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