Single-subject Research Studies Research Articles

The Effect of Halliwick Method on Aquatic Skills of Children with Autism Spectrum Disorder

Swimming and the skills associated with participation in the aquatic environment tend to be an integral part of the movement literacy complex. Non-participation then affects the safety of movement in the aquatic environment and may also be the reason for the limitation of movement, psychological, and social development compared to peers. This study is a single-subject research study. The aim of this study is to evaluate the effect of a seven-week intervention program of the Halliwick method in the development of aquatic skills, gross motor skills, and mental skills relevant for aquatic competence for children with autism spectrum disorder. Seven children with autism spectrum disorder participated in swimming classes for a two-week baseline period and a seven-week intervention program of the Halliwick method, one time per week. To measure the effect in the field of aquatic skills, we used the Alyn Water Orientation Test 1. To determine the level of gross motor skills, we used the Gross Motor Function Measure test. There was an improvement in aquatic skills and gross motor skills in seven participants; two of them did not improve in mental adjustment oriented to the breathing control sections in the water.

The impact of mindfulness-based cognitive therapy on math anxiety in adolescents

In this nonconcurrent, multiple-baseline, single-subject research study, the authors conducted a preliminary exploration of whether mindfulness-based cognitive therapy (MBCT) can be expanded to the treatment of math anxiety. Three high school students who were assessed with high levels of math anxiety met individually twice a week for 6 weeks with the school counselor who used a manualized MBCT treatment for anxiety as the intervention. A weekly administration of a math anxiety measurement tool showed a decrease in math anxiety for all three participants.

Effect of a 16-month exercise training program on functional capacities in a centenarian male master athlete: A case study

The effects of exercise training have never been investigated in centenarians. This single-subject research study aimed to assess the effects of a structured training protocol on functional capacities in a centenarian master athlete. A 99.5 years old male subject participated in the study. Before and after a 16-month training intervention the participant underwent a test battery for flexibility (YMCA sit and reach), balance (single leg stance), upper limb strength (hand grip and pinch strength), and lower limb power (counter movement jump) and muscular endurance (horizontal leg press with 85 kg load). After training, sit and reach (-3 cm) and counter movement jump (- 0.5 cm) scores decreased, whereas single leg stance (+1.3 s), left hand grip (+2.0 kg), right hand pinch (+ 0.5 kg), and horizontal leg press (+2 repetitions) scores increased. Right hand grip strength and left-hand pinch strength did not change after training. When pre- and post-training scores were compared to gender-matched normative values, flexibility resulted well below average, maybe because of a relatively broad age category (> 65 years). When more specific age categories were available, the participant’s balance resulted slightly below average (age category 80-99 years) and upper limb strength above average (age category > 85 years). No normative values were found for lower limb power and muscular endurance. In conclusion, this study highlights that structured exercise training may play a role in maintaining – and even in increasing – functional capacities in the oldest old age.

Teaching a Phonological Awareness Skill With the Time-Delay System in a Mainstream Setting: A Single-Subject Research Study

The present study focused on instruction in identifying the 1st sounds of different words. We taught this phonological awareness skill in a mainstream classroom through an evidence-based strategy of time delay to a student with severe intellectual and developmental disability. We implemented the time-delay strategy within a single-subject design and a multiple baseline across 3 different sets. Results indicated that the student learned to identify the initial letter sound of the words taught once the intervention ended and across the maintenance period. Contributions and limitations of the study are presented, and future research and practical implications are discussed.

Training Mental Toughness In Sport

In January 2017, after a week of strenuous, military-style, and anecdotally-based workouts designed to test the level of mental toughness (MT), three Pac-12 football players were diagnosed with rhabdomyolysis. In sporting environments, are there any safe and effective, empirically-based MT interventions? To date, there has been no attempt to collate all available empirical evidence in regards to development of MT in Sport. PURPOSE: To summarize evidence relating to MT training programs in developing MT levels. METHODS: Cross-sectional designs and pre- and post-test experiments were included. No publication date restriction was imposed. Participants of any age, gender, sport, or level were included. This search was applied to Embase, Scopus, PubMed, and SPORTDiscus. Two reviewers assessed the risk of bias using: (a) for RCTs, the PEDro scale, (b) for before-after studies with no control group, the ‘Before-After (Pre-Post) Studies With No Control Group’, and (c) for single-subject research study, the ‘Quality Indicators’. The outcomes of primary interest were the scores of MT, which were translated into standardized variables (SMD). The meta-analysis was completed using a random-effects model. RESULTS: Nine studies were included in the systematic analysis and seven in the meta-analysis. The methodological quality of those nine studies was not high. Common areas that increased the risk of bias include: (a) RCT’s: allocation was not concealed, key outcomes were self-reported, no blinding of all subjects/assessors, and no random allocation of subjects; (b) Before-After Studies With No Control Group: No enrollment of all subjects who meet the inclusion/exclusion criteria, no blinding of assessors, and no reporting of relevant information; and (c) Single-subject design: fewer than three data points per phase without justification. MT scores increased by 0.88 standard deviations (95% CI). The values contained within the confidence interval were at least medium effect sizes and the variance of this estimate was 0.23. CONCLUSIONS: A strong positive effect was observed. Therefore, the results are promising. Nevertheless, the authors believe that conclusions cannot be drawn due to limited number of reliable results, which creates a high level of uncertainty. However, this finding itself is of value.

SSDOnt: An Ontology for Representing Single-Subject Design Studies.

Single-Subject Design is used in several areas such as education and biomedicine. However, no suited formal vocabulary exists for annotating the detailed configuration and the results of this type of research studies with the appropriate granularity for looking for information about them. Therefore, the search for those study designs relies heavily on a syntactical search on the abstract, keywords or full text of the publications about the study, which entails some limitations. To present SSDOnt, a specific purpose ontology for describing and annotating single-subject design studies, so that complex questions can be asked about them afterwards. The ontology was developed following the NeOn methodology. Once the requirements of the ontology were defined, a formal model was described in a Description Logic and later implemented in the ontology language OWL 2 DL. We show how the ontology provides a reference model with a suitable terminology for the annotation and searching of single-subject design studies and their main components, such as the phases, the intervention types, the outcomes and the results. Some mappings with terms of related ontologies have been established. We show as proof-of-concept that classes in the ontology can be easily extended to annotate more precise information about specific interventions and outcomes such as those related to autism. Moreover, we provide examples of some types of queries that can be posed to the ontology. SSDOnt has achieved the purpose of covering the descriptions of the domain of single-subject research studies.

A Meta-Analysis of Single-Subject Research on Behavioral Momentum to Enhance Success in Students with Autism.

We conducted a meta-analysis of single-subject research studies investigating the effectiveness of antecedent strategies grounded in behavioral momentum for improving compliance and on-task performance for students with autism. First, we assessed the research rigor of those studies meeting our inclusionary criteria. Next, in order to apply a universal metric to help determine the effectiveness of this category of antecedent strategies investigated via single-subject research methods, we calculated effect sizes via omnibus improvement rate differences (IRDs). Outcomes provide additional support for behavioral momentum, especially interventions incorporating the high-probability command sequence. Implications for research and practice are discussed, including the consideration of how single-subject research is systematically reviewed to assess the rigor of studies and assist in determining overall intervention effectiveness .

A Review of Technology-Based Interventions to Teach Academic Skills to Students with Autism Spectrum Disorder

A comprehensive review of the literature was conducted for articles published between 1993 and 2012 to determine the degree to which technology-based interventions can be considered an evidence-based practice to teach academic skills to individuals with Autism Spectrum Disorder (ASD). Criteria developed by Horner et al. (Except Child 71:165-178, 2005) and Gersten et al. (Except Child 71:149-164, 2005) were used to determine the quality of single-subject research studies and group experimental research studies respectively. A total of 29 [Corrected] studies met inclusion criteria. Of these studies, only three single-subject studies and no group studies met criteria for quality or acceptable studies. Taken together, the results suggest that practitioners should use caution when teaching academic skills to individuals with ASD using technology-based interventions. Limitations and directions for future research are discussed.

Reconsidering Overlap-Based Measures for Quantitative Synthesis of Single-Subject Data

Overlap-based measures are increasingly applied in the synthesis of single-subject research. This article considers two criticisms of overlap-based metrics, specifically that they do not measure magnitude of effect and do not adequately correspond with visual analysis. It is argued that these criticisms are based on fundamental misconceptions regarding the nature of effect sizes and their appropriate interpretation in single-subject research. Suggestions for considerations in evaluating single-subject research studies are offered, including the need to separately consider experimental control and magnitude of effect.

Comparative efficacy of the Picture Exchange Communication System (PECS) versus a speech-generating device: Effects on requesting skills

An experimental, single-subject research study investigated the comparative efficacy of the Picture Exchange Communication System (PECS) versus a speech-generating device (SGD) in developing requesting skills for three elementary-age children with severe autism and little to no functional speech. Results demonstrated increases in requesting behavior for all participants across intervention phases with both augmentative and alternative communication (AAC) intervention strategies; however, difficulties were observed with picture discrimination. The Wilcoxon signed pair test did not reveal significant differences between PECS and the SGD for any participant. Findings suggest PECS and SGD are equally appropriate for developing initial requesting skills. Based on the current findings, successful implementation of either AAC strategy is achievable when appropriate instructional strategies are used.

Teaching Writing to At-Risk Students: The Quality of Evidence for Self-Regulated Strategy Development

This study evaluates the quality of the research and evidence base for a writing intervention called Self-Regulated Strategy Development (SRSD; Graham & Harris, 1989; Harris & Graham, 1996) for students with and at risk for learning disabilities, using criteria for group research studies suggested by Gersten et al. (2005) and single-subject research studies suggested by Horner et al. (2005). Five experimental and quasi-experimental studies and 16 single-subject studies investigating SRSD were analyzed on numerous methodological dimensions. Both the group design and single-subject studies also met proposed standards for an evidence-based practice. The potential value of analyzing approaches and interventions using the proposed quality indicators and standards for evidence-based practices is discussed, as are implications for research and practice.

A Preliminary Examination to Identify the Presence of Quality Indicators in Single-subject Research

Scholars in the field of special education put forth a series of papers that proposed quality indicators for specific research designs that must be present for a study to be considered of high quality, as well as standards for evaluating a body of research to determine whether a practice is evidence-based. The purpose of this article was to pilot test the quality indicators proposed for single-subject research studies in order to identify points that may need clarification or revision. To do this, we examined the extent to which the proposed quality indicators were present in two single-subject studies, both examining the effects of teacher praise on specific behaviors of school-age children. Our application of the quality indicators indicated that neither study met the minimal acceptable criteria for single-subject research. We discuss the use of the quality indicators in relation to their clarity and applicability and suggest points for deliberation as the field moves forward in establishing evidence-based practices.

The Effect of Hippotherapy on Postural Control in Sitting for Children with Cerebral Palsy

The purpose of this single subject research study was to examine the effects of a once weekly, 10-week hippotherapy program for three children, ages 27–54 months, with cerebral palsy. Participants were rated as Level V on the Gross Motor Function Classification System. The Sitting Dimension of the Gross Motor Function Measure was used to establish a baseline of sitting abilities, and was administered every 2 weeks during intervention. The Sitting Assessment Scale and the Gross Motor Function Measure were administered before, after, and 4 weeks post-intervention. Parental perceptions of the hippotherapy intervention were assessed using questionnaires. None of the children made gains on any of the standardized outcome measures. Parental perceptions were very positive, with reported improvements in range of motion and head control.

Evaluating Single-Subject Treatment Research: Lessons Learned from the Aphasia Literature

The mandate for evidence-based practice has prompted careful consideration of the weight of the scientific evidence regarding the therapeutic value of various clinical treatments. In the field of aphasia, a large number of single-subject research studies have been conducted, providing clinical outcome data that are potentially useful for clinicians and researchers; however, it has been difficult to discern the relative potency of these treatments in a standardized manner. In this paper we describe an approach to quantify treatment outcomes for single-subject research studies using effect sizes. These values provide a means to compare treatment outcomes within and between individuals, as well as to compare the relative strength of various treatments. Effect sizes also can be aggregated in order to conduct meta-analyses of specific treatment approaches. Consideration is given to optimizing research designs and providing adequate data so that the value of treatment research is maximized.

Effects of a Six-Week Eccentric Exercise Program on Patients with Patellar Tendinopathy: Single-Subject Research Study

Purpose: Eccentric exercise is commonly recommended in the conservative treatment of chronic tendinopathies. This single-subject research study evaluated the effects of a six-week eccentric exercise program developed for patients with patellar tendinopathy (jumper's knee). Methods: Four patients (mean age 23.75 years; three female, one male) with unilateral patellar tendinopathy participated in this study. A nonconcurrent multiple baseline design was implemented and involved repeated measures of knee pain, knee function, and peak isometric force of the quadriceps and hamstring muscles. Measurements of isokinetic average torque of the quadriceps and hamstring muscles were collected prebaseline and postintervention. The intervention phase involved a six-week eccentric exercise program. Data were analyzed both visually and statistically. Results: Visual results indicated reductions in intensity (n = 3) and unpleasantness (n = 3) of knee pain, improved knee function (n = 3), increased isometric quadriceps peak force of the ipsilateral side (n = 3) and the contralateral side (n = 4), increased isometric hamstring peak force of the ipsilateral side (n = 1) and the contralateral side (n = 1), and increased concentric average torque of the ipsilateral quadriceps (n = 2) and the contralateral side (n = 3). Most visual analyses were supported by the C-statistic. Discussion: The eccentric exercise program showed mixed clinical benefits for four patients with patellar tendinopathy. However, none of the patients achieved full recovery within the suggested six-week treatment period.

Effects of a Six-Week Eccentric Exercise Program on Patients with Patellar Tendinopathy: Single-Subject Research Study

Effects of a Six-Week Eccentric Exercise Program on Patients with Patellar Tendinopathy: Single-Subject Research Study

The Effect of Choice-Making as an Intervention for Problem Behavior

Supporting people with disabilities in expressing preferences and making choices is a core value in positive behavior support. Indeed, in recent years, the field has increasingly focused its attention on the importance of making choices and the potential benefits of choice-making opportunities in enhancing the quality of life of people with disabilities. In addition, an emerging database is suggesting that providing opportunities to make choices can serve as an intervention for decreasing problem behavior. The authors of this article examine the efficacy of the use of choice-making as an intervention for reducing problem behavior through a meta-analysis of single-subject research studies using choice-making as an intervention. A search of the PsycINFO and ERIC databases yielded 13 studies that met the meta-analysis criteria, with interventions affecting 30 participants. The impact of choice interventions was evaluated using the percentage nonoverlapping data and percentage zero data metrics. Overall, providing choice opportunities resulted in clinically significant reductions in the number of occurrences of problem behavior. The authors discuss the benefits of utilizing choice as an intervention and provide future directions for research in this area.

Effects of overloading of the lower hemiparetic extremity on walking speed in chronic stroke patients: A pilot study1

The objective of this pilot study was to investigate the carry-over effects on comfortable walking speed after overloading the lower hemiparetic extremity in chronic stroke patients. A single subject research study was conducted using a withdrawal design (A-B-A-B-A) on three patients with ischaemic middle cerebral artery infarction. Chronic stroke patients were recruited with stage 3 or 4 Fugl-Meyer scores in the lower extremity and the ability to ambulate independently without walking aids. Based on this withdrawal design, the daily procedure included walking at comfortable speeds 5x10 meters during the A_1 phase and 3x10 meters during all subsequent phases. This procedure was repeated for five consecutive days. Two lbs (B_1) and 6 lbs (B_2) weight cuffs were attached to the distal lower hemiparetic extremity and randomized over the two B phases. Control (A_1, A_2, A_3) and intervention (B_1, B_2) phases were alternated with brief resting periods. Mean comfortable walking speed for 10 meters constituted the outcome variable. All patients showed significant differences between phases (chi^2 = 34.187; p<0.001). However, with the exception of a carry-over effect between the A_1 (0.86 m/sec) and A_2 (0.89~m/sec) phases in one subject (p=0.043) no significant carry-over effects were found on ensuing A_2 and A_3 control phases. Although gradual improvements in comfortable walking speed between subsequent days were found the present pilot study did not demonstrate favorable group effects on comfortable walking speed as a result of limb overloading.

Describing the unusual behavior of children with autism

The behaviors of children with autism have been described by professionals, by family members, and also by those with autism. This article analyzes four different types of reports that contain descriptions of those with autism: (1) case studies, (2) diagnostic reports and single-subject research studies, (3) family accounts, and (4) autobiographical descriptions. Authors describe the behaviors of those with autism differently depending upon their relationship with the person they are describing, their intended audience, their goals, and the genre they use for conveying their descriptions. Authors were found to use the following types of descriptions, to varying degrees in order to achieve their goals: (1) descriptions of what a child did on a particular occasion; (2) descriptions of what a child typically does or did; (3) descriptions of what a child should have done; (4) descriptions of how behavior was experienced by a child or family member; (5) descriptions of how a third party reported a behavior; (6) metaphoric descriptions of behaviors; and (7) descriptions of how behaviors mesh with traits often associated with autism. A detailed examination of how behaviors of children with autism are described indicates that the way someone with autism is regarded and described is strongly related to what the describer wants to accomplish.

Infant/Parent Interaction: Studies and Intervention Guidelines Based on the SIAI Model

Social interactions between caregiver and infant provide the interpersonal context for the infant's development. However, research indicates that the prelinguistic communicative characteristics of infants with handicaps may differ from those of handicapped infants in ways which interfere with the ease with which pleasurable interactions are established. Intervention directed toward facilitating such interactions should therefore be a major component of any 0-3 program, and a number of models have been outlined for this purpose. One of these, the SIAI (McCollum, 1983) has recently been tested through a series of single subject research studies (McCollum, 1984; Stayton, 1984). The present paper illustrates the variety of ways in which the model was used in these studies, and draws from them a number of practical intervention guidelines gleaned both from the results of the studies and from the experiences of the interventionists who implemented the studies.