Identifying Effective PracticesAutism Spectrum Disorders Characterized by: Difficulty with...
Transcript of Identifying Effective PracticesAutism Spectrum Disorders Characterized by: Difficulty with...
Identifying Effective Practices
Sorting Through the Claims of
Evidence Based Practices
LASARD Project
October, 2011
Autism Spectrum Disorders
Characterized by:
Difficulty with communication
Difficulty with social interaction
Repetitive behaviors/restricted interests
Educational programming should address core
characteristics
(American Psychiatric Association [DSM-IV-TR], 2000)
LAQI Key Areas
Communication
Social Interaction Behavior
Curriculum & Instruction
Environment Inclusive Practices
Collaboration
Transition
http://www.hdc.lsuhsc.edu/
Evidence-Based Practices
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Evidence-based Practice is defined as:
“Educational Practices that have
been demonstrated effective
based on quality research.”
Odom, Brantlinger, Gersten, Horner, Thompson, and Harris (2005) as cited in
Test et al., (2009)
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Core Components
1. Individualized supports and services for students and
families
2. Systematic instruction
3. Comprehensible and/or structured environments
4. Specialized curriculum content
5. A functional approach to problem behaviors
6. Family involvement
Iovannone, Dunlap, Huger, & Kincaid (2003)
Evidence-Based Practices
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Systematic Instruction includes:
Carefully planning for instruction by identifying valid
educational goals,
Carefully outlining instructional procedures for teaching,
Implementing the instructional procedures,
Evaluating the effectiveness of the teaching procedures,
Adjusting instruction based on data
Iovannone, Dunlap, Huger, & Kincaid (2003)
Evidence-Based Practices
Successful Outcomes
Effective treatments that are:
Systematically and objectively verified
Replicated
Tailored to needs of student and team
Family
School
Implemented with fidelity
Simpson (2005)
Determining Evidence-Based Practices
•National Initiatives
•Research synthesis
Terminology in identification of Evidence-based Practices
US DOE NPDC-ASD NAC Other criteria (Simpson, 2008)
Meets evidence standards
Evidence-based practices
Established Scientifically based practices
Meets evidence standard with reservations
Emerging Promising practices
Does not meet evidence based standards
Unestablished Practices with limited supporting information
Ineffective/ Harmful
Not recommended
US DOE What Works Clearinghouse
What Works Clearinghouse, 2008, p. 13
US DOE What Works Clearinghouse
What Works Clearinghouse, 2008, p. 73
Council for Exceptional Children Division for Research
Published in Exceptional Children, Vol. 71 (2), Winter 2005 Overview by Odom, Brantlinger, Gersten, Horner, Thompson,
& Harris
Evaluating quality of evidence from:
Correlational research (Thompson, Diamond, McWilliam, Snyder, & Snyder)
Single subject design (Horner, Carr, Halle, McGee, Odom, & Wolery)
Group experimental and quasi-experimental (Gersten, Fuchs, Compton, Coyne, Greenwood, & Innocenti)
Qualitative studies (Brantlinger, Jimenez, Klingner, Pugach, & Richardson)
National Professional Development Center on Autism Spectrum Disorder
autismpdc.fpg.unc.edu
Definition of EBP
LSU-HSC Human Development Center
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To be considered an evidence-based practice (EBP) by The National
Professional Development Center on ASD, efficacy must be established through peer-reviewed research in scientific journals using:
randomized or quasi-experimental design studies. Two high quality experimental or quasi-experimental studies,
single-subject design studies. Three different researchers must have conducted five high quality single subject design studies, or
combination of evidence. One high quality randomized or quasi-experimental group design study and three high quality single subject design studies conducted by at least three different investigators or research groups.
National Professional Development Center on Autism Spectrum Disorders, 2010
Evidence Based Practices
Computer-aided instruction
Differential reinforcement
Discrete trial training
Extinction
Functional behavior assessment
Functional communication training
Naturalistic interventions
Parent-implemented intervention
Peer-mediated instruction/intervention
Picture Exchange Communication System ™
Pivotal response training
Prompting
Reinforcement
Response interruption/redirection
Self-management
Social narratives
Social skills training groups
Speech generating devices
Stimulus control
Structured work systems
Task analysis
Time delay
Video modeling
Visual supports
National Professional Development Center on Autism Spectrum Disorders
National Autism Center
www.nationalautismcenter.org
National Autism Center Ratings
Strength of evidence based on Scientific Merit Rating
Scale:
Research design
Measurement of the dependent variable
Measurement of independent variable
Treatment fidelity
Participant ascertainment
Generalization
NAC, 2009
National Autism Center: Established Treatments
Antecedent Package
Behavioral Package
Comprehensive
Behavioral Treatment for
Young Children
Joint Attention
Intervention
Modeling
Naturalistic Teaching
Strategies
Peer Training Package
Pivotal Response
Treatment
Schedules
Self-management
Story-based Intervention
Package
Retrieved from: http://autismpdc.fpg.unc.edu/content/national-standards-project
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Scientifically-based Practices Applied behavior analysis (ABA)
Pivotal response training (PRT)
Discrete trial training (DTT)
Promising Practices PECS
Incidental Teaching
Structured Teaching (TEACCH) Visual Supports
SCERTS
Social Stories
Video Modeling
Peer Support Strategies
Assistive Technology
Simpson (2005)
Evidence-Based Practices
Selected Evidence-Based Practices
Inclusion here does not indicate specific
endorsement of these practices over
others
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Systematic application of behavioral principles to
change behavior.
Behavior, both adaptive and maladaptive, is learned.
Learning occurs as a result of the consequences of the
behavior.
Behavior refers to a student’s response and can be academic
skills/knowledge or social/emotional responses.
Alberto & Troutman (2009)
Applied Behavior Analysis (ABA)
Discrete Trial
Incidental Teaching
Peer Mediated Strategies
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Lowrey, 2008
Response Prompting Strategies
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Based on the principles of ABA
Prompting strategies provide a systematic delivery system that increases the likelihood the student will respond correctly
Includes verbal, gestural, model, physical, & visual prompts
Systems include: Least-to-Most Prompting Systems
Most-to-Least Prompting Systems
Graduated Guidance Prompting Systems
Constant & Progressive Time Delay Systems
Naturalistic Prompting Procedures Alberto & Troutman, 2009
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Based on principles of ABA
The discrete trial method has four distinct parts:
1. the trainer's presentation,
2. the child's response,
3. the consequence
4. a short pause between the consequence and the next
instruction (between interval trials).
Discrete Trial Training
Lovaas, O. I. (1981)
NPDC on ASD Checklist
http://autismpdc.fpg.unc.edu/content/discrete-trial-training-0
WWC on DTT
http://ies.ed.gov/ncee/wwc/reports/ece_cd/lovaas_model/index.asp
Functional Communication Training (FCT)
LASARD
Communication based intervention
Reduces or eliminates problematic behavior by
teaching the student a specific form of
communication matched to the function of the
problematic behavior
Communicative form will replace problematic
behavior because it is more efficient and effective
Carr, Levin, McConnachie, Carlson, Kemp, & Smith (1994)
Steps for Implementation: FCT
12/2/2011 LASARD
1. Complete a functional behavior assessment of the challenging behavior.
2. Identify a replacement behavior as a substitute for the challenging behavior
3. Manipulate the environment to elicit the challenging behavior to provide opportunities to practice replacement behavior and plan opportunities for generalization
4. Prompt student to use replacement behavior
5. Do not reinforce challenging behavior and provide immediate reinforcement for use of replacement behavior
6. Shape the response
7. Fade the use of prompts
8. Increase the time between the replacement behavior and the reinforcement
Data collection throughout!
Adapted from Franzone (2009)
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Based on principles of ABA
Individuals exchange a picture of a desired item for
that desired item
Later phases teach individuals to discriminate
pictures, put together simple sentences, comment,
answer direct questions
Frost & Bondy, 2002
Picture Exchange Communication System (PECS)
PECS Phase II Video
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Treatment and Education of Autistic and Communication related handicapped CHildren
Uses Systematic Instruction Principles
Based on the principles of Structured Teaching: Principle 1: Physical Structure
Principle 2: Scheduling
Principle 3: Work System
Principle 4: Routine
Principle 5: Visual Structure
Not behavior modification (like ABA), but more reliant on environmental stabilizers
www.teacch.com
TEACCH
TEACCH
Pictures retrieved from: http://www.preschoolfun.com/pages/teacch%202008.htm
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Visual schedules Allows students to:
Make sense of environment
Predict scheduled events
Comprehend expectations
Anticipate changes throughout
the day Heflin & Simpson, 1998
Choice boards Assists students to:
Know what choices are available
Participate in the decision making process Hodgdon, 1995
Visual Supports
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Carol Gray Describes a situation, skill, or concept in terms of relevant social cues,
perspectives, and common responses in a specifically defined style and
format.
Goal is to share accurate social information in manner that is easily
understood by its audience.
Goal should never be to change the individual’s behavior, rather
that the individual’s improved understanding of events and expectations
may lead to more effective responses.
Social Stories ™
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Billy’s Snack Book
When I am at school, we take a break called snack time. At snack time all of the kids usually go outside. I usually go outside too! There are lots of kids outside at snack time. Some of the kids are standing. Some of the kids are sitting, but they are talking to each other. The kids like to talk to each other at snack time. I will try to talk to the other kids too!
There are many things I can talk to the other kids about:
I can ask them what kinds of things they like to do after school.
I can tell them what kinds of things I like to do after school.
I can talk about what Disney movies I like.
I can ask about what Disney movies they watched.
I can ask them if they have pets.
The kids will like me if I talk to them. They will want to be my friend!
Scattone, D., Tingstrom, D., & Wilczynski, S. (2006)
Sample Social Story
NAC Evidence Level - Established
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Video modeling interventions involve a child watching videotapes of positive examples of adults, peers, or him- or herself engaging in a behavior that is being taught.
Can refer to interventions that use the self as model (video self-modeling) and interventions that use another as model (e.g., peer or adult).
May be created for a wide array of skills (e.g., social, communication, functional) and in a variety of settings (e.g., home, school, community).
Delano, M. (2007).
Video Modeling
Hahnville video modeling
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Peer-mediated interventions are effective in increasing social interactions between typical peers and students with ASD and related disabilities.
May include Peer training
Peer tutoring
Peer networking
PALS (systematic)
Owen-DeSchryver, J., Carr, E., Cale, S., & Blakeley-Smith, A. (2008).
Peer Support Strategies
http://kc.vanderbilt.edu/pals/
NPDC on ASD Checklist
http://autismpdc.fpg.unc.edu/content/peer-mediated-instruction-and-intervention
PMI- Systematic planning for implementation
Students
Activity Target skills Teaching/ Prompting
Peers to be included
Jill Lunch Initiate and maintain appropriate conversations with peers
Picture supports
2 Females
Corey Lunch Utilize typical interpersonal skills during a conversation with peers (space, facing speaker, appropriate volume)
Scripts 2 Male
Reese Lunch Maintain age-appropriate conversations with peers
Scripts with instruction for redirection
1 Female, 1 Male
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AT – Used to support or enhance the functional
capabilities of individuals with disabilities
May include computer-assisted instruction, mobility devices,
high and low tech adaptations, and AAC
AAC – Supporting existing speech or developing
independent use of a non-speech symbol system
May include sign language, PECS, voice output devices
• National Research Council (2001)
Augmentative/Alternative Communication (AAC) Assistive Technology (AT)
What evidence-based practice to use?
One size does not fit all!
Consider:
The student’s needs
The student’s learning style, temperament, and interests
Your program strengths/needs
Supports already in place
History of what has and has not worked
Your professional knowledge
Adapted from Odom, S. & Cox, A. (2009)
Data Based Decision Making
Let data be your guide to practices that are effective
for each student.
Baseline
Intervention
Maintenance
Alberto & Troutman, 2009
Summary
Identify and use evidence-based practices
Identify an area of individual student need
Consider the research base of practices that address that
need by consulting national resources and professional
journals
Match the practice to the needs of each individual student
Make decisions on efficacy from data