Early Behavioral Intervention Research Articles

Incorporating Video Feedback Within a Parent-Implemented Naturalistic Developmental Behavioral Intervention Package Via Telepractice

Delays in communication are commonly experienced by young children who are not meeting developmental milestones. Early naturalistic developmental behavioral interventions are efficacious, and parents can successfully embed these communication strategies into playtime routines, including when coaching is delivered via telepractice. Video feedback is a strength-based coaching method that has been successfully applied to increase positive parenting behaviors (e.g., descriptive praise, responsivity). However, limited research exists on the use of video feedback as a coaching tool for parents of children with developmental delays for communication interventions. We evaluated the effects of a telepractice-based parent training followed by joint reflections and video feedback coaching on parent strategy use and child communication targets, using a concurrent multiple-baseline across three parent–child dyads design. Parent perceptions of the feasibility and appropriateness of the intervention were positive. We discuss implications and provide suggestions for future research and practice.

A person-centered perspective on differential efficacy of early behavioral intervention in children with autism: A latent profile analysis

BackgroundIndividuals with autism spectrum disorder (ASD) present heterogeneous symptom manifestations and responses to intervention. Despite being well-established, early intensive behavioral intervention (EIBI) has produced inconsistent responding across studies. Investigating individual differences and identifying more homogenous subgroups in samples may lead to a better understanding of symptom heterogeneity in ASD and response to EIBI. MethodAdopting a person-centered perspective, we conducted latent profile analyses (LPA) to explore the presence of homogenous subgroups in our sample of 233 preschoolers with ASD receiving early behavioral intervention services. We investigated predictors of group membership using logistic multinomial regressions and outcomes of membership with the BCH approach available in Mplus. ResultsWe found four latent profiles in our sample: a mild impairment profile, a severe impairment profile, and two intermediate profiles with combinations of mild to moderate autistic symptoms, adaptive functioning, and intellectual functioning. Only the annual family income predicted profile membership. All profiles made progress during the intervention period, with varying magnitudes of change. During the follow-up period, the moderate impairment and the severe impairment profiles showed stability or improvement in adaptive functioning, while the two mild impairment profiles showed a slight decrease. ConclusionsOur study contributes to the literature by suggesting the presence of distinct profiles with differences in their response to EIBI. The profiles associated with better short-term outcomes were different than the profiles who maintain their gains more consistently over time. This finding may guide both practitioners and researchers assessing the effects of intervention.

At a Crossroads—Reconsidering the Goals of Autism Early Behavioral Intervention From a Neurodiversity Perspective

This Viewpoint discusses the use of a strengths-based approach to define outcome measures and emphasize the unique abilities of autistic individuals in an effort to promote positive self-esteem and potentially reduce the high rates of depression and anxiety experienced by youth with autism.

Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts

Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families’ barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool’s utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.

Brief Report: Machine Learning for Estimating Prognosis of Children with Autism Receiving Early Behavioral Intervention-A Proof of Concept.

Although early behavioral intervention is considered as empirically-supported for children with autism, estimating treatment prognosis is a challenge for practitioners. One potential solution is to use machine learning to guide the prediction of the response to intervention. Thus, our study compared five machine algorithms in estimating treatment prognosis on two outcomes (i.e., adaptive functioning and autistic symptoms) in children with autism receiving early behavioral intervention in a community setting. Each machine learning algorithm produced better predictions than random sampling on both outcomes. Those results indicate that machine learning is a promising approach to estimating prognosis in children with autism, but studies comparing these predictions with those produced by qualified practitioners remain necessary.

Adverse childhood experiences, sleep problems, low self-control, and adolescent delinquency: A longitudinal serial mediation analysis.

Several studies link adverse childhood experiences (ACEs) to delinquency. Yet, developmental sequalae accounting for this association remain unclear, with previous research limited by cross-sectional research designs and investigations of singular mediating processes. To redress these shortcomings, this study examines the longitudinal association between ACEs and delinquency as mediated by both sleep problems and low self-control, two factors which past research implicates as potentially important for understanding how ACEs contribute to antisocial behavior. Data collected from 480 adolescents (71.3% boys; 86.3% White) and their parents participating in the Michigan Longitudinal Study was used to conduct a serial mediation analysis. The association between ACEs (prior to age 11) and delinquency in late adolescence was found to operate indirectly via sleep problems in early adolescence and low self-control in middle adolescence. Nonetheless, a direct association between ACEs and later delinquency remained. Pathways through which ACEs contribute to later delinquency are complex and multiply determined. Findings indicate that early behavioral interventions, including improving sleep and self-control, could reduce later delinquency. Still, more research is needed to identify additional avenues through which the ACEs-delinquency association unfolds across development.

Values-based cognitive behavioural therapy for the prevention of chronic whiplash associated disorders: A randomized controlled trial.

BackgroundWhiplash is a common traffic‐related injury with up to 50% of those affected continuing to experience symptoms one‐year post‐injury. Unfortunately, treatments have not proven highly effective in preventing and treating chronic symptomatology. The overall aim of this study was to test the effectiveness of an early values‐based cognitive‐behavioural therapeutic intervention (V‐CBT) delivered within 6 months post‐injury in preventing chronic symptomatology compared to wait list controls.MethodsThe study was a two‐armed randomized controlled trial. Participants (n = 91) experienced pain, disability and at least one psychological risk factor (e.g. enhanced pain‐catastrophizing) after a whiplash trauma no later than 6 months prior. Participants were randomized to 10 sessions of V‐CBT starting 1 week (group A) or 3 months (group B) post‐randomization. The primary outcome was pain‐related disability, while secondary outcomes were pain intensity, neck‐pain related disability, depression, anxiety, PTSD symptoms, pain‐catastrophizing and kinesiophobia. These were evaluated at baseline and at 3, 6, 9 and 12 months post‐randomization.ResultsAt 3 months, group A demonstrated clinically important effects on all outcomes that were significantly better than group B (waitlist). When group B received the intervention at 6 months, they also demonstrated clinically important effects on all outcomes. However, there was a significant difference at 12 months for the primary outcome, in which group B increased their disability levels, while group A remained stable.ConclusionsWhile this indicates that an intervention window for early prevention of disability after whiplash injury may exist, this needs to be tested in a truly early intervention.SignificanceAn early Values‐based Cognitive Behavioural Therapeutic intervention delivered within 6 months post‐injury (mean days 117) was effective in reducing pain‐related disability and psychological distress compared to the control group that received the intervention later after a three months wait‐list period. The effects were sustained at 12 months follow‐up. The early intervention was significantly more effective in reducing pain‐related disability compared to the control group, indicating that an intervention window for early prevention of disability after whiplash injury may exist.

Protocol for a Longitudinal Study of the Determinants of Metabolic Syndrome Risk in Young Adults.

As many as 76.7% of U.S. young adults have at least one metabolic syndrome risk factor. Often undetected, metabolic syndrome risk factors cluster with other risk factors increasing risk of future cardiometabolic disease. The prevention of metabolic syndrome risk accrual through early behavioral interventions is crucial for at-risk populations. This paper outlines the protocol for the Health E Start study, including the objectives, methodology, ethics, and dissemination. Additionally, we discuss the goals of the National Institutes of Health Research Enhancement Award (R15) that funded this project and how this funding will facilitate the comprehensive training of undergraduate researchers. The long-term goal of the study is to develop a theoretically driven intervention for the prevention of metabolic syndrome risk development in college students. To facilitate this goal, the aims are to identify 1) behavioral targets for the prevention of metabolic syndrome risk development and 2) the motivations behind such behaviors to develop a theoretical framework for use in intervention design. Longitudinal observational design. Transition from living at home to independent living at colleges across the U.S. High school seniors (n = 150) who will be transitioning to college within 3 months of graduating. For aim 1, metabolic syndrome risk will be quantified into a risk score using a principal components analysis of traditional risk factors. Associations between changes in lifestyle behaviors and changes in the risk score will identify population-specific behavioral targets. For aim 2, changes in psychological, social, and environmental antecedents of observed behaviors will be identified. Identifying the relationship between behavior change and metabolic syndrome risk, and the psychosocial and environmental predictors of observed behavior changes will facilitate the design of targeted interventions for the prevention of metabolic syndrome risk progression in the early college years.

Molecular Epidemiology and Transmission Dynamics of the HIV-1 Epidemic in Ethiopia: Epidemic Decline Coincided With Behavioral Interventions Before ART Scale-Up.

BackgroundEthiopia is one of the sub-Saharan countries hit hard by the HIV epidemic. Previous studies have shown that subtype C dominates the Ethiopian HIV-1 epidemic, but the evolutionary and temporal dynamics of HIV-1 in Ethiopia have not been closely scrutinized. Understanding the evolutionary and epidemiological pattern of HIV is vital to monitor the spread, evaluate and implement HIV prevention strategies.MethodsWe analyzed 1,276 Ethiopian HIV-1 subtype C polymerase (pol sequences), including 144 newly generated sequences, collected from different parts of the country from 1986 to 2017. We employed state-of-art maximum likelihood and Bayesian phylodynamic analyses to comprehensively describe the evolutionary dynamics of the HIV-1 epidemic in Ethiopia. We used Bayesian phylodynamic models to estimate the dynamics of the effective population size (Ne) and reproductive numbers (Re) through time for the HIV epidemic in Ethiopia.ResultsOur analysis revealed that the Ethiopian HIV-1 epidemic originated from two independent introductions at the beginning of the 1970s and 1980s from eastern and southern African countries, respectively, followed by epidemic growth reaching its maximum in the early 1990s. We identified three large clusters with a majority of Ethiopian sequences. Phylodynamic analyses revealed that all three clusters were characterized by high transmission rates during the early epidemic, followed by a decline in HIV-1 transmissions after 1990. Re was high (4–6) during the earlier time of the epidemic but dropped significantly and remained low (Re < 1) after the mid-1990. Similarly, with an expected shift in time, the effective population size (Ne) steadily increased until the beginning of 2000, followed by a decline and stabilization until recent years. The phylodynamic analyses corroborated the modeled UNAIDS incidence and prevalence estimates.ConclusionThe rapid decline in the HIV epidemic took place a decade before introducing antiretroviral therapy in Ethiopia and coincided with early behavioral, preventive, and awareness interventions implemented in the country. Our findings highlight the importance of behavioral interventions and antiretroviral therapy scale-up to halt and maintain HIV transmissions at low levels (Re < 1). The phylodynamic analyses provide epidemiological insights not directly available using standard surveillance and may inform the adjustment of public health strategies in HIV prevention in Ethiopia.

Analysis of the Nursing Effect of Early Behavioral Intervention in Total Laryngectomy for Patients with Laryngeal Cancer

Analysis of the Nursing Effect of Early Behavioral Intervention in Total Laryngectomy for Patients with Laryngeal Cancer

Sex-dependent influence of postweaning environmental enrichment in Angelman syndrome model mice.

IntroductionAngelman syndrome (AS) is a rare neurodevelopmental disorder caused by mutation or loss of UBE3A and marked by intellectual disability, ataxia, autism‐like symptoms, and other atypical behaviors. One route to treatment may lie in the role that environment plays early in postnatal life. Environmental enrichment (EE) is one manipulation that has shown therapeutic potential in preclinical models of many brain disorders, including neurodevelopmental disorders. Here, we examined whether postweaning EE can rescue behavioral phenotypes in Ube3a maternal deletion mice (AS mice), and whether any improvements are sex‐dependent.MethodsMale and female mice (C57BL/6J Ube3atm1Alb mice and wild‐type (WT) littermates; ≥10 mice/group) were randomly assigned to standard housing (SH) or EE at weaning. EE had a larger footprint, a running wheel, and a variety of toys that promoted foraging, burrowing, and climbing. Following 6 weeks of EE, animals were submitted to a battery of tests that reliably elicit behavioral deficits in AS mice, including rotarod, open field, marble burying, and forced swim; weights were also monitored.ResultsIn male AS‐EE mice, we found complete restoration of motor coordination, marble burying, and forced swim behavior to the level of WT‐SH mice. We also observed a complete normalization of exploratory distance traveled in the open field, but we found no rescue of vertical behavior or center time. AS‐EE mice also had weights comparable to WT‐SH mice. Intriguingly, in the female AS‐EE mice, we found a failure of EE to rescue the same behavioral deficits relative to female WT‐SH mice.ConclusionsEnvironmental enrichment is an effective route to correcting the most penetrant phenotypes in male AS mice but not female AS mice. This finding has important implications for the translatability of early behavioral intervention for AS patients, most importantly the potential dependency of treatment response on sex.

Salivary Alpha-Amylase Activity and Mild Cognitive Impairment among Japanese Older Adults: The Toon Health Study.

There is growing interest in examining objective markers for early identification and behavioral intervention to prevent dementia and mild cognitive impairment in clinical and community settings. To investigate the association between salivary alpha-amylase as an objective measure of psychological stress response and mild cognitive impairment for the implication of psychological stress in the development of mild cognitive impairment. This cross-sectional study involved 865 participants aged ≥ 65 years. A saliva sample was collected in the morning, and the levels of salivary alpha-amylase were assayed. Mild cognitive impairment was evaluated using the Japanese version of the Montreal Cognitive Assessment; a score < 26 was indicative of mild cognitive impairment. A multivariable logistic regression model was used to examine the association of salivary alpha-amylase and mild cognitive impairment after adjusting for age, sex, current drinking status, current smoking status, body mass index, hypertension, diabetes mellitus, physical activity, education, social support, social network, and heart rate variability. Salivary alpha-amylase was associated with mild cognitive impairment (the multivariable-adjusted odds ratio [95% confidence interval] for the 1-standard deviation increment of log-transformed salivary alpha-amylase was 1.24 [1.07-1.44]). This significant association persisted after adjusting for various confounding factors. Elevation of salivary alpha-amylase was associated with mild cognitive impairment among Japanese community-dwelling older adults. This suggests that salivary alpha-amylase is a useful objective marker of psychological stress responses associated with mild cognitive impairment.

Supplemental Material for Early Behavioral Interventions for Children and Adolescents With Autism Spectrum Disorder in Routine Clinical Care: A Systematic Review and Meta-Analysis

Supplemental Material for Early Behavioral Interventions for Children and Adolescents With Autism Spectrum Disorder in Routine Clinical Care: A Systematic Review and Meta-Analysis

Determinants of condom use during last sexual intercourse among male college youth of Kaski, Nepal: A cross-sectional survey.

The National Family Planning program of Nepal has introduced the condom as an important family planning method. Despite the continuous effort from the public and private sectors at various levels, its use among youth remains low. Therefore, this study aimed to assess the factors associated with condom use during the last sexual intercourse among male college youth. We conducted a cross-sectional study and analyzed the responses of 361 male college youth (aged 19 to 24 years who reported being sexually active preceding six months of the survey), among the 903 participants who reported being involved in vaginal and anal sexual intercourse. The chi-square test was primarily used to find the associated factors and then, stepwise logistic regression was performed by selecting the covariates after the multicollinearity test followed by adjustment of confounders. We found that more than one-fourth (27.4%) of the sexually active male youth had used the condoms during their last sexual intercourse. Postgraduate male youth were four times more likely to use the condoms during the last sexual intercourse than undergraduate male youth (AOR = 4.09, 95% CI; 2.08-8.06). Similarly, married youth were less likely to use the condoms during the last sexual intercourse with 95% lower odds than their counterparts (AOR = 0.05, 95% CI; 0.01-0.38). Male youth with adequate knowledge about the condoms were 8 times more likely to use them compared to those with inadequate knowledge (AOR = 8.42, 95% CI; 4.34-16.33). Likewise, male youth with favorable attitude towards the condoms were 2.5 times more likely to use them compared to their counterparts (AOR = 2.58, 95% CI; 1.23-5.42). Similarly, male youth having two or more sex partners were 4.5 times more likely to use the condoms than the youth having only a sex partner (AOR = 4.57, 95% CI; 2.38-8.76). The study concluded that slightly more than one-fourth (27.4%) of male college youth in Kaski district used the condoms during their last sexual intercourse. Level of education, marital status, knowledge about condoms, attitude toward condoms, and number of sex partners are the determinants of condom use among male college youth so recommended for early behavioral interventions, especially in knowledge and attitude. Further studies focusing on including the rural youth and larger geography may help to reach a firmer conclusion.

Sleep Well! An adapted behavioral sleep intervention implemented in urban primary care.

To describe the adaptation, feasibility, and initial outcomes of Sleep Well!, an intervention for early childhood insomnia and insufficient sleep, designed for families from lower-socioeconomic status backgrounds presenting to large metropolitan primary care sites. Fifteen caregiver-child dyads (caregivers: 92.3% mothers, 80.0% Black, 53.3% ≤ 125% US poverty level; children: 73.3% female, 86.7% Black, mean age = 3.0 years) participated in this multimethod, single-arm trial. A family advisory board of caregivers (n = 4) and a clinician advisory board of sleep experts, primary care clinicians, and psychologists (n = 13) provided intervention feedback throughout the pilot. Most adaptations were related to intervention delivery methods, with some related to sleep strategies. At postintervention, caregivers completed surveys on intervention acceptability and cultural humility (primary outcomes) and completed semistructured interviews. Caregivers also reported on child sleep pre- and postintervention. Thirteen (86.6%) families completed Sleep Well! and 12 (80.0%) completed pre- and postintervention measures. Caregivers reported strong intervention acceptability and cultural humility. There were preintervention to postintervention reductions in child sleep problems, bedroom electronics, sleep onset latency, and night awakening frequency and duration. Nighttime sleep duration and overall insufficient sleep also improved. Qualitative data also showed strong intervention acceptability and perceived flexibility, with few participation barriers. A brief, early childhood behavioral sleep intervention delivered in primary care with families from primarily lower-socioeconomic status backgrounds and/or racially minoritized backgrounds is feasible to implement, with strong retention rates, acceptability, and perceptions of cultural humility. Child sleep improvements are positive and warrant replication in a randomized controlled trial. Registry: ClinicalTrials.gov; Name: Implementing Behavioral Sleep Intervention in Urban Primary Care; URL: https://clinicaltrials.gov/ct2/show/NCT04046341; Identifier: NCT04046341. Williamson AA, Okoroji C, Cicalese O, etal. Sleep Well! An adapted behavioral sleep intervention implemented in urban primary care. J Clin Sleep Med. 2022;18(4):1153-1166.

Cultural adaptations of obesity-related behavioral prevention interventions in early childhood: A systematic review.

SummaryInterventions for obesity prevention can effectively reduce obesity‐related behaviors in young children. Understanding how to leverage and adapt evidence‐based interventions is needed to improve reach among culturally and linguistically diverse families. This systematic review aimed to synthesize the approaches and outcomes of culturally adapted early childhood obesity‐related behavioral prevention interventions. Multiple electronic databases were systematically searched in March 2021. All study designs were included if they reported cultural adaptations of an intervention targeting at least one obesity‐related behavior (infant feeding, nutrition, physical activity, and/or sleep) among children aged 0–5 years. Studies that only conducted language translations or that developed new interventions were excluded. Two authors independently conducted critical appraisals using the Mixed Method Appraisal Tool. Findings were synthesized narratively, based on the Stages of Cultural Adaptation theoretical model and the Framework for Reporting Adaptations and Modifications‐Enhanced. Twelve interventions met the inclusion criteria, with varied study designs. Few reported all aspects of cultural adaptation processes, and the cultural adaptation strategies documented varied. The results suggest that cultural adaptation of obesity‐related behavioral prevention interventions targeting young children increases acceptability among target cultural groups, yet effectiveness is inconclusive due to a lack of trials. More detailed reporting of cultural adaptation processes and further effectiveness trials are needed to evaluate future work.

Adapting pharmacological dose-finding designs for early phase behavioral intervention development research.

The use of systematic dose-finding designs to develop behavioral health interventions is lacking. In contrast, drug development research consistently follows a prescribed, regulated, and iterative pathway that begins with empirically establishing optimal drug dose. Adapting dose-finding methodologies from the drug development literature offers several advantages to increasing the feasibility, efficiency, and rigor of this important intervention refining step for behavioral intervention development. This article discusses the current state of the science for dose finding within the behavioral intervention development literature. A detailed overview of one drug development dose-finding methodology (the Accelerated Biased Coin Up-and-Down design) is then presented, using our work to adapt the Prevention Plus Intervention for treatment of pediatric obesity for mHealth delivery as an example of how this design can be applied to empirically derive the dose for a behavioral intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Detection of maternal and fetal stress from the electrocardiogram with self-supervised representation learning

In the pregnant mother and her fetus, chronic prenatal stress results in entrainment of the fetal heartbeat by the maternal heartbeat, quantified by the fetal stress index (FSI). Deep learning (DL) is capable of pattern detection in complex medical data with high accuracy in noisy real-life environments, but little is known about DL’s utility in non-invasive biometric monitoring during pregnancy. A recently established self-supervised learning (SSL) approach to DL provides emotional recognition from electrocardiogram (ECG). We hypothesized that SSL will identify chronically stressed mother-fetus dyads from the raw maternal abdominal electrocardiograms (aECG), containing fetal and maternal ECG. Chronically stressed mothers and controls matched at enrolment at 32 weeks of gestation were studied. We validated the chronic stress exposure by psychological inventory, maternal hair cortisol and FSI. We tested two variants of SSL architecture, one trained on the generic ECG features for emotional recognition obtained from public datasets and another transfer-learned on a subset of our data. Our DL models accurately detect the chronic stress exposure group (AUROC = 0.982 ± 0.002), the individual psychological stress score (R2 = 0.943 ± 0.009) and FSI at 34 weeks of gestation (R2 = 0.946 ± 0.013), as well as the maternal hair cortisol at birth reflecting chronic stress exposure (0.931 ± 0.006). The best performance was achieved with the DL model trained on the public dataset and using maternal ECG alone. The present DL approach provides a novel source of physiological insights into complex multi-modal relationships between different regulatory systems exposed to chronic stress. The final DL model can be deployed in low-cost regular ECG biosensors as a simple, ubiquitous early stress detection and monitoring tool during pregnancy. This discovery should enable early behavioral interventions.

Changes in Autistic Symptoms and Adaptive Functioning of Children Receiving Early Behavioral Intervention in a Community Setting: A Latent Growth Curve Analysis.

Despite showing effects in well-controlled studies, the extent to which early intensive behavioral intervention (EBI) produces positive changes in community-based settings remains uncertain. Thus, our study examined changes in autistic symptoms and adaptive functioning in 233 children with autism receiving EBI in a community setting. The results revealed nonlinear changes in adaptive functioning characterized by significant improvements during the intervention and a small linear decrease in autistic symptoms from baseline to follow-up. The intensity of intervention, initial age, IQ and autistic symptoms were associated either with progress during the intervention or maintenance during the follow-up. The next step to extend this line of research involves collecting detailed data about intervention strategies and implementation fidelity to produce concrete recommendations for practitioners.

Consultation-Liaison Telepsychiatry on an Inpatient Obstetrical Labor and Delivery Unit.

Limited access to mental health resources has challenged clinicians in delivering early behavioral health interventions to perinatal populations. We describe telepsychiatry consultations to a rural hospital's labor and delivery unit. To demonstrate how consultation-liaison services during peripartum hospitalization could meet this need. One-year data from electronic medical records of women who were at risk of postpartum syndromes and offered a telepsychiatry consult was extracted and reviewed. A total of 85 consults were conducted via telepsychiatry primarily for depression, anxiety, and medication management. Bedside psychotherapeutic interventions and education were provided to 63 patients, medications were initiated for 32 patients, and outpatient referrals were made for 47 patients. Our results indicate that consultation-liaison telehealth can successfully engage at-risk mothers in psychiatric treatment. Given accelerated telemedicine efforts due to the COVID-19 pandemic, improving access to telepsychiatry for rural, peripartum populations is an important area of development.