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Maximizing Outcomes for Young Children with Autism Spectrum Disorders: Defining Intensity of Intervention. Phil Strain & Ted Bovey Positive Early Learning Experiences Center. Opening Discussion.

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Maximizing Outcomes for Young Children with Autism Spectrum Disorders: Defining Intensity of Intervention

Phil Strain & Ted Bovey

Positive Early Learning Experiences Center


Opening discussion
Opening Discussion Disorders:

What are the key program features currently in place that you relate to positive outcomes for children?


General principals
General Principals Disorders:

  • All interventions require a minimum amount of time to be effective.

  • A sole focus on hours as a measure of intensity is misguided.

    • Yet Doctors, interventionists, other providers AND parents continue to make treatment recommendations or requests based on hours.

  • Where do recommendations for x number of hours come from?

    • Lovaas (1987) study.

    • National Research Council (2001) book Educating Children with Autism.


Getting to quality outcomes is not just about hours of direct services
Getting to Quality Outcomes is Not Just About Hours of Direct Services

  • We suggest, getting to quality outcomes is a complex process that involves many components including:

    • Social validity (functionality) of goals

    • High numbers of meaningful response opportunities

    • Comprehensiveness of intervention

    • Fidelity of intervention delivered

    • Utilization of data-based decision-making


The formula for success
The Formula for Success Direct

Social validity of goals x

Response opportunities x

Comprehensiveness of intervention x

Fidelity of intervention delivered x

Data-based decision-making =

Quality Outcomes


Social validity of goals
Social Validity of Goals Direct

  • Why is this so important?

    • Not enough time to teach everything or something trivial.

      • Addresses Functional Outcomes

    • Helps ensure consumer satisfaction.

      • Think beyond child outcomes (e.g., parent’s skill acquisition, their ability to address everyday activities, general reduction in parental stress)


What makes an outcome functional
What Makes an Outcome Functional? Direct

Links directly to communicating wants, needs and aversions.

Links directly to child participation in typical activities and routines.

Links directly to gaining access to typical peers.

Links directly to improving independent movement, participation & communication.

Links directly to preparation for success in future environments (criterion settings).

Links directly to parent’s availability and skill(s) related to everyday routines.


Activity functional outcomes
Activity – Functional Outcomes Direct

Given the following scenario please discuss and come up with one outcome with High Social Validity.

A family is struggling with their bedtime routine(s), including oppositional behavior, parental frustration, lack of sleep and potential safety issues.

A family has a child with low cognitive skills, is nonverbal and does not follow simple directions. This skill deficit is particularly upsetting during meal preparation when Mom is not readily available.


Creating multiple meaningful learning opportunities
Creating Multiple Meaningful Learning Opportunities Direct

  • Why is this so important?

    • If other variables are held constant (learning opportunities are meaningful, focused on functional skills, delivered with fidelity, and reinforced) then more opportunities will result in more rapid skill acquisition.

    • Lots of practice needed to reach Fluency and Independent Performance.


Creating multiple meaningful learning opportunities1
Creating Multiple Meaningful Learning Opportunities Direct

  • Easy with traditional adult directed instructional strategies (DTT).

  • How do you do it effectively using Naturalistic Teaching methods?

    • Isolate teaching objectives (what am I working on now).

    • Increase likelihood of teachable moments through use of everyday activities, preferred materials and child choice.


Video
Video Direct

Video courtesy of Center on the Social and Emotional Foundations for Early Learning.


Video1
Video Direct

Video courtesy of UCSD Autism Intervention Research Laboratory


Activity creating learning opportunities
Activity – Creating Learning Opportunities Direct

  • Given the outcomes below, identify multiple opportunities to target this skill throughout a variety of daily activities and routines.

    • Comes to parent when name is called.

    • Identifies body parts.

    • Asks for a desired item.

    • Dresses and undresses self.

  • Part II


Comprehensiveness of intervention
Comprehensiveness of Intervention Direct

  • Why is this so important?

    • No evidence of spill-over effects from one intervention focus to another.

    • Children with ASD have many needs directly related to autism symptomology!

      • Language & Communication

      • Social Skills and Social Reciprocity

      • Stereotypic Behaviors


Comprehensiveness of intervention1
Comprehensiveness of Intervention Direct

  • Children with ASD often also have many needs NOT directly related to autism symptomology!

  • Functional Playskills

  • Persistent challenging behaviors (e.g., tantrums, aggression)

  • Motor skill delays

  • Self Help Skills (eating, sleep and toilet training).


Comprehensiveness
Comprehensiveness Direct

  • Key is that intervention goals must be individualized based upon the child and families needs.

  • Errors occur in two ways:

    • Over-programming & Under-programming

  • Leads to the Conundrum of Autism Curricula.


  • Fidelity of intervention
    Fidelity of Intervention Direct

    • Why is it so important?

      • High correlation between fidelity and outcomes

      • Little if any evidence that children with autism learn from errors (through trial and error)

      • Young children likely have multiple providers, multiplying the importance of fidelity.


    Ways to measure fidelity
    Ways to Measure Fidelity Direct

    • Development of fidelity checklists

      • Designed to ensure strategies are implemented correctly (adherence) and with high quality.

      • Adult Verbal Behavior

        • Adherence: Demands are limited to necessary behaviors, Child is reinforced with positive praise and attention and redirected with positive language, ratio of 4:1 is maintained

        • Quality: Praise is meaningful, is delivered in timely fashion and is behavior specific, Rate is increased prior to difficult tasks (build momentum).

      • TACSEI Family Coaching Checklist


    Fidelity measurement exercise
    Fidelity Measurement Exercise Direct

    • You have a new interventionist that wants to teach a child how to make a PB&J sandwich. The parents are also very interested in teaching this skill.

    • Develop a checklist that will measure whether the parent and interventionist are teaching the skill the same way.

      • Focus on the environment, materials, prompting & steps.

      • Remember this is not a checklist of the steps needed to make a PB&J it is a checklist to help adults teach the skill with fidelity.


    Data based decision making
    Data-based Decision Making Direct

    • Why is this so important?

      • No evidence-based practice is universally effective.

      • Diversity within population implies that no one intervention will be universally applicable.

      • No existing technology to assess who will respond best to what intervention… Therefore ongoing data collection is the only alternative.

      • Provides unambiguous metrics of growth for consumers and multiple providers.


    Examples of easy to use data systems
    Examples of Easy to Use Data Systems Direct

    3

    Screams

    Measuring Levels of Assistance/Prompting

    Measuring Behavior Change


    The data process
    The Data Process Direct

    Modify Instruction


    Data based exercise
    Data-Based Exercise Direct

    Visually analyze the following data sets and determine your course of action.


    Interpreting your data example 1
    Interpreting Your Data – Example 1 Direct

    Data sheet measuring levels of assistance





    Interpreting your data example 5
    Interpreting Your Data – Example Direct 5

    Target Behavior

    Key established for the behavior (based on baseline data):

    5 = 16 or more times

    4 = 9-15 times

    3 = 5-8 times

    2 = 2-4 times

    1 = 0-2 times

    Behavior Rating Scales


    What do we mean by maximizing outcomes
    What Do We Mean by Maximizing Outcomes Direct

    Continued movement towards independence in functional skills and/or the reduction of problem behavior(s).

    Increased skills (both for children and parents).




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