Peer Review History
Original SubmissionMay 25, 2020 |
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PONE-D-20-15702 Highways to happiness for ASD adults? Perceived causal relations among clinicians PLOS ONE Dear Dr. Deserno, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 21 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Review PONE-D-20-15702 ### GENERAL COMMENTS In general, this is a very interesting manuscript that has used a network methodology to shed a light on a new methodology (PCR) to catch clinical aspects regarding ASD. Nevertheless, to achieve the best shape, the manuscript needs some modifications. The authors tend to use several personal choices to justify some decisions (without a proper rationale to justify them). Two of the most problematic topics of the article are: a) the sample size (n=29 completed the questionnaire and n=16 were enrolled in the follow-up), and b) is the use of the term "causal". If by one side, the authors mention correctly "association network", by the other, they tend to classify associative relationships as causal ones. The authors should avoid using “causal” when data is correlational. The authors should have more care regarding the organization of the text. For example: the tables are out of order, the methodology and discussion presents redundant parts, and more than once, the reader needs to read again a part of the text to understand the intentions of the authors. Rather than using the term "empirical data", it would be more appropriate to rename this sort of information as "subjective data" (gathered directly from patients) in opposition to "objective data" (gathered from clinicians regarding their patients). Because, as a matter of fact, this study compares personal observation of patients with observations from clinicians. Since "empirical data are facts that are obtained by observation or experiment", both data used in the research could be considered empirical. The definition used by the authors does not consider as empirical the second cluster of data. Nevertheless, this assumption is not correct. In a more general comment, to improve the comprehensibility of the text, it would be very interesting if the text was built having blocks of information in mind. Them, pairing each part of the text with the next section. Example: The concepts and gaps mentioned in the introduction should be paired with the aims of the study. Then, these previous parts being paired with the corresponding part on the methods used for answering each of these questions (in a step-by-step fashion). Followed by the results you have for each of those questions. And, finally, the discussion of these results (still pairing them with the previous blocks), and the presentation of a conclusion ### INTRODUCTION • LINES 65 to 68 – I suggest the authors place the primary purpose of the study at the end of the introductory section. The same could be said regarding information regarding LINES 90 to 93. • LINES 85 to 93 – The authors should think about dividing the sentence in two at least. Since it is too long, it is difficult to follow, and the reader has to read again to catch all the information it provides. • LINES 94, 106, and 119 – The authors should reconsider the use of these numbered steps ("First", "Second", "Third"). It is unnecessary. Moreover, the paragraphs they begin with were the continuity of the literature review on the field brought by the introductory section. So, it doesn't make sense the use of them… • LINES 108 and 109 – The authors make an imperative affirmation. Nevertheless, it is a supposition. So that they should use a conditional verbal form instead of such an illation. — "This suggests that professionals working in the clinical field already WOULD/COULD/MAY conceptualize psychological constructs as a set of causal relations between symptoms and other factors" • LINE 110 – It is not adequate mention "in our view". If the authors made a brief review and from that, they concluded that the sort of information is underused, so mention that. Avoid this sort of postulation. E.g.: "A BRIEF SEARCH IN PUBMED DEMONSTRATES THAT THERE IS LACK OF STUDIES…" • In general, it is interesting the use of questions to incite the readers toward some aspects of the literature gap. Nevertheless, some of them could be placed as affirmations (and their respective references). The overuse of the questions may give the impression that the authors did not perform a good literature review (what doesn't seem to be the case). But to prevent this imprecise impression, use the questions only for the most important points raised in the text (and only those the authors intend to answer with the present manuscript). In LINE 133-134, for example, the authors mention: "The aim of the current study is to take the first steps towards addressing these questions…". The problem is: there were so many questions… which one of them do they intend to answer? All of them? • LINE 125 – Mention, in an apposition, what is Delphi Methodology (e.g.: "a structured communication technique") • LINE 136 to 137: Divide the aims of the study. The too-long sentence could be better explained as: "The aims are: a)……… , b)………… , c) ………" . This separation will make the text easier for readers. • The PCR methodology should be explained before the presentation of the aims/objectives (that should be the very last points of the introductory section). • LINE 147 – I suggest changing the term "client" for "patient"… • LINE 150 – Suppress "exploratory". • LINE 151 – Although the proposal of look into Deserno et al. 2017 is interesting, that proposition would be more suitable for the reader if the article would be presented in a medium with hypertextual tools (which is not the case of PLOS ONE). So, explain very briefly, in the introduction, before presenting the aims, the domains of well-being as presented in Deserno et al., 2017. • LINES 155 – 156 – Why do the authors would like to explicitly mention the PCR as an objective of the paper, deviating from the core results? ("…provide an example of how to use the PCR toolbox to integrate the knowledge of clinicians in empirical studies"). Is it necessary? Wouldn't this interesting work itself be a proper example? • LINES 156 – 158 – More suitable for the "Methods section". • LINES 159 – 167 – This paragraph would be unnecessary if the introductory section would be properly constructed. This last paragraph should be dedicated to the aims and objectives (that — in this article — were separated through the introduction. Moreover, sentences such as (LINES 164 – 165): "…the exact same variables found in Deserno et al. (2017)" should be avoided because the reader should have all the essential information for understanding this article without the necessity of reading additional articles. The last sentence should be placed in Methods. ### METHODS • In general, this section is prolix, presents redundant parts, and is not straightforward. It needs to be reformulated to provide to the reader a better understanding of the step-by-step of what was done. • Regarding the PCR network, remember always use "'perceived causal' effect" instead of "causal effect", "causal network", "causal relation" etc (ex.; line 270, 272) since one perception does not indicate a real causal effect. • Concerning the sample, how many clinicians were invited to participate, and how was the acceptance rate among all clinicians invited? How the authors calculated (and eventually decided) that the number of raters was enough (n=29)? How do the authors think about the number of responders in the follow-up phase? • It is not clear how the selection of the institutions and the raters was done. Do the services investigated were the only facilities treating ASD in the region? Provide a glimpse both the selection of the sample. The simple mention that the authors "knew all the clinicians" is not descriptive enough and does not allow replications. Provide objective criteria. • Why the authors have included raters with different backgrounds (psychologists, psychiatrists, behavioral scientists, and social workers)? Since their formation is quite different from each other some bias on the appreciation of causal relations could certainly occur. Moreover, the PCR intends to access causal relations based on their clinical expertise. Even though the patients are the same, the clinical perception of a professional is biased by people's academic background. • In the same direction, mention that because they work in such facilities, "we know that all clinicians participating in the current study are involved in diagnostic work, consultation, and intervention services" is not informative enough. Besides that, how the authors guarantee that some of the respondents do not work only in the administration or coordination of such settings rather than as clinicians. • The authors should avoid expressions such as: "[they] consider 'advanced experience with ASD'". Such subjective evaluation weakens the methodology of the study. For example, mention only that "we knew that they are [specialists]" is too fragile. Objective criteria would be preferable. • What is CASS18+? I suppose it is an institution/facility for the treatment of ASD. Explain previously used abbreviations. • Provide a table with the demographic characteristics of the group. • Provide to the reader a brief explanation of Deserno et al., 2017 and also Frewen et al., 2012 study. Despite hypertextual material is interesting, this sort of tool is not suitable for PLOS ONE and burdens the reader. • LINES 204 to 210: That is "Statistical Analysis" rather than "Measure and Procedure". • FIGURE 1 and 2: The quality of the images does not allow us to read the texts inside the nodes or in the figure legends. Figure 2 needs a legend. • LINES 243 – 247: The authors mention that: "Therefore, we decided to split the EMPIRICAL network in three (overlapping) parts with an (almost) equal number of nodes (j1= 14, j2=13, j3=13) based on their clustering in the EMPIRICAL network to ensure study feasibility." Is that correct? • LINES 243 – 252: This was the less comprehensible part of the methodology. Reformulate it to allow a better understanding. It would help a lot providing a diagram/draw/scheme with the step-by-step of the methodology. • LINES 250 – 252: "Large rater groups"? The author assessed only 29 raters… It is not clear what was done. • The low number of raters is a serious question. And, when allocated to one of the three different groups, the number is even smaller (n=9, 10, and 10). • LINE 259 – Why the authors have asked the raters to choose THREE targets? Based on what rationale? • LINE 276 – Why the authors have used a threshold of 6? Based on what rationale? • It also is not clear why, having in mind that the empirical network reflects partial correlations scaled between -1 and 1, why the authors have used clinicians' ratings from 0 to 10. Why not using a Likert scale, for example? Moreover, comparing two different networks with two different methodologies would not be problematic? • I wonder if the authors could have further commentaries on the following sentence from LINES 276 and 277: —"Manually thresholding the visual representation was necessary since the raters tended to attribute very high values to edges, they thought were present." Do the authors did not expect that ceiling effect (since they search for "perceived causal effects", those how seem to the raters more intense would be valued)? Do the way the questions were asked did not favor that behavior? Moreover, in LINE 278, the authors mention that "did not specify such thresholds for any of the analyses". Nevertheless, they mention that (LINE 275-275) "only those causal relations endorsed by the raters with an average rating of at least 6 (on a scale from 0 to 10) on the PCR were included in the visual representation of the network". It seems that one sentence contradicts the other. ### RESULTS • The results section is difficult to follow and, sometimes, no distinguished from what should be in the discussion. The sentences are very long, and the excessive number of examples and comparisons with previous studies (that should be done in Discussion rather than in Results — E.g. LINE 339 – 343) makes it difficult for the reader to retain the main findings among the profusion of information. The text would benefit a lot if the authors would be more direct in reporting the results, commenting them only at the Discussion. Focus on the main findings. Although this sort of methodology provides uncountable information, is detrimental to the text if the authors try to mention everything they find. • The authors do not present numerical results in this section. This data is important and not presented only as supplementary material (LINE 359). • All tables and figures must be close to their title, footnotes, and all material referent to them. Is difficult to follow the results because the figures do not present this information. Moreover, the Figures do not have titles, but long explanations of what they represent. That fact indicates clearly that the figures are not self-explanatory as they supposed to be (at least in partly). • The quality of the images is poor making it impossible to read them. • LINE 337 – The authors should provide the list of abbreviations in the text and not only in the supplementary material. • The comprehension of the Tables and Figures should be independent of the text (and vice-versa). They have to contain all the necessary information for their comprehension (e.g. LINE 374 — the table title contains references to the text). • There is no reference in the text regarding where Table 1 should be placed. It was put in the text but not mentioned. • LINE 377 – 384: It is not clear why the authors decided to investigate the interventions the raters would do. That's not one of the aims of the study and with such a small number of raters, the results are not meaningful. • LINE 387 – 393 and 458 – 469: This paragraph is not part of the Results section. It describes the methodology. • LINE 431: "…between -1 AND 1…" • Where is Figure 4 that is mentioned in the text? • LINE 496 – 499: This paragraph is not part of the Results section and should be placed in the Discussion section. ### DISCUSSION • In general, the Discussion is easier to read than the rest of the text, although repetitive. Nevertheless, the authors tend to stretch the line in some conclusions to explain some findings. For example, I did not understand the sentence in LINE 526-528: "This would be consistent with the plausible idea that ASD symptoms arise from sources external to the current networks (e.g., from problems associated with brain development)." How's that, "external to the current network"? Are not all the ASD symptoms part of a neurodevelopmental problem? Moreover, having assessed only about 30 clinicians from a limited number of facilities is too forced, and — why not say — presumptuous, mention that "we found that the way clinicians perceive cause-effect relations between ASD symptoms". • Again, in Discussion, the problem of "causal" inferences persists. • I suggest the following articles in order to improve the quality of the text: A. Docherty M and Smith R. The case for structuring the discussion of scientific papers. BMJ 1999;318;1224-1225; B. Horton R. The hidden research paper. JAMA, June 5, 2002—Vol 287, No. 21. • LINE 523: Wouldn't be "…other than THE influence…" rather than "…other than THAT influence…"? • LINE 562: I do not think is fair the authors mention that they have used "large rater groups". The sample size is quite small and its subdivision smaller. This should be mentioned as a limitation. • LINE 568: It is interesting the authors mention that "it is important to note that the centrality of nodes in the empirical network indicates the importance of a node…", but they relegate centrality measures to supplementary material. • LINE 572 – 573: This is one of the most important sentences in the manuscript that deserves more attention from the authors: — "…assuming that the variables in question indeed form a causal system with symmetric effects…". It is important to mention that, based on an assumption that variables investigated to form a causal system according to the current literature, the networks were built. So, it is necessary to caution regarding the conclusions of the study. • LINE 608: "schematic representation of PERCEPTION OF cause-effect " rather than "schematic representation of cause-effect " ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1 |
Highways to happiness for autistic adults? Perceived causal relations among clinicians PONE-D-20-15702R1 Dear Dr. Deserno, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Geilson Lima Santana, M.D., Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No |
Formally Accepted |
PONE-D-20-15702R1 Highways to happiness for autistic adults? Perceived causal relations among clinicians Dear Dr. Deserno: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Geilson Lima Santana Academic Editor PLOS ONE |
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