New England Center for Children

Asynchronous electronic consults, or eConsults, are a novel way for pediatric infectious disease (PID) physicians to provide non-urgent specialty advice to other clinicians. We sought to evaluate the first 5 years of a PID eConsult program with a specific focus on the utility, acceptability, and sustainability of the program. Data were abstracted from the electronic medical records for eConsults completed from March 2018 through October 2023 including patient and referring provider characteristics and consultation information. Recommendations were analyzed for content. Referring providers were surveyed to assess their experience and satisfaction with the eConsult service. In the first 5 years of the program, 727 eConsults were completed. In 461 consultations (64.8%), the PID clinician suggested a change to the plan (new or additional diagnosis, diagnostic study, and/or therapeutic intervention) with 81.8% including counseling for the referring provider or patient. Of referring provider survey responders, 98.3% were satisfied/very satisfied with the eConsult program. Only 3.4% of respondents were dissatisfied with the turnaround time although 22% still found traditional "curbside" telephone calls to be more valuable than eConsults. Both the number of individual referring providers and the number of referring practices increased steadily over 5 years. Asynchronous eConsults present a novel platform for PID specialists to formally provide recommendations. A majority of recommendations changed the diagnostic plan and treatment while providing education to both patients and referring providers. Our program demonstrated acceptance of this consulting format from referring providers and sustainability over the first 5 years of the program.

ABSTRACT Assent refers to the willingness to participate in a specific activity, such as research, by someone who cannot legally provide consent. In early childhood development (ECD) research, seeking assent is often flexible and not a legal requirement. This study used a mixed methods approach to explore parents’ perspectives on assent procedures. A relational communication pathways model is presented for obtaining authentic assent from children aged 0-8, emphasizing the triadic relationship between parent, researcher, and child. A bilingual (Arabic and English) online survey was completed by 490 parents (87% mothers, 13% fathers) in the United Arab Emirates. Findings showed that 86% of respondents preferred researchers to seek assent from their child, and 67% would respect their child’s dissent. However, 50% would try to convince their child to continue if the research had already begun. Participants emphasized the importance of ongoing communication and relationship-building efforts for successful engagement with young children.

Objectives This review summarizes research on Parent Training (PT) in the context of teaching activities of daily living (ADLs) to children with developmental disabilities or autism. Methods Researchers searched APA PsycInfo for peer-reviewed articles published through 2023. Articles were screened to ensure that studies included PT, participants included parents or caregivers of children with autism or developmental disabilities, and activities of daily living were taught. Researchers also reviewed the reference lists of the articles found via PsycInfo for additional articles. Results All studies employed experimental designs, and most parents met mastery criteria, suggesting that the PT interventions were generally efficacious in changing parent behavior. Due to a lack of comparative analyses and consistently reported efficiency measures, we were not able to draw conclusions about the most efficacious or efficient PT methods. Most studies included an assessment of social validity, but only four studies involved the child in assessing social validity. Conclusions The literature provides support for the efficacy of PT interventions for ADLs. However, this area of literature would benefit from intervention comparisons, detailed data on efficiency of training, and the assessment of social validity with parents and children and multiple points in the intervention process.

Abstract Individuals diagnosed with autism spectrum disorder (ASD) often engage in stereotypic behavior that is challenging to treat due to difficulties isolating the maintaining reinforcer. The purpose of this study was to identify and treat motor stereotypy in an infant at risk of ASD. Although several studies have investigated the prevalence and topographies of stereotypy in young children, none have identified the age at which it emerges and treated it before 1 year of age. Redirection of stereotypy to toy play and reinforcement for toy engagement was implemented in a multiple baseline design across topographies of stereotypy. Results indicate decreases in all topographies of stereotypy to near‐zero levels across the course of the study. These findings are discussed as they relate to the implications of identifying stereotypy in infancy and intervening as soon as it is identified.

Differential reinforcement of alternative behavior (DRA) without extinction is an effective intervention for reducing problem behavior maintained by socially mediated reinforcement, particularly when implementing dense schedules of reinforcement for appropriate behavior. Thinning schedules of reinforcement for an alternative response may result in resurgence of problem behavior. Resurgence may be of particular concern in the treatment of problem behavior without extinction because problem behavior that resurges is also likely to encounter reinforcement and thus can be expected to maintain. In the present investigation, we compared the effectiveness of single and concurrent DRA schedules in decreasing the probability of resurgence when problem behavior continues to produce reinforcement throughout all phases of the evaluation. Concurrent DRA schedules reduced or eliminated the likelihood of resurgence compared with a single DRA schedule during a treatment challenge.

We have carefully studied the properties of linear fractional transformations on the Euclidean plane; it is now time to look elsewhere. There are many possible candidates for exposition but probably the single most important is hyperbolic space. The hyperbolic plane was the original example of a non-Euclidean space—that is, a geometry that satisfied all of Euclid’s axioms for plane geometry save for what is now known as the Fifth Postulate.

The previous chapter dealt almost exclusively with the problem of constructing various models of the hyperbolic plane and hyperbolic 3-space and showing that we could get the isometry groups via linear fractional transformations. This chapter will reap the rewards of our hard work: we will start by using the techniques we have developed to understand the geometry of these spaces; we will end by using these spaces to prove results about the groups $$PSL(2,{\mathbb {R}})$$ and $$PSL(2,{\mathbb {C}})$$ . Thus, we will see that the group theory and the metric geometry feed each other, enriching both.

In Chapters 1 and 2 , we studied the properties of linear fractional transformations; I motivated this as a means of understanding certain kinds of geometries. Now is a good time to make good on this promise: we are going to see how convenient inversive geometry is when attacking various problems that would have given the ancient Greeks and later geometers trouble.

The use of effective reinforcers is paramount to the effective treatment for individuals with intellectual or developmental disabilities (IDD). Reinforcers, however, are both idiosyncratic and potentially ephemeral, which can make their identification challenging. Because reinforcers cannot be identified a priori (i.e., before they are delivered contingently and their effect on behavior is observed), behavior analysts have focused on methods that may predict which stimuli and events will function as reinforcers. This chapter reviews the research on stimulus preference assessments (SPA) that has led to a robust technology for individually delivered assessments to (1) identify preferred stimuli that may function as reinforcers, and (2) validate those preferred stimuli function as positive reinforcers. Additionally, this chapter reviews the research on teaching others to implement stimulus preference assessments. The chapter concludes with recommendations and considerations related to best practices in using stimulus preference assessments.