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MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER. Deficits in social attachments and behavior Deficits in verbal and nonverbal communication Presence of perseverative, stereotyped, repetitive, behaviors. Social Interaction Differences. Kids with autism smile!

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main diagnostic features of autistic disorder
MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER

Deficits in social attachments and behavior

Deficits in verbal and nonverbal communication

Presence of perseverative, stereotyped, repetitive, behaviors

slide2

Social Interaction Differences

  • Kids with autism smile!
  • Social interaction may be desired but difficult
  • Poor reciprocity in social interaction
  • Relationship with care providers may be most strongly developed
  • Peer relationships difficult
slide4

Autistic Types

Unknown

Aloof

Passive

Interactive but odd

Dr. Lorna Wing

slide5

Communication Differences

  • Delayed/Different Communication
  • Speech without communication vs. communication without speech
  • Echolalia
  • Poor gesture use
  • Instrumental hand leading
  • Playlalia and lack of symbolic play
slide7

Stereotyped Behavior

  • Perseverative Interests or play
  • Motor stereotopies in preschool and beyond
  • Insistence on sameness/routine
  • Need for “prediction” and “control”
  • Preoccupation with parts of objects
slide9

What is not addressed in the DSM-IV

  • Sensory Processing
  • Temperament
  • Motor Planning
  • Imitation
  • Anxiety and Avoidance
  • Adaptive Skills
  • Impact of intellectual functioning
other features of autism
OTHER FEATURES OF AUTISM

Incidence is cited at rate of between 1 in 2500 to 1 in 500 births.

4:1 boys to girls ratio

Lifespan disorder

No known etiology although known to be organic in nature.

Commonly accompanied by mental retardation

Heterogeneous disorder

treatment
Treatment

Although current push towards identifying biological bases of the disorder, no treatment implications are on the horizon.

The form of treatment with the greatest empirical validation is treatment based upon a behavioral model.

slide14

Behavioral Model

Treatment based on the systematic application of the principles of learning

Consitently empirically demonstrated to be effective in improving the behavior of children with autism

Developed via the methodology of applied behavior analysis

Initial demonstrations were the first to show these children could learn in a systematic manner

components of discrete trial training

Components of Discrete Trial Training

Instruction > Response > Consequence

Presenting Instructions and Questions:

Child attending

Easily discriminable

Short and consistent

Child responds or fails to respond

Consequences:

Types of consequences

Manner of presenting consequences

results of early behavioral intervention
Results of Early Behavioral Intervention

Initial demonstrations involved highly structured discrete trial format

Proved to be very effective in establishing a wide range of behaviors in these children

Provided basis for all behavioral treatments to follow

Can lead to substantial improvement in many children with autism

problem areas
Problem Areas

Generalization

Stimulus

Response

Lack of spontaneity

Robotic responding

Prompt dependency

Slow progress

Time consuming

Difficult to implement

Children and treatment provider may not like

naturalistic strategies
Naturalistic Strategies

Developed in response to needed improvements

Arose from a number of different laboratories

Called “incidental teaching,” “pivotal response

training,” “milieu treatment,” etc.

All share many of the same components

components of pivotal response training
Components of Pivotal Response Training

Motivation

Child Choice

Reinforce Attempts

Direct Reinforcement

Intersperse Maintenance Tasks

Frequent Task Variation

Turn Taking

Responsivity

Tasks Involve Simultaneous Multiple Cues

results of naturalistic treatment strategies
Results of Naturalistic Treatment Strategies

Greater generalization

More positive affect

More positive home interactions

More enjoyable for both children and treatment provider

parental affect subject means
Parental AffectSubject Means

Negative/Neutral Affect   Positive Affect

OverallRating

Subject

parent child interaction measures
Parent-Child Interaction Measures

Positive

Neutral

Negative

Individual Target BehaviorPivotal Response Training

Interaction Scales

Parent Training Conditions

developing individualized treatments
Developing Individualized Treatments

Important child variables

Important parent and family variables

Important cultural variables

Important treatment/behavior interactions

slide28

PRT DATA SET

JODO

CHLI

ZATA

NOFO

JOCO

THBL

AIAC

ADMI

CHDE

ALKO

YOTK

DAGL

CANE

DABO

PACH

STWI

ROBE

JOTO

KYMA

KYBR

JBBA

DYRE

BESM

SASI

JECI

KASU

ROTO

JASA

ELTU

JOTA

BOBA

ANCR

slide29

BEST RESPONDERS

JODO

CHLI

ZATA

NOFO

JOCO

THBL

AIAC

ADMI

ALKO

CHDE

YOTK

DAGL

CANE

DABO

PACH

STWI

ROBE

JOTO

KYMA

KYBR

JBBA

DYRE

BESM

JECI

SASI

KASU

ROTO

JASA

ELTU

JOTA

BOBA

ANCR

slide30

NON RESPONDERS

JODO

CHLI

NOFO

ZATA

JOCO

THBL

AIAC

ADMI

CHDE

ALKO

YOTK

DAGL

CANE

DABO

PACH

STWI

ROBE

JOTO

KYMA

KYBR

JBBA

DYRE

BESM

SASI

JECI

KASU

ROTO

JASA

ELTU

JOTA

BOBA

ANCR

profile behaviors
Profile Behaviors

Toy Play

Approach Behavior

Avoidance Behavior

Verbal Self-Stimulatory Behavior

Nonverbal Self-Stimulatory Behavior

slide32

Best Responders Profile

Mean Percent Interval Occurrence

slide33

Non Responders Profile

Mean Percent Interval Occurrence

slide34

Language Data - Responders

Mean Percent Interval Occurrence

slide35

Responders

Toy Play

Mean Percent Interval Occurrence

Social Skills

language data non responders
Language Data Non-Responders

Mean Percent Interval Occurrence

slide37

Non-Responders

Toy Play

Mean Percent Interval Occurrence

Social Skills

what about other treatments
What about other treatments?

6 children: 5 boys, 1 girl

Age range: 24-47 mo.

6 children matching original nonresponder profile except for one area:

3 matching profile EXCEPT had lower avoidance

3 matching profile EXCEPT had higher toy play

experimental conditions
Experimental Conditions

Baseline

Varying length of baseline

Child had free access to a variety of toys

Opportunities to respond once per minute

No contingencies

PRT

3 weeks

Specific aims – imitation of sounds/words; eye contact, appropriate play

DTT

3 weeks

Specific aims – imitation of sounds/words; eye contact, imitation of actions (with objects); receptive commands

conclusions
Conclusions

Change of either of two elements of the original (Sherer & Schreibman, 2005) profile led to changes in PRT treatment outcome.

Children responded at a level in between the original responders and nonresponders

PRT profile was not predictive oftreatment outcome with DTT suggesting specificity of PRT profile

slide44

Parental Stress

  • Parents experience significant stress in areas related to child with autism
    • Long-term care
    • Limits on family opportunity
    • Koegel, Schreibman, Loos, Dirlich-Wilhelm, Dunlap, Robbins & Plienis (1992)
slide45

Parental Stress Con’t

  • Different types of training have a differential effect on stress of parents
    • Naturalistic strategies reduce stress more than highly structured techniques
  • Parental stress is correlated with progress of child in family-oriented programs
  • Parents under high degree of “parent domain” stress (PSI) may not benefit from parent training.
slide46

Parent Support

  • Parents enrolled in parent training programs report that social support would be likely to reduce stress.
    • Gallagher, Beckman & Cross, 1983
    • Moes, Koegel, Schreibman & Loos, 1993
slide47

Parent Support/Information Group

  • Purpose:
    • Does participation in a parent group reduce stress in parents of children recently diagnosed with Autistic Spectrum Disorders?
    • Do parents enrolled in a parent group learn the training techniques better than parents not enrolled in a parent group?
individualizing placement type
Individualizing Placement Type
  • Which children will benefit most from early inclusion programming?
conclusions1
Conclusions
  • Autism is a complex disorder
  • One treatment methodology, placement type or parent program will not be optimally effective for all children or families.
  • Continued individualization of intervention necessary.