Parent Implemented Intervention for Children with Autism Spectrum Disorders

1. Parent Implemented Intervention for Children with Autism Spectrum Disorders Dawn R. Hendricks, Ph.D.

2. Parent Implemented Intervention:Session Topics • Rationale for parent implemented intervention • Obstacles to parent implementation • Measures of effectiveness for parent implemented intervention • Skills targeted through parent implemented intervention

3. Parent Implemented Intervention:Session Topics • Effective components of parent training programs 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Three tiered plan for parent training

4. Total Performance SystemGoal: Overall Purpose of the Organization

5. Objective #1 Describe the Rationale to Involve Parents in their Child’s Program

6. Parent Involvement: Why is it Needed with Children with ASD? • Early intervention • Intensive intervention • Intervention agents throughout his/her lifespan • Challenging behavior • Generalization

7. Parent Involvement: Why use it with Individuals with ASD? • Parents of children with ASD report higher levels of stress and depression • Two of the most frequently described sources of stress for family members are: • Potentially disruptive behavior in public places • The corresponding restrictions this behavior places on family activities • Involved parents report increased feelings of competence and decreased feelings of depression and stress

8. Objective #2 Barriers to Parent Implementation

9. Activity • Generate a list of barriers that may prevent parent implementation • Environmental • Child • Parent • Service provider

10. Dawn’s List of Barriers Scheduling Transportation Other competing priorities (e.g. children, work, sleep!) Experience / Knowledge of service provider Amount / intensity of intervention

11. Dawn’s Critical List of Barriers Parent knowledge / skills Parent readiness Parent emotional state / mental health (e.g. depression) Parent adversity factors (e.g. single parent, socioeconomic disadvantage) Parent attitude (e.g. pessimism) Parent regard towards EI / Strategies Child factors (e.g. age, severity of disability)

12. Objective # 3 Describe the Measures Used to Determine the Effectiveness of Parent Implemented Intervention

13. Measures of Effictiveness Koegel, Koegel, Harrower, & Carter (1999) & Symon (2001) • Family/environment goodness of fit • Parents’ implementation (frequency & fidelity) • Parents’ concerns/issues/values • Cost-benefit analysis

14. Measures of Effectiveness Child Progress • Immediate • Long Term

15. Objective # 4 Describe the Skills Targeted Through Parent Implemented Intervention

16. Child Progress Sufficient Evidence Base: -Reduction of problem behaviors -Improvement in adaptive behavior -Improvement in communication -Improvement in social skills -Improvement in cognitive performance -Improvement in on task behavior

17. Strategies Employed to Reduce Problem Behavior • Functional Behavior Assessment • Functional Communication Training • Prompting • Reinforcement • Natural Environment Strategies • Environmental Arrangement • Visual Strategies • Social Stories • Pivotal Response Training

18. Strategies Employed to Improve Communication / Social • Natural Environment Strategies • Imitation and Modeling • Joint Action Routines/Joint Attention • Pivotal Response Training • Prompting • Reinforcement • Environmental Arrangement • Functional Behavior Assessment • Functional Communication Training • Discrete Trial / Structured Teaching • Picture Exchange Communication System

20. Objective #5 Describe the Components of an Effective Parent Training Program

21. Effective Components of Parent Training Programs 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Three tier plan for parent training

22. Activity • Due to a sudden accident, you now are taking care of a friend’s elderly parent. • This parenthas Alzheimer's and speaks Chinese • What is your immediate priority? • What are your goals?

23. Step 1 Determine Needs of the Family Areas of concerns and needs regarding the child Strengths of the child and family Child behaviors that impact family functioning Parent-child interactions including type, frequency, nature, and reciprocity of interactions Family activities, routines, and physical layout of the home Supports and resources within the immediate and extended family and community

24. How do we Determine Needs? Ask questions….lots and lots! Observe Break the day into time intervals or activities Discuss privately before IFSP Observe Skip the formalities Acknowledge claims as valid

25. Sample Questions What is your family proud of? What is your favorite thing about your child/family? Now is your time to brag on your family… What is the best time of day? Why? What is the most challenging time of day? Why? What is the favorite thing you do with your child? Tell me about dinner. How do you take care of grocery shopping? Who is there for you when things get rough? Tell me about the bed time routine. Walk me through a typical day. What opportunities does your child have to play with other children? Can you describe how his brother interacts or plays with him?

26. Things to Observe Dinner time routine Down time Grocery store Car ride Playing in yard Toileting /diapering

27. IFSP • Where is this Addressed? • Child and Family Activities • Family identified resources, priorities and concerns

28. Group Activity List common areas of need by families with children with ASD.

29. Step 2Determine Goals Address areas of concern and priority for the child, parents, and/or family members Create a positive impact on family functioning and not cause additional stress to the parents or family Can be implemented by parents with consistency Are appropriate for parents to implement in home and/or community settings

30. ACORN Battery of tests that any goal statement should pass in order to be effective. If not passed, the goal statement will not be effective

31. ACORN A = Does the goal describe an ACCOMPLISHMENT? C = Does the team have CONTROL over achieving the goal? O = Does the goal statement describe the OVERALL goal of the team? R = Is the goal statement RECONCILABLE with the other goal statements? N = Does the goal statement describe a goal that is quantifiable? (NUMBER)

32. Goals

33. Sample Questions Imagine a year from now, what would you like to be different in terms of__________ (stated concern, for example, child’s activity level; family’s child care situation; child’s communication…)? Imagine a year from now, are there some things you would like to stay the same? What are the kinds of things you’d like to see your child do better? What would you like your child to do next in terms of ______________ (e.g., using his/her hands; learning new information; taking care of his/her own needs; understanding what is said to him/her; making his/her needs known; playing with toys…)? What would you like to see happen for your family during the next # months/year? Are there concerns regarding safety? Are there times of the day that are difficult? What might need to change to make that time of day easier or more pleasant?

34. Goals May Include Issues Related to Home and Family • Rearrange the play room • Install child-proof door knob • Use picture schedule for play routine • Create consistent night routine • Take trip to grocery store, enter door and leave • Use choice board in kitchen for snack items • Use visual to indicate termination of game

35. Goals: Examples Jake’s sister will participate in motor exercises three times each week by modeling the exercises and interacting with Jake. Megan’s brother will present two choices for a play activity and will play for five minutes. Paris’s mother will use a first/then board when going to the grocery store. When asking Callie a question or giving an instruction, Callie’s family members will first gain her attention by standing in front of her, tapping her on the shoulder, and pointing to his/her mouth.

36. Group Activity List potential family and home goals that may be included

37. Where Can this Go on the IFSP Outcome –place for the family’s ability to assist in their child’s development (family outcome) or developmental goal (child outcome)

38. Step 3Develop the Intervention Plan Incorporates intervention within the context where target behaviors occur Incorporates intervention into naturally occurring daily routines to the maximum extent possible Includes practices that have an evidence base and have been shown to be effective when implemented by parents Includes instructional practices that are compatible with parent knowledge, characteristics, routines, and preferences

39. Develop the Intervention Plan Instructional strategy broken down into step-by-step directions Frequency and duration of instruction When and where to provide instruction Who will implement Materials required How long to implement Consequences / reinforcement

40. Autism Internet Modules www.autisminternetmodules.org Parent Intervention Protocol Form Parent Implemented Behavior Intervention Plan

41. Prioritizing Area that has the smallest effort but biggest impact Area that addresses safety Area that adds order / control Area that will increase interaction with parent Area that will increase access to the community

42. Cognition/play • Medical, sensory, safety • Communication • Environmental • Interaction Level 5- Level 4 - Level 3 - Level 2 – Level 1 –

43. Activity • Case Study • List potential outcomes • Prioritize items in the intervention plan

44. Parent Interview Lena Winslow Mother of Katherine

45. Step 4Provide Training Three-tier approach Individualized model

46. Influences on Efficacy

47. Influences of Efficacy: Cognition Sense-making Examples and counter examples Substitution Problem solving

48. Three-tier Approach • Self-administered Programs • Literature • Audiovisual material • Computer-delivered information

49. Three-tier Approach • Group-based Programs • More therapist attention • Cost efficient • Support kinship and engagement

50. Three-tier Approach • Individually Administered Programs • Increased flexibility • Individualization of content • Feedback by therapist and family