amy matthews, ph.d. & jamie owen- deschryver, ph.d. grand valley state university start...
TRANSCRIPT
Amy Matthews, Ph.D. & Jamie Owen- DeSchryver, Ph.D.
Grand Valley State University
START Orientation Young Children with Autism Spectrum
Disorders
Orientation to START and Early Childhood (EC)
Training
Evidence-Based Practices for Young Children with
ASD
Critical Components of Effective Programs
Foundations of ASD
Identification and Diagnosis
Next Steps
Agenda for Today
Early childhood programming is not a foreign concept
You know some basic information about autism spectrum disorders
You have experience working as a team
You are interested in young children with ASD
Assumptions
Who is here?Why Are we here?
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
2000
4000
6000
8000
10000
12000
14000
16000
18000
Michigan Students with an ASD EligibilityN
um
ber
of
stu
den
ts
1,208
17,415
5,682
If 1 in 68 children have an autism spectrum disorder…
The average elementary building will have 4-5 children with ASD
The average middle school building will have 8-9 students
The average high school will have about 14-15 students
Latest CDC Report
*Center-based programs
Autism is no longer a low incidence disorder
Latest CDC Report
We need to change our approach to educating
young children with ASD
START Primary Components
Team-based Intensive Training
START Early Childhood Intensive Training
START K-12 Intensive Training
START Building Your Future Training
Intensive yearlong training with multidisciplinary school based teams in
the areas of teaming and problem solving, effective educational
programming for students with Autism Spectrum Disorders, and systems
change.
START Intensive Training
Making Professional Development EffectiveLang & Fox (2003)
Traditional professional development (training without follow up to support implementation) yields a 5-10% implementation of strategies success rate
With follow up, that number can rise to 75-90%
Overview of Intensive Training
Location All trainings will run from 8:30-3:30 Breaks in am and pm Lunch will be provided CEUs will be offered Binders for each participant and
flashdrive for each sub team We will always leave with an action plan
Logistics
Snow Days
START Training is canceled if… “insert decision here”
Sub team leaders provide a contact phone number at home or cell to start the phone tree
Get home/cell numbers from your team members
ACTION PLANYou will complete a team action plan at
each meeting
During this training we will talk about how to teach…
oEarly Learners
oEmerging Learners
oTransitioning Learners
Everyone is at a Different Stage of Learning
Participating in this training, everyone is at a different stage…
oEarly Learners
oEmerging Learners
oTransitioning Learners
Everyone is at a Different Stage of Learning
Evaluate what you hope to get out of this training
oContent – I am an early learner and I just need some information to get started!
o Implementation – I am an emerging learner. I know quite a bit, but I want to better implement effective practices in my classroom
oSpecific skills – I am a transitioning learner and I think my classroom is running pretty well; now I want to tackle some more advanced practices
oCEUs – I have to get CEUs and this is as good as anything else
Everyone is at a Different Stage of Learning
National Research Council Report http://www.nap.edu/openbook.php?isbn=0309072697
National Autism Center National Standards Project (
http://www.nationalautismcenter.org)
National Professional Development Center on ASD (NPDC) (http://autismpdc.fpg.unc.edu/)
Ohio Center on Autism and Low Incidence (OCALI) AIM website (http://www.autisminternetmodules.org)
Where do we get information about evidence-based approaches?
National Autism Center
National Standards Project
Where do we get information about evidence based practices?
AIM website (http://www.autisminternetmodules.org)
Behavioral Discrete trial training
(DTT) Differential
reinforcement Extinction Prompting Reinforcement Response interruption/
redirection Stimulus control Task analysis Time delay
Independence Self-management Structured work systems
Social Peer-mediated intervention Social skills training groups
Motivation Functional behavior
assessment Functional communication
training
Evidence-Based Practices (NPDC)
Visual Visual supports Video modeling Social narratives
Natural environment Pivotal Response
Training (PRT) Naturalistic
interventions
Communication Speech generating
devices PECS
Technology Computer-aided
instruction
Parent Parent-implemented
interventions
Evidence-Based Practices (NPDC)
A list of intervention strategies is not enough; interventionists need to identify child needs, develop plans to address needs, and match needs to instructional strategies (Strain, Schwartz & Barton, 2011)
NOT just about interventions found to have strong research support (Cook et al., 2009)
Decision making process that informs all professional decisions (Sakett et al., 2000)
Professional wisdom is part of selecting, adapting, monitoring, and implementing EBP (Cook et al., 2008)
Family and individual input is critical (Strain et al., 2012)
Evidence-Based Practice
Comprehensive Programs
Children’s Toddler School
Early Start Denver Model
Walden Toddler Program
Project DATA
Early Intensive Behavioral
Intervention (EIBI)
Empirically-Supported Treatments
Discrete trial teaching
PECS
Prompting
Pivotal Response Teaching
Reinforcement
Social narratives
Video modelingCritical Program
Components
Critical Components
Perhaps it is not unique features of model programs, but common features that result in positive outcomes (Boyd, Hume, McBee, Alessandri, Gutierrez, Johnson, Sperry & Odom, 2013)
This is not the same as “eclectic”
Critical Components
Early is better (by 3½) Intervention at identification Identification/intervention before age 3
Intensity matters (at least 25 hours/wk, full year, with low ratio)
Active engagement/Structured teaching time Minimal “free time” Lots of learning opportunities Each moment is a teachable moment
Family participation
Individualized goals, regularly monitored
What are the Critical Components of Effective Programs?
National Research Council, 2001
Most model programs range from 25-40 hours per week
Intensity/number of hours may not matter as much as quality of hours of intervention
Multiple and varied embedded learning opportunities
Active engagement
Critical Components:Intensity
(Strain et al., 2011)
Exposure to typical curriculum and activities
Targets core skills that have long-term impact on independence and quality of life, including child’s success and happiness in school, home & community
Critical Components:Curriculum
“Interventions are increasingly focused on behaviors that immediately improve the child’s independent functioning in natural settings (e.g., toilet training, verbal requesting) or behaviors that are essential for learning other important skills and long-term outcomes (e.g., imitation, joint attention)” (Strain, Schwartz & Barton, 2011, p. 327)
Individualized goals, regularly monitored
Practices are matched to individual needs
Focus on generalization
Data-based decision making is employed
Critical Components:Individualized Approach
Providing opportunities with typical peers (Strain et al., 2011)
The opportunity to interact successfully, not just be in the same room, with typically developing peers on a regular basis is a necessary component of effective intervention programs for all children with ASD, especially young children.
Critical Components:Foundations
(Strain et al., 2011)
Focus on predictability and routine
Functional approach to problem behavior
Team approach
Skilled interventionists
Transition planning
Critical Components:Teaching Practices
(Strain et al., 2011)
Law IDEA
Literature Evidence Based Practice
Student DataOutcomes
All practices must align with…
We Know What W
orks
Why would public school programs have trouble
adjusting to fit the recommendations and needs for young children with ASD?
Ratios (ECSE classrooms) Intensity/Time (0-3 and 3-6)
Training of staff Philosophy
Getting families involved
Implementation challenges in public school settings
Other sources of increasing service hours Insurance Medicaid / MIChild Parent Training/Coaching Innovative projects in collaboration
with universities, CMH, and within school districts/counties (e.g. Project DATA)
Ways to Increase Intervention
Big change only happens when we change whole systems
We did what we did when we knew what we knew
Once we know different, we are accountable
Systems Change
Getting Critical Mass
Getting enough people moving in the right direction in order to move the whole system forward
This is what the START Project is all about !
Identify and intervene early Use evidence based practices Increase learning opportunities (i.e.
opportunities to respond with feedback) and student engagement
Use effective instructional delivery (3 Rs: Request, Response, Reaction)
Focus on meaningful, functional goals and tasks (independence and socialization)
Establish an effective classroom structure to ensure learning
Big Ideas for Early Intervention
Establish positive patterns of behavior early on
Prevent problem behaviors with antecedent strategies
Provide lots of meaningful integration opportunities
Use data to confirm progress and make programming decisions
Carefully plan for transition to elementaryWork as a team and include families
Big Ideas for Early Intervention
Help you develop a program that allows children to
make the most progress
Working Together This Year: What is our goal?
What would a highly effective classroom for young children with ASD look like?
Effective Practices Assessment Tool for Young Children with ASD
Statewide Autism Resources and Training (START) Effective Practices Assessment Tool
for Young Children with Autism Spectrum Disorders
Team: ____________________________ District: ____________________ Date: _________________ AREA 1: Critical Program Components
Current Status/Progress
Not in Place Partially In Place In Place 1------------------------------2---------------------------- 3------------------------------4------------------------------- 5
Pri
orit
y L
evel
1
– 5
1=lo
w, 5
=h
igh
CRITICAL COMPONENTS
1. Students are actively engaged with many learning opportunities throughout the day
1 Students each receive less than 5 learning opportunities (including entire request, response, reaction sequence) per hour on average. Students are actively engaged in
productive activities less than 50% of the time.
2 3 Students each receive
approximately 10 learning opportunities (including entire
request, response, reaction sequence) per hour on average. Students are actively engaged in productive activities more than
80% of the time.
4 5 Students each receive more than
20 learning opportunities (including entire request,
response, reaction sequence) per hour on average. Students are actively engaged in productive activities more than 80% of the
time.
Priority
1 2 3 4 5
CRITICAL COMPONENTS
2. Programming is individualized to meet student needs
1 Students receive traditional preschool instruction with minimal adjustments for
individual needs.
2 3 Programming is individualized for some students, some of the
time, but not consistently enough to make rapid progress toward
IEP goals.
4 5 Instructional goals, methods,
prompts and response requirements are individualized to meet the student’s abilities, needs,
and developmental level.
Priority
1 2 3 4 5
Early Childhood Assessment Tool
Foundation in Autism Spectrum Disorders: Just the Facts
Asperger Syndrome identifed in 1944 by Hans Asperger
Autism identified in 1943 by Leo Kanner
Foundations of ASD
Autism’s First Child
The Atlantic Monthly
In 1943, Donald Triplett of Forest, Mississippi
became the first person to be diagnosed with ASD.
His parents chose not only to accept him as he was, but created a hometown environment of love and friendship that refused to
allow others to misinterpret or
misrepresent him or his “oddity.”
Biologically-based, developmental disability
Historically 70-75% were thought to have some degree of cognitive impairment; recent estimates closer to 50% (Volkmar et al., 2004)
Autism Spectrum Disorders
Occurs 4 times as often in males than in females
Girls may be more severely affected (Rice, 2007) but may not be as pronounced in toddlers (Carter et al., 2007)
Autism Spectrum Disorders
Autism means that someone is really smart in some things
but needs a lot of help in other things.
Mrs. Fizell’s 2nd Grade class (1999)
from Barry Prizant
Definition of Autism:
Characteristics are evident during early development
70-95% with a documented developmental concern before the age of 2 years
13–30% of children had a reported developmental regression by 2 years of age
Autism: What do we know?
(Mandell et al., 2009)
Children are identified and diagnosed at younger ages
More children with milder characteristics are being diagnosed
Inclusion of children across the spectrum including Asperger (and PDD-NOS)
Increased public awareness
Increased Prevalence: Why?
Boyd, et al., 2010
Idiopathic in 90-95% of cases (uncertain cause)
Genetic Identical twins – 69-95% and Fraternal twins –
3-8% (Dawson, 2008) Sibling study – 19% of younger siblings of
children with ASD develop an ASD (Ozonoff et al., 2011)
Etiology
Relatively normal development with a subsequent loss of language skills around the second year.
Occurrence in ASD range from 15-30% Questions unanswered at this time
(Landa, 2008): Was the child developing normally or were
signs unnoticed? Did the child regress or did skill development
slow?
Regression
Early Identification
Early social behaviors Social smiling Looking at faces Responding to one’s name
Early communication behaviors Producing vocalizations Using a variety of gestures Coordinating verbal and nonverbal behavior
(pairing eye contact with vocalization)
Early Identification: Early Warning Signs
Boyd, et al., 2010
The core symptoms of autism are represented social-communication impairments and restricted and repetitive behaviors. Yet the earliest sign of autism is often manifested as a deficit in joint attention, which has a significant and pervasive impact on all developmental domains.
Joint Attention
Restricted and repetitive behaviors Repetitive or limited use of toys or objects in
manipulative play High rates of stereotypic motor behaviors Intense focus on narrow interests
Early Identification: Early Warning Signs
Boyd, et al., 2010
Researchers at the UC Davis M.I.N.D. Institute have found that infants later diagnosed with autism exhibited unusual exploration of objects long before being diagnosed. Studying a group of children at high risk for developing autism, the researchers found that those eventually diagnosed with the disorder were more likely to spin, repetitively rotate, stare at and look out of the corners of their eyes at simple objects, including a baby bottle and a rattle, as early as 12 months of age.
-Ozonoff et al., 2008
Early Signs
The study, published online in the journal Nature, found that infants who later developed autism began spending less time looking at people’s eyes between 2 and 6 months of age and paid less attention to eyes as they grew older. By contrast, babies who did not develop autism looked increasingly at people’s eyes until about 9 months old, and then kept their attention to eyes fairly constant into toddlerhood.
--Warren & Klin, 2013
Autism Speaks/First Signs video glossary(also see Treatment videos)
Early Signs of Autism – Kennedy Krieger
Signs of ASD Videos
Early Identification
Mean age of autism diagnosis is 34 – 61 months
Mean age of first parental concern is 18 – 19 months
Gap of 1-2 years before autism treatment begins
Earlier identification earlier intervention
Intensive early intervention = better outcomes
Mandell et al, 2005
n = 965
Age
Developmental rates from 6-24 months: language development
9 children with ASD; 27 with typical development
Months Rogers, et al, 2010
Stability of diagnosis around 2 years of age with valid assessment and trained team (Lord, et al., 2006)
Early Identification
Black, Hispanic, or other race/ethnicity - less likely than White children to have a documented ASD
Disparity persisted for Black children,
regardless of IQ
Disparity for children of other ethnicities when IQ was lower than 70
Disparities in Identification
(Mandell et al., 2009)
Differences in Brain Development and
Cognitive Processing
Dr. Eric Courchesne explains the underlying brain biology of autism at the International Meeting for Autism Research (IMFAR)
Brain Development
Theory of Mind
Sally Anne Test Video
Diagnostic Changes
DSM 5 (May 2013)
Autism Spectrum Disorder
Autistic Disorder
CDDRett’s
Disorder
PDD-NOSAsperger
DSM IV (1994-2013)PERVASIVE DEVELOPMENTAL DISORDERS
Previous DSM-IV Definition of Autism(MI definition)
Restricted & Repetitive Behavior
Impairment in Socialization
Impairment in Communication
Autism Spectrum Disorder DSM 5 Definition (2013)
Deficits in social communication
and social interaction across multiple contexts
*2 core features with 7 criteria can result in 12 combinations that all lead to the same diagnosis of ASD (See DSM V handout)
Restricted, repetitive patterns
of behavior, interests, or
activities
With or without intellectual impairment With or without language impairment Associated with known medical or
genetic condition or environmental factor Associated with another
neurodevelopmental, mental, or behavioral disorder
Severity Level
Specifiers
Dimensional Ratings for DSM 5 ASD
Social Communication Restricted, Repetitive Patterns of Behavior
Requires very substantial support
Severe deficits in social communication, severe impairment in functioning
Inflexibility, extreme difficulty with change, severe impairment in functioning
Requires substantial support
Marked deficits in social communication apparent even with supports, limited initiations and responses
Inflexibility, difficulty with change apparent to casual observer, interferes with functioning in variety of contexts
Requiring support Without supports, deficits in social communication are noticeable. Difficulty initiating and successfully responding.
Inflexibility causes significant interference in functioning in one or more contexts. Problems with organization and planning.
Diagnosticians are good at distinguishing ASD vs. not ASD but lack of consistency regarding autism vs. PDD-NOS vs. Asperger
No consistent research evidence for separation of Asperger from autism
Diagnostic biases by race and SES
Goals is to be more SENSITIVE (correct inclusion) and more SPECIFIC (correct exclusion)
Why the Change
Impairment of pragmatics
diagnosed based on difficulty in the social uses of verbal and nonverbal communication in naturalistic contexts
which affects the functional development of social relationships and discourse comprehension and
cannot be explained by low abilities in the domains of word structure and grammar or general cognitive ability
Social (Pragmatic) Communication Disorder (NEW to DSM 5)
Rule out Autism Spectrum DisorderMust be present in early childhood
Conceptual Framework
Social Impairment
Speech/Communication
Deficits
Repetitive Behaviors & Restricted Interests
Autism
Spectrum
Disorder
Intellectual Disability
Language Disorders
OCD
Social AnxietyADHD
Intervening early and intensively is key to skill development and avoiding behaviors before they happen
Wrightslaw“All available research strongly suggests that intensive early intervention makes a critical difference to children with autistic spectrum disorders. Without early identification and diagnosis, children with autism are unlikely to learn the skills they need to benefit from education.”
Early Intervention
Dawson, et al. (2012). Early Behavioral Intervention Is Associated With Normalized Brain Activity in Young Children With Autism. Journal of the American Academy of Child & Adolescent Psychiatry, 51(11), 1150-1159.
“This was the first trial to demonstrate that early behavioral intervention is associated with normalized
patterns of brain activity, which is associated with improvements in social behavior, in young children
with autism spectrum disorder.”
Brain Changes from Behavioral Interventions
Teaching Requesting (Manding)
Social responsiveness Responsive to requests (eye contact and one-
step directions) Responding to initiations
Imitation Skills
First year priorities and beyond
Top 3 Targets for Intervention
(Weiss & Zane, 2010)
For children with ASD, these 3 skills are challenging and must be embedded throughout activities and across settings and people.
They should be considered in how we set up the environment, deliver instruction, and engage siblings and peers.
Children will need MANY presentations and opportunities to develop initial skills in these areas and then advance these skills for success in school.
Top 3 Targets for Intervention: Requesting, Responsiveness, and Imitation
"If you think you are too small to make a difference, try sleeping in a room with a mosquito"
- African proverb
We can make a difference
Goal setting for each module Program/classroom Personal/Professional
End of the Year Celebration Teams present on progress/successes and
ongoing work plans
Goal Setting
Next meeting date – November 13 & 14
Bring a copy of your classroom schedule
Work on: Effective practices assessment tool –Turn in
at next training
Review early intervention readings
Next Steps