Florida Conference for Supporting Military Youth with Special Needs - speaker Dr. Daley on Autism.

1. 6/19/2012
1. It is possible to identify children as young
Best Practices for Serving as 1 year old
Children with Autism Spectrum
Disorders
Teresa Daly, Ph.D, BCBA-D
UCF Center for Autism and Related Disabilities
and important to do so
Why you SHOULD identify early 2. When you’ve met one child with
• Brain plasticity ASD, you’ve met one child with
• Speech “sensitive period” ASD
• Research findings
– Earlier treatment highly correlated with
options at age 6
– Verbal language by age 5 best
predictor of future outcomes
• Rare resolution without active and intensive intervention
• Link children and families to services that will address their
needs intensively during the preschool years
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Autism Social
Spectrum
Restricted
skills Interests &
Attention
Disorders
Communication
Childhood
Disintegrative
Disorder
Autistic
Disorder
Rett’s
Disorder
Pervasive Developmental Disorder
Not Otherwise Specified Asperger’s
Disorder
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2. 6/19/2012
Core Deficits for Autism Spectrum
Disorders
Differences in
socialization
ASD
Differences in Repetitive behaviors,
communication interests and activities
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3. 6/19/2012
-Dalton, 2005
Basic Communication
Language
of the
Eyes
& prelinguistics
Eye contact Follow gestures Object/Person
Gestures Give me Existence/Nonexistence
Vocal Play Objects Recurrence
Back & forth Actions Rejection
Other vocabulary Attribution
Directions Possession
One Word Stage: Intonation Action/Locative Action
Facial Expressions Locative State/State
Requests Notice
Protests 14 grammatical
Responds morphemes
Comments
Greets
Games
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4. 6/19/2012
A: happy
B: Afraid
C: Disgusted
D: Distressed
A: Guilty
Harder for
AS to B: Thinking
recognize C: Flirting
Belief- D: Arrogant
based facial
expressions
Viewer with ASD (Red Line)
Normal Comparison Viewer
(Yellow Line)
Ami Klin
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5. 6/19/2012
Social Skills Needs Higher Level Social Skills
• Social smile • Greeting others • Understanding • Joking around
• Eye contact during • Responding to greetings perspective • Noticing disinterest
social interactions • Imitating actions of peers • Understanding • Conversational tags
• Eye contact coordinated • Using positive touch intonation
with speech • Initiating conversation
• Participating in group action • Understanding social
• Accepting positive • Turn-taking • Maintaining
touch rules conversation
• Watching peers
• Accepting proximity of • Giving and receiving
other children • Responding with speech • Sharing good fortune
• Initiating with speech compliments
• Staying in proximity
• Seeking proximity • Conversation
• Showing • Symbolic play
Engagement Needs Independence Needs
• Sustained attention/Endurance • Dressing/undressing
• Joint attention • Feeding/drinking
• Task completion • Toileting
• Variety in leisure and work skills • “Personal responsibility”
• Activity Participation • Navigating the world
• Interactions • Home Skills/Chores
• Leisure Skills/Interests
Recommendations
Tolerance (re: intervention)
Needs • Begin as soon as autism is suspected
• Clothing • Group participation
• Minimum of 25 hours per week, year
• Having to
• Routines round
communicate better
• Routine changes
• Sounds
• Proximity • Engaged in systematically planned
• Touch
• Demands developmentally appropriate
• Activities of daily
• Choices living educational activities
• Waiting (toothbrushing,
• Food variety haircuts)
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6. 6/19/2012
Priorities: Key Targets for Effective Programming:
• Functional Spontaneous Communication Engagement: Playing with toys, participating in
activities, interacting with people.
• Social instruction throughout the day in various
settings Play Skills: Knowing what to do with toys; using
toys in increasingly complex ways.
• Cognitive development and play skills
Communicating: Using words and gestures to
• Proactive approaches to behavior problems let others know what is wanted or
unwanted.
• To the extent it promotes acquisition of goals,
Independence: Doing things for oneself (at the
specialized instruction provided in a setting that
includes ongoing interactions with typically appropriate developmental level).
developing children
Tolerance: Accepting things that are not exactly
what is most enjoyable (peer
proximity, activity participation, etc.)
Prioritizing Intervention: Prioritizing Intervention:
Young Children Elementary Age Children
• Family priorities • Family priorities
• Disability-dictated priorities • Disability-dictated priorities
• Multiple opportunities each day • Multiple opportunities each day
Language/Communication Language/Communication
Social/Relating Functional Academics
Self-Help Social
Motor Motor
Other Other
Prioritizing Intervention: Older Prioritizing Intervention: 18-22
Children year olds
• Family priorities • Family priorities
• Life Skills • Life Skills
• Multiple opportunities each day • Multiple opportunities each day
Functional Academics Vocational
Functional Academics
Vocational
Social
Leisure
Leisure
ADLs
Self
Other help
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7. 6/19/2012
Curriculum for Students with Functional Skills?
Autism Spectrum Disorders
• Does the child need or use this skill in
MUST everyday life?
1) First: Address core deficits • Does the child need this skill both now
* Communication
and in the future?
* Socialization
• Does someone else currently have to
* Restricted interests and attention
help him perform this skill?
2) Then: Address FUNCTIONAL academics
• Will learning this skill enable the child to
reading, money, time, measurement
be more like “typical” peers?
3) Then: Address additional academics
• Will learning this skill enable the child to
world geography, penmanship
participate in the community?
(Jacobs, 1993; Bruder, 1995)
Functional skills are
• Every case is different
• Used and not forgotten
• Easier to learn because of real-life
• What works for one may not work for
application
another
• More easily generalized because they take
place in the settings where they are
needed • Parents know their own child best
• A pathway to independence
• Parents can be effective teachers, IF they
have training, support and the availability
Hanen More than Words Implications for Parents and
Program Teachers
• Don’t assume
• Communicate
• Evaluate everything—accept nothing
blindly
• Be a good consumer
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8. 6/19/2012
Characteristics of
Evidence-based Practices Effective Programs*
• Early implementation
• Systematic teaching
• Functional skills (core deficits)
• Specified curriculum, evaluation methods
• Supportive environments and routines
• Family involvement
• Inclusion opportunities
• Intensity
• Staff and program development
(Dawson & Osterling, 1997; Izeman & Strain,
1995; Harris and Handelman, 1992)
*Caveat emptor: programs=programs designed for preschoolers
Points of Agreement Among
Intensity
Experts
• Intensity matters • 12 months per year
• Low teacher-child ratio (1:2 or 1:3)
• Early matters • extensive individualized treatment plans
• Parents/Families matter • Data-driven
• Data matter • High hours of engagement – no wandering,
self stimulation
• Systematic/empirical approach matters
• Engagement includes active involvement with
• Training matters adults/therapists and peers
• No down-time—active teaching across all
parts of waking day
(NEC*TAS, 1997) • Equal emphasis on home and school
Criteria for Evidence-Based
Practices for Focused Interventions
(NPDC-ASD)
• Two high quality randomized experimental
group design or quasi-experimental group
designs that rule out selectivity and other
threats to internal validity
• Five high quality single subject design
• At least three different researchers in
different locations
• Each study has at least three
demonstrations of experimental
control
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9. 6/19/2012
Established Evidence Based Comprehensive Models vs.
Interventions Focused Interventions
• Antecedent Package (99 Studies)
• Behavioral Package (231 Studies) • Comprehensive models are multi-
• Comprehensive Behavioral Treatment for Young Children (22 component programs designed to
Studies)
• Joint Attention Intervention (6 Studies) positively and systematically affect the
• Modeling (50 Studies) lives of children with ASD and their
• Naturalistic Teaching Strategies (32 Studies) families
• Peer Training Package (33 Studies)
• Pivotal Response Treatment (14 Studies) • Focused interventions are procedures that
• Schedules (12 Studies) promote individual skills or learning within
• Self-Management (21 Studies) a specific skill area.
• Story-Based Intervention Package (21 studies)
(NAC, 2009)
Focused Interventions to Decrease
Focused-Interventions Identified
Interfering Behaviors
• Skill Building Behavioral intervention • Positive behavior support
practices – Functional Behavior Assessment
– Prompting – Differential reinforcement of alternative
behavior
– Time delay
– Extinction
– Reinforcement
– Response interruption/redirection
– Task Analysis and Chaining
– Stimulus Control
– Functional Communication Training
Focused Interventions
Focused Interventions: key
components of Comprehensive Interventions to support skill development
and independent functioning
Model Program
• Visual supports
• Discrete trial training • Individualized work systems
• Naturalistic interventions • Video modeling
• Pivotal response training • Computer-assisted instruction
• Self-management
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10. 6/19/2012
Second Level of Evidence:
Focused Interventions
Emerging
Interventions to Address Social Skills • Augmentative and Alternative Communication Device
(14 studies)
• Social skills training • Cognitive Behavioral Intervention Package (3 studies)
• Developmental Relationship based Treatment (7
• Peer mediated intervention studies)
• Exercise (4 studies)
• Social Stories • Exposure Package ( 4 studies)
• Picture exchange communication system • Imitation based Interaction (6 studies)
• Initiation Training (7 studies)
(PECS) • Language Training Production (13 studies)
• Language Training Production & Understanding) (7
studies)
• Massage/Touch Therapy (2 studies)
(NAC, 2009)
Emerging (Second Level,
Unestablished Treatments
Cont’d)
Multi component Package (10 studies) • Academic Interventions (10 studies)
Music Therapy (6 studies)
Peer mediated Instructional Arrangement (11 studies)
– One size fits all; Traditional approaches
Picture Exchange Communication System (13 studies) • Auditory Integration Training (3 studies)
Reductive Package (33 studies)
Scripting (6 studies) • Facilitated Communication
Sign Instruction (11 studies) • Gluten- and Casein-Free Diet (3 studies)
Social Communication Intervention (5 studies)
Social Skills Package (16 studies) • Sensory Integrative Package (7 studies)
Structured Teaching (4 studies)
Technology based Treatment (19 studies)
Theory of Mind Training (4 studies)
(NAC, 2009) (NAC, 2009)
Your Guide Training Resources
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11. 6/19/2012
YouTube
• Butterfly Effects Channel
State ASD Portal: WHAT IS CARD?
www.autismflorida.com • Center for Autism and Related Disabilities
• State Funded Program
• No charge to families
• Autism Society of Florida
• Consultative Support
• Florida Department of Education
• Enhance community supports and programs
Professional Development Portal
• Capacity builder
• CARD
• Leadership in ASD
• Develop programs to fill gaps
CARD SERVES
Dial 800 9-AUTISM
Qualifying Diagnoses
• All DSM-IV Pervasive
Developmental Disorders
Currently CARD centers
provide support to over
• Deaf-Blind
25,000 individuals in the • Deaf/Blind & Additional
state.
Developmental Disability
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12. 6/19/2012
CARD Strengths are Built on INDIVIDUALIZED & FAMILY
ASSISTANCE
• Dedicated, experienced, credentialed staff Services
• Interdisciplinary teaming • Telephone and email
• Ability to help others through education support
and training, demonstration, and feedback • Referrals advice and
information
• Collaborative relationships • In-home or in-community
• Broad perspective on the current issues in consultation
ASD • Transition and Post-High
School Support
INDIVIDUALIZED & FAMILY
ASSISTANCE TECHNICAL ASSISTANCE
More Services
• Classroom consultation • Help develop
• Educational Training evidence-based
Opportunities programming for
• Support Groups a school, college,
community
Services are individualized and will vary depending group, or agency
on CARD funding and the family’s needs and
priorities
PUBLIC AWARENESS TRAINING
• Website: www.ucf-card.org • Regional Workshops
• Weekly E-updates • On-site modeling and
• Resource guide, Library coaching
• Community Events and • In-services, institutes
Initiatives
• Annual CARD Conference
• Speaker’s Bureau
• Pre-Conference Teacher
• Media presentations
Training Day
• Autism Awareness Events
• Community-based training
• Screenings
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13. 6/19/2012
3. Children with ASD thrive on
CARD CANNOT: predictability
• Handle emergency crisis situations
• Research and
• Provide therapy or case management
observation indicate that
• Provide Legal or Educational Advocacy predictability reduces
• Provide Medical Advice or Diagnose tantrums, anxiety, and
• Provide financial assistance inappropriate behavior in
children with ASD at all
• Duplicate services of other state agencies
ages and levels of
functioning
Even children with AS who have When shown multiple TV screens,
above normal IQs, have marked it is hard for children with autism
difficulty in disengaging attention. to stop looking at one in order to
shift attention to newer visual
stimuli.
Implications for Parents and
It appears particularly difficult to disengage Teachers
and look up or look left. There is a bias for
the right, lower corner. • Have a daily schedule
The problem with disengagement appears • Prepare the child for changes
to be upsetting to children with AS.
• When the unpredictable happens, show
Motor movements were noted to help the child how and when the routine will be
compensate. reestablished
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14. 6/19/2012
3. Children with Autism have
Strengths that can be promoted
• Many children with autism have
a strong visual sense that can
be used to assist them with
their weaker areas
• Many children with autism
have memory strengths that
enable them to succeed at data
management occupations
4. Children with Autism Grow Up
• Children with
Autism experience
the same physical
and hormonal
changes that
typically
developing
children do
• Children with autism grow into adults who
desire a rich quality of life that includes a
variety of leisure options, comfortable
living quarters, and the right to
occasionally sleep late and eat too many
doughnuts
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15. 6/19/2012
Implications for Parents and
Teachers • Beginning early, encourage adherence to
societal standards
• Engagement is essential
• Develop leisure skills that are likely to be
• Target core areas early available to the child as an adult and are
• Prepare for the future with the long view in likely to be age appropriate for an adult
mind
Some Useful Transition to Work Skills
Survey Says
Personal Mobility Task Scheduling
Endurance • Yes, child has...
Seeking Assistance » Special Needs (N=504) ASD (N=1496)
Functional • Bank account 55% 37%
Quality Control/ Communication • Cell phone 41% 9%
Self Checking • Personal computer 40% 44%
Age Referenced • MP3 player 49% 23%
Self Monitoring of Clothing & Hygiene • Cash card 6% 1%
Behavior Peter Gerhart, 2005)
Easter Seals, 2009
5. Progress is not
TECHNOLOGY RULES!
always linear
• Slow and steady will win the
race, but sometimes it will
feel like you are going
backwards
• Keep in mind that those
setbacks are almost always
precursors to a major
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16. 6/19/2012
Implications for Parents and
Teachers
• View setbacks as
• Keep a progress journal—document opportunities
achievements and dates
• Ask for help-or at least
• Surround yourself with positive people ask for data
• Take time to breathe • Be relentless
"Never give in, never
give in, never, never,
never, never - in
nothing, great or
small, large or petty -
never give in except
to convictions of
honor and good
sense. Never, Never,
Never, Never give
up."
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