Current Best Practices For Students With Autism Spectrum Disorders

1. Current Best Practices For Students With Autism Spectrum Disorders Dr. Karen A. Berkman Mindy Stevens

2. Today’s Presentation Agenda • Review current research in the field of ASD • Provide an overview of best practices in education for students diagnosed with ASD • Discuss implementation fidelity and review administrator observation tool for classrooms

3. Where We’ve Been and Where We’re Going “Autism research has been primarily focused on discovery for the past decade, but now the field is turning a corner such that movement toward development, refinement, translation, and delivery will be possible.” (Clara Lajonchere, Autismspeaks, 2008)

4. Current Theories Genetic • Genetics contributes to ~60-90% • No single gene has been found with increased risk of 10-20 fold • Current thinking: common alleles, possibly in uncommon combinations • Environment:Recent evidence to suggest a gene x environment interaction

5. Current Trends in Autism Bulk of the current research is on basic causes and psychological processes • Genetics • Neurobiology and Physiology • Developmental course • Etiology • Theory of Mind • Language and Communication • Perception and Cognition • Matson, JL. & LoVullo, SV.(2008)

6. Treatment Research • Autism Speaks-funded research • GI • Sleep • Quality of Life • Combating Autism Initiative • Diet and Nutrition • Parent-Based Sleep Education Program • Hormonal Factors in Adolescents • Novel Screening Methods (EEG) • Partnerships: • LEND Network (Education and Training) • American Academy of Pediatrics (Education and Dissemination)

7. CDC Autism Activities • Focus is on prevalence studies for 8 year children across 14 states • Updated statistics forthcoming from 2004-2006 • Studies on relationship between MMR immunizations and autism

8. Collaborative Programs of Excellence in Autism (CPEA) Conducts research in the following areas: • Causes of autism • Early detection • Behavioral and communication characteristics • Treatment

9. CPEA Network Project Autism Spectrum Disorder in the Second Year: Stability and Change in Syndrome Expression • Results indicate stability of clinical diagnosis and syndrome expression in the second year • Highlights advantages and limitations of the ADI-R and ADOS-G for diagnosing and documenting symptoms of ASD in infants • (Chawarska, Klin, Volkmar, in press)

10. Studies to Advance Autism Research and Treatment (STAART) Network • 8 centers funded by 5 NIH Institutes • Focus of STAART Network is; • Causes • Diagnosis • Early Detection • Prevention • Treatment

11. STAART Network Project Abnormal functional connectivity in autism spectrum disorders during face processing • A significant relationship between abnormal functional connectivity and clinical severity in the ASD group was observed • Results suggest that abnormal neural connection within the limbic system may contribute to the social impairments observed in ASD • (Kleinhans, Richards, Sterling, Stegbauer, Mahurin, Johnson, Greenson, Dawson, Aylward, in press)

12. Other Studies of Interest • Autism and Sleep Disorders • Autism in Infancy • Definition and development of the phenotype in autism • Neonatal social responses of infant siblings • Girls with autism spectrum disorders • Non-social rewards and autism

13. Other Studies of Interest CeFAR (University of Pittsburgh) findings to date: • Difficulty tracking faces extends to objects, although more subtle • The cause may, in part be due to general difficulties grouping parts to make a whole • The difficulty extends to all facial expressions, but mostly those which are expressed in the eye region of the face • This may be related to difficulty zooming out to focus on the bigger picture instead of one small detail • Brain activation is more than normal to common objects and less activated when looking at faces

14. Other Studies of Interest Kennedy Krieger Studies underway are: • Early diagnosis and intervention (R. Landa) • Brain activity and motor tasks (S. Mostofsky) • Metabolic disorders and ASD (E. Tierney)

15. What Determines Best Practice?

16. Key Questions • What are the anticipated outcomes from using a particular practice and do the outcomes match the student’s needs? • “evidence-based” “research-based” terms used loosely to sell products • Pass rigorous and objectively measured standards • Appraisal of the extent of the outcomes match needs of students

17. Key Questions Are there potential risks associated with implementing a practice? • Dropping an existing method • Time/cost constraints

18. Key Questions What are the most effective ways of evaluating a particular method or approach? • Evaluate negative outcomes and undesired side effects • Evaluation responsibilities

19. Educational Best Practices

20. Best Practices • DTT (Discrete Trial Training) • TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) • Incidental Teaching • Pivotal Response Training • Verbal Behavior Training

21. Discrete Trial Training • Breaking a task down into its smallest units • Teaching a unit with a distinct beginning and end, separated by a brief interval • One teaching unit is called a “trial” • Trials can be “massed” or “distributed” • Reinforcing each correct response

22. Advantages of DTT • Can assure massive numbers of opportunities/trials • Teacher controlled • Little thought involved • Easy to assess the data

23. Disadvantages of DTT • Prompt dependency • Cost • Generalization • Need to reprogram for spontaneous skill use • Requires specific programming time blocks • Doesn’t build fluency (% correct)

24. TEACCH • Person-centered support of individuals of all ages and skill levels. • Employs approach known as “Structured Teaching” • Work systems • Independence • Predictability • Visual Cues

25. Advantages of TEACCH • Independence • Predictability • Routine • Structure • Consistency

26. Disadvantages of TEACCH • Social interaction and verbal communication are not emphasized • Does not promote interaction with typical peers

27. Incidental Teaching • Developed by Hart and Risley, and adapted for autism by McGee, Charlop, McClanahan • Child-initiated, activity based instruction • Appropriate for use with inclusive groups • Natural activity-based contexts • Promotes generalization and spontaneous skill use • Reinforcer built into the episode • Targets speech, play, social and academic skills

28. Advantages Of Incidental Teaching • Can be done anywhere, any time, by anyone • Does not require massive training • Inherent generalization built-in • Consistent with developmentally appropriate teaching and inclusion • Workable in a developmental classroom setting • Short episodes • Natural, activity-based • Spill-over to play skills • Less protest/escape/aversive control • Encourages spontaneous skill use

29. Disadvantages of Incidental Teaching • Depends on engagement • Cannot control number of trials/data analysis issues • Teacher must remain hyper vigilant or created opportunities • Must create opportunities

30. Pivotal Response Training • Pivotal Responses central to wide area of function and will produce change across a number of behaviors • Ex: motivation, self-initiation • Involves discrete trial format • Uses natural reinforcement • Intersperse mastery and teaching trials • Use child selected materials • Actively teaches child-initiated responses

31. Advantages of PRT • Child initiates • Natural reinforcers • Increased motivation • Deters inappropriate behavior

32. Disadvantages of PRT • Labor intensive • Staff must be adequately trained in the method

33. Verbal Behavior Training • Language as a behavior • Find out what the child wants then teaching them how to request it • Child led • ABLLS (Assessment of Basic Language and Learning Skills)

34. Advantages of Verbal Behavior Training • ABLLS allows for tracking of a child’s progress • Useful verbal operators • May be used at school and in the home

35. Disadvantages of Verbal Behavior Training • Cost may be high to the school districts • Labor intensive • Requires small staff to pupil ratios

36. Characteristics of Effective Programs* • Early implementation • Systematic teaching • Functional skills (core deficits) • Specified curriculum, evaluation methods • Supportive environments and routines • Family involvement • Inclusion opportunities • Inensity • Staff and program development • *Caveat emptor: programs=designed for preschoolers

37. Administrators’ Role in Choosing and Evaluating Best Practices • A team approach • Make a commitment to the method • Provide district training(s) on the method • Consider using the “Observation Instrument for Autism Classrooms” and tying it with a teacher’s Professional Development Plan (PDP) or any other type of evaluation • Create a process for conducting yearly reviews and evaluations of the methods in designated time frame

38. Observation Instrument for Autism Classrooms • Brief overview • Instruction and Interaction • Classroom staff responsibilities

40. References • Evidence-Based Practices and Student’s With Autism Spectrum Disorders. Simpson, Richard. Focus on Autism and Other Developmental Disabilities; Fall 2005; Proquest Education Journal • NCLB, 2002 • Dawson & Osterling, 1997; Izeman & Strain, 1995; Harris and Handelman, 1992 • CARD, University of Central Florida • Frequently Asked Questions Regarding Verbal Behavior by Mary Barbera, RN, MSN, BCBA • Mesibov, G.B., Shea, V., & Schopler, E. (with Adams, L., Burgess, S., Chapman, S.M., Merkler, E., Mosconi, M., Tanner, C. & Van Bourgondien, M.E.). (2005). The TEACCH approach to autism spectrum disorders.  New York: Kluwer Academic/Plenum.

41. References • HOW TO TEACH PIVOTAL BEHAVIORS TO CHILDREN WITH AUTISM: A TRAINING MANUAL, Robert L Koegel • AutismWeb • Autism Research Institute, Stephen Edelson, Ph.D.

42. CARDCenter for Autism and Related Disabilitieshttp://card-usf.fmhi.usf.edu