Behavioral symptoms of autism spectrum disorder (ASD) begin to emerge around 12 months of age and are preceded by subtle differences in how infants process and interact with the world (Elsabbagh & Johnson, 2010). Similar atypical behavioral patterns and markers of brain organization (`endophenotypes') are present in infants at risk for ASD (HRA) due to their family history, regardless of whether they ultimately develop the disorder. Possible endophenotypes of ASD were investigated through four studies that examined event-related potentials (ERPs) to speech and language in HRA and low-risk control (LRC) infants as part of a larger, longitudinal project. Chapter 2 examined ERPs to language-specific phonemes at 6, 9, and 12 months (n=59 at 6mo, 77 at 9mo, and 70 at 12mo) and found that HRA infants were not delayed in phonemic perceptual narrowing yet exhibited atypical hemispheric lateralization of ERPs at 9 and 12 months. Chapter 3 explored these findings further in a sample with known developmental outcome (n=60 at 6mo, 75 at 9mo, and 72 at 12mo) in order to understand how these ERPs differ between infants who ultimately develop ASD and infants who do not. Chapter 4 examined responses to repeated speech stimuli at 9 months (n=95). HRA infants exhibited atypically large ERPs to repeated speech, and this pattern was associated with better later language ability. Finally, Chapter 5 examined ERPs to words at 18 and 24 months (n=41 at 18mo, 52 at 24mo) and found evidence for atypical topography of responses to known versus unknown words, particularly at 18 months. These findings provide evidence that in HRA infants, even those who do not develop ASD, neural processing of linguistic stimuli is altered during infancy and toddlerhood. The results from Chapter 4 suggest that at least some of the differences seen in HRA infants who do not develop ASD may reflect beneficial, rather than disordered, processing. Overall, these results contribute to growing evidence that familial risk for ASD is associated with atypical processing of speech and language during infancy. Future work should continue to investigate more closely the implications of atypical neural processing for infants' later development.

The Centers for Disease Control (CDC) reported that approximately 1 in 54 children in the U.S. is diagnosed with an Autism Spectrum Disorder (ASD) (CDC, 2020). The prevalence of individuals diagnosed with or at-risk for ASD has increased over the past two decades (Baio et al., 2018). Impairments in social functioning, a central feature of ASD, have widespread effects on the lives and opportunities of individuals with this disorder (American Psychiatric Association, 2013). As a result, individuals with ASD are less satisfied with opportunities for social inclusion, physical well-being, and interpersonal relationships compared to individuals with intellectual disabilities (Arias et al., 2018). Technology-aided intervention may be used to reduce some of the barriers limiting access to social skills intervention. In particular, the technology-aided intervention can provide a highly motivating medium for the rehearsal of skills in a safe, controlled, and self-paced manner (Parsons & Beardon, 2000), allow for treatment programs to be implemented with high precision and fidelity with less variability, and reduce the cost of the intervention and other accessibility barriers (Ploog et al., 2013). VR has been studied extensively in training social skills for individuals diagnosed with ASD. With the flexibility and projected effectiveness that VR offers, it can provide more opportunities to learn and practice strategies for recognizing daily challenges that involve forming social relationships and related reasoning with more flexibility. VR provides a safer platform for people with ASD rather than practicing the social skill with actual people in a class or a group, it can be an excellent precursor for teaching these skills. There exists sufficient literature to provide evidence regarding the effectiveness of VR-based SST relevant for OT practice. However, the gap between the existing literature and method to integrate it in OT practice restrains OT practitioners to adopt and integrate VR in practice. Lack of comprehensive training designed specifically for OT practitioners to educate about the methods to implement, VR system selection for the priority population, and the theoretical base for implementation and use are some common barriers to using VR. To this end, this program is designed to empower OT practitioners to become efficient and confident in using this technology for addressing social skills deficits related to ASD. This is a professional development program to be delivered based on theory-driven approaches. The program is comprised of a training workshop accompanied by a hands-on practice element to provide OT practitioners with the avenue to learn, practice, and evaluate their current practices and knowledge regarding VR. Acquiring this training in using VR-based approaches will not only prepare therapists to confidently provide just the right challenge to the clients with autism according to their needs but also enhance the scope of individual OT practice.

Receiving a diagnosis of autism spectrum disorder is often a pivotal moment for parents. The diagnostic feedback session can provide helpful information for moving forward with their child’s care but can also be filled with conflicting emotions. A few studies have looked at common parent experiences and have suggested actions for providers, but there is little information about how providers can predict parent reactions to the diagnosis and adjust their feedback accordingly. This study investigated factors related to parent reactions to the diagnostic disclosure session using a) interviews with providers that commonly diagnose autism; b) a focus group with parents of children with autism; and c) a mixed-methods survey of 189 parents with autistic children diagnosed in the US in the past 3 years. Overall, providers seem to give more information to families who are already knowledgeable about autism, helping them leave even more prepared. However, families who come to feedback very anxious about receiving a diagnosis are most critically in need of a breadth of information and are at risk of leaving the session feeling lost and unprepared if they do not receive adequate resources during feedback. Providers should be aware of parent anxiety about diagnosis and prior autism knowledge, as these factors predict parent post-session preparedness, positive emotions, difficult emotions, and confusion. Providers can help promote positive emotional reactions for parents and prevent confusion by increasing their positivity, warmth, and respect towards the family, and by being clear and confident in their communications.

People with a diagnosis of autism spectrum disorder (ASD) often have difficulties understanding or applying skills related to Social-Emotional Learning (SEL). An individual having a better understanding of SEL concepts is generally associated with more fulfilling connections with others and increased satisfaction in life. Since people with ASD tend to have greater success with learning in structured environments, we created a module to teach these skills using Nearpod. These modules were created with videos of a person embodying a cartoon dog face using Animoji for two reasons; because the animation was meant to appeal to children, and the creation was user-friendly enough for teachers to potentially create or replicate this model. Along with these videos, the modules also included multiple choice questions about content from the lessons and about scenarios portraying different emotions. Participants came to a research lab where they completed the modules at a computer while being supervised by researchers. Looking at the results from the intervention there was little to no trend between baseline and intervention sessions across four participants. While Nearpod is a tool that could be useful for parents or teachers to create and present video modeling lessons, participants had difficulty navigating the modules without support from the researchers due to length of the modules, getting easily distracted and difficulty with using the technology. Some directions for future research may include delivering similar content using animated avatars through shorter, more child-friendly delivery methods.

There is significant literature demonstrating the effectiveness of video modeling for teaching skills to students with disabilities. Still, much less is known about how video modeling, particularly point-of-view video modeling (POV-VM), might be applied to teach academic skills to children with an autism spectrum disorder. This multiple probe single-case design study used explicit instruction techniques to teach multiplication, division, and fraction skills to two elementary-aged students with an autism spectrum disorder. A visual analysis of the data showed that POV-VM using explicit techniques to deliver the videos is an effective intervention for autistic students This research study adds to the evidence supporting POV-VM in providing instruction to autistic students.

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The purpose of the study was to describe the experiences and reasoning of occupational therapists' about obstacles and opportunities of implementing interventions via telerehabilitation for individuals with ADHD, Autism Spectrum Disorder or Intellectual Disability. Data were collected via semi-structured interviews with occupational therapists in psychiatric outpatient care and adult habilitation. Based on a qualitative content analysis, collected material was analysed, which resulted in an overall theme, “Commitment and embracement of a new role in the implementation of interventions is challenged by lack of conditions and four categories: New demands for ability and knowledge, Challenge in the digital environment regarding objects that constitute the environment and interaction, Changed conditions for the meeting increase accessibility for occupational interventions and New possible working method as an alternative in the near future.” Results show that the occupational therapists' reasoning is twofold where obstacles currently affect the execution and quality of the occupational therapy intervention, but where the commitment of the working method leads to a continued development of interventions via telerehabilitation. The study implies that the introduction of telerehabilitation should be implemented with regard to interventions in occupational therapy and that there is a need for coordination of working method via telerehabilitation for the occupational therapist who meets the individual. Further studies in the field focusing on the conditions for interventions through telerehabilitation and individuals ability to handle telerehabilitation are recommended.

Young adults with autism spectrum disorders (ASD) experience high rates of comorbid mental health concerns in addition to distress arising from the core symptoms of autism. Many adults with ASD seek psychological treatment in outpatient facilities in their communities that are not specifically geared towards individuals with ASD. However, few studies have looked at the effectiveness of standard psychotherapeutic care in adults with ASD. This study aims to discover how individuals with autism spectrum disorders fare in psychotherapy within a college counseling setting compared to their neuro-typical peers. Clients with ASD (n = 94) or possible ASD (n = 109) were identified from counseling center case notes and the Outcome Questionnaire-45 (OQ) was used to track distress at each session. Clients with ASD showed no difference in level of distress at intake compared to their neuro-typical peers (n = 29,326) and improved about the same amount from pre- to post-treatment. However, students with ASD stayed in treatment for significantly more sessions than neuro-typical clients. Overall, adult therapy clients with autism spectrum disorder appear to benefit from typical counseling center services as much as their neuro-typical peers. They also tend to stay in therapy longer than their peers. Results are discussed with implications for counseling centers and future research directions.

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