Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents.

In the United States, more than 75,000 autistic adolescents graduate from high school each year, and many lack the skills to successfully transition to college, work, and independent living. Daily living skills (DLS) in autistic adolescents without an intellectual disability (ID) fall 6 to 8 years behind peers. Better DLS are linked to more positive adult outcomes for autistic individuals. Surviving and Thriving in the Real World (STRW) is the only known evidence-based intervention that targets age-appropriate DLS in autistic adolescents without ID. The study objective was to evaluate STRW's efficacy compared with an active comparator (Program for the Evaluation and Enrichment of Relational Skills [PEERS]). Autistic adolescents in their last 2 years of high school were randomized to STRW or PEERS. Outcome measures were the Vineland Adaptive Behavior Scales, Third Edition (VABS-3), DLS domain and subdomains (Personal, Domestic, Community), and DLS Goal Attainment Scaling (DLS-GAS) areas (Morning Routine, Cooking, Laundry, Money). Adolescents were randomly assigned to STRW (n = 34) or PEERS (n = 30). Owing to COVID-19, 28.1% received in-person intervention and 71.9% received telehealth intervention. STRW youth made significant gains on the VABS-3 DLS domain ( p = 0.01) and Domestic subdomain ( p = 0.005) and DLS-GAS Total, Laundry, and Money areas (all p 's < 0.05) compared with PEERS. STRW shows promise for acquiring age-appropriate DLS compared with PEERS. Adolescents in STRW progressed toward achieving DLS in the average range and closing the gap between chronological age and DLS. By improving DLS, STRW may facilitate more successful adult outcomes.

Daily living skills (DLS) are one key predictor of autistic adults attending post-secondary education, obtaining employment, and living independently. However, these skills often lag behind typical development for autistic people regardless of their cognitive abilities. Autistic adolescents and their caregivers have indicated a desire for more DLS supports. While there are evidence-based practices (EBPs) to teach DLS, autistic adolescents without intellectual disabilities are unlikely to receive DLS instruction in their general education coursework, and caregivers report lacking resources and strategies to teach these skills at home. To address these concerns, we developed an eLearning module series to support caregivers of autistic adolescents without intellectual disabilities in promoting DLS at home. The current single case design study measured the impact of the modules on caregiver fidelity to the EBPs and adolescent independence with self-selected DLS. The study also assessed the social validity of themodules. The results of this study reveal functional relationships between the module series and caregiver fidelity to the EBPs and to adolescent independence with targeted DLS. The caregivers and the adolescents both rated the acceptability, feasibility, and significance of the intervention favorably. These results indicate that the novel eLearning series is a successful and practical way to support autistic adolescents and their families to target and enhance DLS at home.

There are a few ecologically valid measurements of Daily Living Skills (DLS)-a critical component of adaptive functioning (AF)-for autistic adolescents and young adults. This is particularly important given that DLS predict outcomes as autistic adolescents transition to adulthood. We pilot-tested the assessment section of two modules of the Computerized Functional Skills Assessment and Training program (CFSAT) in 25 autistic (n = 4 female) and 25 non-autistic (n = 6 female) adolescents and young adults to evaluate preliminary feasibility in an autistic sample. Tasks involved using an ATM and ticket-buying machine. We also assessed AF and DLS with a well-validated self-report questionnaire. We examined group differences in performance and relationships between performance on CFSAT and an existing measure of AF and DLS. We also conducted regression analyses to investigate the associations between age, IQ, executive functioning (EF), and CFSAT task performance. All but one autistic participant were able to complete the CFSAT tasks. Autistic participants made more errors, but did not take longer to complete the task, than non-autistic participants. Performance correlated strongly with self-reported AF generally and DLS specifically. The regression analyses revealed that task performance was associated with EF in the autistic group, but not the non-autistic group. These results provide preliminary support for the use of a new performance-based ecologically valid assessment of DLS in an autistic population. Two CFSAT modules were well-tolerated and detected differences in DLS ability. Strong correlations with an existing measure of AF suggest evidence of construct validity. The EF was associated with CFSAT task performance in autistic individuals. Such a tool could help identify individuals who would benefit from a DLS intervention.

Adolescents with autism spectrum disorder (ASD) without an intellectual disability (ID) have daily living skills (DLS) that fall below their chronological age and affect their ability to achieve successful adult outcomes, but little is known about their specific DLS challenges. Utilizing the Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3) in a sample of 151 adolescents with ASD without an ID, we explored the VABS-3 DLS domain, subdomains, interview topics, and individual items. Results indicated that Community DLS was a relative strength, followed by Domestic DLS, and then Personal DLS. Adolescents with ASD demonstrated significant challenges in many age appropriate DLS subdomain interview topics and individual items, indicating a need for interventions to increase acquisition of DLS to improve adult outcomes.

Adolescents with autism spectrum disorder (ASD) without an intellectual disability have daily living skills (DLS) impairments. An initial feasibility pilot of Surviving and Thriving in the Real World (STRW), a group intervention that targets DLS, demonstrated significant improvements. A pilot RCT of STRW was conducted to extend these findings. Twelve adolescents with ASD were randomized to the treatment or waitlist groups. The treatment group had significant DLS improvements on the Vineland Adaptive Behavior Scales, 3rd Edition and the DLS goal attainment scale. Four adolescents from the waitlist crossed over and completed STRW. Entire sample analyses with 10 participants demonstrated large DLS gains. Results provide further evidence of the efficacy of STRW for closing the gap between DLS and chronological age.

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence

To investigate the clinical implementation and effectiveness of the humanistic care nursing model, and to offer a reference for enhancing humanistic care practices in clinical settings. Three hundred and eighteen nurses and five hundred and two inpatients were selected as the control group and observation group before and after the implementation of humanistic care model in China from October to November 2023 and from May to June 2024. The differences of humanistic care ability, humanistic care behavior, medical narrative ability, nurses' perception of the hospital's attention to their caring ability, patients' and nurses' satisfaction, and patients' evaluation of nurses' caring behavior were compared between the two groups. After the implementation of the humanistic care model, the total score of nurses' humanistic care ability, humanistic care behavior, medical narrative ability and scores of all dimensions were significantly increased, nurses' perception of the hospital's attention to their caring ability was significantly increased, patients' evaluation of nurses' caring behavior was improved, and both patients' and nurses' satisfaction were increased, with statistical significance (p < 0.05). The implementation of humanistic care nursing model can effectively improve managers' care for nurses, further improve nurses' humanistic care ability, humanistic care behavior and medical narrative ability, patients have a higher evaluation of nurses' caring behavior, and nurses' and patients' satisfaction has been improved. We recommend that hospital administrators not only provide care for patients but also extend their support to nurses. It is essential to continuously optimize the "care chain" among nurse managers, nurses, and patients.

This study aims to assess the effectiveness of training in nursing ethics and humanistic nursing care in enhancing the quality of nursing services and increasing patient satisfaction within the "Internet + Health care" framework in ophthalmology wards. A cohort of 20 nurses from the ophthalmology ward of the hospital participated in a 3-month training program from January to March 2024, focusing on nursing ethics and humanistic nursing care within the "Internet + Health care" framework. A total of 300 patients scheduled for cataract surgery in the same ward were selected for the study, with 150 patients allocated to control and intervention groups. The control group received standard nursing care under the "Internet + Health care" model, while the intervention group received care from nurses who had also undergone nursing ethics and humanistic care training. The humanistic care ability of nurses pretraining and post-training, as well as patients' self-efficacy, psychological resilience, and patient satisfaction, were compared between the 2 groups. Post-training, the nurses in the intervention group demonstrated significant improvements in knowing (83.86±7.26 versus 62.34±6.52, P<0.01), courage (78.31±7.82 versus 60.78±7.04, P<0.01), and patience (65.74±6.87 versus 51.49±5.43, P<0.01) dimensions, along with an overall increase in the caring ability inventory (CAI) total score (228.24±12.68 versus 185.43±10.44, P<0.01). Patients in the intervention group exhibited higher scores on the General Self-Efficacy Scale (GSES) (33.62±4.83 versus 26.38±4.46, P<0.05) and the Connor-Davidson Resilience Scale (CD-RISC) (74.33±6.06 versus 61.04±5.28, P<0.05), as well as a significantly higher satisfaction rate (98.67% versus 92.00%, P=0.028) compared to the control group. The findings indicate that training in nursing ethics and humanistic care significantly enhances the nurse-patient relationship and overall quality of nursing care in ophthalmology wards.

While existing literature has demonstrated that Daily Living Skills (DLS) performance of autistic individuals is lower than what is expected of their age and cognitive abilities, limited studies have examined DLS in autistic adults. This study aimed to understand the influence of intellectual function (IQ) and contextual factors (i.e., provision of opportunities) on autistic individuals' DLS performance. Participants included 33 autistic individuals ranging in age from 16 to 35years. Their caregivers were administered the Vineland Adaptive Behavior Scales, 3rd edition's (Vineland-3) caregiver interview form. A novel coding system was developed to capture the frequency of reasons for participants' non-performance of DLS tasks, based on caregiver's report. "Target" scores reflecting expected possible score if reasons for nonperformance could be addressed were computed. Qualitative analysis of parental responses indicated that, for adults with average or higher IQ, lack of opportunity to learn and/or implement the skill was the most frequent reason for not performing DLS. Lack of opportunity was also the second most common reason provided for adults with NVIQ below 85, following cognitive ability. Taking into account reasons for nonperformance, "Target" scores were, on average, 7.65 points higher for the NVIQ ≥ 85 group. These findings highlight a need for multi-dimensional assessment to go beyond individual strengths and difficulties to also include contextual factors that may influence adults' skill acquisition and performance. It is essential that clinicians ensure that adequate opportunities for learning and performance are available to promote acquisition of important DLS.

Daily living skills (DLS), such as personal hygiene, meal preparation, and money management, are important to independent living. Research suggests that many individuals with autism spectrum disorder exhibit impairments in daily living skills relative to their cognitive skills. This study examined predictors of daily living skills attainment and trajectories of daily living skills in a longitudinal sample referred for possible autism spectrum disorder and followed from 2 to 21 years of age. Consistent with previous studies, participants with autism spectrum disorder and nonspectrum diagnoses showed continual development of daily living skills throughout childhood and adolescence. Early childhood nonverbal mental age was the strongest predictor of daily living skills attainment for both diagnostic groups. Group-based modeling suggested two distinct trajectories of daily living skills development for participants with autism spectrum disorder. Skill levels for both groups of young adults with autism spectrum disorder remained considerably below age level expectations. Whereas the "High-DLS" group gained approximately 12 years in daily living skills from T2 to T21, the "Low-DLS" group's daily living skills improved 3-4 years over the 16- to 19-year study period. Nonverbal mental age, receptive language, and social-communication impairment at 2 years predicted High- versus Low-DLS group membership. Receiving greater than 20 h of parent-implemented intervention before age 3 was also associated with daily living skills trajectory. Results suggest that daily living skills should be a focus of treatment plans for individuals with autism spectrum disorder, particularly adolescents transitioning to young adulthood.

Motor skill difficulties are common in autistic children and are related to daily living skills (DLS). However, it remains unclear which specific motor tasks are most likely to impact overall DLS. This study sought to fill this gap. In 90 autistic children and adolescents (ages 6-17 years), we found that fine/manual motor tasks, like drawing or folding, demonstrated significant medium-sized relations with DLS, even after accounting for IQ and sensory features, whereas tasks in the areas of bilateral coordination, upper-limb coordination, and balance only related to DLS (small effect sizes) prior to accounting for IQ and sensory features. When looking at an overall balance score, we found that IQ significantly interacted on the relation between overall balance and DLS. These results further demonstrate the particular importance of fine/manual motor skills for DLS in autistic youth, even when accounting for IQ and sensory features. Indeed, accounting for sensory features strengthened the relations between fine/manual motor skills and DLS. Our findings provide evidence of the impact of cognitive factors on the relation between balance and DLS, indicating that it may be that autistic individuals with lower IQs experience relations between balance and DLS that are different than their peers with higher IQs. Our findings support the benefit of considering individual motor skills rather than domain-level information when assessing ways to promote DLS in autistic youth. The results further shed light on the importance of fine motor skills, as well as the unique relationship of balance and DLS in autistic individuals with lower IQs.

Objective To study the effect of the theory of human nature care on the rehabilitation on Schizophrenia patients. Methods 120 cases of Schizophrenia were divided into study and control groups. Study group was given the human care nursing for 2 months, and the effects were evaluated by the caring behavior as-sessment scale, SCL - 90 and the scale of satisfaction degree of comfortable. Results The scores of all these scales were no different before study, but the scores of study group were better than those of control group after 2 months. Conclusions Using the theory of human nature care not only was in favour of Schizophrenia for rehabilita-tion, but also communication for the nurses and patients, and it could improve the satisfaction of patients. Key words: Schizophrenia; Theory of human nature care; Nurse and Management; Satisfaction

Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey

The role of family quality of life in the caregivers of autistic adolescents receiving treatment for daily living skills.

BackgroundAutistic adolescents are more likely to experience depression than their non-autistic peers, yet risk factors for depression in autistic adolescents are not well understood. Better mechanistic knowledge of depression in autistic adolescents is critical to understanding higher prevalence rates and developing targeted interventions. Altered reward responsiveness and social processes, as assessed by clinical and neural measures [i.e., electroencephalography (EEG)], are important risk factors for depression in non-autistic adolescents that remain largely unexplored in autistic adolescents, even though autistic people have higher rates of depression, exhibit reward differences, and often experience difficulties in social interactions. Therefore, a multimethod investigation of social and nonsocial reward responsivity and their associations with depression symptoms in autistic adolescents, particularly over time, is needed.MethodsThe current project will employ clinical and neural measures (i.e., interviews, EEG tasks) of social and nonsocial reward responsivity and depression to test associations between these constructs in autistic adolescents for the first time. A clinical sample of 100 autistic adolescents (14–17 years old) without intellectual disability and with varying severity of depression symptoms (at least 50% with current depression) will be recruited. Clinical and neural measures will be administered at two timepoints one year apart. Planned analyses will test cross-sectional and longitudinal relations between clinical and neural measures of reward responsivity and depression symptoms.DiscussionThis systematic study of reward responsivity and depression in autistic adolescents is likely to advance our collective understanding of depression in this population by informing risk stratification models and identifying potential intervention targets. Findings may also establish the reliability of several clinical and neural measures of reward responsivity in this population that can eventually be used to measure treatment outcome and identify predictors of treatment response.