Oral health problems have been a major public health concern profoundly affecting people’s general health and quality of life. Given that oral health data is composed of several measurable dimensions including clinical measurements, socio-behavioral factors, genetic predispositions, self-reported assessments, and quality of life measures, strategies for analyzing multidimensional data are neither computationally straightforward nor efficient. Researchers face major challenges to identify tools that circumvent the processes of manually probing the data. The purpose of this dissertation is to provide applications of the proposed methodology on oral health-related data that go beyond identifying risk factors from a single dimension, and to describe large-scale datasets in a natural intuitive manner. The three specific applications focus on the utilization of 1) classification regression tree (CART) to understand the multidimensional factors associated with untreated decay in childhood, 2) network analyses and network plots to describe connectedness of concurrent co-morbid conditions for pediatric patients with autism receiving dental treatments under general anesthesia, and 3) random forests in addition to conventional adjusted main effects analyses to identify potential environmental risk factors and interactive effects for periodontitis. Compared to findings from the previous literature, the use of these innovative applications demonstrates overlapping findings as well as novel discoveries to the oral health knowledge. The results of this research not only illustrate that these data mining techniques can be used to improve the delivery of information into knowledge, but also provide new avenues for future decision making and planning for oral health-care management.

Children with autism spectrum disorders typically experience language deficits in multiple areas, including form, content, and use. These children often receive speech therapy with individual sessions (one child and clinician), group sessions (several children), or a combination of both. Although research has deemed individual therapy successful, there is still debate regarding the success of group therapy, and there is virtually no literature examining a comparison between individual and group therapy. The current case-study investigated the relative effectiveness of individual versus group therapy for one six-year-old female with moderate autism spectrum disorder. The child underwent ten alternating therapy sessions of similar structure with consistent language targets during one academic semester. All sessions were transcribed using Systematic Analysis of Language Transcripts (SALT) conventions, and analyzed via the SALT program and Microsoft Excel t-tests. Results indicate that individual sessions yielded larger improvement with syntax and semantics, while group sessions produced greater progress with pragmatics and social skills, suggesting that a combination of both therapy types may be most beneficial. Social validation of group therapy also signified high parent satisfaction with overall growth during the semester. Implications of this study, as well as recommendations for future research and clinical practice are discussed.

This study examines the impact of raising a child with an autism spectrum disorder on relationship quality using the double ABCX model of adjustment and adaptation. Respondents (N = 126) recruited through Autism Society listervs completed online surveys designed to measure three factors of relationship quality: satisfaction, positive perceptions, and negative perceptions. Results from hierarchical multiple regression models indicate that the double ABCX model accounted for 47% of variance in satisfaction, 72% in positive perceptions, and 50% in negative perceptions, for predicting the quality of couple relationships. Implications for clinicians working with couples are discussed, such as the need for treatment that focuses on stress management and increasing support through affectionate, emotional, tangible, and social interactions.

Students with Autism Spectrum Disorders often do not respond to common pedagogical strategies and traditional in vivo teaching approaches. From my observations, students diagnosed with Autism Spectrum Disorders learn best when material is presented through technology. Based on the information found in the literature review and personal observations from working with students with special needs, when students with Autism Spectrum Disorders receive video based instruction by watching recorded art lessons, they may learn to develop artistic skills and retain more art content knowledge with greater success than through traditional teaching methods. The purpose of this research study is to test the hypothesis that video based teaching methods can improve the learning of students with autism in a series of art lessons.

The purpose of this study was to examine how participation in an academic and behavioral remediation summer camp impacts broad adaptive behavior in children with autism spectrum disorders. Adaptive behavior was measured by administering the Adaptive Behavior Assessment System, Second Edition (ABAS-II; Harrison & Oakland, 2002) to the parents of a sample of 23 children whose ages ranged from 5 years, 10 months to 11 years, 4 months. Adaptive behavior was assessed prior the beginning of camp and again during the last week of camp. Repeated measures ANOVA and repeated measures MANOVA were conducted to assess whether significant changes in adaptive behavior were observed. Results from these analyses indicated statistically significant changes in adaptive behavior were not observed, but the MANOVA indicated there was a significant interaction between time and gender. Although significant improvement in adaptive behavior was not observed, there also were no significant decreases in adaptive behavior. Additionally, clinical significance was assessed using reliable change indexes (RCI). These analyses suggested most children did not exhibit clinically significant changes in adaptive behavior. Results also were mixed with three children reportedly exhibiting clinically significant increases and two children reportedly exhibiting clinically significant decreases in adaptive behavior. Suggestions for future research include using a control or comparison group, obtaining larger sample size, using multiple measures of adaptive behavior, and obtaining observations of adaptive behavior from multiple sources. / Department of Special Education

This study explored school nurses knowledge of the diagnostic criteria and secondary conditions related to Autism Spectrum Disorders (ASD), their involvement in the identification and treatment of ASD, their knowledge of medication used to treat ASD, and their overall medication management of children with ASD. Participants included 100 school nurses, representing 18 states, who completed a survey on ASD. The response rate was 16.45%. The majority of school nurses were aware Autism and Asperger’s Disorder should fall under the classification of ASD within the school setting. They were less sure on whether PDD-NOS should be included as an ASD. A high percentage indicated they received training in the area of ASD from self-study rather than from formal coursework or supervised clinical experiences. Results found limited involvement of school nurses during the assessment and evaluation process. However, there was more involvement after children had been classified with an ASD, which was primarily limited to the administration of medication and medical treatments. School nurses reported being qualified to administer medication to children with ASD. They also reported being knowledgeable regarding the potential side effects of the medication they administered. The most common medication administered to children with ASD was stimulants. One anti-psychotic medication, Risperdal, appears to be administered fairly frequently by school nurses to children with ASD. Eighty percent surveyed did not report making any medication errors. The majority of school nurses were responsible for supervision of un-licensed personnel in the administration of medication. Besides nurses, secretaries/administrative assistants were the most common school employees administering medication within schools. / Department of Special Education

This study explored the effectiveness of an eight-week summer day camp that used applied behavior analysis (ABA) to decrease maladaptive behaviors and increase prosocial behaviors of children with autism spectrum disorders. Little is known about how children with autism spectrum disorders respond to ABA treatment in the camp setting. Using a multiple case study approach, behaviors were measured using direct observation techniques in a sample of 5 children ranging from 7 years, 5 months to 9 years, 1 month. Results were assessed using visual inspection of graphs and assessing trendlines of the data. Results of the study indicated that all five participants demonstrated at least two behaviors that changed in the intended direction (i.e., target behaviors decreased, replacement behaviors increased). Overall, for all five participants, 68% of behaviors changed in the intended direction. Among the behaviors that changed in the intended direction, 65% demonstrated a moderate rate of change within the eight weeks of camp. A number of possible explanations for these results, as well as for unfavorable findings, are discussed. Because this study was considered a preliminary investigation, these positive results support the need for future studies to further examine this relatively unexplored setting through replication. / Department of Educational Psychology

This thesis discusses epistemological and ethical issues in classifi cation and diagnosisof psychiatric conditions, and briefly discusses realism about psychiatric conditions. I use autism spectrum disorder (ASD) as a case study to examine whether the explanatory and predictive power of classi fication and diagnosis could be improved if psychiatry adopts a cause-based framework in place of a symptom-based framework. However, there is signifi cant debate regarding the sort of explanatory pattern that will adequately represent the complex causation involved in psychiatric conditions. I develop a preliminary list of criteria for adequate explanatory patterns in psychiatry, and use these criteria to analyze explanations of ASD. I show that explanatory patterns unable to meet these criteria limit the validity and reliability of diagnosis. However, I argue that an integrated pattern that includes biological, cognitive and social levels of explanation may meet the criteria. Thus, diagnosis of ASD could improve if psychiatry adopted a cause-based framework informed by an intergrated explanation pattern. More accurate diagnosis of ASD may allow earlier access to Intensive Behaviourial Intervention/Applied Behavioural Analysis treatment programs, which may increase the effectiveness of this treatment and reduce the amount of resources individuals with ASD require from governments over their lifespans. Explaining these conditions using an integrated pattern of explanation can further challenge myths regarding the causes of ASD, and may provide support for Canadian lawsuits petitioning for expanded public funding of IBI/ABA programs.

Given the broad public health concern, lack of reliability of diagnosis across providers and substantial resources needed to support individuals with Autism Spectrum Disorder, the current study serves to contribute to the field in informing the contexts of both research and clinical service. The utility of a standardized sensory-motor battery was investigated in regards to its ability (1) to determine what, if any, differences exist between ASD diagnoses or subgroups in both sensory functioning and motor functioning; and (2) to determine whether such discrepancies, if they exist, are capable of differentiating groups. Results from the quadratic discriminant analysis demonstrated that the factor scores derived from the Dean-Woodcock Sensory-Motor Battery significantly differentiated the ASD and nonclinical comparison groups. Factor 1 (Simple Sensory Skills) exhibited the strongest relationship, followed by Factor 2 (Cortical Motor and Complex Sensory Skills), then Factor 3 (Subcortical Motor Tasks and Auditory/Visual Acuity Skills). Findings from the study lend initial evidence of the use of the DWSMB as a potential measure to include within the two-stage diagnostic process for ASD. Use of the DWSMB as a screening measure may facilitate access to early intervention services given the primitive nature of sensory-motor tasks. In addition, the availability of the DWSMB as a standardized measure of sensory and motor functioning may promote increased sensitivity and specificity among diagnostic providers thus improving outcomes of individuals with ASD who can access services more readily with earlier, more reliable diagnoses. / Access to thesis permanently restricted to Ball State community only. / Department of Educational Psychology

This is a mixed-methods study investigating parental satisfaction and wait times as parents inquire about an autism spectrum disorder diagnosis for their child in a Northern Ontario community. Satisfaction and wait times of those diagnosed with an autism spectrum disorder (ASD) by a single practitioner were compared to satisfaction and wait times of those diagnosed by the multidisciplinary assessment team in the Sudbury/Manitoulin region (the Autism Diagnostic Team; ADT). No significant differences were noted between groups on satisfaction or wait times. However, ADT group received much more consistent service, with less variation in wait times between clients, and more consistent provision of comprehensive services prior to the diagnostic meeting. Points of interest are noted for practitioners including increased wait times for parents of children with milder forms of ASD and for girls. No differences in wait time or satisfaction were noted between language groups. Content analysis of the qualitative interviews representing mainly single practitioners saw the emergence of themes including difficulty activating the assessment process, concerns regarding the wait, and appointment demands. The importance of professional expertise, empathy, and respectful communication also emerged. Parents felt the experience was deeply distressing and they often experienced abandonment following the diagnostic process. Additionally, parents whose children did not receive a diagnosis often felt confusion about what to do next. Reducing wait times, increasing professional expertise, completing comprehensive assessments, and using truly interdisciplinary teams should continue to be the focus of service improvements that may translate into improved satisfaction.