Children with autism spectrum disorder (ASD) often require early intensive behavioral interventions (EIBI) to improve their skills in a variety of domains. Error correction is a common instructional component in EIBI programs because children with ASD tend to make persistent errors. Ineffective error correction can result in a lack of learning or undesirable behavior. To date, research has not systematically investigated the use of reinforcement during error correction for children with ASD. This study compared the effects of correcting errors with and without reinforcement and their impact on preferences of young children with autism spectrum disorder (ASD). Four boys with ASD between 3 to 7 years old in China participated in this study. In the context of a repeated-acquisition design, each participant completed three sets of matching-to-sample task under the two error-correction procedures. During the error correction with reinforcement condition, the participants received the reinforcers after correct responses prompted by the researcher following errors. During the without-reinforcement condition, the participants did not receive any reinforcers after prompted responses. The number of sessions required to reach mastery criterion under the two conditions varied among the participants. Visual analysis did not confirm a functional relation between the error-correction procedures and the sessions required to reach mastery. With regard to children’s preferences, three children preferred the with-reinforcement condition and one preferred the without-reinforcement condition. The findings had conceptual implications and suggested practical implications relating to treatment preference.

Research has clearly demonstrated that variables associated with the family, child, and utilization of social supports relate to parent perceived competency. However, the research has failed to demonstrate which variable best predicts parent perceived competency. The primary goals of this study were to identify those variables that account for the most variability in parent perceived competency, to examine the relative effects of child characteristics on parental psychopathology, and to evaluate the moderating effects of social support on parent perceived competency based upon various parental characteristics. Participants for this survey study consisted of a convenience sample of 91 female primary caregivers of children (aged birth to three years) who received their initial evaluation at the University of South Florida Early Steps Program (ESP) clinic during a twelve-month data collection period. Inclusion criteria for this study required that participants were the female primary caregiver of the infant or toddler, all participants were primarily English speaking, and the infant or toddler had to be diagnosed with a medical and/or developmental diagnosis by an evaluator at the ESP clinic during the initial visit. Participants completed several questionnaires including assessments of female primary caregiver stress, depression, perceived sense of competency, utilization of social support, perception of child functioning, and perception of child behavior. Results of this study suggest that parent-reported stress and depression symptoms are significantly related to parent-perceived competency. Further, female primary caregivers whose child has medical and developmental disabilities report higher levels of stress and depressive symptoms compared to those whose child have developmental disabilities only. Similarly, female primary caregivers whose child has significant behavioral problems report higher stress and depression symptoms than those whose child does not have behavioral problems. Implications of these results as they relate to intervention development, limitations of this study, as well as future directions for research are also discussed.

This study investigated outcomes of a parent training curriculum: Helping Our Toddlers Developing Our Children's Skills (HOT DOCS), using secondary analyses of existing data collected between May 2007 and March 2009. The evaluation studied the impact of specific components of the parent training program on both participants' knowledge and attitudes and their perceptions of target children's behavior. Caregivers (n = 334) of children between the ages of 18 months and 5.11 years of age who were participants in the parent training program were included in the study. Measures included a pre/post knowledge test, pre/post rating scales of child problem behavior, and a program evaluation survey. Results indicated significant increases in caregiver knowledge following participation in the program, but non-significant differences between groups of participants based on various demographic variables. Prior to participation in the program, caregivers' perceptions of the severity of child problem behaviors were significantly different from that of the normative population. Following participation in the program, results showed a significant decrease in caregiver perceptions of the severity of child problem behaviors, regardless of caregiver/target child demographic variables. Caregiver feedback indicated high levels of satisfaction with the program.

The Getting Ready to Learn (GRTL) program is an early intervention program designed to improve the developmental skills and learning capacity of Native American children in the Northwest Arctic region of Alaska. Early intervention programs have been found to decrease high school dropout rates and increase employment rates, which contribute to better health outcomes in young adulthood. The Northwest Arctic is a remote area that lacks many resources. As such, the people of this region experience various health disparities. The GRTL program was implemented in 7 of the 11 villages in the Northwest Arctic Borough of Alaska (NWABA). The purpose of this thesis was to evaluate the impact the GRTL program may have had on the development skills (communication, gross motor, fine motor, problem solving, social-personal skills) of participating children and reading behaviors of participating caregivers. Two survey instruments were used to evaluate the GRTL program. Specifically, the Ages and Stages Questionnaire (ASQ) measured developmental skills of participating infants and children, and the Parent Questionnaire (PQ) measured caregiver's satisfaction with the program and reading behaviors of caregivers with their child. Interviews with program employees were also conducted to further interpret the results from the surveys. Program employees reported there was significant community support for the GRTL program, and parents were pleased with the program. Parents especially liked having a place that allowed them to focus on their child and believed the atmosphere provided positive socialization opportunities. Key informants also reported barriers to participation, which included harsh weather conditions that limited program participation. The ASQ indicated an increase in the means of development skills on the post-test; although most were not significantly different. The PQ showed a significant increase in reading behaviors from participating caregivers. Overall, the qualitative results suggest the GRTL program had a positive impact on its participating children and caregivers.

This qualitative study critically examines the researcher’s music therapy clinical practice with a preschool child with global developmental delay. The researcher/student music therapist critically examined and refined her clinical practice using an action research model. Each cycle consisted of a plan, action, data collection, reflection, and analysis. The researcher was the main participant. The child, his mother and a speech-language therapist were co-participants with different roles. The child and his mother participated in the sessions. The speech-language therapist observed three sessions through a window. Feedback from the child’s mother and the speech-language therapist contributed to the reflective data. Important issues that developed through the cycles related to early intervention techniques (having fun, being playful and spontaneous, and being in close proximity). Other important issues that developed were, the use of the voice and guitar; confidence; professionalism with parents and other health professionals; self-awareness; and the understanding of early childhood development (especially in the area of communication). Related literature on aspects of music therapy practice, music therapy in early intervention, music therapy and communication, and action research are described. These results cannot be generalised. However, they may firstly, illustrate relevant trends in early intervention, and secondly, enable the researcher to adapt skills learnt to use in future practice in early intervention

Lack of a brief empirically-verified screener for problematic and potentially problematic cannabis use has hampered implementation of a proactive opportunistic cannabis screening and early intervention (SEI) initiative in New Zealand. Addressing this instrumentation need was the primary aim of this thesis. This thesis also investigated the nature, prevalence, severity, and natural history of cannabis-related problems among a heterogeneous sample of 212 ‘at risk’ adolescent and adult users recruited from the community. In a 3-phase developmental design the CUPIT question candidates were first generated employing an Expert Panels methodology. The CUPIT structure, crosssectional, and longitudinal psychometric properties were then systematically tested, incorporating measures of cannabis-related pathology and DSM-IV/ICD-10 diagnoses of cannabis use disorders as criterion standard. High levels of cannabis consumption and related health and psychosocial problems reported portrayed a highly-disordered sample, most marked among adolescents. DSMIV/ICD-10 diagnoses were almost universal with no significant adolescent/adult differences in dependence symptoms count or severity. The two CUPIT subscales (Impaired Control, Problems) derived from principal components analyses exhibited good test-retest and internal consistency reliability and highly significant ability to discriminate diagnostic subgroups along the severity continuum (nonproblematic, risky, problematic use). At the 12-month follow-up, 194 adolescents and adults reported significantly increased cannabis consumption (adolescents), symptoms, and dependence severity. Baseline CUPIT subscale scores demonstrated highly significant longitudinal predictive utility for respondents’ diagnostic group membership, health and psychosocial problems, and significantly improved prediction of other measured outcomes in conjunction with age and gender. ROC analyses identified a CUPIT score of 12 to be the optimal cut-point for maximum sensitivity for both currently diagnosable cannabis use disorder and those ‘at risk’ in this sample. The empirical findings of this thesis research provide a compelling rationale for systematic implementation of opportunistic SEI among consumers of publicly-funded health and social services in New Zealand. Data confirmed that the vast majority of those needing help are unaware, or do not perceive, they need help. This thesis argues that, facilitated by the CUPIT, reliable proactive detection and appropriate intervention for early-stage cannabis use problems has potential for enormous cumulative impact on public health gains and the individual’s quality of life.

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There is an enduring and prevailing disparity between the clinical prevalence of alcohol, tobacco and other drug-related problems and the frequency that nurses recognise and intervene in these common problems. The extant nursing literature has long determined an urgent need for further investigation into why nurses do not respond to patients with ATOD-related problems in the consistent and effective manner that the prevalence of these costly health problems require, or in a manner that reflects the opportunities that nurses have to offer brief and timely intervention. This thesis reports and discusses the investigation of factors that determine identification, assessment and interventions of patients with alcohol, tobacco and other drug-related problems by a randomly selected sample of Registered Nurses [n=1281] in practice in New South Wales, Australia. Of particular interest was the relationship between nurses' ATOD knowledge, therapeutic attitudes and clinical activity. Multiple quantitative and qualitative methods were used, firstly to systematically investigate factors within the nurse and their clinical setting that might predict desired clinical behaviour towards addressing ATOD-related problems, and secondly, to analyse and describe nurses' self-reported perceptions, views and experiences of the issue and what aids or impedes it. The research instrument - a 72 item self-completed questionnaire was developed and refined within a process of three (3) pilot studies and test-retest method. A multiple regression model was developed to establish the predictors of key clinical behaviours. Thematic coding was used to analyse the perceptions of these nurses as to the factors that affect their ability to intervene with patients who have ATODrelated problems. Convergent and divergent concerns between quantitative and qualitative findings became apparent. Thematic analysis of open-ended responses demonstrated that nurses report a complex of factors that affect their ability and capacity to intervene with patients who have ATOD-related problems. Among these are factors located within nurses themselves, within their patient(s), within their workplace, within other health professionals and within the broader social/cultural context. The latter part of the thesis systematically considers the relationships between the quantitative and qualitative findings within this large sample of registered nurses. From this comprehensive level of analysis, workforce implications for ATOD education, training and organisational support for nurses, the most numerous group of health care workers, have been readily identified. The major empirical finding of this investigation is that there is a significant difference between positive attitudinal sets and motivation of practicing registered nurses to perform desired ATOD-related clinical activities, and the lower reported frequency at which this occurs. The qualitative findings are highly convergent with the empirical ones. It is the nurse's self-identified lack of knowledge, skills, experience and confidence that is now reported as having the greatest effect on their ability to assess, identify and offer brief and timely intervention for patients with ATOD-related problems, rather than any prevailing beliefs and attitudes that these patients were not worthy of their care, or outside the legitimate framework of their nursing role.

There is a need of more evidence‐based knowledge of different treatment/training‐approaches for children with Cerebral Palsy (CP) to better describe the objectives of interventions, effects on functioning and fulfilment of health care needs. The general aim of this thesis was to evaluate the effectiveness of intensive training in groups (ITGs) with a habilitation approach and a conductive education approach. In addition, this thesis explored different meanings of participation in ITGs to parents from a parent perspective. This thesis consists of two parts, a quantitative evaluation of the effectiveness of two ITGs (paper I‐III) and a qualitative study exploring parents’ different ways of experiencing ITGs (paper IV). Fifty‐four children, 3‐16 years old, with different types of CP, intellectual capacity and level of gross motor function, participated with their parents in a four weeks ITG with a short‐term and a one‐year follow‐up (paper I‐III). The second sample was strategically composed of parents to 15 children with CP with experiences of ITGs in different settings. The results showed that the proportion of clinically significant change in gross motor capability, functional skills or self‐reported individualized goal measure didn’t show any major differences between the two ITGs. One period of ITG facilitated small clinical and parent reported improvements in functioning for the short‐term. Nine children out of 54 made a clinically significant improvement in gross motor capability (GMFM‐88 total score); 36 children improved if an improvement in any dimension A‐E was counted for. Twenty‐two children out of 52 improved in one of the domains self‐care, mobility and social function (PEDI Functional Skills). Twenty‐eight parents out of 54 perceived a clinically significant improvement on the self‐reported individualized goal measure. Most individualized goals dealt with motor activities and movement‐related body functions in both ITGs. The self‐reported individualized goal measure was not found to be more sensitive to change than the clinical measures. The one‐year follow‐up showed that children had a stable level of functioning. No child deteriorated on the clinical measures short‐term and at the one‐year follow‐up. A higher proportion of change was seen in the social function domain at the one‐year follow‐up, indicating a better potential to change in social function than in gross motor function. The majority of children had a high consumption of training delivered by the Child and Youth Habilitation and merely half of the group continued with repeated ITGs. The differences in functional outcome between children continuing with repeated ITGs compared with only customary Child and Youth Habilitation were limited to a higher proportion of improvements in social functioning. Parents perceived a high service quality in both ITGs. To parents, fulfilment of health care needs was as important as functional outcome. The probability for high service quality was associated with previous experience of the ITG, high expectations of improvements, if expectations and improvements in gross motor capability were achieved and if the child participated in the ITG with the habilitation approach. Therapists in the habilitation approach were more involved in discussions with parents about expectations for the ITG and knowledge exchange than conductors were, indicating more familycenteredness. The qualitative study points to a variety of parental needs that may be met at ITGs but also indicates some problems that should be addressed. Five overarching meaning categories of ITGs were described: ITGs as knowledge promotion, as a complementary training resource, as a bracket to ordinary life, as building up relations with therapists, and as a leisure‐activity. An additional category – “ITGs as risk for ill‐being” – subsumed different kinds of problems that may arise. Conceptions suggest that ITGs contribute to parents’ improved knowledge, support and well‐being, but ITGs could also negatively influence family‐functioning. Professionals and parents need to discuss parents’ previous experiences of ITGs, expectations of functional improvements, the functioning of the child and health care needs in order to individualize goals for ITGs and make the objectives for participation clear. There were no major differences in effectiveness between the two ITGs, a habilitation approach and conductive education approach. Various training approaches should be chosen depending on the child’s and family’s needs. In the choice between different training approaches it is of equal importance to acknowledge functional needs of the child as well as health care needs of the child and parent.

This thesis presents an ethnographic action research study of Deaf and hearing parents and infants participating in a family American Sign Language (ASL) literacy program in Ontario. The thesis documents the context for parents and children’s learning of ASL in an environment where resources for supporting early ASL literacy have been scarce. At the time of the study, restrictions were placed on young Deaf and hard of hearing children’s learning of ASL, as the Ontario government’s Infant Hearing Program frequently did not provide ASL services to children who received cochlear implants or auditory-verbal therapy. This operational language policy of Ontario infant hearing screening and early intervention services was maintained despite evidence for the benefits that learning ASL confers on spoken and written language development in Deaf children. In this context, participation in a family ASL literacy program is a means for both supporting emerging ASL literacy in young children and resisting pathologizing Discourses (Gee, 2008) regarding signed language and Deaf identity. Through semi-structured interviews and observations of six individual families or parent-child dyads, the study documents participants’ encounters with gatekeepers who regulate Deaf children and their families’ access to ASL. At the same time, the setting of the ASL Parent-Child Mother Goose Program is presented as a Deaf cultural space and thereby a counter-Discourse to medical Discourses regarding Deaf identity and bilingualism. This space features the Deaf mother participants’ ASL literacy and numeracy practices and improvisations of ASL rhymes and stories to enhance their suitability for young children. The practices of the ASL Parent-Child Mother Goose Program leader also serve to define and support emergent ASL literacy in young children. In addition, a Deaf cultural space inside a broader context of public services to young Deaf children provides a means for the hearing mother participants to facilitate critical inquiry of issues surrounding bilingualism, ASL, and a Deaf identity. Collectively, the findings from this study highlight the benefits of emergent ASL literacy in Deaf children and their families, and provide an evidence-based rationale for Canadian governments and government agencies to better support this development.