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Furthermore women's health clinic okc buy cheap female cialis 20 mg, emergent themes suggest that children would be more motivated to engage with materials when they are enabled greater creative freedom breast cancer surgery buy discount female cialis 20 mg online. Collaborative Lego play may provide more opportunities for naturalistic play and would also be more motivating to children if the creative element of the medium was emphasised women's health clinic broadbeach female cialis 20 mg on line. The role of the engineer required use of fairly complex language womens health protection act female cialis 20mg fast delivery, including prepositional language and Lego specific vocabulary pregnancy 9th week generic 20mg female cialis visa. These themes suggest the importance of encouraging children to swap roles frequently within sessions menstruation 10 days delayed cheap female cialis 20mg overnight delivery. This would provide children with the opportunity to practice skills of turn taking but also to ensure that motivation is not adversely affected by remaining in difficult roles for prolonged periods of time. Despite difficulties experienced, children remained interested in Lego therapy and wanted to continue participation in the intervention. Children spoke positively about the intervention and wanted it to occur more frequently Page | 152 It just really starts my week off well and makes me really really happy. Children enjoyed showing others the rewards they have achieved and spoke about feeling proud when they received rewards, for example I quite like them because I feel proud when I get a Lego point. In this study Lego points and certificates were given to reward social behaviour and building (see Appendix 10 for details of the reward system). However, children described feeling proud when receiving rewards, Page | 153 suggesting that extrinsic rewards may play an important role in developing engagement in activities that are not intrinsically motivating. LeGoff (2004) allowed children to exchange Lego points for rewards such as Lego models. This may have increased the motivation to work towards rewards in his sessions, and consequently children may have been more motivated to engage in social behaviour. LeGoff (2004) found that behaviours eventually occurred even when rewards were not offered, and children began to be motivated by social approval. Children did not comment on social approval in this study and related achievements only to individual accomplishments. It is apparent that some children enjoyed being rewarded for things that they found difficult in this study. However, the rewards offered by the intervention were not sufficient to encourage the children to interact with others when they did not want to . The decision was made not to offer tangible rewards in this study because of monetary implications for schools. However, points could be exchanged for time doing something the children enjoy outside of the session, such as going on the computer or building Lego alone. Although some of the rewards offered in Lego therapy in this study were dependent on collective group attainment, no children related successes or rewards to group factors. Children did not allude to the fact that they were motivated to attain collective group goals, and they did not appear to be motivated by social approval within the group. There was a sense that children were not certain about behaviour required to achieve certificates and Lego points, or could not remember why they had been given rewards. An implication for this is that rewards are unlikely to have the desired influence on behaviour. It is important that children are clear about expectations and the behaviour required to achieve rewards. Future Lego therapy groups should ensure that this is made clearer to children, and school staff should be encouraged to adhere to the reward structure. These included a lack of engagement with the research process, acquiescence and recency effects, poor memory for personal events and a difficulty in answering open questions and expressing personal preferences (Preece, 2002). Measures were taken to ensure that such effects were minimised, including using visual aids and a task focus, starting with open questions and narrowing down to more closed questions if required, and reassuring children that there were no right or wrong answers. Furthermore, children were given the option to be accompanied by a familiar adult. This study highlighted the need for prompts to elicit information, however, responses were sufficiently detailed to generate themes and conclusions. Data collected from interviews suggest that children were able to express their views and opinions and children made a worthwhile contribution to the research process. This point is of particular relevance to this study as the interviewer was present in Lego therapy sessions, and thus familiar to the children. The children may have felt a pressure to give favourable responses in the interview and may not have felt comfortable giving negative responses to the researcher. Researchers have recommended that responses are triangulated with perspectives from others close to the child (Preece & Jordan, 2010), however, the decision was taken not to obtain the perspectives of others in this study. Within a post-positivist paradigm it is recognised that an objective reality can only be known imperfectly (Robson, 2011). The reason for this was that seeking the perspectives of others would Page | 156 merely indicate a difference in perspective rather than an objective truth. A method to further increase the validity of responses is respondent validation, in which participants are asked to give their perspective on themes generated. However, it was not feasible to do this in this study because interviews were conducted in the last week of the summer term. Seeking respondent validation after the summer holiday would have reduced the validity of findings, because research suggests that children have poor memory for personal events (Preece, 2002). It is important to recognise that responses given in this study may lack validity, and therefore should not be reported as an objective measure of truth or reality. This study sought to explore factors relating to interest and motivation, and findings should be considered to be illuminative rather than confirmatory. It is also possible that the visual support cards used in the interviews limited the topics of discussion to the aspects of the intervention that featured in the cards, and therefore limited the emergent themes. However, children were given the opportunity to first answer open-ended questions and picture cards were only introduced when the children required prompts. The children were in groups with other children with social communication difficulties, thereby limiting their opportunity for interactions with socially competent peers. This challenges the social inclusion of children participating in the intervention because children were required to spend time away from peers. Page | 157 Children spent time outside of the classroom and thus opportunities to engage with other children in the classroom were reduced. Wolfberg and Schuler (1999) argued that collaborative play with more competent peers provides opportunity for practicing more complex forms of play and to further develop skills in imitation. This study did not provide children with the chance to interact with typically developing peers within the intervention, and thus reduced opportunities to utilise peers as agents for change. Furthermore, Smith and Gilles (2003) suggest that it is important to teach social skills in the environment in which skills are ordinarily required, particularly for children with social difficulties. It was suggested that acquisition, maintenance and generalisation is further promoted when skills are taught in naturalistic environments (Smith & Gilles, 2003). Collaborative play should thus occur in the environment in which skills would be required, and with socially competent peers. It would also promote social inclusion within the school environment, and provide opportunities for authentic collaboration. Possible sources of bias and subjectivity in qualitative analysis include ignoring information that conflicts with hypotheses, over or under-reacting to information, and inconsistency in analysis (Robson, 2011). Measures were taken to overcome the possibility of bias; the philosophical assumptions upon which the analysis was based were clearly stated, the researcher acknowledged their role in the study, and a colleague of the researcher analysed one interview transcription for initial codes. Measures were also taken to ensure that the data were analysed objectively and without bias. One transcription was shared with a colleague of the researcher to ensure that the initial codes were valid. The transcription was analysed by both raters independently, then compared and discussed. It is possible that coding could have been affected by researcher bias as the analysis progressed; however, unfortunately it was not feasible for all data to be coded by an additional rater. Braun and Clarke (2006) discussed the need for researchers to remain reflexive throughout the process of thematic analysis. It is also important to outline Page | 159 potential sources of bias to ensure transparency. It was therefore important to consider potential sources of bias within myself, through being reflexive about my role in the research. I ensured that I remained consciously aware and reflexive throughout the entire research process. Working with children in schools in the local authority highlighted a need for a greater range of quality, evidence-based interventions that can be delivered within the school environment. Aside from the time invested in delivering the programme, I have no investment in the intervention. However, the intervention was already established in 11 schools in the local authority. Lego therapy is currently delivered to schools in the Local Authority, despite there being no research evidence to evaluate its effectiveness when delivered outside of the clinic. Consequently there may be an implicit pressure to demonstrate effectiveness of the intervention. I ensured that I remained consciously aware of this pressure throughout the research process, in order to minimise the chances of it inadvertently biasing my interpretation of the findings. Educational Psychologists commonly recommend interventions to support children, and provide training to staff so Page | 160 that staff can deliver interventions in school. A number of implications have arisen from the emergent themes, and these should be considered when implementing the intervention in the future. Implications relate to both the structure and delivery of the intervention, and are presented in Table 17. This study highlighted ways in which the intervention could be developed in order to promote motivation to engage in collaborative Lego play. Freestyle play enables more creative and naturalistic play, whilst providing opportunities to facilitate social interaction. The emergent theme of Lego as a strength and interest suggests that Lego is an appropriate medium through which to promote engagement in interaction. However, motivation to participate in collaborative play may be further promoted through the use of Lego in naturalistic play. The guidance provided to activity leaders could be applied to naturalistic play, in order to facilitate appropriate and positive social interactions. Group composition should also be carefully considered in order to include socially competent peers. This would promote social inclusion and enable more complex social skills to be practiced and modelled. Page | 161 Future research should further address the importance of rewards in promoting interest and engagement in interventions. This study has indicated that some children enjoyed receiving rewards but some showed little interest. Emergent themes suggested that rewards were administered inconsistently and children lacked an understanding of behaviours which would result in rewards. This study suggests that whilst children spoke positively about interactions with others, children were inherently interested in building alone when they had the opportunity to do so. Further research could explore the impact of rewards on motivation to engage in social behaviours, when rewards are of greater interest to children. Naturalistic Lego play should occur in the environment in which social skills would ordinarily be required, in order to promote generalisation. Swapping roles regularly should be built the facilitator should prompt children to into the programme. Children had the swap roles regularly option to decide how often to take turns and this resulted in children staying in one role for too long Group dynamics can be detrimental to Group dynamics should be considered both intrinsic motivation to participate in when setting up the group. Dynamics the programme and willingness to engage should be monitored as the intervention in interactions with others progresses to ensure that children have the opportunity to experience successful and rewarding interactions with others Training in facilitation should place more emphasis on conflict resolution Group composition should include typically developing peers to increase inclusion, to promote modelling of appropriate behaviour, and to reduce conflicts in groups Page | 163 Conclusions this research study explored Lego therapy as an intervention to promote social competence in children with Asperger syndrome. The first study explored outcomes in social competence following participation in Lego therapy and programme fidelity when the intervention was delivered by school staff.
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If the above has not been helpful here is another plan that may be more beneficial: Day one: Colace or Senokot with Stimulant, take as directed on package insert. Day two: if no results from day one: Dulcolax tablets, two tablets twice this day. Day three: if no results from day one: Dulcolax suppository If no results by the p. Expectations for Pain Relief After Total Hip Replacement Total hip replacement is a great operation. It is highly predictable in terms of improvement in pain, function and quality of life. However, you must be patient to achieve many of these wonderful benefits of the surgery. The high quality pain relief that characterizes a good total hip replacement frequently takes 3 to 6 months to achieve. Stated differently, it is normal for you to still have some pain in your hip for as much as 3 to 6 months after your surgery. The pain relief will come, but you should not expect great relief of pain in less than this time. Higher demand activities (such as going up and down stairs) frequently take 6 to 9 months before patients feel comfortable doing them. It is permissible to go up and down stairs whenever you can safely navigate them but it will take much longer to do them normally and with great confidence. Please plan ahead and call the office for pain medication refills Monday-Friday before 4 p. Please do not hesitate to call us if you have any questions, problems or confusion about your hip or your recovery. L ess th an5 mins to complete Efficacy Scale Scoring:H igh erscore = betterselfefficacy h ttp://patienteducation. L ess th an2 mins to complete Exercise Scoring:H igh erscore = more ph ysicalactivity h ttp://patienteducation. L ess th an2 mins to complete N um ericPain Scoring:H igh erscore = greaterpainintensity R ating Scale h ttp:// L ess th an1 minto complete N um ericScale Scoring:H igh erscore = greaterpainintensity h ttp://patienteducation. L ess th an5 mins to complete Score (O K S) Scoring:O riginalmeth od:lowerscore = betterfunction. L ess th an10 minutes to complete O steoarth ritis Scoring:Subscale scores converted to 0-100 scale. H igh erscore = betteroutcome O utcom e Score Specialconsiderations:C ontains th e W O M A C O A Index3. L ess th an10 minutes to complete O steoarth ritis Scoring:Subscale scores converted to 0-100 scale. H igh erscore = betteroutcome O utcom e Score Specialconsiderations:C ontains th e W O M A C O A Index3. R epeated Stand Specialconsiderations:M ustuse th e same straigh tback ch airwith outarm rests. U sually < 2 minutes Scoring:L owerscore = betterperformance Specialconsiderations:F orsafety,ensure th atth e patientdoes notturnaround inth e middle ofa fligh tofstairs to descend. Th us,modify th e number ofsteps ascended based uponth e available numberofsteps forth e specificfligh tofsteps. Th is testtakes 10-15 minutes to compete and involves a series ofactivities th atch allenge TinettiM obility balance. Cementless Humeral Resurfacing Arthroplasty in Active Patients Less Than Fifty-five Years of Age David S. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active pa tients who were less than fty-ve years of age. Methods: We reviewed prospectively collected clinical data on a series of thirty-six patients under fty-ve years of age with end-stage glenohumeral arthrosis, but without osteonecrosis, who had undergone a cementless humeral resurfacing hemiarthroplasty performed by a single surgeon. We assessed pain, function, and patient satisfaction and documented all complications. Complications included one traumatic subscapularis rupture at six weeks, three cases of arthrobrosis, and one deep hematoma. No obvious radiographic evidence of loosening was noted at the time of the latest follow-up. One shoulder was converted to a stemmed total shoulder arthroplasty at twenty-four months because of pain, but the implant was not loose at the revision. The remaining thirty-ve patients were satised with the outcome at the time of the latest follow-up and had returned to their desired activity. Conclusions: Cementless humeral resurfacing arthroplasty is a viable treatment option for younger, active patients. Implant loosening and glenoid wear do not appear to be concerns in the short term despite the high activity levels of many patients. However, it is not well understood which patients is a condition without an ideal solution. These activities can be performed without affecting the life span of the C patients desire a treatment that will provide pain relief implant. This is particularly true for cemented glenoid compo and restore their ability to perform activities of daily living but nents, which are known to loosen in up to 39% of patients by 1 also, in some cases, that will enable them to return to sports the time of mid-term to long-term follow-up. When nonoperative measures fail, arthroplasty patients participating in collision sports have a theoretical risk of Disclosure: the authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benets (consulting fees associated with course instruction) of less than $10,000 or a commitment or agreement to provide such benets from a commercial entity (Biomet Orthopedics). No commercial entity paid or directed, or agreed to pay or direct, any benets to any research fund, foundation, division, center, clinical practice, or other charitable or nonprot organization with which the authors, or a member of their immediate families, are afliated or associated. A video supplement to this article will be available from the Video Journal of Orthopaedics. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: Preservation of the humeral head allowed the native in made preoperatively, at the rst postoperative visit, at six clination, offset, head-shaft angle, and version of the humerus months, at one year, and then annually thereafter. They were to be maintained, facilitating later revision to a conventional evaluated for loosening, determined by the presence of implant 3,4 total shoulder arthroplasty if needed. Because radiographs were not standardized (they were 5-7 sults of arthroplasty in younger patients. The primary pur made with different techniques and by different technicians as pose of this study was to report the results of cementless the patients were not always seen at the same ofce), the degree humeral resurfacing arthroplasty in a consecutive series of of glenoid erosion, the glenohumeral relationship, and the patients who were younger than fty-ve years of age. F 287 shoulder arthroplasties in patients with symptomatic end-stage glenohumeral arthrosis. All patients were treated diographic evidence of osteonecrosis, with or without any de with a cementless humeral resurfacing arthroplasty that was gree of head collapse, were not considered candidates for this performed by the senior author (D. A rst-generation ceph meral resurfacing arthroplasty might not address bone pain or alosporin was administered intravenously thirty to sixty min structural abnormalities of the humeral head in a patient with utes prior to the incision. A general anesthetic in Conservative treatment, including physical therapy, intra conjunction with a preoperative interscalene block was used articular injections (corticosteroids and/or hyaluronic acid), for all patients. The patient was placed in a semi-reclined and/or arthroscopic debridement, had failed for all patients. The age of fty-ve years or less was chosen because of the A deltopectoral approach was used, with preservation of typical high level of activity of this patient population in our the pectoralis major tendon and the circumex humeral ves community as well as reports in the literature that suggest sels. Aggressive soft-tissue releases of the subscapularis and the possible problems with traditional arthroplasty in this age anterior and inferior aspects of the capsule were performed 1,8 group. In addition, we have had experience with younger when necessary to improve tendon excursion. Many patients in this series had previously ligament and the rotator interval, the inferior aspect of the been told by other medical providers that no options other capsule, the anterior aspect of the capsule, and any anterior than conservative treatment were available. The anterior aspect of the capsule was this study was approved by our institutional review left attached to the subscapularis to enhance suture xation of board, and all enrolled patients provided informed consent to the tendon back to its stump on the lesser tuberosity. Posterior undergo the surgical procedure and follow-up examinations, capsular plication was not performed, and excessive posterior including completion of the rating instruments used in this laxity after implant placement and subscapularis repair was investigation. Treatment options other than cementless hu eliminated with closure of the rotator interval. After 2003, some of these patients were also en biceps was repaired with nonabsorbable suture to the surrounding rolled in a simultaneous multicenter, prospective study of ce rotator cuff tissue at its entrance into the joint at the end of the mentless humeral resurfacing arthroplasty in which no patient procedure. The intra-articular portion of the biceps tendon was age or pathological conditions were specically excluded. Data collected included the suspected etiology of the the cementless humeral resurfacing arthroplasty was 3,4 arthrosis, the visual analog pain score (marked on a 10-cm performed with use of the previously described technique. The most appropriately sized implant was chosen and was oid surface to a more symmetric concavity and to restore placed with respect for anatomic version and inclination, version of the glenoid. Specically, the implant that defects were lled with allograft cancellous bone when they provided the best head coverage was chosen. Full-thickness rotator cuff tears were repaired with use not used; autogenous or allograft cancellous bone was utilized of suture anchors, but partial tears, subacromial impingement, to ll minor humeral head defects. No patient was treated with and arthritis of the acromioclavicular joint were not addressed. Finally, degenerative labral tears were debrided to a stable rim the glenoid was treated in some patients, if clinically prior to placement of the implant. An anatomic repair of the indicated at the time of the surgery and on the basis of ra subscapularis, without medialization or z-lengthening, was diographic ndings (eccentricity of the glenoid and/or cystic always performed regardless of the preoperative range of ex changes). Suture anchor repair was employed along the glenoid type, but biologic resurfacing with a meniscal allograft lesser tuberosity when the subscapularis tendon grossly ap or human dermis allograft (GraftJacket; Wright Medical Tech peared thinner laterally or when we used an implant that nology, Arlington, Tennessee) or microfracture (for focal, con seemed to rest near the insertion after impaction, as the latter tained chondral defects) was performed in some patients. The deltopectoral inter When there was eccentric absence of articular cartilage, the val, subcutaneous tissues, and skin were all closed with ab remaining cartilage was debrided manually to restore the glen sorbable sutures. Three patients underwent cancellous bone-grafting combined with biologic resurfacing with GraftJacket to treat a contained glen oid defect resulting from loosening of screw xation that had been used for a prior coracoid transfer. One patient received a lateral meniscal allograft to treat posterior instability and a decient labrum. Two patients underwent microfracture of small (<1-cm) chondral defects of the glenoid, and eighteen had manual debridement of articular cartilage, but not re aming, to restore uniform concavity to the glenoid fossa. In the eight patients who appeared to have an early, type-B1, glenoid 11 wear pattern according to the system of Walch et al. This grossly restored glenoid version as there was no apparent osseous decit or erosion. Two shoulders in which the anterior articular surface was absent and the posterior surface was intact were treated in a similar manner. In these cases, care was taken to not pene trate deep into the supporting subchondral bone and only enough bone was removed to restore the gross uniform con cave appearance of the glenoid fossa. Four patients had simultaneous repair of isolated rotator 2 cuff tears, which ranged in size from 1 to 4 cm. As mentioned, all patients, even those without path ological involvement of the biceps tendon, underwent a biceps Formal physical therapy was started after the rst postopera tenodesis.
Page | 249 Give details of any other ethical issues which may arise from this project (e women's health clinic kalgoorlie buy female cialis 20mg otc. Once the data has been transcribed the original recordings will be destroyed and transcripts will be stored securely by the researcher menopause irregular bleeding cheap 20mg female cialis visa. I will also provide the children with a full debrief and provide additional time to answer any of their concerns or questions womens health weekly purchase female cialis uk. Page | 250 Page | 251 Appendix 47 Literature Review this literature review has been marked and examined separately from the examination of this thesis breast cancer treatments buy female cialis from india. Relevance of the topic within the Educational breast cancer cakes buy 20mg female cialis overnight delivery, Political and 3 Psychological context 3 women's health clinic greenville tx purchase cheap female cialis. The review provides a theoretical and empirical framework for my research study and enables a critical analysis of the published research. Critical analysis of research provides important implications for the current research study, and enables the current research to extend and build upon existing research studies and literature. The research study consists of two phases; the first is an evaluation of Lego therapy as a social skills intervention for children with Asperger Syndrome and High Functioning Autism, and the second is an exploration of the experiences and perceptions of the children and school staff involved in the research study. This literature review thus seeks to explore the literature to support both phases of the research study. Section two of the literature review justifies the current topic as an area for further exploration, and outlines its relevance to Educational Psychologists and other educational professionals. Finally, section five considers the existing gaps in the research literature, and clarifies ways in which the current study will fulfil the need for further research in the field. In addition to this, a manual search of the Journal of Autism and Developmental Disorders was also conducted. Research papers were excluded from the review if they were not relevant to the research questions, if they were not specific to Autism or Page | 253 Asperger Syndrome, or if they did not hold particular relevance to the British education system. The Salamanca statement called upon governments to prioritise inclusive education, and established a universal framework for inclusive practice. However, the social difficulties experienced by children with Autism are a barrier to inclusion in a mainstream setting (Greenway, 2000); Koegel, Koegel, Frea, and Fredeen (2001) advocate the inclusion of children with developmental delays in mainstream education Page | 254 settings, but believe that inclusion in mainstream settings alone does not result in social competence. Supporting the inclusion of children with Asperger Syndrome is a significant challenge for Educational Psychologists in the United Kingdom (Greenway, 2000). The prevalence of Autism is thought to be increasing, and whilst there is a great deal of contention surrounding this issue, suggested reasons for the increase include an increasing awareness and diagnosis, changing diagnostic criteria, and increasing age of mothers at childbirth (Weintraub, 2011). However, additional reasons for the apparent increase are still largely unknown (Weintraub, 2011). Regardless of the reasons for the increasing prevalence, a significant issue for Educational Psychologists is finding effective ways to support the needs of children with Autism, and to enable children to be successfully included within mainstream settings. A diagnosis of Pervasive Developmental Disorder requires the presence of difficulties in social communication, social interaction and social imagination. These three Page | 255 social difficulties form the triad of impairments, proposed by Wing and Gould (1979). It is proposed that Autism and Asperger Syndrome will be merged into one single category of diagnosis. The proposed criteria will place these four disorders on a continuum from mild to severe, with degree of severity specified alongside a diagnosis. The reason for this is that these are the terms that commonly feature in current published research studies in the United Kingdom. Greenway (2000) describes how some researchers have avoided using the terms Asperger Syndrome and High Functioning Autism, either because of the difficulty associated with distinguishing between Asperger Syndrome and Autism, or for philosophical reasons associated with categorising individual needs according to medical criteria. Molloy and Vasil (2002) argue that the use of medical labels such as Autism and Asperger Syndrome place emphasis on deficits rather than strengths, and believes that applying medical terminology to developmental disorders is counter-productive. Whilst the arguments outlined by Molloy and Vasil (2002) hold certain validity, Greenway (2000) makes an equally valid point. Greenway (2000) argues that the tendency to avoid medical classifications in research makes it difficult for educational professionals to discover appropriate research. Educational research plays a vital role in enabling professionals to recommend educational practices that are evidence-based. Educational professionals therefore need to be able to determine which children an intervention is suitable for, and medical classifications have a role to play in this. Page | 257 Spence (2003) provided a differentiation between social skills and social competence. Social skills refers to the verbal and non-verbal skills required for social interaction, such as eye contact, turn taking, joining in conversations and selecting appropriate topics for conversation (Spence, 2003). Social competence refers to the positive outcomes that are achieved as a result of an interaction with others, for example, sustained and reciprocal interactions (Spence, 2003). Sigman and Ruskin (1999) described the extent to which children engage with peers as a crucial element of social competence. LeGoff (2004) operationalised social competence as initiation of contact with peers, duration of social contact and levels of aloofness and rigidity. For the purposes of this study, social skills will refer to the skills required to initiate and maintain interaction, and social competence will refer to the quality of interaction with others, which includes the amount of interactions, duration of interactions and reciprocity. Lord and MaGill-Evans (1995) also report a lack of spontaneous engagement in games with peers. The views of 19 children and their families were sought through the use of self-report measures. Findings indicated that the children recognised that they have difficulties with both social skills and social competence, but that parents reported lower levels of social competence than the child self-reports. Participants reported to have friendships in school, although friendships were reported to be problematic. More recent research has sought to explore the perceptions of children with Asperger Syndrome and High Functioning Autism. Emergent themes led the researchers to conclude that children placed value on friendships, although the nature and reciprocity of friendships did not appear to be understood by children. Attwood (2006) suggests that children with Asperger Syndrome are troubled by a lack of friendships and often experience loneliness. Attwood (2006) describes how children with Asperger Syndrome are often either socially isolated on the school playground, or actively involved with other children but in a way that peers perceive to be socially intrusive. Children were thought to exhibit one of two patterns of interaction; either they were quiet and withdrawn or they were forceful and intrusive socially. There was a tendency for social skills to improve with age, with more children reporting to have a best friend later on in childhood. However, many children enjoyed spending time alone and frequently engaged in solitary activities. This study used a retrospective review of medical records to gather the information; thus findings may not be a valid reflection of lived experience. Despite the variability, social skills and interaction continued to be the most significant of the difficulties experienced. This suggests that although gains made were small, gains were maintained after a period of non-intervention. No differences in treatment effect were found between studies that used group intervention and those Page | 261 that used individual intervention, although individual interventions produced higher generalisation effects. No significant relationships were found between outcomes and treatment length, duration and total hours. Only 14 of the 55 studies included in the meta-analysis measured treatment fidelity, so it is not possible to ascertain whether or not the intervention was delivered successfully or not. Treatment fidelity data is essential to help determine whether low treatment effects can be attributed to poor treatment implementation or the treatment itself. However, within each study positive outcomes were often limited to a subset of participants or outcome measures, thus firm conclusions about effectiveness were often not made. Finally, only one study obtained follow up measures to determine whether gains were maintained. These Page | 262 findings have important implications for future research, and the proposed research will attempt to address the criticisms made by Rao et al. A comparison of the reviewed research is presented in Figure 2 on page 13, and conclusions and implications from the reviewed research will be considered. There are three modules in the programme; Communication, Working with Others and Friendship Skills. However, a follow up study was not conducted so it is not possible to comment upon whether treatment gains were maintained. The programme incorporated a computer game, parent training sessions, a hand out for teachers and small group sessions. Parental reports indicated greater improvements in social skills in the intervention group in comparison to the wait list control group, and teacher ratings indicated significant gains in social functioning after participation on the programme. This study used a large sample size, a control measure, and also obtained follow up measures to see if gains had been maintained. This research demonstrates that social skills interventions can be effective over a relatively short time frame, with gains that are maintained over time. However, Hanley Hochdorfer, Bray, Kehle, and Elinoff (2010) found no evidence to suggest that Social Stories are an effective intervention for children with Autism and Asperger Syndrome. Reynhout and Carter (2006) conducted a review of published research measuring the effectiveness of social stories and concluded that the effectiveness is highly variable. They were unable to determine which components of social stories were effective, and suggested future research should explore elements of efficacy further. Sansosti and Powell-Smith (2006) presented evidence to demonstrate positive effects of social stories on social behaviour. The intervention was evaluated on the basis of the total time each boy spent engaged in positive interaction related to the targeted social behaviours, during play time. Significant increases in positive behaviour were seen in two out of the three boys. The sample size of this study was small, which limits the Page | 264 potential to generalise these findings to other children. Positive changes in behaviour may have been the result of social maturation over time, and control measures were not taken to help eliminate this possibility. Greenway (2000) suggested that Circle of Friends is an effective intervention for children on the Autism spectrum. Circle of Friends is an approach which aims to facilitate and promote the development of friendships, through enlisting the help of classmates (Frederickson, Warren, & Turner, 2005). Whitaker, Barratt, Joy, Potter, and Thomas (1998) conducted a qualitative study exploring the impact of inclusion within a Circle of Friends group. Emergent themes suggested the target child experienced improved social integration, increased peer contact, and increased empathy from peers. The intervention consisted of a whole class meeting followed by weekly meetings with a smaller group of children. Frederickson found that acceptance increased and rejection decreased in class mates after the whole class meeting. However, such gains were not maintained and the initial gains reduced throughout the Page | 265 small group intervention period. This suggests that a Circle of Friends approach may be useful in promoting social acceptance when delivered as a whole class approach, but gains may not be long lasting. This research provided little evidence to suggest that the weekly Circle of Friends sessions were beneficial for social acceptance and inclusion. No changes were found in the behaviour of the focus children, suggesting that the Circle of Friends approach influences the attitudes of the other children and not the behaviour of the focus child. They were also encouraged to take a directive rather than supportive approach to assisting the child with meeting weekly targets. Whilst the benefits of promoting social acceptance in peers is indisputable, Dodge, Pettit, McClaskey, Brown, and Gottman (1986) cyclical model of social competence suggests that positive changes in social acceptance are not likely to be maintained if behaviour change does not occur in the child. Inclusion Criteria:Participantsshould be ofprim ary schoolage (4-11),w ith AspergerSyndrom e orHigh Functioning Autism. Author(s) Intervention Diagnosis N um berof Control M easurem ent Duration of StatisticalO utcom e Follow up participants m easure intervention and age Barry etal. Com m unication and M aladaptive w eek,18 w eeks duration ofinteractions,no Hum phrey, sessions N =16 Lego dom ains(Sparrow etal. M aladaptive Behaviour Sansostiand SocialStories Asperger N =3,aged 9 Betw een Structured behavioural Tw ice perday Positive effectsseen in 2 w eek Pow ell-Sm ith Syndrom e 11 groups observationsm easuring during targeted socialbehaviours, follow up (2006) baseline occurrence offocusbehaviours intervention although gainsw ere not design period m easured forstatistical control (intervention significance. W hitakeret Circle of Autism and N =7,aged 7 N o Structured interview s, Range of Im proved socialintegration, N o al. Winter-Messiers (2007) interviewed children with Asperger Syndrome about their special interests. They noted positive relationships between talking about special interests and improvements in social, emotional and communication skills. Children used more appropriate verbal language, social interaction and body language when talking about their area of special interest. All children showed improvement in at least one area previously highlighted as a deficit area.
Consider whether extending your high school graduation date by 1 to 3 years will help you to reach your postsecondary goals pregnancy ultrasounds order 10 mg female cialis overnight delivery. Visit the school career center and ask the Career Center Specialist to tell you about the college and career planning resources available in your school menstrual 6 days late purchase female cialis paypal. Meet with your case manager to discuss the comprehensive vocational assessment services offered locally to decide whether a referral is appropriate menstrual extraction at home buy female cialis once a day. Sophomore Year Tasks Ask your parent or special education teacher to help you prepare to meet with your teachers to explain your disability and request accommodations menstrual odor treatment cheap female cialis 20mg with amex. Add to your understanding and use of learning strategies to help you access the same coursework as your peers womens health ct purchase female cialis master card. Review diploma options women's health clinic chico ca purchase female cialis in india, revise choice as necessary, and plan course of study to meet requirements. Consider whether extending your high school graduation date by 1 to 3 years will help you to reach your postsecondary goals. Discuss with guidance counselor appropriateness of enrollment in career-related courses. Meet with your case manager to discuss available career/vocational assessment options to decide whether a referral is appropriate. Continue to explore interests through extracurricular activities, hobbies, volunteer work, and work experiences. Identify interests, aptitudes, values, and opportunities related to occupations in which you are interested. Junior Year Tasks Identify the appropriate academic adjustments and auxiliary aids and services that you will need in postsecondary settings and learn to use them efficiently. Learn time management, study skills, assertiveness training, stress management, and exam preparation strategies. Arrange to meet with your teachers to explain your disability and request accommodations. Consider whether extending your high school graduation date by 1 to 3 years will help you to reach your postsecondary goals. Meet with your case manager to discuss available career/vocational assessment options to decide whether a referral is appropriate. Continue to explore your interests through involvement in school or community based extracurricular activities and work experiences. Focus on matching your interests and abilities to the appropriate postsecondary goals. If your career goals require postsecondary education, look for schools that have courses in which you might be interested. Speak with representatives of colleges, technical schools, training programs, and/or the military who visit your high school or present at college and postsecondary fairs. Gather information about college programs that offer the disability services you need. Visit campuses and their disability service offices to verify the available services and how to access them. Colleges want current evaluations, usually less than 3 years old when you begin college. Arrange to meet with your teachers to explain your disability and request accommodations. Consider whether extending your high school graduation date by 1 to 3 years will help you to reach your postsecondary goals. Discuss with guidance counselor appropriateness of enrollment during fifth, sixth, or seventh year of high school in career-related courses. Meet with your case manager to discuss available career/vocational assessment options to decide whether a referral is appropriate. Continue to explore your interests through involvement in school or community based extracurricular activities and work experiences. Focus on matching your interests and abilities to the appropriate postsecondary goals. Meet with your school guidance counselor early in the year to discuss your postsecondary plans. Plan to visit schools, colleges, or training programs in which you are interested early in the year. Evaluate the disability services, service provider, and staff of any schools in which you are interested. Obtain copies of any school records that document your disability to obtain accommodations in postsecondary environments. While goals may be more broadly stated (In math, Jim will learn addition and subtraction using carrying and borrowing. In general, a good behavioral objective must: Identify the learner Identify the specific skill or behavior targeted for increase Identify the conditions under which the skill or behavior is to be displayed Identify criteria for competent performance Each of these components will be discussed in turn in the following sections. Identify the Specific Skill or Behavior Targeted for Increase In identifying the specific skill or behavior targeted for increase, you are, in effect, clearly stating exactly what the learner is expected to be doing when the objective is met. This requires a precise description of skill in terms that are both observable and measurable. In the previous example, the overall goal was stated as: In math, Jim will learn addition and subtraction using carrying and borrowing. On the other hand, in the second example given, the behavioral objective is stated as: When presented with 10 double-digit addition problems involving carrying, Jim will complete all problems with 90 percent accuracy within 10 minutes. In this case we know: Where the task is presented (in the classroom) How many problems are presented (10) What type of problems are presented (double-digit addition with carrying) In writing clear and measurable behavioral/educational objectives, it is important to use those verbs and related descriptors that are observable and measurable. Once this objective is achieved as stated, Jim is to be considered competent at the task and ready to move on to the next objective. The resource listed below provides more information on this important part of the educational process. Teaching children with autism to mind-read: A practical guide for teachers and parents. The Power Card Strategy: Using special interests to motivate children and youth with Asperger Syndrome and autism. Using the Power Card Strategy to teach sportsmanship skills to a child with autism. Super skills: A social skills group program for children with Asperger Syndrome, high-functioning autism and related challenges. Skillstreaming the adolescent: New strategies and perspectives for teaching prosocial skills. Asperger Syndrome and the hidden curriculum: Practical solutions for understanding unwritten rules. Thinking of you, thinking of me: Philosophy and strategies to further develop perspective taking and communicative abilities for persons with social cognitive deficits. The other half of Asperger Syndrome: A guide to living in an intimate relationship with a partner who has Asperger Syndrome. Asperger Syndrome employment workbook: An employment workbook for adults with Asperger Syndrome. Asperger Syndrome and the elementary school experience: Practical solutions for academic and social difficulties. Children and youth with Asperger Syndrome: Strategies for success in inclusive settings. Asperger Syndrome and sensory issues: Practical solutions for making sense of the world. Asperger Syndrome and difficult moments: Practical nd solutions for tantrums, rage, and meltdowns (2 ed. The site offers an overview of its annual conference and its quarterly newsletters. This site also features discussion forums and information on advocacy and special education legislation. Its mission is to put applied research to work providing answers to questions that parents, families, individuals with autism, teachers, and caregivers confront each day. The Web site contains monthly newsletters, a comprehensive list of resources, and an overview of practical research underway in autism spectrum disorders. Parent, teacher, and self-report of problem and adaptive behaviors in children and adolescents with Asperger Syndrome. Recognition of faux pas by normally developing children and children with Asperger Syndrome or high functioning autism. The social behavioral and academic experiences of children with Asperger Syndrome. Sensory processing issues associated with Asperger Syndrome: A preliminary investigation. Using a personal digital assistant to enhance the independence of an adolescent with Asperger Syndrome. The cognitive profile of anorexia nervosa: A comparative study including a community-based sample. Understanding the nature of autism: A guide to autism spectrum disorders (2nd ed). Autism and Asperger Syndrome in seven year-old children: A total population study. Behavioral and emotional disturbance in high-functioning autism and Asperger Syndrome. This book provides guidelines for meeting the needs of the child with Asperger Syndrome in your class, from elementary to high school. Rather, Autism Speaks provides general information about autism as a service to the community. The information provided in this kit is not a recommendation, referral or endorsement of any resource, therapeutic method, or service provider and does not replace the advice of medical, legal or educational professionals. This kit is not intended as a tool for verifying the credentials, qualifications, or abilities of any organization, product or professional. Autism Speaks has not validated and is not responsible for any information or services provided by third parties. About this Kit Autism Speaks would like to extend special thanks to the Advisory Committee for the time and effort that they put into reviewing the Asperger Syndrome and High Functioning Autism Tool Kit. Asperger Syndrome and High Functioning Autism Tool Kit Advisory Committee Ann Brendel Geraldine Dawson, Ph. Chief Science Officer, Autism Speaks Research Professor, University of North Carolina, Chapel Hill Peter F. Strong Center for Developmental Disabilities Brian Kelly * ** Parent Artie Kempner* Parent Gary S. Mayerson* Founding Attorney, Mayerson & Associates Kevin Murray* Parent Linda Meyer, Ed.
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References
- Venegas MF, Navas EL, Gaffney RA, et al: Binding of type 1-piliated Escherichia coli to vaginal mucus, Infect Immun 63:416n422, 1995.
- Strauss JS: Biology of the sebaceous gland and the pathophysiology of acne vulgaris. In Soter NA, Baden HP, editors: Pathophysiology of dermatologic diseases, New York, 1991, McGraw-Hill, pp 195-210.
- Castellanos A, Interian A, Myerburg R: The resting electrocardiogram. In Fuster V, Alexander R, O'Rourke R, editors: The Heart, ed 11 New York, 2004, McGraw-Hill, pp 295-324.
- Ray WZ, Lee A, Blackburn SL, et al: Pseudotumor cerebri following tapered corticosteroid treatment in an 8-month-old infant, J Neurosurg Pediatr 1(1):88-90, 2008.