<p><strong>Background and objectives:</strong> Recently, more attention has been placed on contributing factors for different prevalence rates of ASDs/PDDs in geographical areas. This study examines the association between diagnosis of ASDs and distance to regional intervention centres using a population-based dataset of children attending Senior Kindergarten classes in Ontario. Demographic and socioeconomic variables were also examined to find significant predictors for diagnosis of ASDs.</p> <p><strong>Methods:</strong> Data from all sites of Ontario with completed Early Development Instrument (EDI) in school years 2009/10 and 2010/11 were included. Individual-level variables were derived based on the data provided by EDI. Neighbourhood-level variables on socioeconomic factors of children’s place of residence were obtained through census data.</p> <p><strong>Results:</strong> 708 out of 66,284 children were reported by teachers to have diagnosis of ASDs, which results in a prevalence rate of 1.0% for ASDs. Children living near regional centres were less likely to be in the diagnosed group (OR=0.77). Moreover, children living in neighborhoods with high proportion of adults with high school diplomas and high proportion of single-parent families were more at risk of being reported as diagnosed (OR=1.27 & 0.73; respectively). MCYS region that a child lives in was found to be another significant predictor for teacher-reported diagnosis of ASDs.</p> <p><strong>Conclusion:</strong> Regional centres were not the only centres providing interventions to children with ASDs in Ontario. Therefore, having in-detailed information about the exact place of receiving intervention for each child would be beneficial. Furthermore, having single-parent family structure as a significant predictor necessitates specific policies for these families to obtain appropriate services, reduce caregiver’s stress, and improve family functioning.</p> / Thesis / Master of Science (MS)

Background. Autism spectrum disorder (ASD) is characterized by persistent difficulties with social communication (American Psychiatric Association, 2013). Due to the high prevalence of ASD there’s a significant demand for services to support these individuals and the involvement of caregivers is considered a crucial element of effective early intervention for young children with developmental disabilities (Siller & Morgan, 2018). The Incredible Years ® is an evidence-based behavioral parent training program with a large body of research demonstrating its efficacy with enhancing positive parenting practices during parent-child interactions for children with behavior problems (Menting et al., 2013). The program is built on the foundational concept of child-led free play. Recently, the program has been adapted for families with young children with developmental disabilities, Incredible Years Program for Autism Spectrum Disorder and Language Delays Ages 2-5® (IY-ASLD). IY-ASLD aims to help parents learn developmentally-attuned language and play strategies to effectively engage with toddlers with ASD or social communication delays. There are few published evaluations of IY-ASLD currently. However, the findings from pilot studies are promising in terms of the feasibility of implementation, with high levels parent satisfaction and attendance. The present study uses data from a pilot study of the IY-ASLD program (N=17), which was adapted to telehealth during COVID-19 pandemic with the assistance of program developer. This dissertation contributes to an emerging body of research by evaluating the IY-ASLD program in a community setting. By examining IY’s group treatment model in a telehealth format, we also gain valuable insight about virtual parenting interventions, which have the potential to significantly expand treatment to more families. Methods. Families were recruited from a specialized early intervention and preschool program that utilizes an Applied Behavior Analysis approach to education. Seventeen (N=17) parent-child dyads from the school enrolled in the program. All or virtually all children referred to this school by their school district are at-risk for or have been diagnosed with ASD. All of the children had an IEP or IFSP with mandated speech services, 71% of the children met criteria for ASD (N = 12) on the Childhood Autism Rating Scale-2-SF, and 2/3 of the sample had adaptive behavior composites below a standard score of 70 on the Vineland Adaptive Behavior Scales- Third Edition Comprehensive Teacher Form (Sparrow et al., 2016) at baseline. The parent participants, all mothers, began and completed a 12-week IY-ASLD telehealth intervention delivered over HIPAA protected Zoom. Mothers were from diverse backgrounds (41% non US born), well-educated (94% college graduate) and had a high median household income. Data from participants was gathered through questionnaires administered to parents, child-functioning measures completed prior to treatment by school personnel, and parent-child interactions videos recorded in the home at pre-, mid-, and post-treatment across a 12-week IY-ASLD intervention. Primary outcome variables were parent verbal behaviors during 5-minute parent-child free play sessions recorded at each time point. Each vocal utterance during free play sessions was coded for function, consistent with the parenting skills that were targeted in the IY-ASLD program (e.g., reducing commands, questions, and corrections, increasing descriptive narration and praise, following the child’s lead). The independent variables were time and dosage (minutes spent in treatment) and the moderators were child’s functioning levels (special education teacher/clinician ratings on the Vineland Adaptive Behavioral Scales- Third Edition (Vineland-3, Sparrow et al., 2016) and Childhood Autism Rating Scale, Second Edition- Standard Form (CARS2= ST, Schloper et al., 2010). Results. Mothers in the IY-ASLD program significantly decreased the ratio of parent-directed language and increased the ratio of child-directed language they used during the free play sessions with large effect sizes and most of the change occurring in the mid-to-post interval. Descriptive statements (tacts) also increased significantly for all participants with large effect sizes; the number of directive or question statements (mands) decreased with medium effect sizes, though the results were not significant. Dosage was not a significant predictor of outcomes at post-treatment when pre-treatment parenting behaviors were taken into consideration, possibly due to low variability in attendance. When child level was analyzed as a moderator, there were large effect sizes for the observed changes in tacts, mands, and overall ratio of child-directed language when children were divided into ASD vs No ASD groups, but small effect sizes when looking at low vs high adaptative behavior groups. There was a significant interaction effect between change in parent language over time and ASD severity of the child; parents of children with ASD did not significantly reduce the number of mands over time, while parents of children without ASD significantly reduced their number of mands over time. This research provides support for a full-RCT of IY-ASLD in this setting, suggesting that the intervention promotes maternal use of child-directed language, particularly for children with language delays as opposed to those with more severe symptoms of ASD. Interventions such as IY-ASLD may help empower parents of preschoolers with disabilities with strategies to facilitate more rewarding free play interactions at home.

Mothers of children with autism face unique challenges that can negatively impact their well-being. Frequently, these challenges require elevated amounts of time, energy, and money to address. In an effort to investigate a low-demand approach to improving well-being, this study employed a signature strengths intervention with mothers of children with autism. Thus far, research on signature strengths with this specific population is very limited. Five mothers of children with autism participated in the study. All were married and highly educated. Four identified themselves as white, one as Hispanic. They ranged in age from 25-44. Each mother had between one and three children with autism. The participants attended an online meeting with the researcher after identifying their strengths. During the meeting, they discussed ways they already used their strengths, as well as more ways they might use them in the future. The participants then entered a four-week practice period. Each week they focused on one strength, aiming to use each strength in three new ways over the allotted seven days. The participants completed surveys to measure parental distress and life satisfaction at three points: baseline, immediately after a four-week intervention phase, and one month after the end of the intervention phase. Additionally, they answered a daily question that queried life satisfaction on a Likert-scale throughout the baseline and intervention phases. Overall, the group reported a decrease in parental distress and an increase in their level of life satisfaction and daily satisfaction. These results add to other research that has found beneficial outcomes for mothers of children with autism who are taught to use their strengths more often. The use of signature strengths interventions could help to address a critical need among this group of mothers: mental health support that does not require excessive effort or time.

An increase in the prevalence rate of autism is not necessarily matched by a concurrent increase in the rate of highly qualified special education teachers. The low ratio of highly qualified teachers to the number of students with autism has resulted in chronic teacher shortages in this area. Alternative certification is used as a mechanism to alleviate the demand for highly qualified teachers in special education. However, alternative certification routes have often left novice teachers underprepared for teaching students with autism, more specifically in the implementation of evidence-based practices necessary for instructional effectiveness. The purposes of the study were: a) to assess the knowledge of novice alternatively certified (AC) teachers in the area of autism education; and b) to determine the extent to which age, credit hours of instruction, formal hours of instruction, amount of professional development, and number of students with autism predict the variance in knowledge scores. Participants included all novice (i.e., first-and second-year) alternatively certified special education teachers in the state of Texas. Data were collected through an electronic survey instrument disseminated state-wide to approximately 33 individuals. Multiple regression was conducted in order to determine the strongest predictors of autism knowledge scores. In addition, a multi-way ANOVA was performed to identify differences between groups. The largest predictor of knowledge of autism was hours engaged in self-directed learning. Overall, AC programs in Texas need to provide basic and core content in the area of autism to increase the knowledge of novice teachers.

An autism spectrum disorder (ASD) diagnosis in childhood comes with inherent vulnerability to adverse experiences. For some, the developmental process of adolescence overwhelms their altered neural system, exacerbating this vulnerability. Adolescence presents an opportunity to mitigate the negative effects of adverse childhood experiences (ACEs) on the developing brain. However, little is known about children who have both ASD and a history of ACEs. This study, first sought to understand the prevalence of ACEs among adolescents with ASD and whether those who have experienced ACEs are placed at further risk for other social and emotional challenges, impacting their transition into adulthood. With adolescents being highly sensitized to their environment, opportunities for intervention in their environments may mitigate the long-term consequences of ACEs. Due to adolescents spending a great deal of their time in school, developing interventions to support those with ASD that can be implemented within the school would be beneficial. Thus, the second aim of this study was to understand how schools can serve as a place for trauma-informed intervention. The Whole School, Whole Community, Whole Child (WSCC) model served as the conceptual framework for this mixed-methods study. Data from the 2020 National Survey of Children’s Health (NSCH) were examined to determine the prevalence of ACEs and further risk for social-emotional issues in adolescents with ASD. Focus groups and semi-structured interviews were conducted with school personnel in public schools to understand how they respond to typically developing and ASD students who have experienced ACEs. The findings showed that 60% of adolescents with ASD had experienced ACEs. Additionally, significant associations were found between the experience of ACEs and a diagnosis of anxiety, depression and ADHD. Furthermore, the experience of ACEs was associated with being bullied, however, no significant association was found with their ability to make friends. Great variability exists in the way schools respond to ACEs, if at all, and lack consistency and clarity in their SEL practices. Therefore, there is a need to identify the school climate components that are needed to provide trauma-informed interventions and determine how to scale these interventions. Further, with the heterogeneity of the ASD profile, identifying which factors are associated with this risk will be helpful in providing tailored interventions, specifically in the school environment.

Maternal binge alcohol consumption has been linked to congenital birth defects in the fetus. Said defects include abnormalities in heart development, a category of disease referred to as Congenital Heart Disease. Given the prevalence of Congenital Heart Disease, with a study showing around 49.9% of women having at least participated in binge alcohol consumption at least once during the early stages of their pregnancy and Congenital Heart Disease being linked to various complications in adulthood, this is a topic relevant to the clinical setting. Alcohol consumption has been linked to decreases in DNA methylation, which generally increases transcriptional expression of nearby genes. This thesis will focus on how alcohol affects the genomic-wide epigenetics of the embryonic heart with the aim of identifying specific genes and sites within those genes that are affected by alcohol exposure in utero. We hypothesize that embryonic mouse hearts exposed to ethanol will show a differential methylation pattern characteristic of hypomethylation versus control hearts not exposed to ethanol. To test this hypothesis, we used oral gavage to administer ethanol to pregnant mice at embryonic age E9.5 (a time associated with heart chamber formation). Maternal mice were sacrificed at E11.5, embryonic hearts were removed, and DNA was extracted for further experimentation with whole genome bisulfite sequencing. Analysis of whole genome bisulfite sequencing data showed a slight trend towards hypomethylation but suggested no significant changes in the overall methylation pattern in embryonic mouse hearts at the genomic level, but we have independently identified several genes whose expression is depressed in the embryonic mouse following a single maternal binge ethanol dose at E9.5, and thus we are investigating potential alcohol-induced DNA methylation alterations in specific target genes of interest. Future investigations into gene and site-specific DNA methylation profiles as well as other epigenetic modifications should prove useful in our quest to learn how maternal alcohol consumption causes cardiac malformations leading to congenital heart disease.

A child’s early language environment, and their parents’ active engagement during parent-child interactions play a vital role in facilitating the development of complex social reinforcers and the growth of their verbal behavior. Using a verbal behavioral approach, this study aimed to measure the statistical significance of changes in the quality and quantity of parent-child interactions after parents participated in a virtual parent-training program. The intervention used was the Incredible Years-ASLD® (Webster-Stratton, 2015) program, which consisted of 12 group parent-training sessions delivered virtually in small groups. Th e study also aimed to assess the association between parental stress and the quality and quantity of parent-child interactions. Participants were seventeen biological mother-child dyads. The participant children attended a full-day, intensive Applied Behavior Analysis (ABA) preschool, with a mean age of 4 years and 3 months and either had an Individual Education Program for a preschooler with a disability or an Individualized Family Service Plan. The number of verbal operants exchanged between the mother and the child during the parent-child interactions were measured at baseline, during, and after the intervention. Parent-child interactions were designed to mirror their naturalistic interactions and consisted of a five-min structured-play task, and a five-min free-play task, which were recorded for future analysis. Self-reported parental-stress levels were measured at baseline and after the intervention using the Parenting-Stress Index-Fourth Edition, Short Form (Abidin, 2012). This pilot study was conducted to statistically evaluate the changes across all three conditions following the IY-ASLD® intervention on a) the quantity of mother-child interactions, as measured by the number of vocal-verbal operants initiated by the mothers (i.e., mands and tacts), and the number of approvals vs. disapprovals; and b) on the quality of mother-child interactions as measured by mothers’ verbal responsiveness to their children’s initiations, mothers’ effectiveness in eliciting a response from their children, and the number of missed opportunities for mothers and children. The results for the first research question demonstrated that there was a statistically significant increase in the number of tacts emitted by the mothers in the free-play task, as well as a statistically significant decrease in the number of approvals following the intervention. There were no statistically significant changes in the number of mothers’ mands or disapprovals. The results for the second research question demonstrated that, following the intervention, there was a statistically significant decrease in the number of missed opportunities for the children during the structured-play task, and in the number of missed opportunities for the mothers in both tasks. There was also a statistically significant decrease in children’s responses to mothers’ initiations in the free-play task. This study also aimed to assess the relation between parental stress and the quality and quantity of parent-child interactions. The findings suggested a statistically significant negative association during the pre-intervention condition between parental-stress and the quality of parent-child interactions, specifically, mothers’ responsiveness to their children’s initiations. Furthermore, mothers’ stress levels were significantly negatively associated with the number of mands emitted by the mothers, but not associated with the quantity of the other vocal-verbal operants.

With the increase in the prevalence rate of children with autism in the U.S. there is a growing need for empirically based treatments to address the many deficits that children with autism manifest. Social Stories™ is one such treatment that has grown in popularity to address social deficits in children with autism. However, no meta-analysis done in recent years has found Social Stories™ to be an effective treatment, stating weak and inconsistent research methodologies as one of the primary issues in the studies examined. The current study sought to examine the use of Social Stories™ using best practice research standards for single subject design. A total of 4 elementary aged students with a special education eligibility of autism participated in the study. Results of the study revealed an increase in pro-social skills for all 4 participants and a promising future for further Social Story™ research and the quest to recognize it as an effective, empirically based treatment for children with autism. Furthermore, teachers reported that they found Social Stories™ to be an effective, feasible intervention, that helped them to better understand their students’ social deficits.

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