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Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement. Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up. There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement. This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program.

Limited research has examined the active ingredients and mechanisms of change of naturalistic developmental behavioral interventions (NDBIs). The present study used an exploratory sequential mixed-methods design to develop a comprehensive Theory of Change of Project ImPACT, an empirically supported NDBI. We used qualitative data from interviews with intervention experts (n = 10), community providers (n = 22), and caregivers (n = 12) to develop a comprehensive causal model of the intervention process. We then tested select paths of the causal model using path analyses with an archival dataset (n = 92). The causal model described how developmental techniques aimed at supporting children's attention and engagement lay the foundation for more adult-directed learning opportunities and subsequent child skill growth. However, hypothesized causal relationships were not supported by our quantitative analyses. In the future, this research can be used to develop and prioritize nuanced research questions related to the timing, optimization, and mechanistic process underlying NDBIs.

Few studies examine the effectiveness of community-based early interventions in unselected samples of autistic children, especially those from minoritized backgrounds. These types of studies require attention to strategies for recruitment, retention, data collection, and support for community providers beyond those used in university-based trials. We conducted a pilot trial of Project ImPACT, a promising caregiver-mediated naturalistic developmental behavioral intervention, in partnership with the early intervention system in a poor, large city. We assessed recruitment and retention strategies, training protocol, and measurement battery. We recruited representative provider and family samples, and had good measure completion among retained participants. Retention varied by study arm, providers had relatively poor fidelity to the intervention despite substantial support, and our measures did not appear sensitive to change. Lessons learned include the need for (a) a ramp-up training period prior to starting the study, (b) intensive implementation supports, and (c) additional strategies for family retention.

Over the past decade, a newer class of interventions has emerged specifically designed for young children with or at high likelihood of autism, which are called Naturalistic Developmental Behavioral Interventions (NDBIs). NDBIs are particularly well-suited as a discipline agnostic, primary intervention for young children with autism and other social communication challenges; however, community providers from multiple disciplinary backgrounds who serve these children typically do not develop competencies in areas crucial for effectively implementing NDBI. The goal of this commentary is to: (a) describe the interdisciplinary competencies needed to deliver NDBIs effectively and (b) provide recommendations for moving the field of early intervention for autism and social communication delays forward. Resources for building these competencies for providers at the pre- and in-service level are also provided.

Practice guidelines for early childhood education (ECE) and clinical autism interventions (Naturalistic Developmental Behavioral Intervention, NDBI) have emerged separately in history, represent different disciplines, and operate within different service systems in the United States. This article identifies priorities, principles, and practices that are shared across the NDBI and ECE frameworks, unique to each framework but compatible with the other, or in conflict. Both frameworks support converging inclusive ECE models focused on autism in that they are both grounded in responsive relationships, natural learning environments, and strategies to promote children's motivation and active engagement. While compatible in general, each framework extends the other in important ways. For example, NDBI goes beyond the ECE frameworks by focusing on a more fine-grained examination of learning strategies and targets. Opportunities for bridging gaps are identified, including the use of implementation science frameworks to integrate perspectives from different stakeholder groups, supporting the scale-up of inclusion preschools in community settings.

Stress response pathways detect and alleviate adverse conditions to safeguard cell and tissue homeostasis, yet their prolonged activation induces apoptosis and disrupts organismal health1-3. How stress responses are turned off at the right time and place remains poorly understood. Here we report a ubiquitin-dependent mechanism that silences the cellular response to mitochondrial protein import stress. Crucial to this process is the silencing factor of the integrated stress response (SIFI), a large E3 ligase complex mutated in ataxia and in early-onset dementia that degrades both unimported mitochondrial precursors and stress response components. By recognizing bifunctional substrate motifs that equally encode protein localization and stability, the SIFI complex turns off a general stress response after a specific stress event has been resolved. Pharmacological stress response silencing sustains cell survival even if stress resolution failed, which underscores the importance of signal termination and provides a roadmap for treating neurodegenerative diseases caused by mitochondrial import defects.

The periodicity of Saturn kilometric radiation (SKR) varies with time, and its two periods during the first 5 years of the Cassini mission have been attributed to SKR from the northern and southern hemisphere. After Saturn equinox in August 2009, there were long intervals of time (March 2010 to February 2011 and September 2011 to June 2012) with similar northern and southern SKR periods and locked SKR phases. However, from March to August 2011 the SKR periods were split up again, and the phases were unlocked. In this time interval, the southern SKR period slowed down by ~ 0.5% on average, and there was a large jump back to a faster period in August 2011. The northern SKR period speeded up and coalesced again with the southern period in September 2011. We argue that this unusual behavior could be related to the so-called Great White Spot (GWS), a giant thunderstorm that raged in Saturn's atmosphere around that time. For several months in 2011, the visible head of the GWS had the same period of ~ 10.69 h as the main southern SKR modulation signal. The GWS was most likely a source of intense gravity waves that may have caused a global change in Saturn's thermospheric winds via energy and momentum deposition. This would support the theory that Saturn's magnetospheric periodicities are driven by the upper atmosphere. Since the GWS with simultaneous SKR periodicity measurements have only been made once, it is difficult to prove a physical connection between these two phenomena, but we provide plausible mechanisms by which the GWS might modify the SKR periods.

Joint attention and imitation are thought to facilitate a developmental cascade of language and social communication skills. Delays in developing these skills may affect the quality of children's social interactions and subsequent language development. We examined how responding to joint attention and object imitation skills predicted rate of expressive and receptive communication growth rate in a heterogeneous sample of autistic children. Children's baseline skills in responding to joint attention uniquely predicted expressive, but not receptive, language growth rate over time, while object imitation did not significantly predict language growth rate over and above joint attention skills. Future research should examine the potential moderating roles of child age and developmental level in explaining associations between joint attention and object imitation and later language development.

This study used a quasi-experimental design to compare the effects of an intercultural development program on students' Cultural Intelligence (CQ) compared with students in a summer research program who did not receive the intervention. Social Learning Theory guided a 9-week student-centered cultural learning course focused on attention, retention, and reproduction of each CQ domain. After the course, students had opportunities to practice their CQ abilities while studying abroad. Pre-assessment CQ determined an individualized learning plan. Reflective journaling and cultural mentoring were used to maximize student CQ growth. Using multi-level modeling, we observed a statistically significant increase in three CQ domains compared to the comparison control group: cognitive (p<0.01), metacognitive (p<0.01), and behavioral CQ (p<0.01). Motivation CQ scores did not significantly improve (p=0.08). Our results suggest that a university intercultural development program that intentionally combines a cultural learning course with a study abroad experience may improve students' CQ.

Naturalistic developmental behavioral interventions (NDBIs) are evidence-based interventions for young children with autism spectrum disorder. There has been growing interest in implementing manualized NDBIs within the early intervention (EI) system without a clear understanding of how these programs and the broader strategies encompassed within them are already used by EI providers. This study examined the use of manualized NDBI programs and broader NDBI strategies within an EI system and factors that impacted their use. Eighty-eight EI providers completed a measure of NDBI program and strategy use. Thirty-three providers participated in a supplemental focus group or interview. Overall, providers described using broader NDBI strategies and the need to adapt manualized NDBI programs. Provider-, intervention-, and organization-level factors impacted their use of NDBI programs and strategies.

Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity and overlap in techniques among naturalistic developmental behavioral intervention models has not been quantified, and there is no standardized measure for assessing the implementation of their common elements. This article presents a multi-stage process which began with the development of a taxonomy of elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using quantitative methods. An observational rating scheme of those common elements, the eight-item "NDBI-Fi," was developed. Finally, preliminary analyses of the reliability and the validity of the "NDBI-Fi" were conducted using archival data from randomized controlled trials of caregiver-implemented naturalistic developmental behavioral interventions, including 87 post-intervention caregiver-child interaction videos from five sites, as well as 29 pre-post video pairs from two sites. Evaluation of the eight-item "NDBI-Fi" measure revealed promising psychometric properties, including evidence supporting adequate reliability, sensitivity to change, as well as concurrent, convergent, and discriminant validity. Results lend support to the utility of the "NDBI-Fi" as a measure of caregiver implementation of common elements across naturalistic developmental behavioral intervention models. With additional validation, this unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool which cuts across a class of evidence-based interventions.

BackgroundContaining coronavirus disease 2019 (COVID-19) has been difficult, due to both the large number of asymptomatic infected individuals and the long duration of infection. Managing these challenges requires understanding of the differences between asymptomatic vs symptomatic patients and those with a longer duration of infectivity.MethodsIndividuals from Los Angeles were tested for COVID-19, and a group positive for COVID-19 chose to have follow-up testing. Associations between symptoms and demographic factors, viral burden measured by cycle threshold (CT) value, and duration of polymerase chain reaction (PCR) positivity were analyzed.ResultsEighteen point eight percent of patients were positive for COVID-19. Asymptomatic COVID-19-positive patients were significantly younger than symptomatic patients (2.6 years; P

Reliable techniques to assess centrally mediated function in healthy individuals are essential to understand the origins of neuromuscular dysfunction in pathologic populations. This study examined the test-retest reliability of corticospinal excitability in the upper extremity musculature of 21 healthy individuals using transcranial magnetic stimulation. Within-session reliability was assessed by comparing tests performed 120 minutes apart. Between-session reliability was assessed by comparing the second (24 hr), third (1-week), and forth (2-week) sessions to the first test. We recorded active motor threshold (AMT) and motor evoked potential (MEP) at 120% AMT of the upper trapezius (UT), middle deltoid (MD), and flexor carpi radialis (FCR) bilaterally. Intraclass correlation coefficients (3,1) were used to assess relative reliability, and minimal detectable changes at 95% confidence level were calculated to assess absolute reliability. Our results suggest that AMT of the MD and FCR demonstrated acceptable within-session and between-session reliability over 24 hours, with all muscles evaluated ranging from moderate to good over 2 weeks. In contrast, MEP amplitudes were less reliable for all muscles, with reliability point estimates ranging from poor to moderate. AMT appears to be a more consistent measure of corticospinal excitability in upper extremity musculature, which may be more appropriate in clinical outcomes research.

Sexual misconduct remains at crisis levels on American college campuses and is vastly underreported. Most research focuses on individual level risks of assault and perpetration, yet campuses vary significantly in sexual offenses and reporting rates. The current study responds to calls to consider institutional factors that shape campus climates for sexual misconduct and reporting. We consider the role of gender in leadership, analyzing the impact of women's appointment as college president on reporting rates over time. We consider individual and organizational mechanisms that may shape the impact of women's appointment on reporting rates. Our analyses rely on data from U.S. colleges and universities between 2005-2020. We find that the appointment of women presidents is associated with a significant increase in reporting of sexual misconduct. We observe a significant increase in reporting during the first year following the appointment and a continued increase in reporting rates over time.

This study explored the spiritual needs of Christian families by surveying and holding focus groups with parents and congregational leaders. We discovered a disconnect between what congregational leaders think is happening with families and the lived experience of families. Congregational leaders often perceive the lack of church engagement from families as disinterest or devaluing of spirituality and faith over and against other pursuits. However, our data revealed that parents deeply value spirituality and issues of faith. This research highlights the need for deep listening on the part of congregational leaders coupled with empathy for the pressures parents are currently feeling.

Vortex crystals are quasiregular arrays of like-signed vortices in solid-body rotation embedded within a uniform background of weaker vorticity. Vortex crystals are observed at the poles of Jupiter and in laboratory experiments with magnetized electron plasmas in axisymmetric geometries. We show that vortex crystals form from the free evolution of randomly excited two-dimensional turbulence on an idealized polar cap. Once formed, the crystals are long lived and survive until the end of the simulations (300 crystal-rotation periods). We identify a fundamental length scale, Lγ=(U/γ)1/3, characterizing the size of the crystal in terms of the mean-square velocity U of the fluid and the polar parameter γ=fp/a2p, with fp the Coriolis parameter at the pole and ap the polar radius of the planet.

Some colleges, departments, and study abroad offices have developed cultural development courses and study abroad opportunities designed to help improve students' cultural awareness, knowledge, and skills. Some evidence suggests combining these approaches can be effective at helping students increase their Cultural Intelligence (CQ). This study examined the effects of a combined semester long, on-campus cultural development course followed by either a three- or six-week faculty-led study abroad program on student CQ. Students in both short-term programs increased in all four CQ domains (motivation, cognitive, metacognitive and behavior CQ) relative to a comparison group. No differences were found between the three- and six-week program for motivation, cognition, and behavior. However, there was a significant difference in metacognitive CQ between the two programs. Our study suggests participating in a semester-long cultural development course prior to a short-term study abroad increases undergraduate students' motivation, cognitive, metacognitive, and behavior CQ.

Defining the central components of an intervention is critical for balancing fidelity with flexible implementation in both research settings and community practice. Implementation scientists distinguish an intervention's essential components (thought to cause clinical change) and adaptable periphery (recommended, but not necessary). While implementing core components with fidelity may be essential for effectiveness, requiring fidelity to the adaptable periphery may stifle innovation critical for personalizing care and achieving successful community implementation. No systematic method exists for defining essential components a priori. We present the CORE (COmponents & Rationales for Effectiveness) Fidelity Method--a novel method for defining key components of evidence-based interventions--and apply it to a case example of reciprocal imitation teaching, a parent-implemented social communication intervention. The CORE Fidelity Method involves three steps: (1) gathering information from published and unpublished materials; (2) synthesizing information, including empirical and hypothesized causal explanations of component effectiveness; and (3) drafting a CORE model and ensuring its ongoing use in implementation efforts. Benefits of this method include: (1) ensuring alignment between intervention and fidelity materials; (2) clarifying the scope of the adaptable periphery to optimize implementation; and (3) hypothesizing--and later, empirically validating--the intervention's active ingredients and their associated mechanisms of change.

The COVID-19 pandemic, and associated social distancing mandates, has placed significant limitations on in-person health services, requiring creative solutions for supporting clinicians engaged in the diagnosis of autism spectrum disorder (ASD). This report describes the five virtual instruments available at the time of manuscript development for use by experienced clinicians making diagnostic determinations of ASD for toddlers across the 12- to 36-months age range. We focus on synchronous virtual assessments in which clinicians guide the child's caregiver through a range of assessment activities and observe spontaneous and elicited behaviors. Assessments are compared on dimensions of targeted behavioral domains, specific activities and presses employed, scoring approaches, and other key logistical considerations to guide instrument selection for use in varied clinical and research contexts.

Although naturalistic developmental behavioral interventions have a sizable and growing evidence base for supporting the development of children on the autism spectrum, their active ingredients and mechanisms of change are not well understood. This study used qualitative content analysis to better understand the intervention process of a parent-mediated naturalistic developmental behavioral intervention. Caregivers completed weekly written reflection responses as they learned each intervention technique. These responses were coded, and code co-occurrences were examined to understand the relationship between implementation of specific intervention techniques and potential mechanisms of change according to caregiver observations. The responses were subsequently compared to a theoretical causal model derived from the intervention manual. Many responses were consistent with the intervention theory; however, some theoretical outcomes were not reported by caregivers, and caregivers described some potential mechanisms that were not explicitly stated in the intervention theory. Importantly, we found that individual techniques were associated with various mechanisms, suggesting that global measures of social communication may be insufficient for measuring context-dependent responses to individual intervention techniques. Our findings point to specific observable behaviors that may be useful targets of measurement in future experimental studies, and as indicators of treatment response in clinical settings. Overall, qualitative methods may be useful for understanding complex intervention processes.

This mixed methods analysis examined provider perspectives on barriers and facilitators to parent training use with Medicaid-enrolled clients. Provider survey data were analyzed using hierarchical linear regression models and thematic analysis was used to analyze follow-up interviews with providers. Qualitative themes were developed inductively from interview transcripts without preconceived hypotheses. Barriers and facilitators were identified at the family-, provider-, and organization-level. Family-level barriers were the only barriers to uniquely predict parent training extensiveness ([beta] = -0.27, p = 0.007), which is a composite measure of parent training frequency and quality. No facilitators uniquely predicted extensiveness, but provider skills and professional training experiences marginally predicted extensiveness (ps < 0.06). Five themes regarding barriers to parent training emerged as follows: logistical barriers, limited family engagement/interest, limited agency support/norms, limited professional training, and family stressors/family structures. Four themes about facilitators emerged as follows: logistical facilitators, agency support/norms, high family engagement/interest, and professional training. Recommendations are provided to increase the use of parent training in low-resourced community settings.

We systematically reviewed research on interventions designed to increase service access for children with special healthcare needs through family empowerment, defined as caregiver's knowledge, attitudes, and behaviors to meet their family's needs. The purpose was to describe these interventions, evaluate the evidence, and understand their relevance for increasing service access for children with autism spectrum disorder. Identified studies (n = 25) showed consistent improvements in knowledge and attitudes, limited assessment of behavior, and mixed outcomes for service access, suggesting a need for greater understanding of how to empower families to meet their service needs. Future research should aim to integrate theory across development, application, and evaluation of interventions, while considering alternative approaches that put more responsibility and burden on systems of care.

Parent training programs focus on parent knowledge and/or skill development regarding strategies to improve child outcomes. Parent training programs are considered evidenced-based treatments for autism spectrum disorder (ASD). Yet little is known about parent training use for youth with ASD served in community settings. This mixed methods project examined parent training for Medicaid-enrolled youth with ASD under age 21. Data were obtained from Medicaid claims for 879 youth and surveys from 97 applied behavior analysis (ABA) providers. Open-ended survey items were analyzed with content analysis. Results demonstrated that the frequency of parent training was low and providers' conceptualization of parent training was inconsistent with evidence-based models. Providers are largely unaware of evidence-based components (i.e., modeling, caregiver practice with feedback) and use them infrequently. Implications for increasing parent training in community settings are discussed.

Parental self-efficacy, parents' beliefs in their ability to successfully parent their child, plays an important role in family outcomes when a child has autism spectrum disorder. It is important to consider therapeutic self-efficacy, one's feelings of self-efficacy regarding their implementation of an intervention, within parent-mediated interventions. The goal of this mixed methods study was to better understand factors that relate to parents' therapeutic self-efficacy when implementing a telehealth-based parent-mediated intervention. Participants were 51 parents of children with autism spectrum disorder between 17 and 83 months old. Parents reported generally high therapeutic self-efficacy, and global parental self-efficacy was significantly related therapeutic self-efficacy. Thematic analysis of parents' written reflections of the intervention's lessons identified four themes that related to therapeutic self-efficacy: the importance of a good fit between the child's skills and the intervention, the importance of a good fit between the parent's interaction style and the intervention, environmental factors support intervention use, and the importance of the child's response to the intervention. Several themes differed for parents with higher and lower therapeutic self-efficacy. Findings suggest that global parental self-efficacy plays an important role in parental therapeutic self-efficacy in parent-mediated interventions. Coaches should specifically ask about the child's skills, parent's interaction style, environmental challenges, and child's response as they support parents in learning.