ED 553: Assessing Effective Treatments for Children with Autism

1. ED 553: Assessing Effective Treatments for Children with Autism Presentation #1BCBA Pervasive Developmental Disorders Science

2. Behavior Analysis Certification Board (BACB) • Board Certified Behavior Analyst (BCBA) or eligible • Master’s degree • course work in behavior analysis • supervised experience in behavior analysis • www.bacb.com • Supervised training by a doctoral level professional specifically in teaching children with autism

3. What is a Pervasive Developmental Disorder (PDD)? • Pervasive developmental disorders are characterized by severe and pervasive impairment in several areas of development: • Reciprocal social interaction skills • Communication skills • Presence of stereotyped behavior, interests, and activities

4. What is a Pervasive Developmental Disorder (PDD)? • These disorders are usually evident in the first years of life and are often associated with some degree of mental retardation. • These disorders may be observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system).

5. Specific Pervasive Developmental Disorders • Autistic Disorder (299.00) • Rett’s Disorder (299.80) • Childhood Disintegrative Disorder (299.10) • Asperger’s Disorder (299.80) • Pervasive Developmental Disorder Not Otherwise Specified (299.80)

6. How Common are Pervasive Developmental Disorders? • Autism: 4.5 per 10,000 live births • All Spectrum Disorders: May be as high as 1 per 300 (CDC) • http://www.asatonline.org/resources/library/autism_rise.html • 3:1 Male-to-Female Ratio • Increase in perceived prevalence may be due to • Increases in requests for service • Changes in diagnostic criteria • An actual increase in prevalence

7. Possible Etiologies • Brain and Nervous Systeml • defects that occur during initial brain development • abnormalities in the brain structures that make up the limbic system. Inside the limbic system, an area emotional behavior. One study of high-functioning children with autism found that the amygdala was indeed impaired but that another area of the brain, the hippocampus, was not. • In a study of younger children, researchers observed low levels of activity in the parietal areas and the corpus callosum. • high levels of the neurotransmitter serotonin have been found in a number of people with autism.

8. Possible Etiologies • Each of these differences has been seen in some but not all the people with autism who were tested. What could this mean? Perhaps the term autism actually covers several different disorders, each caused by a different problem in the brain. Or perhaps the various brain differences are themselves caused by a single underlying disorder that scientists have not yet identified. Discovering the physical basis of autism should someday allow us to better identify, treat, and possibly prevent it. • http://www.asatonline.org/resources/library/causes_autism.html

9. Possible Etiologies Genetic • Prenatal/Perinatal complications • Maternal Rubella 10% risk of Autism • Environmental • Psychogenic • “refrigerator mother” • Immunizations • http://www.immunize.org/mmrautism/index.htm

10. Current Research Areas • Intervention technologies to improve symptoms • Etiology • Nervous system changes associated with autism

11. Diagnostic Criteria for 299.00: Autistic Disorder A. A total of six (or more) from (1), (2) and (3), with at least two from (1) and one each from (2) and (3) • (1) Qualitative impairment in social interaction • (2) Qualitative impairment in communication • (3) Restricted repetitive and stereotyped patterns of behavior, interests and activities Adapted from: Diagnostic and Statistical Manual, 4th Ed., APA, 1994

12. I. Qualitative Impairment in Social Interaction • Marked impairment in the use of non-verbal behaviors such as eye contact, facial expression or gestures to regulate social interaction • Failure to develop appropriate peer relationships • Lack of spontaneous seeking to share enjoyment or interests • Lack of social/emotional reciprocity

13. II. Qualitative Impairments in Communication • Delay in, or total lack of, the development of spoken language • In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation • Stereotypic and repetitive use of language • Lack of varied, spontaneous pretend or social play

14. Restrictive Repetitive and Stereotyped Patterns of Behavior or Interests • Preoccupation with one or more stereotyped and restricted pattern of interest that is either abnormal in intensity or focus • Inflexible adherence to non-functional routines • Stereotyped and repetitive motor mannerisms • Persistent preoccupation with parts of objects

15. Autistic Disorder (299.00) B. Delays or abnormal functioning in at least one of the following areas: social interaction, social communication, or symbolic or imaginative play, with onset prior to the age of three. C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

16. Diagnostic Criteria for 299.80: Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) • This category should be used when there is severe and pervasiveimpairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behaviors are present but the criteria are not met for a specific PDD Adapted from: Diagnostic and Statistical Manual, 4th Ed., APA, 1994

17. Learning Characteristics of Children with Autism • Stimulus overselectivity • Difficulty responding to natural contingencies • Difficulty generalizing skills • May rely on rote memory • May memorize information rather than comprehend it • May demonstrate proficient performance on tasks demanding visual spatial judgment and pattern recognition • Splinter skills

18. Learning Characteristics of Children with Autism • Difficulty in all dimensions of language including expressive/receptive language and: • Phonology - Rules determining how sounds can be sequenced • Morphology - Rules for meaning of sounds (e.g., un, pro, con) • Syntax - Rules for a language’s grammar • Semantics - Rules for meaning of words • Pragmatics - Rules for communication • especially difficult for a child with autism

19. Why does Autism Need Such a Specialized Treatment? • Because its is a type of Pervasive Developmental Disorder (PDD) • A child with autism is affected along multiple dimensions • (Unlike certain other single dimension problems: • learning disability, communication disorder, emotional and behavioral disorders)

20. Why does Autism Need Such a Specialized Treatment? • Learning deficits • Affects every aspect of child’s education • Language disabilities • Articulation, expressive, receptive, spontaneous, conversation, non-contextual vocalizations • Behavioral disorders • Stereotypic behavior: motor, visual, tactile, • Compulsive behaviors • rigidity of routine, intolerant of change

21. Why does Autism Need Such a Specialized Treatment? • Attentional deficits • Lack of eye contact, availability of learning, unaware of danger • Emotional impairments • Non-contextual emotions, lack of self-concept • Social impairments • Eye contact, gestures, facial expression, greetings, awareness of other children, friendships, • Play skills deficits • Imaginative, pre-occupations with objects/activities, general content knowledge

22. Why does Autism Need Such a Specialized Treatment? • Sleep disturbances • Going to sleep late, getting up early, getting up during the night • Toileting impairments • Lack of awareness of accidents • Eating disabilities • Texture, appearance, gustatory

23. How do we help?It All Begins with Knowledge • Knowledge lets us know how things work • That information is only useful if it is accurate • “My brother’s cousin’s landscaper’s uncle told me that this plant derivative cures acne!” • Unfortunately lots of knowledge sources can have inaccuracies and biases • So how do we know which knowledge is accurate?

24. Ah Ha! Science! • Science is nothing more than a certain way to gather knowledge • strives to minimize bias and maximize accuracy • Uses objective, systematic, and direct observation of phenomena being studied • Likely to be most accurate source of knowledge for how things work in the world

25. What Does Science Look At? • Test tubes and lab coats? • Specifically, how does the environment we live in affect what we do, think and feel? • Various things affect me and what I do affects others • I’m a teacher and I’m most interested in knowing how what I’m doing is affecting a child’s learning • Specifically, what is going to be the most effective educational strategy for each particular child?

26. How Can We Use Science to Study What & How a Child Learns? • We have a scientific branch of psychology that has been developing for SEVENTY years • It’s called…. • Applied Behavior Analysis

27. What is Applied Behavior Analysis? (Cooper, Heron, Heward, 1987) Applied behavior analysis is the science in which • procedures derived from the principles of learning • are systematically applied to improve socially significant behavior • and to demonstrate experimentally that the procedures employed were responsible for the improvement in behavior • Why?

28. Scientifically Validated Treatment: Applied Behavior Analysis (ABA)(a/k/a Behavior Management; Intensive Behavioral Intervention [IBI]) • “The use of non-validated treatment approaches for children with autism may be ineffective and possibly harmful to your child and may take time away from treatments that have shown to be effective.” (Green, 1996; New York State Department of Health, 1999) • “Intensive, behavioral intervention early in life can increase the ability of the child with autism to acquire language and ability to learn.” • “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.” • U.S. Surgeon General, David Satcher, M.D., Ph.D.