Stepping Stones Triple P: An RCT of a Parenting Program with Parents of a Child Diagnosed with an Autism Spectrum Disorder

Whilst the Triple P Positive Parenting Program has a large evidence base (Sanders, Clinical Child and Family Psychology Review 2:71–90, 1999; Sanders, Journal of Consulting and Clinical Psychology 68:624–640, 2000) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious (Roberts, Journal of Clinical Child and Adolescent Psychology, 35(2):180–193, 2006), to date Stepping Stones has not been evaluated with the ASD population. Fifty-nine families with a child with ASD aged between 2 and 9 participated in this randomized controlled trial. The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour, parental over reactivity and parental verbosity being maintained at follow-up 6 months later. Further, the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy. The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD. Limitations and future research are also addressed.     

A Randomized Controlled Trial of Group Stepping Stones Triple P: A Mixed‐Disability Trial

Stepping Stones Triple P (SSTP) is a parenting program designed for families of a child with a disability. The current study involved a randomized controlled trial of Group Stepping Stones Triple P (GSSTP) for a mixed‐disability group. Participants were 52 families of children diagnosed with an Autism Spectrum Disorder, Down syndrome, Cerebral Palsy, or an intellectual disability. The results demonstrated significant improvements in parent‐reported child behavior, parenting styles, parental satisfaction, and conflict about parenting. Results among participants were similar despite children's differing impairments. The intervention effect was maintained at 6‐month follow‐up. The results indicate that GSSTP is a promising intervention for a mixed‐disability group. Limitations of the study, along with areas for future research, are also discussed.     

Effect of body configuration at step contact on balance recovery from sideways perturbations

Compensatory stepping is an important protective mechanism to prevent falling. To recover from sideways perturbations side steps are generally more advantageous than cross-over steps. However, there is lack of understanding of the characteristics of compensatory side steps following sideways perturbations that separate successful recoveries (i.e., no falls) from falls, the most clinically relevant outcome following a balance perturbation. We aimed to identify the critical determinants for successful side stepping after large sideways balance perturbations. Twelve healthy young adults were subjected to large leftward perturbations at varying intensities on a translating sheet. For recovery attempts started with a side step, we determined body configuration variables (frontal-plane leg and trunk angle) at first step contact, as well as spatiotemporal step variables (onset, length, duration, velocity). A logistic regression analysis was conducted to determine the predictive ability of body configuration and spatiotemporal variables on the probability of success (no fall vs. fall); perturbation intensity (peak jerk of translating sheet) and a random effect for individual were also included in the model. In the final model, leg angle and peak jerk were retained as predictors of successful balance recovery and these variables correctly classified the recovery outcome in 86% of the trials. This final ‘body configuration’ model yielded a −2 log likelihood of −36.3, whereas the best fitting model with only spatiotemporal variables yielded a −2 log likelihood of −45.8 (indicating a poorer fit). The leg angle at a given perturbation intensity appears to be a valid measure of reactive side step quality. The relative ease of measuring this leg angle at step contact makes it a candidate outcome for reactive stepping assessments in clinical practice.     

Examination of reactive motor responses to Achilles tendon vibrations during an inhibitory stepping reaction time task

Inhibition is known to influence balance, step initiation and gait control. A specific subcomponent of inhibition, the perceptual inhibition process, has been suggested to be specifically involved in the integration of proprioceptive information that is necessary for efficient postural responses. This study aimed to investigate the inhibition requirements of planning and executing a choice step initiation task in young adults following experimental perturbation of proprioceptive information using Achilles tendon vibrations. We developed an inhibitory stepping reaction time task in which participants had to step in response to visual arrows that manipulated specific perceptual or motor inhibition according to two proprioceptive configurations: without or with application of vibrations. Performance of twenty-eight participants (mean age 21 years) showed that Achilles tendon vibrations induced an increase in attentional demands (higher reaction time and longer motor responses). Further, this increase in attentional demands did not affect specifically the different inhibitory processes tested in this reactive stepping task. It suggests that attentional demands associated with the vibratory perturbation to postural control do not lead to a shift from automatic to more attentional inhibition processes, at least in young adults.     

Effects of support surface and optic flow on step-like movements in pre-crawling and crawling infants

Step-like movements were examined in pre-crawling (n = 9) and crawling (n = 9) 6–13 month-old infants in the air and on a surface in response to a static pattern or optic flows that moved toward or away from the infant. Infants completed six 60-s trials. A significant interaction between locomotor status and support condition revealed that pre-crawling infants made more step-like movements in the air than on a rigid surface. In contrast, crawling infants made an equivalent number of step-like movements in the air and on the surface. Optic flow did not influence the number of step-like movements made by infants. The pre-crawling infant finding is consistent with a finding in a previous study in which two month-old infants were shown to step more in the air than on the ground. This finding is discussed relative to the idea that the infant stepping pattern disappears because the legs become too heavy to lift.     

Topological assessment of gait synchronisation in overground walking groups

Walking is one of the fundamental forms of human gross motor activity in which spatiotemporal movement coordination can occur. While considerable body of evidence already exists on pedestrian movement coordination while walking in pairs, little is known about gait control while walking in more complex topological arrangements. To this end, this study provides some of the first evidence of spontaneous gait synchronisation while walking in a group. Nine subjects covered the total distance of 40 km at different speeds while assembled in a three-by-three formation. Two experimental protocols were applied in which the subjects were either not specifically asked to or specifically asked to synchronise their gait. To obtain results representative from the point of view of gait control, the movement coordination was quantified using the indirectly measured vertical component of ground reaction force, based on output from a network of wireless motion monitors. Bivariate phase difference analysis was conducted using wavelet transform, synchronisation strength measures derived from Shannon entropy, and circular statistics. A fundamental relationship describing the influence of the group walking speed on individuals’ pacing frequency was established, showing a positive correlation different from that previously reported for walking in solitude. A positive correlation was found between the average synchronisation strength within a group and group’s walking speed. The most persistent coordination patterns were identified for pedestrians walking front-to-back and side-by-side. Overall, the spontaneous gait synchronisation while walking in a group is relatively weak, well below the levels reported for walking in pairs.