early intervention program for children with autism

EARLY INTERVENTION PROGRAM

FOR CHILDREN WITH AUTISM

Jaruwan Kittisopit, M.D.

The Walden Program

• Research based Early Childhood Program• Established 1985• Emory Autism Center, Department of

Psychiatry and Behavioral Science, Emory Medical School, Atlanta, Georgia, USA

• Systematic replication of the Toddler Center Model for typical children’s day care by O’Brien, Porterfield, Herbert-Jackson, Risley 1979.

The Walden Program Hallmarks

• Naturalistic ABA approach“Incidental Teaching concepts”

Behavioral approach : Applied Behavior Analysis,

ABA Traditional ABA

Discrete-trial procedure ( Lovaas 1981)

Comprehensive or Naturalistic ABAIncidental Teaching (McGee

et.al.,1983,1999)

Pivotal Response Training ( Koegel,1999)

Peer-mediated strategies ( Strain and Kohler,1998)

Program

Mean Ageat entry (range)in months

Hoursper weeks

UsualSetting a

ConceptsOrientation b

PrimaryTeachingProcedure

Children’s unit 40(13-57)

27.5 School (s) t-B Discrete trial

Denver communityBased approach

46(24-60)

20 School(I),home,community

D Playschoolcurriculum

Developmental Intervention model

36(22-48)

10-25 Home, clinic D Floor timetherapy

Douglass 47(32-74)

30-40 School (S, I),home

t-B Discrete trial, naturalistic

LEAP 43(30 -64)

25 School (I),home c-B Peer-mediated interventionnaturalistic

Pivotal Response Training 36(24-47)

varies School(I),home,community, clinic

c-B Pivotal response training

TEACCH 36(24 up)

25 School (s), clinic M Structured teaching

UCLA Young Autism Project 32

-30(46)

-204

0

Home t-B Discrete trial

Walden 30(18-36)

36 School(I), home c-B Incidental teaching

a (S) Segregated classroom; (I) Inclusive classroomb(t-B) Traditional Behavioral approach; (c-B) Comprehensive Behavioral approach; (M) Mixed approach

Lord C, McGee JP, eds. National Research Council (2001). Educating Children with Autism. Committee on Educational Intervention for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press, 2001.

The Incidental Teaching

• Definition: A systematic protocol of instruction that is delivered in the context of natural stimulus conditions of everyday environments

• Origin: Teaching complex language in the disadvantaged, typical children

• ABA concept • Peer Incidental Teaching & Inclusion

settingHart & Risley 1968,1974, 1975,1982McGee GG, Almeida MC, Sulzer-Azaroof B, Feldman RS. Promoting reciprocal interactions via peer incidental teaching. J Appl Behav Anal 1992; 25:117-26.

The Incidental Teaching Procedure

• Environmental is arranged • Child initiates • Teacher prompts : Use least to most prompts• Child responds• Teacher immediately provide

Access to the desired item/activity ( Contingent Reinforcer)

Praise and Confirm the correct response

• Child enjoys the desired item :Keep interaction enjoyable

• Teacher keeps looking for child initiation, or Create the next Teachable Moment

Incidental teaching Discrete Trial

• Child friendly session• Natural setting• Child initiated • Correlation of the

response and the reinforcer ( internal reinforcer)

• Slower to master the skill

• Overcome generalization and initiation problem

• Highly structured session

• Distract free setting• Teacher directed• No correlation btw

the response and the reinforcer

(external reinforcer)• Faster to master the

skill• Less generalization

and initiation

The Walden Program Hallmarks

• Naturalistic ABA approach“Incidental Teaching concepts”

• Positive Behavioral Interventions and Supports

• Promote Social and Language development “Verbal-only-program”

• Early inclusion• Active family collaboration

Family training 2 hr/ 2 wk for Home based-program 10 hr/wk

The Walden Program Hallmarks• Environmental

arrangement : Cubby, Toy shelves, Hobby boxes, Name tags, Seats, Gates, Physical zones

• Toy rotation system & Teaching theme

• Reinforcer assessment system

The Walden Program Hallmarks

• Overlapping activities schedules

• Designated teaching zones & Goal & Individual goal Free play – Play skill, Vocabulary Snack – CommunicationOutdoor – Peer interactionTable – Peer interaction & Academic readiness

The Walden Program Structure

• Combined Center and Home-based Program ( 25-30 hr plus 10 hr/ wk)

• Classrooms : Toddler, Preschool, Pre-Kindergarten

• 5 d/ wk, Full day , 8:30-15:30 , all year• Teacher : Child 1:3 1:4 1:5• CWA : TYP 1:2 (total 12-15)• Staff

Individual Educational Plan, IEP

Sequences of Social Goals across

the Walden treatment continuum

• Toddler

• Preschool

• Pre-K

• Social Responsiveness• Play Skills • Tolerance of Peer Proximity

• Focus on Peers• Synchrony of Play• Response to Peer interaction

• Conversation with peers• Peer Negotiation• Attraction of Peer bids• Initiation of Interactions• Sustained Interactions• Community Participation

Sequences of Communication Goals across

the Walden treatment continuum

•Toddler

•Preschool

•Pre-K

• Initial Verbalizations• Verbal Requests• Vocabulary

• Pragmatics of Conversation• Amount of talking• Complexity of Language• Correct of Syntax• Elaborated Vocabulary

• Vocabulary and Corrections

Sequences of Behavioral Goals across

the Walden treatment continuum

• Toddler • Preschool

• Pre-K

• Engagement• Independent Daily Living• Decreased Behavior

Problems

• Conventional School Behaviors

• Academic Readiness

The Walden Program Structure

• Ongoing Objective AssessmentEntry-Exit VDODaily probes1:1 recordsBiweekly review of individual

case • Program Evaluation

TeachersClassrooms

Outcomes of The Walden Graduates

McGee GG, Morrier MJ, Daly T. Walden Early Childhood Program. In:

Handleman JS, Harris SL. eds. Preschool Education Programs for Children with Autism 2nd ed. Austin: Pro-ed, 2001:157-90.

N = 34 (10 @ Neuro Dx)

Entry Exit

Age, yr 3.6 ( 2.0-5.6)

6.0 ( 4.11- 7.4)

% Peer Interactio

n

3 11 (1 -27 )( 17/34 in TYP range 6-39)

% Verbal cases

0 80% NV- 4/34 ¾ NeuroDx

% of Verbalizat

ion

6 16

Regular School

26/33