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Health, Medicine, Nursing
Critical Review: Psychology (Article Critique Sample)
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Lesack, R., Bearss, K., & Celano, M. (2014).Parentâ€“Child Interaction Therapy and Autism Spectrum Disorder: Adaptations with a Child with Severe Developmental Delays. Clinical Practice in Pediatric Psychology, 2(1), 68-82
Parentâ€“Child Interaction Therapy and Autism Spectrum Disorder: Adaptations with a Child with Severe Developmental Delays is a study that was undertaken by William G. Sharp Roseanne Lesack, Karen Bearss and Georgia Marianne Celano from Emory University School of Medicine and Marcus Autism Center, Atlanta. The aim of the study was to apply Parent -Child interaction therapy (PCIT); a training program that was developed for typically developing children that has shown great potential for children with Autism Spectrum Disorder (ASD), to children with ASD, pronounced developmental delays as well as aggression, non compliance and tantrums.
The caregivers at home and in community setting lack efficient and effective support presenting a major public health need. There is also need to identify and study interventions that are effective in reducing recurrent problem behaviors of children with ASD that present safety concerns like aggression, elopement and disruption, these behaviors also interfere with the educational programming of the child.
Participant: Kevin a five year boy is the main participant of the study. He was diagnosed with Autism Spectrum disorder. Clinical observations by a licensed psychologist show that he had significant language delay and no use of compensatory strategies. His vocalizations were non directed and lacked communicative intent. Kevin had elevated problem behavior as reported by the parent which included; non compliance, self- injury, aggression, tantrums and dangerous behavior. Kevin also exhibited multiple stereotypic behavior and very low instances of eye contact.
Measures: In PCIT, progress is evaluated by using Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999) the parentâ€™s report of the childâ€™s problem behavior. Progress was also measured through direct observation of the Parent- Child interaction during treatment sessions. The Dyadic Parentâ€“Child Interaction Coding System, 3rd edition (DPICS; Eyberg,
Nelson, Duke, & Boggs, 2004) was used in assessing these interactions.
Setting: The sessions were done weekly lasting forty five minutes each. Kevin and his mother participated in them. The treatment was at a specialized center for children with ASD. Sessions were conducted in a room that had a way mirror which was used to observe the parent child interactions. A microphone linked the therapy room to the observation room. Communication to Kevinâ€™s mother was through an ear bug device.
Method: The study used two intervention procedures
* Child Directed Interaction.
It involved repeating vocalization with the appropriate communicative intent followed by correct word(s) for the item(s) or action(s). (Example "Ahâ€™ you said â€˜ballâ€â€). The parent was instructed to ignore non functional and stereotypic vocalizations.
* Parent Directed Interactions
This involved using the name of the child as a prompting cue before issuing a command. They also adopted three step prompting method to introduce target commands, that is; verbal, model and physical prompting. Gesture cues were used for all commands.
* Time out
Time out was introduced for a target command after three consecutive compliances to a command involving verbal and model prompting. There was a reduced sit requirement that was increased with successful sitting. The holding chair was used as a backup time out procedure.
Results: At the end of the sessions, Kevinâ€™s mother was able to successfully give direct commands. She offered praise contingent on Kevinâ€™s compliance with demands with minimal coaching required. The time out procedure was correctly implemented. Kevinâ€™s mother expressed confidence in using PCIT at home and community settings.
Conclusion: Compared to other validated intervention for ASD, PCID offers an intervention that can be used in multiple settings given appropriated adaptations are identified and made. This approach is also economical offering an intervention that parents can implement at home and public places with relatively minimal clinical contact. Further research should be done to evaluate the best treatment elements for optimal clinical outcomes as well as to develop treatment guidelines specific to this population.
Description of Participants and Setting
In this single research study the participant was well described. The age, gender and diagnosis details are clear. The participant is a five year old boy that was diagnosed with autism spectrum disorder through an external evaluation. The clinical observations of the participant made by licensed psychologists are included in depth. The clinical interview and behavioral observations were done in accordance to the diagnostic criteria specified in the American Psychiatric Association. Description of the participant is exhaustive and sufficient enough to enable someone to identify individuals with the same characteristics.
Kevin was not selected for participation but was referred to the PCIT program because of his parentâ€™s report of elevated problem behavior. Evaluation of Kevin prior to treatment showed markedly low eye contact, low levels of functional vocalizations, stereotypic behaviors and disruptive behaviors at a high rate. This study may be replicated in children who exhibit characterizes similar to those exhibited by Kevin before commencements of treatment as potential participants.
The physical setting of the study is clearly included; the study took in a specialized center for children with ASD. The room were treatment was done is described as having a one way mirror used for observation of Parent -Child interaction by the psychologist. The means through which communication between the parent and psychologist took place is also mentioned. The duration of each session and the entire treatment is also specified.
Dependent variables are divided into two based on the phases. The first phase called Child Directed Interactions (CDI) that was aimed at teaching the care giver to follow the child lead during play. The aim is to increase the â€˜do skillsâ€™ and minimize the â€˜donâ€™t skillsâ€™. The participantâ€™s mother was also encouraged to perform five minutes CDI skill practice session at home. The homework completion rate were reviewed and recorded at the beginning f each session. The second phase involves Parent Directed Interactions (PDI) that was used to teach the parent how to issue direct commands. The dependable variables have been described with clarity in the study.
The dependable procedure is quantifiable. The study gives the mastery criteria for PDI as that during a five minute period the caregiver should give a direct command seventy five percent of the time and follow through with treatment procedures after issuing a command seventy five percent of the time.
The measurement of the dependable variable is through the use Eyberg Child Behavior Inventory to report the childâ€™s problem behavior and Dyadic Parentâ€“Child Interaction Coding System to measure the parent child interaction during sessions. These tools of measurement valid and can be replicated in a similar study.
The dependent variables were consistently measured during each session over the fifteen week period that the treatment took place. The homework completion rate was also measured. The Interobserver agreement was eighty three percent which is above minimal standards. It was calculated by total agreements of parent category divided by total agreements and disagreements.
The dependent variable in this case study was selected for its social significance. The "Do" Skills like Behavior descriptions, reflections, and labeled praise are encourage for the healthy development of any child. Donâ€™t Skills like Questions, commands, and negative talk are discouraged and should be used less often by care givers. It is important for caregivers in the home and community setting to be able to effectively issue a command to their children with ASD so as to ensure fewer struggles when raising them and effectively deal with such behavior as aggression, elopement, disruption and other hazardous behavior.
The independent variable in this study is the Time- out Procedure...
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