Psychology Commons^™

Racial Discrimination Is Associated With Acute Posttraumatic Stress Symptoms And Predicts Future Posttraumatic Stress Disorder Symptom Severity In Trauma-Exposed Black Adults In The United States, Claire M. Bird, E. Kate Webb, Andrew T. Schramm, Lucas Torres, Christine L. Larson, Terri A. Deroon-Cassini

Psychology Faculty Research and Publications

In the United States, Black residents exposed to a traumatic event are at an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing more severe symptoms compared to their non‐Hispanic White counterparts. Although previous work has suggested a link between racial discrimination and PTSD symptoms, no studies have assessed this association in a sample of traumatic injury survivors. The current study investigated whether (a) past racial discrimination was associated with acute posttraumatic stress symptoms (PTSS) and (b) discrimination prospectively contributed to the prediction of future PTSD symptoms. African American and/or Black patients (N = 113) were recruited from an …

Acute White Matter Integrity Post-Trauma And Prospective Posttraumatic Stress Disorder Symptoms, Carissa N. Weis, Ashley A. Huggins, Tara A. Miskovich, Jacklynn M. Fitzgerald, Kenneth P. Bennett, Jessica L. Krukowski, E. Kate Webb, Terri A Deroon-Cassini, Christine L. Larson

Psychology Faculty Research and Publications

Background: Little is known about what distinguishes those who are resilient after trauma from those at risk for developing posttraumatic stress disorder (PTSD). Previous work indicates white matter integrity may be a useful biomarker in predicting PTSD. Research has shown changes in the integrity of three white matter tracts—the cingulum bundle, corpus callosum (CC), and uncinate fasciculus (UNC)—in the aftermath of trauma relate to PTSD symptoms. However, few have examined the predictive utility of white matter integrity in the acute aftermath of trauma to predict prospective PTSD symptom severity in a mixed traumatic injury sample.

Method: Thus, the current study …

Stability Of Hippocampal Subfield Volumes After Trauma And Relationship To Development Of Ptsd Symptoms, C. N. Weis, E. Kate Webb, Ashley A. Huggins, Maddy Kallenbach, Tara A. Miskovich, Jacklynn M. Fitzgerald, Kenneth P. Bennett, Jessica L. Krukowski, Terri A Deroon-Cassini, Christine L. Larson

Psychology Faculty Research and Publications

Background

The hippocampus plays a central role in post-traumatic stress disorder (PTSD) pathogenesis, and the majority of neuroimaging research on PTSD has studied the hippocampus in its entirety. Although extensive literature demonstrates changes in hippocampal volume are associated with PTSD, fewer studies have probed the relationship between symptoms and the hippocampus’ functionally and structurally distinct subfields. We utilized data from a longitudinal study examining post-trauma outcomes to determine whether hippocampal subfield volumes change post-trauma and whether specific subfields are significantly associated with, or prospectively related to, PTSD symptom severity. As a secondary aim, we leveraged our unique study design sample …

Remote Teaching Of Publication-Quality, Single-Case Graphs In Microsoft Excel, Robert K. Lehardy, Kevin C. Luczynski, Stephanie Hood, Ciobha A. Mckeown

Psychology Faculty Research and Publications

Microsoft Excel is ubiquitous, cost-effective, and can be used to create publication-quality single-case design graphs. We systematically replicated the GraphPad Prism video tutorial by Mitteer et al. (2018) to teach 24 master's students to create multiple-baseline graphs using Excel 2016. Students' mean accuracy on the multiple-baseline graph was 25% in pretraining, 86% with the video tutorial, and 96% with the review checklist. Next, students used the same video tutorial to create multielement and reversal graphs. Students' mean accuracy on the multielement graph was 93% with video tutorial and 94% with review checklist, and accuracy on the reversal graph was 82% …

Descriptive Assessment Of Conversational Skills: Towards Benchmarks For Young Adults With Social Deficits, Stephanie Hood, Britany M. Beauchesne, Tara A. Fahmie, Alexandra Go

Psychology Faculty Research and Publications

Descriptive assessments are necessary to identify social norms and establish a foundation for experimental analysis. Much of the social skills intervention literature involves goals that have been selected through interviews and direct observation of behavior without a reference to desired outcomes. The purpose of the current study was to extend research on descriptive assessments of conversations by including additional measures and examining conversational behavior across contexts. We conducted a descriptive assessment of social skills exhibited by 16 neurotypical young adults. Participants had 10-min conversations in groups and 1-on-1 with friends and novel individuals. We then assessed variability within and across …

Recommendations For Clinical Practice, Research, And Policy To Address The Effects Of The Covid-19 Pandemic On Anxiety Symptoms In Immigrant And U.S.-Born Latina Mothers, Sandraluz Lara-Cinisomo, Kimberly D'Anna-Hernandez, Amy L. Non

Psychology Faculty Research and Publications

No abstract provided.

Kicking In Diabetes Support (Kids) Intervention Effects: Parent Reports Of Diabetes Management, Jessica C. Kichler, Astrida S. Kaugars

Psychology Faculty Research and Publications

Objectives: The Kicking In Diabetes Support (KIDS) Project is a semistructured multifamily group therapy (MGT) intervention for adolescents who have type 1 diabetes (T1D) and their parents, which incorporates both peer support and family systems processes to improve diabetes management skills. The purpose of the present study was to evaluate the clinical utility of this intervention by examining parent perspectives and health-related outcomes. Methods: Adolescents and their parents participated in the 8-session (6 core sessions and 2 booster follow-up sessions at 2 and 4 months) intervention in 1 of 8 waves of the group administration over a four-year period. Parents …

Circulating Endocannabinoids And Prospective Risk For Depression In Trauma-Injury Survivors, Jacklynn M. Fitzgerald, Samantha Chesney, Tara Sander Lee, Karen J. Brasel, Christine L. Larson, Cecilia J. Hillard, Terri A Deroon-Cassini

Psychology Faculty Research and Publications

Biological mechanisms associated with response to trauma may impact risk for depression. One such mechanism is endocannabinoid signaling (eCB), a neuromodulatory system comprised of the CB1 subtype of cannabinoid receptors (CB1R), encoded by the CNR1 gene, and two primary endogenous ligands: 2-arachidonoylglycerol (2-AG) and N-arachidonylethanolamine (AEA), hydrolyzed by monoacylglycerol lipase (gene name MGLL) and fatty acid amide hydrolase (gene name FAAH). Preclinical data suggest that eCB/CB1R signaling acts as a stress buffer and its loss or suppression increases depression-like behaviors. We examined circulating concentrations of the eCBs (2-AG and AEA) days and six months after a traumatic injury …

Identifying Subtypes Of Trichotillomania (Hair Pulling Disorder) And Excoriation (Skin Picking) Disorder Using Mixture Modeling In A Multicenter Sample, Jon E. Grant, Tara S. Peris, Emily J. Ricketts, Christine Lochner, Dan J. Stein, Jan Stochl, Samuel R. Chamberlain, Jeremiah M. Scharf, Darin D. Dougherty, Douglas W. Woods, John Piacentini, Nancy Keuthen

Psychology Faculty Research and Publications

Body-focused repetitive behavior disorders (BFRBs) include Trichotillomania (TTM; Hair pulling disorder) and Excoriation (Skin Picking) Disorder (SPD). These conditions are prevalent, highly heterogeneous, under-researched, and under-treated. In order for progress to be made in optimally classifying and treating these conditions, it is necessary to identify meaningful subtypes. 279 adults (100 with TTM, 81 with SPD, 40 with both TTM and SPD, and 58 controls) were recruited for an international, multi-center between-group comparison using mixture modeling, with stringent correction for multiple comparisons. The main outcome measure was to examine distinct subtypes (aka latent classes) across all study participants using item-level data …

Five-Year Change In Body Mass Index Predicts Conversion To Mild Cognitive Impairment Or Dementia Only In Apoe Ɛ4 Allele Carriers, Kylie R. Kadey, John L. Woodard, Allison C. Moll, Kristy A. Nielson, J. Carson Smith, Sally Durgerian, Stephen M. Rao

Psychology Faculty Research and Publications

Background:

Body mass index (BMI) has been identified as an important modifiable lifestyle risk factor for dementia, but less is known about how BMI might interact with Apolipoprotein E ɛ4 (APOE ɛ4) carrier status to predict conversion to mild cognitive impairment (MCI) and dementia.

Objective:

The aim of this study was to investigate the interaction between APOE ɛ4 status and baseline (_bBMI) and five-year BMI change (ΔBMI) on conversion to MCI or dementia in initially cognitively healthy older adults.

Methods:

The associations between _bBMI, ΔBMI, APOE ɛ4 status, and conversion to MCI or …

Exercise Training-Related Changes In Cortical Gray Matter Diffusivity And Cognitive Function In Mild Cognitive Impairment And Healthy Older Adults, Daniel D. Callow, Junyeon Won, Gabriel S. Pena, Leslie S. Jordan, Naomi A. Arnold-Nedimala, Yash Kommula, Kristy A. Nielson, J. Carson Smith

Psychology Faculty Research and Publications

Individuals with Mild Cognitive Impairment (MCI) are at an elevated risk of dementia and exhibit deficits in cognition and cortical gray matter (GM) volume, thickness, and microstructure. Meanwhile, exercise training appears to preserve brain function and macrostructure may help delay or prevent the onset of dementia in individuals with MCI. Yet, our understanding of the neurophysiological effects of exercise training in individuals with MCI remains limited. Recent work suggests that the measures of gray matter microstructure using diffusion imaging may be sensitive to early cognitive and neurophysiological changes in the aging brain. Therefore, this study is aimed to determine the …

Having No Words For Feelings: Alexithymia As A Fundamental Personality Dimension At The Interface Of Cognition And Emotion, Olivier Luminet, Kristy A. Nielson, Nathan Ridout

Psychology Faculty Research and Publications

This special issue brings together two important reviews and seven cutting-edge empirical papers concerning the influence of alexithymia on cognitive and emotional processing. Alexithymia is a multifaceted construct that is characterised by difficulties identifying one’s feelings; difficulties describing one’s feelings to others; and an externally focused, utilitarian cognitive style. In this paper, we begin by considering how emotion science has evolved in its understanding of personality traits, before highlighting the potential importance of alexithymia research for the field of cognition and emotion. After summarising the historical context of alexithymia research, we consider the contributions of the featured papers to the …

Event-Related Potentials, Inhibition, And Risk For Alzheimer’S Disease Among Cognitively Intact Elders, Kathleen Hazlett Elverman, Elizabeth Rose Paitel, Christina Marie Figueroa, Ryan J. Mckindles, Kristy A. Nielson

Psychology Faculty Research and Publications

Background:

Despite advances in understanding Alzheimer’s disease (AD), prediction of AD prior to symptom onset remains severely limited, even when primary risk factors such as the apolipoprotein E (APOE) ɛ4 allele are known.

Objective:

Although executive dysfunction is highly prevalent and is a primary contributor to loss of independence in those with AD, few studies have examined neural differences underlying executive functioning as indicators of risk for AD prior to symptom onset, when intervention might be effective.

Methods:

This study examined event-related potential (ERP) differences during inhibitory control in 44 cognitively intact older adults (20 ɛ4+, 24 ɛ4-), …

Cognitive-Emotional Processing In Alexithymia: An Integrative Review, Olivier Luminet, Kristy A. Nielson, Nathan Ridout

Psychology Faculty Research and Publications

Alexithymia is a multifaceted personality construct characterised by difficulties identifying one’s feelings and distinguishing them from bodily sensations, difficulties describing one’s feelings to others, and an externally oriented cognitive style. Over the past 25 years, a burgeoning body of research has examined how alexithymia moderates processing at the cognition–emotion interface. We review the findings in five domains: attention, appraisals, memory, language, and behaviours. The preponderance of studies linked alexithymia with deficits in emotion processing, which was apparent across all domains, except behaviours. All studies on behaviours and a proportion of studies in other domains demonstrated emotional over-responding. Analysis at the …

Applying The Vulnerability Stress Adaptation Model Of Marriage To Couples Raising An Autistic Child: A Call For Research On Adaptive Processes, Hillary Katherine Schiltz, Amy V. Van Hecke

Psychology Faculty Research and Publications

Parents of children on the autism spectrum are particularly susceptible to strain in their romantic relationships due to unique risk factors. While some relationships deteriorate, however, others endure and thrive. The Vulnerability Stress Adaptation (VSA) Model of Marriage (Karney & Bradbury, 1995; Fig. 1) offers a framework to explain, not only poor marital outcomes, but also the process by which degradation of relationships occurs over time. The VSA Model posits that a combination of internal (within-person) vulnerabilities and external stressors influence relationship quality and, in turn, stability, by affecting couples' abilities to collaborate to adapt to stressors and solve problems …

Feasibility, Acceptability, And Preliminary Outcomes Of A Culturally Adapted Evidence-Based Treatment For Latino Youth With Adhd, Alyson C. Gerdes, Theresa Lauer Kapke, Margaret Grace, Al Castro

Psychology Faculty Research and Publications

Objective: To advance our knowledge about the most effective way to treat Latino youth with ADHD, the current feasibility and pilot study compared a culturally adapted evidence-based treatment (CAT) for ADHD to standard evidence-based treatment (EBT). Method: Following a comprehensive ADHD assessment, 61 Latino families of school-aged children (mean age of 8 years) were randomly assigned to either CAT or standard EBT (i.e., parent management training). Results: CAT outperformed standard EBT when examining homework completion and mother-reported treatment satisfaction. Apart from two trends favoring CAT, CAT and EBT both resulted in significant improvements in parent- and teacher-reported ADHD symptoms and …

Forecasting Chaotic Events And The Prediction Of A Rare Cognitive Ability, Stephen J. Guastello, William Futch, Lucas A. Mirabito, Dominique Green, Laura Marsicek, Brittany Witty

Psychology Faculty Research and Publications

People often live and work in chaotic environments, and thus need to forecast and control what will happen next. The management of chaos is an apparently rare skill, and it would be valuable to identify and develop this skill in the workforce. Untrained undergraduates (N = 147) forecasted number series from four chaotic attractors of varying levels of complexity. They contributed measurements of 16PF personality traits, general intelligence, field independence, and divergent thinking. The results indicated that field independence and personality traits associated with the creative personality profile were the most frequent correlates of performance on forecasting one to …

The Role Of Loneliness As A Mediator Between Autism Features And Mental Health Among Autistic Young Adults, Hillary Schiltz, Alana J. Mcvey, Bridget Dolan Wozniak, Angela Haendel, Rachel Stanley, Alexis Arias, Nakia Gordon, Amy V. Van Hecke

Psychology Faculty Research and Publications

Autistic adults commonly experience anxiety and depression. These mental health concerns are often tied to social experiences, such that mental well-being can be supported by social connection and deteriorated by loneliness. The mediating role of social and emotional loneliness (i.e. social isolation and lack of emotional attachment, respectively) between autism features and mental health has yet to be empirically tested among autistic adults. Here, 69 autistic young adults completed self-report questionnaires assessing social contact (Friendship Questionnaire), autism features (Autism Quotient), mental health (Liebowitz Social Anxiety Scale, Social Phobia Inventory, Beck Depression Inventory), and loneliness (Social and Emotional Loneliness Scale for …

Dacc Resting State Functional Connectivity As A Predictor Of Pain Symptoms Following Motor Vehicle Crash: A Preliminary Investigation, Jacklynn M. Fitzgerald, Emily L. Belleau, Lauren E. Ehret, Colleen Trevino, Karen J. Brasel, Christine L. Larson, Terri A Deroon-Cassini

Psychology Faculty Research and Publications

There is significant heterogeneity in pain outcomes following motor vehicle crashes (MVCs), such that a sizeable portion of individuals develop symptoms of chronic pain months after injury while others recover. Despite variable outcomes, the pathogenesis of chronic pain is

currently unclear. Previous neuroimaging work implicates the dorsal anterior cingulate cortex (dACC) in adaptive control of pain, while prior resting state functional magnetic resonance imaging studies find increased functional connectivity (FC) between the dACC and regions involved in pain processing in those with chronic pain. Hyper-connectivity of the dACC to regions that mediate pain response may therefore relate to pain severity. …

A Systematic Review Of Cognitive Event-Related Potentials In Mild Cognitive Impairment And Alzheimer’S Disease, Elizabeth Rose Paitel, Marielle R. Samii, Kristy A. Nielson

Psychology Faculty Research and Publications

This systematic review examined whether event-related potentials (ERPs) during higher cognitive processing can detect subtle, early signs of neurodegenerative disease. Original, empirical studies retrieved from PsycINFO and PubMed were reviewed if they analyzed patterns in cognitive ERPs (≥150 ms post-stimulus) differentiating mild cognitive impairment (MCI), Alzheimer’s disease (AD), or cognitively intact elders who carry AD risk through the Apolipoprotein-E ε4 allele (ε4+) from healthy older adult controls (HC). The 100 studies meeting inclusion criteria (MCI = 47; AD = 47; ε4+ = 6) analyzed N200, P300, N400, and occasionally, later components. While there was variability across studies, patterns of reduced …

Hippocampal Functional Connectivity And Memory Performance After Exercise Intervention In Older Adults With Mild Cognitive Impairment, Junyeon Won, Daniel D. Callow, Gabriel S. Pena, Leslie S. Jordan, Naomi A. Arnold-Nedimala, Kristy A. Nielson, J. Carson Smith

Psychology Faculty Research and Publications

Background:

Exercise training (ET) has neuroprotective effects in the hippocampus, a key brain region for memory that is vulnerable to age-related dysfunction.

Objective:

We investigated the effects of ET on functional connectivity (FC) of the hippocampus in older adults with mild cognitive impairment (MCI) and a cognitively normal (CN) control group. We also assessed whether the ET-induced changes in hippocampal FC (Δhippocampal-FC) are associated with changes in memory task performance (Δmemory performance).

Methods:

32 older adults (77.0±7.6 years; 16 MCI and 16 CN) participated in the present study. Cardiorespiratory fitness tests, memory tasks (Rey Auditory Verbal Learning Test (RAVLT) and …

Synaptic Processes And Immune-Related Pathways Implicated In Tourette Syndrome, Douglas W. Woods

Psychology Faculty Research and Publications

Tourette syndrome (TS) is a neuropsychiatric disorder of complex genetic architecture involving multiple interacting genes. Here, we sought to elucidate the pathways that underlie the neurobiology of the disorder through genome-wide analysis. We analyzed genome-wide genotypic data of 3581 individuals with TS and 7682 ancestry-matched controls and investigated associations of TS with sets of genes that are expressed in particular cell types and operate in specific neuronal and glial functions. We employed a self-contained, set-based association method (SBA) as well as a competitive gene set method (MAGMA) using individual-level genotype data to perform a comprehensive investigation of the biological background …

Assessing The Psychometric Proprieties Of The Attitudes Toward Seeking Professional Psychological Help Scale–Short Form (Atspph-Sf) Among Latino Adults, Lucas Torres, Brooke E. Magnus, Natasha Suhail Najar

Psychology Faculty Research and Publications

The Latino population continues to underutilize mental health services at an alarming rate. The Attitudes Toward Seeking Professional Psychological Help Scale–Short Form (ATSPPH-SF) is one of the most commonly used instruments to assess help-seeking attitudes. The current study sought to evaluate the factor structure and test for the presence of differential item functioning on the ATSPPH-SF with a sample of Latino adult individuals across nativity status (U.S.- vs. foreign-born), language format (English vs. Spanish), and gender. The analyses revealed two relatively independent factors named Openness to Seeking Treatment and Value and Need in Seeking Treatment. Measurement equivalence and practical implications …

The Role Of Alexithymia In Memory And Executive Functioning Across The Lifespan, Anthony N. Correro, Elizabeth Rose Paitel, Steven J. Byers, Kristy A. Nielson

Psychology Faculty Research and Publications

Alexithymia is a personality trait characterised by difficulties identifying feelings (DIF), describing feelings (DDF), and externally oriented thinking (EOT). Alexithymia has been associated with poorer memory, at least for emotive materials, and recently, with executive and neural dysfunction. Aging is also accompanied by poorer memory and executive functioning (EF), neural dysfunction, and increasing alexithymia. Thus, the hypothesis of a general cognitive impairment in alexithymia, particularly in elders, needs investigation. Three large, independent, cross-sectional experiments (n = 296, 139 and 121, respectively) investigated memory and EF in healthy adults, ranging from young to old adulthood, with age, sex, and the …

Temporal Dynamics Of Event-Related Potentials During Inhibitory Control Characterize Age-Related Neural Compensation, Elizabeth Rose Paitel, Kristy A. Nielson

Psychology Faculty Research and Publications

Aging is accompanied by frontal lobe and non-dominant hemisphere recruitment that supports executive functioning, such as inhibitory control, which is crucial to all cognitive functions. However, the spatio-temporal sequence of processing underlying successful inhibition and how it changes with age is understudied. Thus, we capitalized on the temporal precision of event-related potentials (ERPs) to assess the functional lateralization of N200 (conflict monitoring) and P300 (inhibitory performance evaluation) in young and healthy older adults during comparably performed successful stop-signal inhibition. We additionally used temporal principal components analysis (PCA) to further interrogate the continuous spatio-temporal dynamics underlying N200 and P300 activation for …

Games Of What If? A Test Of Remote Associations, Stephen J. Guastello

Psychology Faculty Research and Publications

Guilford’s (1968) discovery of the difference between convergent and divergent thinking abilities was an important milestone in the understanding of human intelligence. There are several types of divergent thinking abilities, one of which is the ability to make remote associations. For instance, the Consequences test (Guilford & Guilford, 1980) asks questions such as, “What would happen if people no longer needed to sleep?” Respondents would give some immediate or obvious implications and some implications that were more remote, e.g., consequences of a consequence. From the perspective of producing creative technological advances, a professional would need to make remote associations in …

Social Media Posts About Racism Leads To Evaluative Backlash For Black Job Applicants, Simon Howard, Kalen Kennedy, Francisco Tejeda

Psychology Faculty Research and Publications

Black Americans post about race and race-related issues on social media more than any other racial group. In this study, we investigated whether Black Americans who post about racism on social networking sites (i.e., Facebook) experience evaluative backlash during the employee selection process. Participants (N = 154) were given a Black job candidate’s cover letter, resume, and a scanned printout of their social media. Depending on what condition they were randomly assigned to, the applicant’s social media contained posts about racism or posts that were race neutral. Results indicated that Black individuals whose posts were about racism were evaluated …

Treatment Use Among Children With Tourette Syndrome Living In The United States, 2014, Sara Beth Wolicki, Rebecca H. Bitsko, Joseph R. Holbrook, Melissa L. Danielson, Benjamin Zablotsky, Lawrence Scahill, John T. Walkup, Douglas W. Woods, Jonathan W. Mink

Psychology Faculty Research and Publications

Treatment of Tourette syndrome (TS) can be complicated by changes over time in tic expression, severity, and co-occurring disorders. Using the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, this study provides descriptive estimates of the use of behavioral interventions and medication among children living with TS. Parent-reported data on 115 children aged 5–17 years ever diagnosed with TS were analyzed to provide descriptive, unweighted results. Overall, 77.4% of children had current or past use of any TS treatment; 59.1% ever used behavioral interventions and 56.1% had ever taken TS medication. Children with "moderate” or …

Psychiatric Medications And Stigmatizing Attitudes In College Students, Benjamin T. Johnson, Peter Philip Grau, Stephen M. Saunders

Psychology Faculty Research and Publications

Research suggests that biological explanations of mental illness include the promotion of the effectiveness of medication, and that such explanations lead to greater attributions of responsibility and potentially greater stigmatizing emotional and behavioral reactions. This study examined whether college students' attitudes toward a fellow student with mental illness are affected by whether the latter is described as having benefitted previously from medication. Results suggest that the promotion of psychiatric medications as helpful may increase stigmatizing attitudes by peers against fellow students with mental illness.

A Randomized Clinical Trial Of A Virtual-Training Program For Teaching Applied-Behavior-Analysis Skills To Parents Of Children With Autism Spectrum Disorder, Wayne W. Fisher, Kevin C. Luczynski, Andrew P. Blowers, Megan E. Vosters, Maegan D. Pisman, Andy R. Craig, Stephanie Hood, Mychal A. Machado, Aaron D. Lesser, Cathleen C. Piazza

Psychology Faculty Research and Publications

Parents play an important role in the treatment of their children's symptoms of autism spectrum disorder (ASD); thus, developing effective, efficient, socially acceptable, and accessible procedures for training parents to implement applied-behavior-analysis (ABA) interventions is critically important. One potential approach involves delivering training via a virtual private network (VPN) over the internet (Fisher et al., 2014). In this study, we conducted a randomized clinical trial to evaluate a virtual parent-training program with e-learning modules and scripted role-play via a VPN. We evaluated parent implementation of ABA skills using direct-observation measures in structured-work and play-based training contexts. Parents in the treatment …