Bachelor of Science, Walsh University, 2018, Honors

The purpose of the current research was to explore the effects of Therapeutic Horseback Riding (THR) on children with Autism Spectrum Disorder (ASD). Two case studies were completed on two boys who have been diagnosed with autism, age 13 and 16, who were recruited for their participation in the study by instructors at a therapeutic riding equestrian facility. Each participant has been enrolled in the THR program since 2010, and the records that had been kept documenting their progress in the program were obtained and analyzed by the researcher, in addition to session observations, and parent interviews. Results showed documented progress in psychosocial, communication, sensory, cognitive, and neuromusculoskeletal skills through documented evaluations completed annually by the instructors at the riding facility. Additionally, parent interviews revealed thorough enjoyment from the program, increased social engagement and interaction, core strength, posture, balance, awareness of surroundings, coordination, motor planning, postural control, and relaxation techniques. This demonstrates the efficacy of the use of Therapeutic Horseback Riding as a treatment Intervention for children with Autism Spectrum Disorder.

Committee: Antonette Doty PT, PhD, PCS (Advisor); Robert Phillips PT, DPT, PhD, NCS (Other) Subjects: Occupational Therapy; Physical Therapy; Psychology; Public Health

Psy. D., Antioch University, 2016, Antioch New England: Clinical Psychology

This manuscript describes an exploratory study that assessed whether play with typically developing peers increased the use of symbolic play in children with Autism Spectrum Disorder (ASD). A version of a sandplay intervention previously investigated by Lu, Petersen, Lacroix, and Rousseau (2010), and modified to include peer-mediated play was used. The intervention explored the effects of sandplay with typically developing peers on engagement in symbolic play by children with ASD. A multiple-case intervention design was used with three children with ASD with varying degrees of severity in functioning. While use of symbolic play by two of the children did increase from baseline with the introduction of the peer-mediated sandplay intervention, these effects were inconsistent. Furthermore, only one of the children demonstrated a continued increase in symbolic play at the follow-up phase. While the results of the intervention are inconclusive, these results necessitate further investigation into this method of intervention for children with autism spectrum disorder, specifically in regard to ASD severity. Theoretical and treatment implications are offered, as well as directions for future research.

Committee: Kathi Borden PhD (Committee Chair); William Slammon PhD (Committee Member); Gina Pasquale PsyD (Committee Member) Subjects: Clinical Psychology

Ph.D., Antioch University, 2025, Antioch Seattle: Counselor Education & Supervision

A qualitative research study focused on Autistic adults explored the lived experiences of trauma. Participants included Autistic adults who have either been professionally diagnosed with Autism Spectrum Disorder or who self-identify as Autistic. Data was collected through a survey with 12 open-ended questions. A thematic analysis revealed six themes: (a) adverse childhood experiences, (b) exposure to violence and loss, (c) difficulty relating to others, (d) complex mind and sensory experiences, (e) medical and mental health challenges, and (f) autistic identity. The themes revealed instances of Autistic people experiencing trauma in ways that differ and vary in clinical presentation from their neurotypical counterparts. Implications and recommendations for professional counseling and counselor education are discussed based on these findings. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Committee: Stephanie Thorson-Olesen PhD (Committee Chair); Amanda Falkers EdD (Committee Member); Keiko Sano PhD (Committee Member) Subjects: Behavioral Sciences; Counseling Education; Counseling Psychology; Therapy

MS, University of Cincinnati, 2019, Medicine: Genetic Counseling

Neurodevelopmental disorders (NDDs) are a group of conditions that include autism spectrum disorder (ASD), developmental delay (DD), and intellectual disability (ID). NDDs can be linked to a genetic etiology through genetic testing, which currently includes chromosomal microarray (CMA), Fragile X testing, PTEN sequencing, and MECP2 sequencing among others. Despite multiple genetic testing options, diagnostic yield from genetic testing remains around 15% on average (Miller et al. 2010). In addition to overall low and variable diagnostic yield, genetic tests for NDDs vary in turnaround time and cost. Algorithmic testing can simplify ordering genetic testing for NDDs and potentially decrease the cost of testing without risk of lowering the diagnostic yield, although time to get results is often increased. Currently, the relative value that parents of children with an NDD place on cost, time, and potential outcome when deciding on genetic testing for their child is unknown. This study used a discrete choice experiment to elicit relative parental value of diagnostic yield, cost, and turnaround time of genetic testing. This study found that parents in an NDD population place the most relative value on a test with a higher diagnostic yield, followed by a test that costs less out-of-pocket. Parents of children with intellectual disability (ID) or a known genetic cause for their diagnosis are more likely to prefer testing with a shorter turnaround time than lower out-of-pocket cost though yield is still their first priority. These results indicate that a clear discussion of potential diagnostic yield is important to these parents and a genetic testing approach that maximizes diagnostic yield should be considered.

Committee: Carrie Atzinger M.S. C.G.C. (Committee Chair); Janet Basil MS (Committee Member); Jennifer Glass MS (Committee Member); Hua He M.S. (Committee Member) Subjects: Genetics

Bachelor of Arts, Walsh University, 2018, Honors

This literature review examined the efficacy of adding Social Pragmatic Communication Disorder to the DSM-V. The similarities and differences between Autism Spectrum Disorder and Social Pragmatic Communication Disorder were discussed. Possible treatment options and the benefits of speech-language therapy were examined. This literature review addressed who is at risk for the devastating effects of social impairments.

Committee: Bob Humphries Ph.D (Advisor); Jo Anna Kelly Ph.D (Other); Ty Hawkins Ph.D (Committee Chair) Subjects: Language; Psychology; Speech Therapy

Psy. D., Antioch University, 2017, Antioch Seattle: Clinical Psychology

In recent years, the diagnosis of autism spectrum disorder (ASD) has been on the rise, prompting a simultaneous increase in scientific study regarding cause, impact, and intervention (Hughes, 2009; Ravindran & Myers, 2012). Research has proposed advances in the treatment of the individuals diagnosed and focused efforts on scholastic, parental, and professional intervention and supports. However, the siblings of ASD children have largely been neglected in this scientific investigation. The purpose of this hermeneutic phenomenological study was to explore neurotypical siblings' experiences in living with a child diagnosed with ASD. Seven adolescents were selected using criterion, convenience, and snowball sampling. Data were collected using semi-structured interviews and were analyzed using thematic reflection (van Manen, 1990). Data analysis uncovered seven themes: (a) personal impact, (b) familial impact, (c) social impact, (d) relational understanding, (e) socio-cultural influence, (f) future outlook, and (g) advice. Findings indicated neurotypical sibling experiences contain both positive and negative perceptions of living with a brother or sister diagnosed with ASD. Perceptions were often influenced by the cultural and societal value placed upon normal behaviors. The need for appropriate education regarding ASD etiology, symptomology, and treatment was deemed to be important for NTD siblings, parents, professionals, and society at large. Additionally, the development of social supports for NTD siblings was suggested.

Committee: Mary Wieneke Ph. D. (Committee Chair); Steve Curtis Ph. D. (Committee Member); Ned Farley Ph. D. (Committee Member) Subjects: Behavioral Psychology; Clinical Psychology; Cognitive Psychology; Counseling Psychology; Developmental Psychology; Early Childhood Education; Families and Family Life; Personal Relationships; Personality; Psychology; Psychotherapy; Social Psychology; Special Education

BS, Kent State University, 2017, College of Education, Health and Human Services / School of Teaching, Learning and Curriculum Studies

Assistive technology devices are being utilized more frequently in classrooms for accommodations and modifications, especially for students with disabilities. These devices can be high technology devices containing batteries, or low technology devices which may be inexpensive and do not require batteries to be used. Throughout the thesis, the use of high technology devices and low technology devices is specified to introduce the idea of integrating devices into general education and special education classrooms. Furthermore, resources are provided regarding learning more about specific devices, how to further implement technology in the classroom, and catalogs to buy devices.

Committee: Robert Cimera Dr. (Advisor); Sloane Burgess Dr. (Committee Member); Annette Kratcoski Dr. (Committee Member); Natasha Levinson Dr. (Committee Member) Subjects: Special Education

Doctor of Philosophy, Case Western Reserve University, 2018, Psychology

Executive function (EF) plays a crucial role in cognitive, behavioral, and socio-emotional development. Children with atypical development may show signs of EF impairment as these foundational components first emerge. Although reliable measurement of preschool EF is critical to understanding a child's development, it can be challenging to assess EF due to the complicated directions and task structure of some of the traditional EF measures. Child-friendly executive function measures tend to assess a limited array of EF skills (i.e., inhibit, initiate, & shift). The development of a measure that assesses a broader array of EF skills (i.e., emotional control, working memory, or planning/organizing) appears critical for better understanding of individual and group differences in EF in the preschool period. Individual differences in EF skills were examined in 25 children with typical development and 50 children with developmental disabilities (Specific Language Impairment (SLI): n=15; Attention Deficit/Hyperactivity Disorder (ADHD): n=18; Autism Spectrum Disorder (ASD): n=17). Results from the Shape School (Espy, 1997) scored in a traditional, narrow manner (i.e. inhibit, initiate, & shift) were compared to an independently developed, broad-based supplemental scoring system (i.e., impulsivity, joint attention, engagement, compliance, working memory, emotional control, and plan/organize). While both the traditional and the supplemental scoring methods were able to differentiate between typically and atypically developing preschoolers, only the broader scoring method was able to identify unique patterns among children with SLI, ADHD, and ASD. EF differences changed as a function of severity of disability, with minor impairment found in children with SLI, moderate impairment found in children with ADHD, and major impairment found in children with ASD. Clinical and educational implications will be discussed.

Committee: Elizabeth Short Ph.D. (Committee Chair) Subjects: Psychology

Psy. D., Antioch University, 2015, Antioch New England: Clinical Psychology

Few empirical studies exist that examine adult Asperger-affected relationships. The purpose of this study was to determine whether the marital satisfaction of individuals in relationships in which at least one partner has Asperger's Syndrome (AS) or Autism Spectrum Disorder (ASD), differs in some significant way from the marital satisfaction of individuals in relationships in which neither partner has AS/ASD. Participants were 126 adults in relationships in which at least one partner had a diagnosis of AS or ASD, recruited from Asperger- and autism-related websites, social media, and organizations from English-speaking countries. Couples consisted of heterosexual and same-sex couples, couples with and without children, and couples in which either the male and/or the female partner had an AS/ASD diagnosis. Members of each couple responded independently. Using an online version of the Marital Satisfaction Inventory, Revised (MSI R), the mean scores of individuals in AS/ASD-affected relationships were compared with the normative data of the MSI R for males and females on each of 10 dimensions of marital satisfaction, resulting in 20 comparisons. The dimensions of martial satisfaction included global distress, affective communication, problem solving communication, time together, aggression, sexual dissatisfaction, disagreement about finances, family history of distress, dissatisfaction with children, and conflict over child rearing. Comparisons were made using independent samples t-tests. Because of the highly significant results, step-down procedures were not needed to correct for possible inflation of Type 1 errors. Of the 20 comparisons, 15 demonstrated significantly more dissatisfaction among individuals in AS/ASD-affected relationships than those from the normative data sample, at p < .001. In all cases, individuals in AS/ASD-affected partnerships were more dissatisfied than their normative sample counterparts. Separate analyses revealed that NT individuals were l (open full item for complete abstract)

Committee: George Tremblay PhD (Committee Chair); David Arbeitman PhD (Committee Member); William Slammon PhD (Committee Member) Subjects: Clinical Psychology

Master of Arts, Case Western Reserve University, 2015, Psychology

This study was designed to examine the role that education and experience play in diagnostic accuracy. Four groups of raters, differing in education (low or high) and experience (low or high), were asked to categorize 93 children with typical development, specific language impairment (SLI), attention-deficit/hyperactivity disorder (ADHD), or autism spectrum disorder (ASD) based on their performance during a standardized five-minute free play assessment. After reviewing the child's play, raters categorized the child into general developmental category (typical or atypical) and specific diagnostic category (typical, SLI, ADHD, ASD) and then ranked their confidence in each categorization. Education and experience did not contribute to accuracy generally or specifically. However, raters classified children with typical development more accurately than children with ASD, ADHD, or SLI, and they also had more success identifying ASD than ADHD or SLI. Overall, raters were more confident when the classification was correct than when it was incorrect.

Committee: Elizabeth Short (Advisor); Robert Greene (Committee Member); Brooke Macnamara (Committee Member) Subjects: Psychology

Master of Arts, The Ohio State University, 2024, Educational Studies

A subset of children with autism spectrum disorder (ASD) have limited or no functional communication skills and need augmentative and alternative communication (AAC) to meet their communication needs. One evidence-based form of AAC, Picture Exchange Communication System (PECS), involves a child exchanging picture icons with a communication partner for desired items. In this study, I aimed to replicate the effects of PECS in prior studies by using a multiple baseline across behaviors design to examine the effects of PECS on communicative exchanges for a 3.5-year-old boy on the autism spectrum. Basic effects were detected for two behaviors but not the third, and therefore a functional relation was not established. An effect might have been detected for the third behavior had I measured total communication and not only PECS exchanges. The child's parent found PECS to be effective and beneficial for her child. This study highlights the importance of focusing on multimodal communication systems that are dynamic and flexible.

Committee: Dr. Tiffany Wild (Committee Co-Chair); Dr. Matthew Brock (Advisor) Subjects: Behavioral Sciences; Education; Special Education

Master of Science, Miami University, 2024, Biology

Autism spectrum disorder (ASD) is strongly linked to cerebellar anomalies. Recent studies have shown that decreases in cerebellar Purkinje cell firing rates and functional connectivity in the cerebella of mice contribute to behaviors associated with ASD. These behaviors include impairments in social interactions, repetitive behaviors, and motor coordination. The heterogeneity of behavioral phenotypes in individuals with ASD is not well understood, and findings from research investigating sex-specific differences in ASD are inconclusive and/or conflicting across studies. Transgenic animal models with targeted deletion of genes linked to ASD provide an opportunity to test for sex-specific differences in ASD phenotypes. Loss-of-function mutations in the tuberous sclerosis gene Tsc1 have been linked to the development of ASD-like behavioral phenotypes. Using well-established behavioral assays, we tested mice with targeted deletion of Tsc1, selectively in cerebellar Purkinje neurons, to determine if there are sex-specific differences in ASD-associated behaviors. We determined deletion of Tsc1 from Purkinje neurons resulted in less severe deficits in social approach preference in females, compared to males; although, no difference between sexes was found in motor coordination or repetitive self-grooming. These results indicate that targeted deletion of Tsc1 from cerebellar Purkinje neurons results in behavioral deficits that are distinct across sexes.

Committee: Joseph Ransdell (Advisor); Kathleen Killian (Committee Member); Anna Radke (Committee Member); Joyce Fernandes (Committee Member); Dawn Blitz (Committee Member) Subjects: Biology

Doctor of Philosophy in Urban Education, Cleveland State University, 2023, Maxine Goodman Levin College of Urban Affairs

This study examined relations among parenting practices and the quality of the relationship between a neurotypically-developing child and their sibling with autism spectrum disorder (ASD). Using a retrospective survey design, participants raised with a sibling with ASD were asked to report on two types of parentification (sibling-focused and parent-focused) and the degree to which their parents communicated with them about their sibling's diagnosis during their childhood and adolescent years. Additionally, participants were asked to self-report on the quality of the relationship with their sibling with ASD as well as their subjective rating of the severity of their sibling's ASD diagnosis. Based on my review of the literature, I hypothesized that parent-focused parentification would be negatively correlated with sibling relationship quality while the converse will be found for sibling-focused parentification. Only a positive correlation was found between sibling-focused parentification and sibling relationship quality. This finding indicates that prosocial behaviors are linked to a positive sibling bond. Contrary to expectations, the moderation analyses used to examine whether proactive parent communication about the ASD sibling's diagnosis would moderate the relationship between parentification types and sibling relationship quality were found to be unsupported. Furthermore, for my second set of hypotheses in which I hypothesized that ASD severity would be associated with worse sibling relationship quality and that both types of parentification would mediate this relationship were also found to be unsupported. Theories as to why none of neither of the moderation nor mediation analyses were significant are discussed in addition to implications for parenting and research.

Committee: Julia Phillips (Committee Chair); Elizabeth Goncy (Committee Member); Graham Stead (Committee Member) Subjects: Families and Family Life; Psychology

Doctor of Philosophy, The Ohio State University, 2023, Psychology

Background: More than 55% of individuals with autism spectrum disorder (ASD) have at least one co-occurring psychiatric disorder including anxiety (20 - 35%) and depression (11 - 23%). However, there are challenges in studying internalizing symptoms in ASD such as complicated symptom presentation, lack of information on the psychometric properties of commonly used measures in ASD, and concerns for the use of self-report instruments. Due to concerns for the accuracy of describing their own internal states and lack of studies on the psychometric properties, use of self-report measures in assessing for anxiety or depressive symptoms in autistic youth is limited both in the clinical and research setting. The primary aim of this study was to assess test-retest reliability and diagnostic validity, the two under-researched psychometric properties, of self-report instruments on depression and anxiety in autistic youth. The secondary aims were to investigate the effect of age, cognitive ability, and adaptive behavior (AB) on these properties and the symptom presentation of these disorders in ASD. Method: Participants were 55 parent-child dyads with children aged 8 - 17 years (Mage = 13.7, SDage = 2.7; Male n = 39) with a previous diagnosis of ASD presenting with at least mild parent-reported depressive or anxiety symptoms. Test-retest reliability was measured through intraclass correlation coefficients (ICCs) between the two time points of the self-reported anxiety and depressive symptoms measured by the Children's Depression Inventory, Second Edition – Self Report Short (CDI 2: SR[S]) and the Revised Child Anxiety and Depression Scale (RCADS), and the diagnostic validity was assessed using a receiver operating characteristic (ROC) curve with the clinical judgement based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) as a criterion. The effect of participant characteristics was analyzed by comparing dichotomous groups (open full item for complete abstract)

Committee: Luc Lecavalier (Advisor); Katherine Walton (Committee Member); Marc Tassé (Committee Member) Subjects: Psychology

Master of Arts, The Ohio State University, 2023, Educational Studies

Students that experience low vision may require vision correction to fully participate in the classroom. However, some students with visual impairments (VI) who have an additional diagnosis of autism spectrum disorder (ASD) may require support to wear glasses. This study examined the effects of positive reinforcement procedures to increase the duration that a kindergarten student with ASD in addition to VI (ASDVI) wears their glasses. Positive reinforcement consisted of verbal praise and access to preferred items. The intervention was implemented in two different settings including the special education classroom, and the all-inclusive general education classroom. Findings from this study demonstrated that positive reinforcement is a promising means to increase glasses wearing for young students with ASDVI. Given previous research has resorted to using punishment-based procedures to promote glasses wearing, this study provides promising initial evidence that positive reinforcement procedures can be an effective and more socially acceptable alternative.

Committee: Tiffany Wild (Committee Member); Matthew Brock (Advisor) Subjects: Special Education

Master of Arts, The Ohio State University, 2023, Educational Studies

Abstract Students with Visual Impairment (VI) may require vision correction to fully participate in their academic experience. However, students with VI on the autism spectrum may be resistant to wearing glasses. In this single-case design study, a changing criterion design was used to test the effects of positive reinforcement on the duration that an elementary student with autism spectrum disorder (ASD) wore their glasses. Positive reinforcement consisted of engaging in preferred activities while wearing glasses and access to preferred tangibles after successfully wearing glasses for predetermined length of time. The criterion gradually increased as the participant was able to meet mastery criteria for each intervention phase. Findings demonstrated a functional relation between positive reinforcement and increased duration of glasses wearing. Given previous research has resorted to using punishment-based procedures to increase glasses tolerance, this study provides promising initial evidence that positive reinforcement procedures can be an effective and more socially acceptable alternative.

Committee: Matthew Brock (Advisor); Tiffany Wild (Committee Member) Subjects: Special Education

Master of Arts, The Ohio State University, 2023, Educational Studies

Autism Spectrum Disorder (ASD) is a neurodevelopmental disability characterized in part by deficits in social communication. When communication is hindered, the ability to request one's wants, needs, and desires, the ability to form relationships, share interests becomes greatly limited (Stoner et. al., 2006). The Picture Exchange Communication System (PECS) was developed for individuals with limited verbal and functional communication skills. The study's purpose was to evaluate the effectiveness of teaching PECS to an individual with ASD. A multiple-baseline across behaviors design was used to examine the effects of PECS training on independent requests made by one 5-year-old child with ASD and limited communication skills. Results indicated that the participant acquired PECS skills for requesting independently across three preferred items and activities. This study replicates previous findings that PECS training can be an effective way to teach children with ASD and limited communication skills. The study also extends research by demonstrating the effectiveness of PECS compared to the absence of intervention and for a child with no previous exposure to communication interventions and limited interests.

Committee: Matthew Brock (Advisor); Tiffany Wild (Committee Member) Subjects: Special Education

Master of Arts, Miami University, 2023, Speech Pathology and Audiology

Joint attention provides children with important opportunities for language learning. To engage in JA children must be able to visually attend to their parents and an object. Children with autism tend to struggle with visual attention. Deaf parents of deaf children have been shown to be more adept at facilitating visual attention in their deaf children. Both autistic and deaf children have unique visual attention needs. To determine if Deaf parents are also more adept at facilitating visual attention in autistic children, we sought to identify the strategies used by Deaf parents of autistic children. We obtained videos of our participants playing with their children and identified 15 strategies which occurred in a single modality or bimodally. We found that most frequently deaf parents were using gaze shifts, linguistic utterances, touching their child's body, and object manipulation to gain and maintain their attention. Additionally, they use the same adaptations Deaf parents use in child directed sign, as well as the unique adaptation of shifting their eye gaze toward their own signs. Eventually, we hope to determine the efficacy of these strategies and if they carry over to hearing and heterogeneous dyads.

Committee: Aaron Shield (Advisor); Amy Lieberman (Committee Member); Donna Scarborough (Committee Member); Trace Poll (Committee Member) Subjects: Speech Therapy

DNP, Otterbein University, 2024, Nursing

Children with autism spectrum disorder (ASD), as well as caregivers, experience significant challenges in their interactions with healthcare providers in a clinical setting. This is primarily due to their issues with communication, social interaction, and sensory sensitivities to anesthetic treatment during premedication or preoperative environments. Due to these characteristics, it is important to maintain and update the current standards of care for children with ASD while utilizing evidence-guided strategies to provide a pre-operative assessment effectively. The pre-operative assessment is a critical component that renders impact throughout the surgical experience with the purpose of risk stratification, preparation of altering the normal physiology of the patient, and emergence from anesthesia. Thus, allowing the altered physiology, caused by the delivery of anesthetic medications intra-operatively, to return to normal. A lack of facility guidelines on how to tailor the anesthetic approach to this patient population leaves a potential margin of error that could endanger the expected outcome of the patient undergoing surgery and contribute to a vastly growing healthcare disparity. The purpose of this project is to examine existing contemporary literature on anesthesia preoperative care of the autistic pediatric population, with a focus on evaluating the current standards of care in place, and the utilization of new evidence-based guidelines to improve the quality of care.

Committee: Brian Garrett (Committee Chair); Amy Bishop (Committee Member); Chai Sribanditmongkol (Committee Member) Subjects: Health; Health Care

PHD, Kent State University, 2023, College of Education, Health and Human Services / School of Lifespan Development and Educational Sciences

The purpose of this study was to determine the effectiveness of a peer mediated intervention to increase social communication acts of preschool children with autism spectrum disorder (ASD). Utilizing a single-subject A-B design across four peer dyads, I examined the overall effectiveness of the intervention in relation to specific nonverbal, verbal, and play behaviors and examine the generalization of social communication acts outside of the intervention period. The study participants consisted of four preschool children with ASD and one typically developing peer partner for each child with ASD. All participants attended integrated preschool settings. Intervention results were reported using visual analysis and participant effect size. The intervention showed small significant increases in some areas of nonverbal interactions, interactive play, and verbal interactions for some of the peer dyads, but not all. Strong levels of implementation fidelity and social validity were also reported.

Committee: Sloane Burgess (Committee Chair); Ching-I Chen (Committee Member); Lisa Audet (Committee Co-Chair) Subjects: Early Childhood Education; Special Education