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Florida Conference for Supporting Military Youth with Special Needs - speaker Dr. Daley on Autism.

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Dod4 copy dr. daley

  1. 1. 6/19/2012 1. It is possible to identify children as young Best Practices for Serving as 1 year old Children with Autism Spectrum Disorders Teresa Daly, Ph.D, BCBA-D UCF Center for Autism and Related Disabilities and important to do so Why you SHOULD identify early 2. When you’ve met one child with• Brain plasticity ASD, you’ve met one child with• Speech “sensitive period” ASD• Research findings – Earlier treatment highly correlated with options at age 6 – Verbal language by age 5 best predictor of future outcomes• Rare resolution without active and intensive intervention• Link children and families to services that will address their needs intensively during the preschool years 3 Autism Social Spectrum Restricted skills Interests & Attention Disorders Communication Childhood Disintegrative Disorder Autistic Disorder Rett’s Disorder Pervasive Developmental Disorder Not Otherwise Specified Asperger’s Disorder 1
  2. 2. 6/19/2012Core Deficits for Autism Spectrum Disorders Differences in socialization ASD Differences in Repetitive behaviors, communication interests and activities 2
  3. 3. 6/19/2012 -Dalton, 2005 Basic Communication Language of the Eyes & prelinguisticsEye contact Follow gestures Object/PersonGestures Give me Existence/NonexistenceVocal Play Objects RecurrenceBack & forth Actions Rejection Other vocabulary Attribution Directions PossessionOne Word Stage: Intonation Action/Locative Action Facial Expressions Locative State/StateRequests NoticeProtests 14 grammaticalResponds morphemesCommentsGreetsGames 3
  4. 4. 6/19/2012 A: happy B: Afraid C: Disgusted D: Distressed A: GuiltyHarder forAS to B: Thinkingrecognize C: FlirtingBelief- D: Arrogantbased facialexpressions Viewer with ASD (Red Line) Normal Comparison Viewer (Yellow Line) Ami Klin 4
  5. 5. 6/19/2012 Social Skills Needs Higher Level Social Skills• Social smile • Greeting others • Understanding • Joking around• Eye contact during • Responding to greetings perspective • Noticing disinterest social interactions • Imitating actions of peers • Understanding • Conversational tags• Eye contact coordinated • Using positive touch intonation with speech • Initiating conversation • Participating in group action • Understanding social• Accepting positive • Turn-taking • Maintaining touch rules conversation • Watching peers• Accepting proximity of • Giving and receiving other children • Responding with speech • Sharing good fortune • Initiating with speech compliments• Staying in proximity• Seeking proximity • Conversation• Showing • Symbolic play Engagement Needs Independence Needs • Sustained attention/Endurance • Dressing/undressing • Joint attention • Feeding/drinking • Task completion • Toileting • Variety in leisure and work skills • “Personal responsibility” • Activity Participation • Navigating the world • Interactions • Home Skills/Chores • Leisure Skills/Interests Recommendations Tolerance (re: intervention) Needs • Begin as soon as autism is suspected• Clothing • Group participation • Minimum of 25 hours per week, year • Having to• Routines round communicate better• Routine changes • Sounds• Proximity • Engaged in systematically planned • Touch• Demands developmentally appropriate • Activities of daily• Choices living educational activities• Waiting (toothbrushing,• Food variety haircuts) 5
  6. 6. 6/19/2012 Priorities: Key Targets for Effective Programming:• Functional Spontaneous Communication Engagement: Playing with toys, participating in activities, interacting with people.• Social instruction throughout the day in various settings Play Skills: Knowing what to do with toys; using toys in increasingly complex ways.• Cognitive development and play skills Communicating: Using words and gestures to• Proactive approaches to behavior problems let others know what is wanted or unwanted.• To the extent it promotes acquisition of goals, Independence: Doing things for oneself (at the specialized instruction provided in a setting that includes ongoing interactions with typically appropriate developmental level). developing children Tolerance: Accepting things that are not exactly what is most enjoyable (peer proximity, activity participation, etc.) Prioritizing Intervention: Prioritizing Intervention: Young Children Elementary Age Children • Family priorities • Family priorities • Disability-dictated priorities • Disability-dictated priorities • Multiple opportunities each day • Multiple opportunities each day Language/Communication Language/Communication Social/Relating Functional Academics Self-Help Social Motor Motor Other OtherPrioritizing Intervention: Older Prioritizing Intervention: 18-22 Children year olds • Family priorities • Family priorities • Life Skills • Life Skills • Multiple opportunities each day • Multiple opportunities each day Functional Academics Vocational Functional Academics Vocational Social Leisure Leisure ADLs Self Other help 6
  7. 7. 6/19/2012 Curriculum for Students with Functional Skills? Autism Spectrum Disorders • Does the child need or use this skill in MUST everyday life? 1) First: Address core deficits • Does the child need this skill both now * Communication and in the future? * Socialization • Does someone else currently have to * Restricted interests and attention help him perform this skill? 2) Then: Address FUNCTIONAL academics • Will learning this skill enable the child to reading, money, time, measurement be more like “typical” peers? 3) Then: Address additional academics • Will learning this skill enable the child to world geography, penmanship participate in the community? (Jacobs, 1993; Bruder, 1995) Functional skills are • Every case is different• Used and not forgotten• Easier to learn because of real-life • What works for one may not work for application another• More easily generalized because they take place in the settings where they are needed • Parents know their own child best• A pathway to independence • Parents can be effective teachers, IF they have training, support and the availability Hanen More than Words Implications for Parents and Program Teachers • Don’t assume • Communicate • Evaluate everything—accept nothing blindly • Be a good consumer 7
  8. 8. 6/19/2012 Characteristics of Evidence-based Practices Effective Programs* • Early implementation • Systematic teaching • Functional skills (core deficits) • Specified curriculum, evaluation methods • Supportive environments and routines • Family involvement • Inclusion opportunities • Intensity • Staff and program development (Dawson & Osterling, 1997; Izeman & Strain, 1995; Harris and Handelman, 1992) *Caveat emptor: programs=programs designed for preschoolers Points of Agreement Among Intensity Experts• Intensity matters • 12 months per year • Low teacher-child ratio (1:2 or 1:3)• Early matters • extensive individualized treatment plans• Parents/Families matter • Data-driven• Data matter • High hours of engagement – no wandering, self stimulation• Systematic/empirical approach matters • Engagement includes active involvement with• Training matters adults/therapists and peers • No down-time—active teaching across all parts of waking day (NEC*TAS, 1997) • Equal emphasis on home and school Criteria for Evidence-BasedPractices for Focused Interventions (NPDC-ASD)• Two high quality randomized experimental group design or quasi-experimental group designs that rule out selectivity and other threats to internal validity• Five high quality single subject design • At least three different researchers in different locations • Each study has at least three demonstrations of experimental control 8
  9. 9. 6/19/2012 Established Evidence Based Comprehensive Models vs. Interventions Focused Interventions• Antecedent Package (99 Studies)• Behavioral Package (231 Studies) • Comprehensive models are multi-• Comprehensive Behavioral Treatment for Young Children (22 component programs designed to Studies)• Joint Attention Intervention (6 Studies) positively and systematically affect the• Modeling (50 Studies) lives of children with ASD and their• Naturalistic Teaching Strategies (32 Studies) families• Peer Training Package (33 Studies)• Pivotal Response Treatment (14 Studies) • Focused interventions are procedures that• Schedules (12 Studies) promote individual skills or learning within• Self-Management (21 Studies) a specific skill area.• Story-Based Intervention Package (21 studies) (NAC, 2009) Focused Interventions to DecreaseFocused-Interventions Identified Interfering Behaviors• Skill Building Behavioral intervention • Positive behavior support practices – Functional Behavior Assessment – Prompting – Differential reinforcement of alternative behavior – Time delay – Extinction – Reinforcement – Response interruption/redirection – Task Analysis and Chaining – Stimulus Control – Functional Communication Training Focused Interventions Focused Interventions: key components of Comprehensive Interventions to support skill development and independent functioning Model Program • Visual supports• Discrete trial training • Individualized work systems• Naturalistic interventions • Video modeling• Pivotal response training • Computer-assisted instruction• Self-management 9
  10. 10. 6/19/2012 Second Level of Evidence: Focused Interventions EmergingInterventions to Address Social Skills • Augmentative and Alternative Communication Device (14 studies)• Social skills training • Cognitive Behavioral Intervention Package (3 studies) • Developmental Relationship based Treatment (7• Peer mediated intervention studies) • Exercise (4 studies)• Social Stories • Exposure Package ( 4 studies)• Picture exchange communication system • Imitation based Interaction (6 studies) • Initiation Training (7 studies) (PECS) • Language Training Production (13 studies) • Language Training Production & Understanding) (7 studies) • Massage/Touch Therapy (2 studies) (NAC, 2009) Emerging (Second Level, Unestablished Treatments Cont’d) Multi component Package (10 studies) • Academic Interventions (10 studies) Music Therapy (6 studies) Peer mediated Instructional Arrangement (11 studies) – One size fits all; Traditional approaches Picture Exchange Communication System (13 studies) • Auditory Integration Training (3 studies) Reductive Package (33 studies) Scripting (6 studies) • Facilitated Communication Sign Instruction (11 studies) • Gluten- and Casein-Free Diet (3 studies) Social Communication Intervention (5 studies) Social Skills Package (16 studies) • Sensory Integrative Package (7 studies) Structured Teaching (4 studies) Technology based Treatment (19 studies) Theory of Mind Training (4 studies) (NAC, 2009) (NAC, 2009) Your Guide Training Resources 10
  11. 11. 6/19/2012 YouTube • Butterfly Effects Channel State ASD Portal: WHAT IS CARD? • Center for Autism and Related Disabilities • State Funded Program • No charge to families • Autism Society of Florida • Consultative Support • Florida Department of Education • Enhance community supports and programs Professional Development Portal • Capacity builder • CARD • Leadership in ASD • Develop programs to fill gaps CARD SERVES Dial 800 9-AUTISM Qualifying Diagnoses • All DSM-IV Pervasive Developmental DisordersCurrently CARD centersprovide support to over • Deaf-Blind25,000 individuals in the • Deaf/Blind & Additional state. Developmental Disability 11
  12. 12. 6/19/2012 CARD Strengths are Built on INDIVIDUALIZED & FAMILY ASSISTANCE • Dedicated, experienced, credentialed staff Services • Interdisciplinary teaming • Telephone and email • Ability to help others through education support and training, demonstration, and feedback • Referrals advice and information • Collaborative relationships • In-home or in-community • Broad perspective on the current issues in consultation ASD • Transition and Post-High School Support INDIVIDUALIZED & FAMILY ASSISTANCE TECHNICAL ASSISTANCEMore Services • Classroom consultation • Help develop • Educational Training evidence-based Opportunities programming for • Support Groups a school, college, community Services are individualized and will vary depending group, or agency on CARD funding and the family’s needs and priorities PUBLIC AWARENESS TRAINING • Website: • Regional Workshops • Weekly E-updates • On-site modeling and • Resource guide, Library coaching • Community Events and • In-services, institutes Initiatives • Annual CARD Conference • Speaker’s Bureau • Pre-Conference Teacher • Media presentations Training Day • Autism Awareness Events • Community-based training • Screenings 12
  13. 13. 6/19/2012 3. Children with ASD thrive on CARD CANNOT: predictability• Handle emergency crisis situations • Research and• Provide therapy or case management observation indicate that• Provide Legal or Educational Advocacy predictability reduces• Provide Medical Advice or Diagnose tantrums, anxiety, and• Provide financial assistance inappropriate behavior in children with ASD at all• Duplicate services of other state agencies ages and levels of functioning Even children with AS who have When shown multiple TV screens, above normal IQs, have marked it is hard for children with autism difficulty in disengaging attention. to stop looking at one in order to shift attention to newer visual stimuli. Implications for Parents andIt appears particularly difficult to disengage Teachersand look up or look left. There is a bias for the right, lower corner. • Have a daily scheduleThe problem with disengagement appears • Prepare the child for changes to be upsetting to children with AS. • When the unpredictable happens, show Motor movements were noted to help the child how and when the routine will be compensate. reestablished 13
  14. 14. 6/19/2012 3. Children with Autism have Strengths that can be promoted• Many children with autism have a strong visual sense that can be used to assist them with their weaker areas• Many children with autism have memory strengths that enable them to succeed at data management occupations 4. Children with Autism Grow Up • Children with Autism experience the same physical and hormonal changes that typically developing children do• Children with autism grow into adults who desire a rich quality of life that includes a variety of leisure options, comfortable living quarters, and the right to occasionally sleep late and eat too many doughnuts 14
  15. 15. 6/19/2012 Implications for Parents and Teachers • Beginning early, encourage adherence to societal standards • Engagement is essential • Develop leisure skills that are likely to be • Target core areas early available to the child as an adult and are • Prepare for the future with the long view in likely to be age appropriate for an adult mind Some Useful Transition to Work Skills Survey Says Personal Mobility Task Scheduling Endurance • Yes, child has... Seeking Assistance » Special Needs (N=504) ASD (N=1496) Functional • Bank account 55% 37% Quality Control/ Communication • Cell phone 41% 9% Self Checking • Personal computer 40% 44% Age Referenced • MP3 player 49% 23% Self Monitoring of Clothing & Hygiene • Cash card 6% 1% Behavior Peter Gerhart, 2005) Easter Seals, 2009 5. Progress is not TECHNOLOGY RULES! always linear • Slow and steady will win the race, but sometimes it will feel like you are going backwards • Keep in mind that those setbacks are almost always precursors to a major development.wmv 15
  16. 16. 6/19/2012 Implications for Parents and Teachers • View setbacks as• Keep a progress journal—document opportunities achievements and dates • Ask for help-or at least• Surround yourself with positive people ask for data• Take time to breathe • Be relentless"Never give in, nevergive in, never, never,never, never - innothing, great orsmall, large or petty -never give in exceptto convictions ofhonor and goodsense. Never, Never,Never, Never giveup." 16