a place to be and something to do: evidence-based practices for children with autism samuel l. odom...
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A Place To Be And Something To Do: Evidence-based Practices for
Children with Autism
Samuel L. OdomFPG Child Development
Institute
Goals of the Presentation
• Provide basic information about ASD• Examine goals of inclusion • Discuss forms of inclusion• Describe measure of quality of programs for
children with ASD• Identify comprehensive treatment models • Describe evidence-based focused intervention
practices• Process of working from goal to practice
selection
Introduction
1 in 68
DSM 5 Diagnostic Criteria
• Impairment in social communication
• Restricted repetitive and stereotyped patterns of behavior
• Onset prior to the age of three years
Demographics
• 75% are male• Multiple etiologies related
to neurobiological causes• Unrelated to
socioeconomic status or race
• Range of IQ scores, but stretches across the continuum
History of Disorder and Trends in Treatment
• Kanner’s Discovery in 1940s
• Psychodynamic approaches (Kanner-Bettleheim-Greenspan)
• Lovaas application of Applied Behavior Analysis
• Structured psycho-educational approach (Project TEACCH)
• LEAP and Walden programs among first inclusive programs
Autism Mystique• Probably more than any disability, or unique
set of abilities, autism has been shrouded in a treatment mystique
• The etiology has gone from refrigerator mothers to epigenetics
• Treatments are more diverse than any known disabilities
• Treatment claims range from amelioration to recovery
Defense Against the Dark Arts
• Many interventions with no scientific evidence have been recommended for children with ASD
Cutting Edge Interventions for Autism (Seri & Lyons, 2011)
• Antifungal treatment• Aquatic therapy• Berad Auditory
Integration Therapy• Chelation Removal of
Toxic Metals• Craniosacral and
chiropractic therapy• Dietary interventions
• Hyperbaric oxygen therapy• Medicinal marajuana• Neuroimmune dysfunction
and antiviral therapy• Sensory gym• Traditional and indigenous
healing • Stem cell therapy• Transcranial Direct Current
Stimulation
Evidence-Based Practices• Translation of the
intervention research literature
• Most based on applied behavior analysis
• Some from other theoretical perspectives
What Do We Mean By Practice?Comprehensive Models vs. Focused Interventions
• Focused interventions are procedures that promote individual skills or learning within a specific skill area.
• Comprehensive models are multi-component programs designed to positively and systematically affect the lives of children with ASD and their families
Definition of Inclusion
• Placement of children with disabilities in programs with typically developing children
• Inclusion defined in different ways (Odom, 2002)
• Forms of inclusion– Community-based– Team teaching– School-based
• Blended model
Choice of Outcomes (Goals) Determine Supports Needed
• Social Integration– Activities promoting
social interaction with members of the class and community
• IEP Objectives and Learning Outcomes– Procedures supporting
learning goals
Equity as a Fundamental Benchmark
• Britto, Yoshikawa, & Bollers (2011) social policy report for Society for Research on Child Development
• Equity is the key concept in establishing early child development programs in internation context– Access– Quality
Outcomes of Inclusive Settings (Schwartz, Staub, Gallucci, & Peck, 1995)
• Participation– As other classmates
• Engagement– Meaningful involvement
• Relationships– Formation of friendships
Comprehensive Treatment Strategies
• Multiple components
• Broad scope • Intensity • Longevity • Manualized
procedures
Examples of Comprehensive Treatment Program
• Lovaas Institute• Pivotal Response Treatment• Early Start Denver Model• LEAP**• TEACCH• Project DATA**• Princeton Child Development Institute**• Walden**• May Institute
Features of CTMs that Focus on Inclusion
• Assessment and goal development
• Majority of children are typically developing
• Class-wide and individual program designed for children
• Naturalistic and direct instruction
• Structure and predictability• Intensity• Parent program• Trained Staff
A Technical Eclectic Approach
• Local programs can and do create their own service models
• Important to have a conceptual framework or theory of change
• Necessary to have a proscribed (manualized) system of assessment, treatment selection, and evaluation
• Necessary to stay close to the science in selecting interventions
Family & Student Priorities
Student Characteristics
Current Environment
Future Environment
Professional Development
Technical Assistance & Support
Program Quality
Goals• Social• Communication• Behavior
Selectionof EBP
Selectionof EBP
Implementa-tion
Outcomes
Influences
Process
Model Features
Quality is Important
Learning Environment
Interdisciplinary Teaming
Program Ecology
Structure & Schedule
Positive Learning Climate
Curriculum & Instruction
Communication
Social Competence
Personal Independence
Functional Behavior
Assessment & IEP
Family Participation
Program Quality
Learner Outcomes
Transition (MHS only)
Autism Program Environment Rating Scale (APERS) Formats
• Preschool-Elementary– Inclusion preschools– Self-contained preschools – K-5 (or beginning of middle school) inclusive– K-5 self contained
• Middle School-High School– Inclusive classes (assumes multiple classes)– Self-contained classes– Transition programs
APERS Preschool-Elementary
• Classroom Environments• Class Structure/Schedule• Positive Classroom Climate• Assessment• Curriculum and Instruction
APERS Preschool-Elementary
• Communication• Staff/Peer Relationships• Functional behavior (Challenging and
Adaptive)• Family Involvement• Teaming
Evidence-Based Practices
Basing Early Intervention on Evidence-based Practices
• Should draw from the current scientific information available that documents what works.– DEC Recommended Practices– National Standards Project– National Professional Development Center on ASD
Systematic Reviews of the Literature for
Evidence Based Practices (EBPs)• In 2009, 11 “treatments” or practices with an evidence base
– Reviewed by National Standard Project from National Autism Center
• In 2010, 24 EBPs– National Professional Development Center (NPDC) – Included 10 years, 1997-2007
• In 2014, 27 EBPs – Second review by NPDC– Included 22 years, 1990-2011
• 29,101 possible studies 456 studies• RCT, quasi-experimental, single case design
– Strength of evidence for assessment – Based on number, type of studies using each EBP
autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/2014-EBP-Report.pdf
Odom, Collet-Klingenberg, Rogers, & Hatton., 2010.; Wong, Odom et al., 2014RCT: randomized clinical trial
Evidence – Based Practices(2014)
Antecedent-based interventions
Cognitive behavioral intervention*
Differential reinforcement
Discrete trial training
Exercise*
Extinction
Functional behavior assessment
Functional communication training
Modeling*
Naturalistic interventions
Parent-implemented intervention
Peer-mediated instruction/intervention
Picture Exchange Communication System
Pivotal response training
Prompting
Reinforcement
Response interruption/redirection
Scripting*
Self-management
Social narratives
Social skills training
Structured play groups*
Task analysis
Technology-aided intervention/instruction*
Time delay
Video modeling
Visual supports * Added from 2014 literature review
Evidence-based Practice Approach
Wong, Odom et al. (2014)
Selecting an Evidence-Based Practice
• Goal: skill being promoted• Your professional wisdom• The learner’s learning style• The learner’s temperament• The learner’s interests and motivators• Supports already in place*• History of what has and hasn’t worked
Evidence-Based Practices are Delicious
Facilitators of Early Childhood Inclusion
• Programs, not children, have to be ready for inclusion– Accepting philosophy– Quality of program (ECERS, ICP, CLASS, APERS)
• Collaboration is the cornerstone• Specialized instruction is essential• Adequate support is necessary
– Advocate in the administration– Resources for training and collaboration
Delivery of Services
http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/NPDC_CoachingManual.pdf
• Initial training• Itinerant coach/
consultant in community child care or school setting
Elements of Successful Coaching Relationships
Includes:• Trust and mutual respect• Training• Willingness to change• Professional attitude• Reciprocity• Communication
Trust and Mutual Respect
• Understand topic-comfort levels• Respect coaching partner’s professional skills• Use shared terminology• Express feelings honestly with compassion• Be open to each other’s belief system
Issue of Program Intensity
• National academy report recommended 25 hours per week of service
• What do you think about this issue?
• Intensity defined as engagement and opportunity to learn
• Intensity directed toward learning goals: what if social integration is a goal?
Questions and Comments?