Project ImPACT : Teaching parents of children with ASD strategies to enhance their child’s social communication

1. Project ImPACT:Teaching parents of children with ASD strategies to enhance their child’s social communication Brooke Ingersoll, Ph.D., BCBA & Katie Meyer, B.A. Michigan State University

2. Session Outline • Research on Parent Training • Overview of the Parent Training Program • Intervention Strategies • Training Format • Training Materials • Teacher Preparation Protocol • Program Evaluation

3. Parent Training Philosophy • Parents’ childrearing knowledge and specific skills can directly enhance their child’s development • Provide systematic instruction in strategies to help parents accomplish specific goals or outcomes for their child • Parent training is a primary intervention strategy

4. Main Focuses of Parent Training • Enhance parents’ skills in engaging their child in play and social interaction • Teach parents strategies to help their child acquire developmental skills • Help parents manage child’s behavior during ongoing daily routines

5. Benefits of Parent Training (Shearer & Shearer, 1977) • Learning occurs in the child’s natural environment • Increased generalization and maintenance of skills • Wider range of behavior can be addressed • Parents can address new behaviors when they occur • Individualization of instructional goals for child and parent • Increased hours of intervention • More opportunities for full family participation in intervention

6. Special Needs in Autism • Intensive needs • 25 hours per week (NRC, 2001) • Difficulty with generalization • High stress levels for parents • High rate of behavior problems

7. Research on Autism (e.g., Koegel et al., 1982) • Parents can learn intervention strategies • Better generalization and maintenance of skills • Increases parents’ leisure and recreation time • Decreases parents’ stress levels • Cost-effective

8. NRC Recommendations for the Education of Children with Autism • Across primarily preschool programs, there is a very strong consensus that the following features are critical: …Inclusion of a family component, including parent training (p. 219). National Research Council. (2001). Educating children with autism. Committee on Educational interventions for children with autism. Division of Behavioral and Social Sciences and Education. D.C. National Academy Press.

9. Barriers to Implementation • Format of parent education models incompatible with classroom-based program • Lack of user-friendly parent education materials • Insufficient teacher preparation in parent education strategies

10. Goals of Parent Training Program • Improve autism-specific deficits • Evidence-based intervention strategies • Training format compatible with classroom-based intervention model • User-friendly training materials • Effective teacher preparation protocol

11. Goals of Parent Training Program • Improve autism-specific deficits • Evidence-based intervention strategies • Training format compatible with classroom-based intervention model • User-friendly training materials • Effective teacher preparation protocol

12. Skills Taught in Project ImPACT

13. Parent Training Curriculum • Developmental strategies (Interactive) • increase parent responsiveness • Behavioral strategies (Direct Teaching) • teach specific social-communication skills

14. Intervention Techniques • Set up your home for success • Interactive Techniques • Follow your child’s lead • Imitate your child • Animation • Modeling and expanding language • Playful obstruction • Balanced turns • Communicative temptations • Direct Teaching Techniques • Prompting and reinforcement • Teaching your child expressive language • Teaching your child receptive language • Teaching your child social imitation • Teaching your child play • Putting it all together

15. Overview of Interactive Techniques • Follow the child’s lead • Provide an opportunity to respond • Wait for the child to respond • Child should acknowledge parent in some way (e.g., eye contact, gestures, body posture, facial expressions, affect, play, language) • Respond to any behavior as meaningful • Model a more complex response

16. Overview of Direct Teaching Techniques • Follow the child’s lead • Provide an opportunity to respond • Wait for a response • Prompt a more complex response • Reinforce the prompted response • Model more complex response

17. Intervention Strategies

19. Goals of Parent Training Program • Improve autism-specific deficits • Evidence-based intervention strategies • Training format compatible with classroom-based intervention model • User-friendly training materials • Effective teacher preparation protocol

20. Integration of Developmental and Naturalistic Behavioral Interventions • Developmental • Denver Model • DIR/Floor Time • Responsive Teaching • SCERTS • Naturalistic • Behavioral • PRT • Milieu Teaching • Incidental Teaching

21. Intervention is naturalistic • Better generalization and maintenance of skills (e.g., Delprato, 2003) • Superior for teaching spontaneous, social-communication skills (Schwartz et al., 1989) • More acceptable to parents (Schreibman et al., 1991) • Leads to more positive family interactions (Koegel et al., 1996)

22. Typical development guides treatment targets • Social-communication skills learned in a similar developmental sequence by all children (Gerber, 2003) • Children with ASD better able to learn skills appropriate for developmental age (Lifter et al., 1993) • Teaching earlier skills increases development of later skills (e.g., Kasari et al., 2008)

23. Social communication develops within affect-laden interactions with responsive caregivers • Relationship between caregivers’ responsiveness and their child’s level of social-communication development (e.g., Siller & Sigman, 2002) • Increased parent responsiveness associated with improvement in: • social-emotional functioning (Mahoney & Perales, 2003). • social-communication skills on CSBS (Wetherby & Woods, 2006) • social interaction, expressive language, and initiations (Aldred et al., 2004)

24. Techniques are based on applied behavior analysis • Interventions based on applied behavior analysis have the strongest evidence-base for children with autism (National Research Council, 2001). • Naturalistic behavioral parent interventions are effective for increasing: • expressive language (e.g., Kaiser et al., 2000) • joint attention (Rocha et al., 2007) • imitation (Ingersoll & Gergans, 2007) • play(Gillett & LeBlanc, 2007)

25. Rationale for a Combined Approach • Developmental and naturalistic behavioral approaches are similar in their implementation • Developmental interventions more focused on promoting social engagement • Naturalistic behavioral interventions more focused on specific skill acquisition

26. Appropriate Intervention Strategies for Parents • Evidence-based • Well-defined (manualized) • Focus on core deficits • Improve parent-child relationship • Incorporated into family routines • Improve family’s quality of life

27. Research on Developmental Parent Interventions • Improvements in social-emotional functioning after 1 year (Mahoney & Perales, 2003). • Changes in parent responsiveness correlated with changes in child’s social behavior • Improvements in social-communication skills after 1 year (Wetherby & Woods, 2006) • Communication skills higher than comparison group at age 3. • Greater improvements in social interaction, expressive language, and initiations in treatment than control group after 1 year (Aldred et al., 2004)

28. Research on Behavioral Parent Interventions • Multiple single-subject design studies showing efficacy for increasing social communication • expressive language (Charlop-Christy & Carpenter, 2000; Kaiser et al., 2000; Laski et al., 1998) • joint attention (Rocha et al., 2007) • imitation (Ingersoll & Gergans, 2007) • play(Gillett & LeBlanc, 2007) • Greater improvements in language in treatment than control group after 1 year (Drew et al., 2002)

29. Goals of Parent Training Program • Improve autism-specific deficits • Evidence-based intervention strategies • Training format compatible with classroom-based intervention model • User-friendly training materials • Effective teacher preparation protocol

30. Training Formats Individual Format 12 weeks Group Format 12 weeks • 24 Sessions (60-90 min) • 2 x per week • Trainer presents techniques • Trainer models techniques • Parent practices while trainer provides feedback • Homework • 6 Group Sessions (2 hrs) • Didactic presentation • Videotaped examples • Group discussion • Homework • 6 Coaching Sessions (45 min) • Trainer models techniques • Parent practices while trainer provides feedback • Homework

31. Group Training with Individual Coaching • More efficient/cost-effective than individualized alone • More individualized than group alone • More effective than group alone • Social Support

32. Group Sessions • Parents are taught techniques through: • Written materials (Manual) • Didactic presentation • Videotaped examples • Group discussion of how techniques can be used during daily activities • Homework

33. Individual Coaching Sessions • Parents get opportunity to practice and receive feedback • Teacher models techniques with child • Parent practices techniques with child • Teacher provides feedback • Teacher helps parents plan how to use techniques at home

34. Training Schedule

35. Goals of Parent Training Program • Improve autism-specific deficits • Evidence-based intervention strategies • Training format compatible with classroom-based intervention model • User-friendly training materials • Effective teacher preparation protocol

36. Training Materials • Trainer manual • Detailed procedures • PowerPoint presentations • DVD • Coaching forms • Parent manual • Description of techniques • Homework

37. Goals of Parent Training Program • Improve autism-specific deficits • Evidence-based intervention strategies • Training format compatible with classroom-based intervention model • User-friendly training materials • Effective teacher preparation protocol

38. Trainer Preparation • Initial Trainer Workshop (2 days) • Program’s theoretical foundation • Intervention techniques • Strategies for conducting parent training • Technical assistance (10 hrs per staff) • Feedback on parent coaching

39. Implementation Oregon Regional Program Autism Training Sites (RPATS)

40. Program Evaluation • Parent evaluation (Ingersoll & Dvortcsak, 2006) • Parent knowledge of intervention techniques • Parent satisfaction • Teacher evaluation • Follow-up teacher survey

41. Increases in Parent Knowledge © Ingersoll & Dvortcsak (2008)

42. Average Ratings on Parent Satisfaction Survey 1=Strongly Disagree, 7=Strongly Agree

43. Follow-Up Teacher Survey • Anonymous web-based survey • 1 to 40 months post-training • Sent to 27 teachers, 23 responded (85%) • Asked to rate responses on 5-point scale • Strongly disagree to strongly agree

44. Appropriateness of Program Elements

45. Perception of Parent Response

46. Perception of Child Response

47. Practical Challenges • Scheduling • Time commitment & compensation • Parent participation • Childcare • Non-English-speaking families

48. Contributors to Success • Strong administrative support • Initial skill with treatment techniques • Philosophical commitment to parent education • Parent enthusiasm

49. Summary • Parents learned skills • Parents felt program was effective • Teachers felt program worked well • Format, Materials, Training Appropriate • Parents and children made gains in skills • Continued to use program after training © Ingersoll & Dvortcsak (2008)

50. Current Research on Project ImPACT • Evaluate short and long-term effectiveness of program • Parent outcomes • Child outcomes • Parent-teacher relationship