
be reading, instead of the teacher, to their nursery school
class, or reading at a 7th grade level at age 3 for example.
There are no associated autistic or autistic-like traits or
behaviors. They are entirely ‘normal’ (neurotypical) chil-
dren. Eventually their classmates catch up with reading
skills but in the meantime the advanced, precocious read-
ing ability at such an early age draws considerable atten-
67. tion. I describe several such examples on the ‘‘Hyperlexia’’
posting on the savant syndrome web site at www.
savantsyndrome.com I refer to this type of early reading
ability as Hyperlexia I.
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http://www.savantsyndrome.com
http://www.savantsyndrome.com
Hyperlexia II is when early reading ability presents as a
‘splinter skill’ as part of an Autistic Spectrum Disorder.
These children read voraciously along with astonishing
memory for what they read. They often have other mem-
orization abilities sometimes linked with fascination with
numbers or calendar calculating skills. These children
show other characteristic language, social and behavioral
symptoms seen in autistic spectrum disorder, including
traits such as withdrawal, poor eye contact, lack of interest
in seeking or giving affection, insistence on sameness, and
68. obsessive compulsive behavior, for example. They usually
carry a formal diagnosis of Autistic Disorder, Asperger’s
Disorder, or pervasive developmental disorder (PPD/NOS)
with intense fascination with words and numbers present-
ing as a ‘splinter skill’.
Hyperlexia III is a less frequently recognized form of
early reading ability. It is not an autistic spectrum disorder
even though there are some ‘‘autistic-like’’ traits and
behaviors that gradually fade as the child gets older. Some
times this is referred to as ‘‘outgrowing autism’’. These
children read early and have striking memorization abilities
sometimes coupled with precocious abilities in other areas
as well. They may show unusual sensory sensitivity, ech-
olalia, pronoun reversals, intense need for sameness, spe-
cific fears or phobias, have lining/stacking rituals and
demonstrate strong visual and auditory memory. Unlike
children with ASD, however, they are often very outgoing
and affectionate with family, even though reserved and
69. distant with peers and would be playmates. They do make
eye contact and can be very interactive with persons close
to them, especially adults. These children present as being
very bright, inquisitive and precocious overall. Indeed
these ‘autistic-like’ traits and behaviors do fade as the child
gets older, but in the meantime parents are exposed to
unnecessary fear and dread because the diagnosis of
‘‘autism’’ has been prematurely and inappropriately applied
without ‘‘hyperlexia III’’ being considered in the differen-
tial diagnosis. Space precludes an extensive discussion of
Hyperlexia III, but the savant syndrome website as www.
savantsyndrome.com provides a number of example of
such cases with respect to characteristics and outcome.
Einstein Syndrome: Children Who Speak Late
In his 1997 book Late Talking Children Thomas Sowell
pointed out how often ‘‘autistic-like’’ symptoms, as
opposed to Autistic Disorder itself, appeared in children
with delayed speech based on parental reports in a group of
70. 46 such children. In a follow-up book 4 years later—The
Einstein Syndrome:Bright Children Who Talk Late—
Sowell expanded that group to 239 late talking children
who were exceptionally late in beginning to speak but were
also exceptionally bright. (Sowell 2001). His book is
replete with examples. As with Hyperlexia III, Sowell
found in his correspondence with parents that many of the
children with delayed speech had been given a diagnosis of
ASD along the way but that the ‘‘autistic-like’’ symptoms
in these children were transient, and like with the Hyper-
lexia III children, those traits and behaviors faded over
time. He recommended careful professional evaluation for
children who speak late by clinicians familiar with the
various parameters and conditions involved with such
children, sparing parents unnecessary worry, concern
and pessimism that always accompanies a diagnosis of
‘‘autism’’. This condition is also discussed in more detail
on the savant syndrome website.
71. Blindisms
Teachers and parents of visually impaired children often
refer to what are called ‘‘blindisms’’ in such children. Ek
and co-workers point out that ‘‘blindisms’’—stereotypical
movements, language problems and certain other behav-
iors—are common in children with congenital or other
types of blindness. (Ek et al. 1998). Hobson described the
similarities in development during pre-school age
(3–4 years) between blind children and those with autism
(Hobson 1993). In both groups impairments in symbolic
play, confusion in the use of language and stereotypes were
frequent. Many of the autistic features in the young, blind
child without cerebral damage disappeared with age. As the
child acquired a better understanding of the surrounding
world, and with the development of language, a basis for
sharing experiences and feelings with other people devel-
oped. Hobson noted ‘‘blindness seems to delay rather than
prevent development in these respects.’’ In 2010 Hobson
72. and Lee did an 8 year follow-up study on nine congenitally
blind and seven sighted children who met formal diag-
nostic criteria for autism. Follow-up of the nine congeni-
tally blind children with ‘autism’ revealed that, in
adolescence, only one such child satisfied the criteria for
that disorder. In contrast, all of the seven sighted children
still did meet the Autistic Disorder criteria. For the group
with what turned out to be autistic-like symptoms, in the
title of his report Hobson uses the interesting term
‘‘reversible autism’’.
Autism, autistic-like symptoms and blindisms can be
confused with each other in visually impaired children. But
just as with children who read early or speak late, differ-
entiation between Autistic Disorder and ‘‘autistic-like’’
symptoms is critical with these children if parents are to be
spared unnecessary distress from an autism diagnosis
improperly applied and, equally important, if the right
treatment is to be applied to the right patient.
73. 570 J Autism Dev Disord (2014) 44:564–571
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http://www.savantsyndrome.com
http://www.savantsyndrome.com
Summary
With all the emphasis by some on the autism ‘epidemic’
and with it the need for early identification and a prolif-
eration of programs, it is important to remember that not
every child who reads at 18 months, draws at 2 years,
hums back all the melodies he or she hears, or likes to line
up railroad cars, resists certain foods, insists on routine,
memorizes license plates and birthdays, has certain fear
and phobias or is very late in speaking is on the autistic
spectrum. If one looks up ‘‘hyperlexia’’ on the internet,
though, most often the site links hyperlexia to autism. That
simply is not so in all cases as pointed out above. That
same link to autism is likewise often made for children who
speak late, or are blind.
74. Again, not so in all cases. While early identification of
autism in affected children is important, those efforts need
to be balanced with sensible caution lest parents be
unnecessarily frightened and overwhelmed by premature,
and erroneous, diagnoses. Except in truly ‘classic’ cases,
often some time of watchful observation needs to elapse
until the ‘natural history of the disorder’ reveals the real
diagnosis. Such ‘watchful observation’, diagnostic caution
and separation of ‘autistic-like’ behaviors from Autistic
Disorder can provide example of what some have called
‘‘reversible autism’’.
References
Brink, T. L. (1980). Idiot savant with unusual mechanical
ability: An
organic explanation. American Journal of Psychiatry, 137,
250–251.
Dorman, C. (1991) Exceptional calendar calculating ability after
early
left hemispherectomy. Brain and Cognition 15, 26–36 London:
75. Churchill.
Down, J.L. (1887). On some of the mental affections of
childhood and
youth. London, Churchill.
Ek, U., Fernello, E., Jacobson, L., & Gillberg, C. (1998).
Relation
between blindness due to retinopathy and autistic spectrum
disorders: A population study. Developmental Medicine and
Child Neurology, 40, 297–301.
Hermelin, B., O’Connor, N., & Lee, S. (1987). Musical
inventiveness
of five idiot-savants. Psychological Medicine, 17, 685–694.
Hermelin, B., O’Connor, N., Lee, S., & Treffert, D. A. (1989).
Intelligence level and musical improvisational ability. Psycho-
logical Medicine, 19, 447–457.
Hobson, R.P. (1993). Autism and the development of the mind.
Hove:
Lawrence Erlbaum.
Hobson, R. P. (2010). Reversible autism in congenitally blind
children? A controlled study Journal of Child Psychology and
76. Psychiatry, 51(11), 1235–1241.
Kanner, L.:217-25055-58 (1944) Early infantile Autism Journal
of
Pediatrics 25, 200–217.
Kapur, N. (1996). Paradoxical functional facilitation in brain-
behavior research. Brain, 119, 1775–1790.
Miller, B., et al. (1996). Enhanced artistic creativity with
temporal
lobe degeneration. Lancet, 348, 1744–1745.
Miller, B., et al. (1998). Emergence of artistic talent in
frontotemporal
dementia. Neurology, 51, 978–982.
Miller, B., et al. (2000). Functional correlates of musical and
visual
ability in frontotemporal dementia. British Journal of Psychia-
try, 176, 458–463.
Minogue, B. M. (1923). A case of secondary mental deficiency
with
musical talent. Journal of Applied Psychology, 7, 349–357.
Mortiz, K. P. (1783). Gnothi Sauton oder magazin der
erfahrungs-
77. seelenkunde als ein lesebuch fur gelehrte and ungelehrte.
Berlin,
Germany: Mylius.
Selfe, L. (1977). Nadia: A case of extraordinary drawing ability
in an
Autistic child. London: Academic Press.
Selfe, L. (2011). Nadia revisited: A longitudinal study of an
Autistic
Savant. New York: Psychology Press.
Sowell, T. (1997). Late talking children. New York: Basic
Books.
Sowell, T. (2001). The Einstein syndrome: Bright children who
talk
late. New York: Basic books.
Treffert, D.A. (1988). The idiot savant: A review of the
syndrome.
American Journal of Psychiatry 145563–145572.
Treffert, D.A. (1989). Extraordinary people: Understanding
savant
syndrome. Lincoln, Nebraska: iUniverse.com.
Treffert, D. A. (2006). Dr. Down and ‘‘developmental
disorders’’.
78. Autism and Developmental Disabilities, 36, 965–966.
Treffert, D. A. (2010). Islands of genius: The bountiful mind of
the
Autistic acquired and sudden savant. London: Jessica Kingsley.
J Autism Dev Disord (2014) 44:564–571 571
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c.10803_2013_Article_1906.pdfSavant Syndrome: Realities,
Myths and MisconceptionsAbstractRealitiesSavant Syndrome
DefinedSavant Syndrome is Not a New Disorder (Nor is
Autism)Not All Savants are Autistic, and Not All Autistic
Persons are SavantsSavant Skills Represent a Spectrum of
AbilitiesThe Acquired Savant: ‘‘Accidental Genius’’The Most
Important Question of All: How do They do It?Some Mysteries
RemainMyths and MisconceptionsSavants are Not ‘Creative’The
‘‘Nadia’’ Effect and the ‘‘Dreaded Trade-Off’’Savant Syndrome
is Always Associated with Low IQAll ‘‘Geniuses’’ and
‘‘Prodigies’’, Past and Present are Really
‘‘Aspies’’‘‘Outgrowing’’ Autism: Separating ‘Autistic-Like’
Traits from Autistic Disorder in Children Who Read Early,
Speak Late, or are BlindHyperlexia I, II and IIIEinstein
Syndrome: Children Who Speak
LateBlindismsSummaryReferences
DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY
79. REVIEW
The genetic landscape of autism spectrum disorders
RASIM O ROSTI1 | ABDELRAHIM A SADEK2 | KEITH K
VAUX1 | JOSEPH G GLEESON1
1 Department of Neurosciences and Pediatrics, Howard Hughes
Medical Institute, University of California, San Diego, CA,
USA. 2 Pediatric Neurology Unit,
Department of Pediatrics, Faculty of Medicine, Sohag
University, Sohag, Egypt.
Correspondence to Joseph G Gleeson at University of California
San Diego, 9500 Gilman Drive M/C 0665, La Jolla, CA, USA.
E-mail: [email protected]
PUBLICATION DATA
Accepted for publication 22nd July 2013.
Published online 1st October 2013.
ABBREVIATIONS
ASD Autism spectrum disorders
CGH Comparative genomic
hybridization
CNV Copy number variants
Autism spectrum disorders (ASDs) are a group of heterogeneous
neurodevelopmental disor-
ders that show impaired communication and socialization,
80. restricted interests, and stereotypi-
cal behavioral patterns. Recent advances in molecular medicine
and high throughput
screenings, such as array comparative genomic hybridization
(CGH) and exome and whole
genome sequencing, have revealed both novel insights and new
questions about the nature
of this spectrum of disorders. What has emerged is a better
understanding about the genetic
architecture of various genetic subtypes of ASD and
correlations of genetic mutations with
specific autism subtypes. Based on this new information, we
outline a strategy for advancing
diagnosis, prognosis, and counseling for patients and families.
Autism spectrum disorders (ASDs) are a group of com-
plex neurodevelopmental disabilities that affect social inter-
action and communication skills. The prevalence of ASDs
appears to be constantly and gradually increasing, but it is
not clear if this is because of clarification of diagnostic cri-
teria or an actual increase in the number of cases. Most
recent estimates find that the median of prevalence esti-
mates of ASD is 62 out of 10 000.1 Those with molecu-
larly defined causes make up roughly 20% of the cases, but
the heritability has been estimated to be 90%, suggesting
as yet undiscovered causes. However, there are new reports
suggesting that the previous estimate of heritability was
too high and may need to be adjusted downwards.2
81. The diagnostic criteria have evolved with increasing clin-
ical and molecular understanding of this umbrella term.
This aspect makes the diagnosis more challenging as the
clinical spectrum is highly variable and the etiological sub-
grouping tends to change with the ever-growing molecular
data now fed by high throughput techniques such as array
comparative genomic hybridization (CGH), whole exome
and whole genome sequencing. The judgment of the
physician, critical in achieving accurate prognosis and
genetic counseling, requires a systematic approach. By
incorporating these techniques along with careful clinical
and neuropsychological assessment, a more accurate
diagnosis of an ASD disorder can be achieved.
Distinguishing between essential autism and complex
(syndromic) autism might be considered the starting point
of this systematic approach.3 Of all individuals meeting cri-
teria for autism, essential autism makes up approximately
75% of the cases. Although essentially a diagnosis of exclu-
sion, the main characteristics are the lack of dysmorphic
features, higher male to female ratio (6:1), higher sibling
recurrence risk (up to 35%), and positive family history
(up to 20%). Syndromic autism, on the other hand, is
characterized by accompanying recognizable patterns of
dysmorphology, a reduced male to female ratio (3.5:1),
lower recurrence risk (4%–6%), and family history to a
lesser extent (up to 9%).1
Clinical recognition of well-known phenotypes leading
to a targeted molecular testing approach can strengthen
the hand of the clinician in answering additional questions
about the recurrence risk and prognosis according to the
molecular basis identified by targeted testing. However, for
most forms of essential autism, there is no familiar pheno-
type that points to one particular genetic cause or another.
83. criteria, underlines the importance of early diagnosis in
successful treatment in such metabolic conditions.8 Condi-
tions such as mitochondrial disorders, adenylsuccinate lyase
and creatine deficiencies may also phenocopy ASD.
Accompanying autistic features in these disorders range
from 0.4% to 80%.1,9,10 Although mitochondrial disorders
can present with autistic features, atypical findings of hypo-
tonia, fatigue with activity, failure to thrive, intermittent
episodes of regression, especially those after fever and ele-
vated plasma lactate concentrations, make diagnosis of the
condition more straightforward. Non-specific features such
as epilepsy and intellectual disability that accompany
autism in the setting of mitochondrial disorders on the
other hand, can make the diagnosis more challenging.
A recent addition to this group of disorders was made
by Novarino et al.11 who reported mutations in the
BCKDK gene in the affected individuals from three consan-
guineous families who had epilepsy, autistic features, and
intellectual disability. The encoded protein is responsible
for phosphorylation-mediated inactivation of the E1a sub-
unit of branched-chain ketoacid dehydrogenase enzyme.
Patients with BCKDK mutations displayed reductions in
BCKDK messenger RNA and protein, E1a phosphoryla-
tion, and plasma branched-chain amino acids. Bckdk knock-
out mice showed abnormal brain amino acid profiles and
neurobehavioral deficits that respond to dietary supple-
mentation. By supplementing the diet of humans with
branched-chain amino acids, the authors were able to nor-
malize plasma branched-chain amino acids levels, but the
degree to which neurocognitive changes are treatable or
reversible remains to be determined.
ASD ASSOCIATED WITH RECOGNIZABLE PATTERNS
OF MALFORMATIONS CAUSED BY SINGLE GENE
DISORDERS