Browsing by Author "Kunze, Megan"

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    Coaching via Telehealth: Caregiver-mediated Interventions for Young Children on the Waitlist for an Autism Diagnosis
    (University of Oregon, 2020-12-08) Kunze, Megan; Machalicek, Wendy
    The average age for an autism diagnosis in the U.S. is 4-years-old (Hine et al., 2018), which is devastatingly late as caregivers often report initial concerns in their child’s development around 12-months-old and reliable autism diagnosis can be made by 18-months (Pierce et al., 2019). For children from under-resourced families in rural communities, the age of diagnosis is even later, around 5-years-old (Martinez et al., 2018). Early diagnosis of ASD provides toddlers access to medically necessary interventions beyond federally funded early intervention (Individuals with Disabilities Education Act, Part C, 2004) during a vital window of developmental opportunity (Warren et al., 2011). Late diagnosis often leads to under-served families despite economic status or geographic location. This study targeted ASD symptomology (i.e., higher-order restrictive and repetitive behaviors and interests; HO-RRBIs) in toddlers by pairing caregivers with an early interventionist via telehealth. Six mother-child dyads (four girls and two boys) whose child was (a) between 18 and 36-months-old, (b) demonstrated difficult levels of inflexible behaviors (i.e., HO- RRBIs), and (c) were on an ASD diagnostic waitlist were recruited from pediatrician offices and service districts throughout the Pacific Northwest and Texas. All families were considered under-served, under-resourced, or living in rural locations. In a concurrent multiple baseline design across participants, caregivers were coached to mediate early intervention to decrease inflexible and increase flexible child behaviors during play sessions through the use of four evidence-based applied behavior analytic strategies: modeling, prompting, differential reinforcement of appropriate behaviors, and response interruption and redirection. A visual analysis of the data combined with Tau-U revealed a strong basic effect between the intervention package and parent strategy use and child flexible and inflexible behavior. These findings were consistent except for one child participant whose results were a medium effect for flexible behaviors, yet a strong effect for inflexible behaviors. Standardized mean difference was beyond zero for all participants. All mothers rated their participation in the study as favorable. Results of distal and non-experimental outcomes are addressed. Implications for science and practice in early intervention for families whose children are at-risk for ASD are discussed.
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    Recommendations for Diversifying Racial and Ethnic Representation in Autism Intervention Research: A Crossover Review of Recruitment and Retention Practices in Pediatric Mental Health
    (2022-10-31) Machalicek, Wendy; Glugatch, Lindsay; Erturk, Buket; Brafford, Tasia; Kunze, Megan; Drew, Christine; Douglas, Allaina; Storie, Sloan; Crowe, Rebecca; Magaña, Sandy
    Disparities in diagnosis and access to healthcare and therapeutic services are well-documented for children with autism spectrum disorder (ASD) from minoritized races and ethnicities, but there is little empirical research to guide the selection and implementation of interventions and practices that will effectively support racially/ethnically diverse children with ASD and their families. This cross-over systematic review summarizes parent-mediated intervention research of children with or at risk for mental health disorders to identify potentially effective recruitment and retention strategies for diverse participants in parent-mediated intervention research for children with autism. Electronic database keyword, lead author name searches in PyschNet, MEDLINE, and ancestral searches were conducted to identify 68 relevant articles that used experimental designs to evaluate the effects of parent-mediated interventions on children with or at risk for mental health disorders. Articles were coded for participant demographics; intervention setting and type, recruitment and retention strategies, cultural adaptation of intervention, and reported attrition. Findings are discussed and applied to practices in autism parent-mediated intervention research. Suggestions for future research and limitations are discussed.