This article suggests that while mental health problems affect 10—20% of children and adolescents worldwide, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. The authors review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems.

Child and adolescent mental health worldwide: evidence for action

Diagnostic and Statistical Manual of Mental Disorders(DSM)-5による分類と診断 (特集 周産期メンタルヘルス : 妊婦の不安とどう立ち向かうか)

This study analyzes the technologies most widely used to work on areas affected by the Autistic Spectrum Disorder (ASD). Technologies can focus on the strengths and weaknesses of this disorder as they make it possible to create controlled environments, reducing the anxiety produced by real social situations. Extensive research has proven the efficiency of technologies as support tools for therapy and their acceptation by ASD sufferers and the people who are with them on a daily basis. This article is organized by the types of systems developed: virtual reality applications, telehealth systems, social robots and dedicated applications, all of which are classified by the areas they center on: communication, social learning and imitation skills and other ASD-associated conditions. 40.5% of the research conducted is found to be focused on communication as opposed to 37.8% focused on learning and social imitation skills and 21.6% which underlines problems associated with this disorder. Although most of the studies reveal how useful these tools are in therapy, they are generic tools for ASD sufferers in general, which means there is a lack of personalised tools to meet each person's needs.

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Technologies as Support Tools for Persons with Autistic Spectrum Disorder: A Systematic Review

We provide an empirically updated Skinnerian-based account of verbal behavior development, describing how the speaker-as-own-listener capability in children (the capability of children to behave as speaker and listener within their own skin) accrues and how it is pivotal to becoming verbal. The theory grew from (a) findings in experiments with children with and without language delays and (b) findings from research devoted to the identification of derived and emergent behavior (i.e., novel, creative, and spontaneous behavior). Experiments identified preverbal instructional histories leading to separate listener and speaker capabilities and experiences that joined the listener and the speaker. Once this learned intercept is present, children engage in conversational self-talk, engage in say-do correspondence, and acquire new vocabulary without direct instruction. These developmental capabilities make it possible for most complex behavior to be learned, including reading, writing, emission of novel tenses and suffixes, and the following of and construction of complex algorithms.

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The Integration of Speaker and Listener Responses: A Theory of Verbal Development

Objective We updated a prior systematic review of interventions for children (0–12 years) with autism spectrum disorder (ASD), focusing on recent studies of behavioral interventions. Data sources We searched the MEDLINE® (PubMed®), PsycInfo, and Educational Resources Information Clearinghouse (ERIC) databases as well as the reference lists of included studies and recent systematic reviews. We conducted the search in December 2013. Methods We included comparative studies (with treatment and comparison groups) of behavioral interventions with at least 10 participants with ASD in the update, and made our conclusions based on the cumulative comparative evidence across the original report and update. Two investigators independently screened studies against predetermined inclusion criteria and independently rated the quality of included studies. Results We included 65 unique studies comprising 48 randomized trials and 17 nonrandomized comparative studies (19 good, 39 fair, and 7 poor quality) published since the prior review. The quality of studies improved compared with that reported in the earlier review; however, our assessment of the strength of evidence (SOE), our confidence in the stability of effects of interventions in the face of future research, remains low for many intervention/outcome pairs. Early intervention based on high-intensity applied behavior analysis over extended timeframes was associated with improvement in cognitive functioning and language skills (moderate SOE for improvements in both outcomes) relative to community controls in some groups of young children. The magnitude of these effects varied across studies, potentially reflecting poorly understood modifying characteristics related to subgroups of children. Early intensive parent training programs modified parenting behaviors during interactions; however, data were more limited about their ability to improve developmental skills beyond language gains for some children (low SOE for positive effects on language). Social skills interventions varied in scope and intensity and showed some positive effects on social behaviors for older children in small studies (low SOE for positive effects on social skills). Studies of play/interaction-based approaches reported that joint attention interventions may demonstrate positive outcomes in preschool-age children with ASD when targeting joint attention skills (moderate SOE); data on the effects of such interventions in other areas were limited (low SOE for positive effects on play skills, language, social skills). Studies examining the effects of cognitive behavioral therapy on anxiety reported positive results in older children with IQs ≥70 (high SOE for improvements in anxiety in this population). Smaller short-term studies of other interventions reported some improvements in areas such as sleep and communication, but data were too sparse to assess their overall effectiveness. Conclusions A growing evidence base suggests that behavioral interventions can be associated with positive outcomes for children with ASD. Despite improvements in the quality of the included literature, a need remains for studies of interventions across settings and continued improvements in methodologic rigor. Substantial scientific advances are needed to enhance our understanding of which interventions are most effective for specific children with ASD and to isolate elements or components of interventions most associated with effects.

Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update

Several reports have demonstrated the emergence of the Naming capability as a function of multiple exemplar instructions (MEI). We compared singular exemplar instruction (SEI) and (MEI) on emergence of untaught listener and speaker responses (Naming) by preschool children who were missing Naming using combined experimental-control group and nested single-case multiple probe designs. We taught training sets of pictures using MEI to 4-participants and the same sets using SEI to another 4-participants with numbers of instructional presentations for SEI participants matched to the MEI participants. Naming emerged for the MEI group but did not for the SEI group. Subsequently, the SEI participants received MEI and Naming emerged. Instructional histories that involve the rotation of speaker listener responding appear to predict the emergence of Naming. We discuss the findings in terms of the relation of the MEI as the source of Naming as a higher order operant and whether or not Naming is a relational frame.

Emergence of Naming in Preschoolers: A Comparison of Multiple and Single Exemplar Instruction

We tested the effects of an intensive tact instruction procedure on numbers of tacts emitted in non-instructional settings (NIS) using a multiple probe design across 3participants (3and 4-year old boys with autism). The dependent variable was tacts emitted in NIS before/after the mastery of sets of 5 different stimuli. The non-instructional settings included the toy area of the classroom, lunchtime, and the school hallway during transition. All probe sessions were conducted daily for a cumulative 15 minutes, 5 minutes in each NIS. Intensive instruction involved increasing the tact instructions to 100-tact learn units above the daily learn units students were receiving daily. The intervention increased vocal verbal operants (tacts and mands) emitted by the target students in NIS. ********** One of, if not the, strongest predictors of schools school success is language (Weikart, 1966). Children with native intellectual disabilities and children from impoverished backgrounds frequently lack functional verbal repertoires when they enter schools. Hart and Risley (1995) found that limited exposure to rich language experiences early one in life is a predictor of language deficits in children from low socioeconomic backgrounds. They found that children from low socioeconomic (SES) backgrounds added an average of "168 words in the 6 months from 30-36 months [while] the children in professional families added an average of 350 or twice as many" (Hart & Risley, 1995, p. 164). From early on, these children develop language and expand their vocabulary at the much slower rate than their peers from the middle class families and over time this gap widens exponentially (Greenwood, Hart, Walker, & Risely, 1994). Woods (1984) found that children with similar low SES backgrounds also emit fewer verbal interactions than their same-age peers from middle class families. When children with native disabilities lack certain verbal capabilities, they inadvertently have infrequent language experiences. Even when children with deficits in language experiences receive behavioral language interventions, their prior lack of language experiences call for the provision of intensive language learning instruction (Greer, Chavez-Brown, Nirgudkar, Stolfi, & Rivera-Valdes, 2005; Greer & Keohane, 2005; Greer, Stolfi, Chavez-Brown, & Rivera-Valdes, 2005). For both types of children intensive language experiences are needed to compensate for deficits in experiences. According to Woods, when the verbal antecedents from the parents were absent, children with native disabilities were usually silent, whereas typically developing children were more likely to have nonverbal antecedents. That is these children were less likely to emit "spontaneous" speech. It appears that typically developing children were more likely to respond to nonverbal antecedents or initiate verbal interactions--that is they responded to the natural establishing operations that control this type of verbal functions. Skinner (1957) characterized these spontaneous verbal initiations as pure mand and pure tact verbal operants. While pure mands are important, building the tact repertoire is most critical to the expansion of verbal repertoires. One reason children with disabilities are often observed not to emit pure tacts apart from instructional setting is that the tact that they are taught is often under the partial antecedent of the verbalizations control of others; that is, impure rather than pure tacts are taught. One may teach the pure tact repertoire by avoiding verbal antecedents may and bringing the tact responses of the student under natural establishing operations. Indeed, Williams and Greer (1993) found that when the establishing operations for pure mands and tacts where incorporated in teaching tacts and verbal antecedents were avoided, their participants emitted more of what is typically characterized as spontaneous speech or the initiation of language interactions. …

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The Effects of Daily Intensive Tact Instruction on Preschool Students' Emission of Pure Tacts and Mands in Non-Instructional Setting.

In this experiment we tested the utility of conditioning voices as reinforcers for listening on (a) acquisition of curricular objectives; (b) attention to, or awareness of, the presence of adults and their voices; (c) preferences for listening to stories in a free-play setting; and (d) emission of stereotypy in the story setting. From a theoretical perspective, the experiment addresses the verbal behavior developmental theory (VBDT) position that conditioned reinforcement for attending to voices is a developmental cusp that makes it possible for children to learn from instruction (Greer & Ross, 2008; Greer & Speckman, 2009). From an applied perspective, the experiment tests a procedure for its usefulness in making it possible for children with severe delays to accelerate learning, choose to listen to adults tell stories in a free play setting, and acquire awareness of adults in their environment.

According to the VBDT, the presence of prerequisite and co-requisite behavioral developmental cusps makes it possible for children to make contact with the instructional benefits of environmental experiences. Rosales-Ruiz and Baer (1996) introduced the notion that behavioral developmental cusps enable children to learn new operants because the new behavioral cusps allow the children to get in touch with the contingencies that follow contact with new aspects of their environment. The newly acquired cusp results in the ability to learn what a child could not learn before and accelerates the establishment of new stimulus control (Greer & Keohane, 2005; Greer & Ross, 2008; Greer & Speckman, 2009).

Developmental cusps may also include the establishment of conditioned reinforcers for observing responses (Keohane, Pereira-Delgado, & Greer, 2009). Studies on the effects of conditioning reinforcers for observing responses have reported accelerated learning of responses associated with the newly conditioned reinforcers for observing responses (Dinsmoor, 1983; Keohane, Luke, & Greer, 2008; Keohane et al., 2009; Pereira-Delgado, Greer, Speckman, & Goswami, 2009; Tsai & Greer, 2006). The observing responses are new operants (Holland, 1958) and these new operants make it possible to acquire discriminative stimulus control that was previously difficult if not impossible to attain.

Some current theories of verbal behavior suggest that “to be truly verbal,” listener and speaker repertoires must be joined such that children have naming (Horne & Lowe, 1996; Greer, Stolfi, Chavez-Brown, Nirgudkar, & Rivera-Valdes, 2005; Greer, Stolfi, & Pistoljevic, 2007; Pistoljevic, 2008), self-talk conversational units (Lodhi & Greer, 1989), and say-do correspondence (Paniagua & Baer, 1982). While these recent expansions of Skinner's (1957) theory incorporate greater attention to the listener than Skinner did in his initial analysis, Skinner's notion that verbal behavior often requires behaving simultaneously as both listener and speaker was also implicit in his initial thesis. The VBDT proposes that the learning and developmental processes leading to the intercept of the initially independent speaker and listener repertoires requires acquisition of separate speaker and listener cusps. These are foundational cusps that must be present if the listener and speaker repertoires are to be joined (Greer & Keohane, 2005; Greer & Ross, 2008; Greer & Speckman, 2009; Keohane et al., 2008).

One of the key developmental cusps that would appear to be necessary, even before what is spoken has a listener function, is the capacity to be reinforced for attending to voices. Research with young typically developing and sensorially intact infants reported that the voices of mothers are a conditioned reinforcer for observing at birth (DeCasper & Spence, 1987). These data propose that the conditioning process occurred in the uterus. In other words, the mother's voice is paired with feeding in the uterus, which conditions the mother's voice as a reinforcer for listening (DeCasper & Spence, 1987). The mother's voice then selects out the infant's attention and the infant responds to her voice significantly more than a stranger's voice (DeCasper & Spence; Ockleford, Vince, Layton, & Reader, 1988). This pairing may not occur or may be defective in some children.

Typically developing children acquire aspects of their parents' language without special instruction or direct reinforcement (Bijou & Baer, 1965; Hart & Risley, 1995; Moerk, 1990; Mowrer, 1954; Novak, 1996; Schlinger, 1995). Some suggest that such incidental learning is traceable to automatic reinforcement for emitting speech that corresponds to what the child hears spoken (Skinner, 1957; Vaughan & Michael, 1982). Of course, the sound of what is spoken by the child can only automatically reinforce her/his speech if attending to the voice of adults is a conditioned reinforcer for observing or attention to voices. This is thought to occur naturally as a result of the pairing of the voice with an established form of reinforcement as proposed by Schlinger (1995).

For more than four decades, stimulus-stimulus pairing procedures have been successfully used to expand the pool of stimuli that function as reinforcers for behavior or an individuals' community of reinforcers, by teaching children to prefer previously non-preferred stimuli via stimulus-stimulus pairings (Greer, Becker, Saxe, & Mirabella, 1985; Greer, Dorow, & Hanser, 1973; Greer, Dorow, Wachhaus, & White, 1973; Keohane et al., 2008; Longano & Greer, 2006; Nuzzolo-Gomez, Leonard, Ortiz, Rivera, & Greer, 2002; Pereira-Delgado et al., 2009; Tsai & Greer, 2006). Existing evidence appears to affirm the role of conditioned reinforcers as a behavioral explanatory construct (Williams, 1994).

Research on stimulus-stimulus pairing to condition reinforcers in experimental analyses in applied settings can be separated into two categories, with the conditioned reinforcement as either (a) the dependent or (b) independent variable. When conditioned reinforcement has been treated as the dependent variable, stimulus-stimulus pairings have been used to condition books as reinforcers for observing responses, previously non-preferred music as a newly conditioned reinforcers for choice responses (Greer, Dorow, Hanser, 1973; Greer, Dorow, Wachhaus, et al., 1973; Greer, et al., 1985), books as reinforcers for observing responses in free play, or toys and computer screens as reinforcers for observing (Longano & Greer, 2006; Nuzzolo-Gomez, et al., 2002). Sundberg, Michael, Partington, and Sundberg (1996), Yoon (1998), and Yoon & Bennett (2006) also reported that pairing preferred stimuli with hearing vocal sounds emitted by adults resulted in increases in children emitting parroting responses (Skinner, 1957) in free play settings.

In some of the studies (Greer, et al. 1985; Longano & Greer, 2006; Nuzzolo, et al. 2002), the newly conditioned reinforcers for play or observing responses also resulted in significant decreases in, or elimination of, stereotypical behaviors in free play. This led the authors of these papers to suggest that building new reinforcers results in the new reinforcers displacing automatic reinforcers for stereotypy for some children, since the newly conditioned reinforcers resulted in allocation of responding to the new reinforcers rather than the emission of stereotypy (Greer et al., 1985; Nuzzolo-Gomez, et al., 2002).

Other experiments have treated the acquisition of conditioned reinforcement as an independent variable. This research has built upon the foundation of stimulus-stimulus pairing, using the procedure to induce conditioned reinforcers for observing responses that are related to instruction. These studies reported accelerated rates of learning of tasks that involved visual and textual stimuli (Pereira-Delgado et al., 2009; Tsai & Greer, 2006) and discriminated responding in pigeons (Dinsmoor, 1983) as a function of acquisition of conditioned reinforcers for related observing responses. In these experiments, the acquisition of conditioned reinforcers was the independent variable (i.e., the stimulus-stimulus procedures was a means to induce conditioned reinforcers), and the effects of newly conditioned reinforcers for observing responses on rates of learning served as the dependent variable.

According to verbal behavior developmental theory, when the cusp of phonemic control is missing, the child lacks basic listener literacy (Greer, Chavez-Brown et al., 2005). Basic listener literacy or phonemic awareness is defined as responding discriminatively to two or more different vowel-consonant combinations (Crystal, 2006). Greer et al. demonstrated that eight children who lacked the basic listener cusp (i.e., the children did not respond accurately to vocal instructions) could be taught to do so in a procedure that involved an intensive immersion in listener instruction. However, for this protocol or instruction in listener responding to be successful, it is possible that voices, as conditioned reinforcers need to be present.

We tested whether the acquisition of voices as conditioned reinforcers would result in increases in observation of others, accelerate learning of educational goals that require listener responding, and increase choosing to listen to stories in a free play setting.

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Effects of Conditioning Voices as Reinforcers for Listener Responses on Rate of Learning, Awareness, and Preferences for Listening to Stories in Preschoolers With Autism

Teaching children with autism requires special set of tools and methods, due to decreased level of attention towards stimuli presented and lessened capability to learn in the ways typical children do, which is manifested within this population. It has been previously shown that computer-assisted intervention is not only an effective method for developing various skills, allowing both learning with teachers and practicing on their own time without the teacher's direct attention, but it nonetheless increases the motivation and results in faster acquisition of these skills.

In this paper we present the first step in developing the LeFCA framework, that will be used for teaching children with autism basic skills and concepts. Within the pilot project, we produced four games for developing matching, pointing out (based on visual and auditory stimuli) and labeling skills, which are considered to be primary skills needed for learning. The results of our preliminary study showed that the created software in native language is completely clear and user friendly for kids with Autism and other special needs, and that is systematically and developmentally appropriately sequenced for learning. Additionally, we found that children were able to generalize learned skills, through a transfer to a new medium or environment without any needed training (i.e. computer). All four participants mastered all programs without any instructional tactic needed.

Nirvana Pistoljevic

Papers

Emergence of Naming in Preschoolers: A Comparison of Multiple and Single Exemplar Instruction

The Effects of Daily Intensive Tact Instruction on Preschool Students' Emission of Pure Tacts and Mands in Non-Instructional Setting.

Effects of Conditioning Voices as Reinforcers for Listener Responses on Rate of Learning, Awareness, and Preferences for Listening to Stories in Preschoolers With Autism

"LeFCA": Learning Framework for Children with Autism.

“LeFCA”: Learning Framework for Children with Autism