comparison of two comprehensive treatment models for young children with asd: teacch and leap samuel...
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COMPARISON OF TWO COMPREHENSIVE TREATMENT MODELS FOR YOUNG CHILDREN
WITH ASD: TEACCH AND LEAP
SAMUEL L. ODOMUNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
This project is funded by the Institute of Education Sciences R324B070219
IES Goal Structure
Topical Area:
ASD
Goal 1: DescriptiveGoal 2: DevelopmentGoal 3: EfficacyGoal 4: Scaling up
Project Aims
To compare the relative efficacy of two comprehensive programs for treating preschool-aged children with autism Comparison with each other Comparison of each with business
Hypotheses TEACCH and LEAP will both be efficacious TEACCH and LEAP will have unique effects TEACCH and LEAP will be more efficacious than Control (Business as Usual-BAU)
Why TEACCH and LEAP?
IES specified evaluation of efficacy of frequently used comprehensive treatment programs
TEACCH and LEAP fit criteria for comprehensive treatment models (Odom, Boyd, Hall, Hume, 2010)
TEACCH and LEAP have substantially different conceptual and theoretical bases
TEACCH (Schopler, Mesibov) Theoretical framework: Cognitive social
learning theory Self contained classroom often used Adult-structured learning opportunities Classroom environment arranged based
on characteristics of autism Special education teacher is the primary
instructor Strong parent involvement component
LEAP (Strain)
Theoretical framework: Applied behavior analysis and early childhood education
Typically developing children are full-time class members
Naturalistic learning strategies Classroom environment like typical EC
setting Co-teaching (EC and ECSE) Strong parent training component
Project Overview
Four year, multi-site study involving the following states: North Carolina Colorado Florida Minnesota
This project is funded by the Institute of Education Sciences R324B070219
Our colleagues
UNC-CH Brian Boyd Kara Hume Steve McDonough Evelyn Shaw Jenille Adams Ann Sam Betsy Humphreys Stephanie Rezska Dwight Irvin
University of Miami Michael
Alessandri Anibal Gutierrez Drew C. Coman Peter Schoultz Jennifer Landoll Stephanie
Novotny
Our Colleagues
University of Minnesota LeAnne Johnson Frank Symons Joe Riechle Emily Monns Breanne Byiers
University of Colorado at Denver Laurie Sperry
EXPERIMENTAL DESIGN
Randomized Clinical Trial preferable but not feasible Two years of implementation necessary for
newly trained teachers Reactivity of interaction between program
philosophy and teacher beliefs Quasi-experimental design
Compare existing programs following TEACCH, LEAP, and BAU models
Design Requires Stringent Attention to Procedural Differences and Fidelity
Teachers had to be trained in TEACCH or LEAP models
Teachers had to have been implementing the TEACCH or LEAP models for two years
Teachers had to reach an acceptable level of fidelity Potential classes screened using fidelity
measures Booster sessions provided each summer for
new classes
Year 1 Overview
Psychometric validation of TEACCH & LEAP fidelity measures To ensure fidelity measures discriminate
the comprehensive models from each other as well as control classrooms
To ensure instruments are reliable
DISCRIMINANT ANALYSIS & RELIABILITY EVALUATION OF FIDELITY MEASURES FOR
COMPREHENSIVE TREATMENT MODELS SERVING YOUNG CHILDREN WITH ASD
Hume, Boyd, Coman, Gutierrez, Shaw, Sperry, Alessandri, & Odom
Year 1 Process
Step 1: Develop and/or modify existing measures &Ensure initial inter-rater reliability across sites
Step 2: Select classrooms & Conduct observations across 4 month periodNote: All 3 measures were completed in each classroom at each observation
Step 3: Conduct analyses
Year 1 Process
3 Fidelity Measures-5 point Likert scale (1=Minimal/No Implementation; 3=Partial;
5=Full)- Select Observe/Report (Use standard interview for a number of
Items)
TEACCH31 items across 9 domains
LEAP38 items across 8 domains
BAU54 items across 8 domains
Step 1: Develop and/or modify existing measures &Ensure initial inter-rater reliability across sites
Step 2
Year 1 Process
Select Classrooms
• 34 Total• 11 TEACCH• 10 LEAP• 13 BAU
Conduct Observations
• 128 observations by primary observer (2-4 per classroom)
Conduct Reliability Observations
• 66 observations by reliability observer (1-2 per classroom)
194 Total Observations
Step 2: Select classrooms & Conduct observations across 4 month period
Year 1 Process
Test-Retest Reliability (ICC)
Inter-rater ReliabilityInternal ConsistencyDescriptive Discriminant Analysis
Step 3: Conduct Analyses
ResultsTest-Retest Reliability
•Total reliability=.81
•.44-.86
TEACCH
•Total reliability=.75
•.46-.86
LEAP
•Total reliability=.83
•.53-.87
BAU
ResultsInter-Rater Reliability
•Total reliability=95%
•76-97%
TEACCH
•Total reliability=97%
•82-98%
LEAP
•Total reliability=93%
•82-100%
BAU
ResultsInternal Consistency
•Total alpha=.94
•.42-.93
TEACCH
•Total alpha=.93
•.55-.90
LEAP
•Total alpha=.94
•.71-.95
BAU
ResultsDescriptive Discriminant Analysis
Study of group separation Identify subscales of measures that best
discriminate between classroom types Form functions that maximize separation
between groups (btw group variance) & minimize dispersion of scores within groups (within group variance)
Canonical Variate 1: Communication, Assessment & Teaching, Visual Schedules, Social/LeisureCanonical Variate 2: Work Systems, Visual Schedules, Visual Structure
TEACCH Fidelity Measure
-5 -4 -3 -2 -1 0 1 2 3 4 5-5
-4
-3
-2
-1
0
1
2
3
4
5
TEACCH LEAP
BAU
Canonical Variate 1
Ca
no
nic
al V
ari
ate
2
Canonical Variate 1: Promoting Social Interaction, Teaching Communication SkillsCanonical Variate 2: Teaching Strategies, Promoting Behavioral Guidance, Teaching Communication Skills
LEAP Fidelity Measure
-5 -4 -3 -2 -1 0 1 2 3 4 5-5
-4
-3
-2
-1
0
1
2
3
4
5
TEACCH LEAP
BAU
Canonical Variate 1
Ca
no
nic
al V
ari
ate
2
Canonical Variate 1: Social/Peer Relations, Curriculum & InstructionCanonical Variate 2: Classroom Structure, Curriculum & Instruction, Class Environment, Challenging Behavior
BAU Fidelity Measure
-5 -4 -3 -2 -1 0 1 2 3 4 5-5
-4
-3
-2
-1
0
1
2
3
4
5
TEACCH LEAP
BAU
Canonical Variate 1
Ca
no
nic
al V
ari
ate
2
Current Status of Project
Years 2-3
--Demographics
--Data collection
--Data analysis
Classrooms and Participants
Classrooms TEACCH = 17
BAU = 22 LEAP = 14 Total = 53
Participants Boys = 116 Girls = 23 Total = 139
Pretest and Posttest Assessments ADOS, CARS and Leiter (Pretest only) General Development
Mullen Vineland PLS-4
Core ASD Assessment Repetive Behavior Scale Child Behavior Checklist Sensory Experiences Scale
Social Participation (Observation) CASPER
Statistical Analysis: Multiple Approaches
Multi-level design with participants nested within classrooms
Increasingly conservative analysis ANCOVA Propensity score model analysis Fixed effects model analysis