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?