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Connie Kasari 2012 Science and Sandwiches

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Connie Kasari 2012 Science and Sandwiches

  1. 1. Engaging Autism: Considerations for underserved, under-represented and under-resourced   Connie  Kasari,  PhD   University  of  California,  Los  Angeles   ASF Science and Sandwiches December 6, 2012 AIR-B --Autism Intervention Research Network for Behavioral Health
  2. 2. UCLA Kasari Lab Intervention Studies  Targeted  Interventions     Core  deficits  (beyond  dose  and  approach)    Underserved,  under-­‐represented     Infants,  toddlers     Minimally  verbal     School  aged,  included  in  general  education     Under-­‐resourced    Community  based     Schools  are  where  all  children  can  be  found  
  3. 3. Engagement  as  Critical  Intervention  Target    Young  children:  focus  on  joint  attention,  play,   engagement  with  parents  (the  core  de?icits)    Look  to  behavioral  signs  of  engagement     Shared  attention  and  affect     Joint  attention     Social  play  with  others     Conversation  
  4. 4. Targeted  Intervention  Approach  to  Address  Problems  of  Engagement    To  affect  engagement,   intervention  needs  to  be   targeted,  dense  and  long  term    The  targets  of  intervention   change  with  development,  and   with  amount  of  impairment  in   individual  children    Debate  in  the  field  as  to  how   much  direct  teaching  versus   naturalistic  methods  should  be   used  
  5. 5. JASPER    Joint  Attention,  Symbolic  Play,  Engagement,  Regulation   Joint Attention Initiations: -Point to share -Show # -Symbolic Play
  6. 6. Change  in  proximal  outcomes:  Joint  attention  and  play   Joint Attention Initiations Play Level
  7. 7. Why  are  these  targets  important?    They  predict  to  distal  language  outcomes   Follow  up  1  year  later:  JA  and  SP   Follow  up  for  Low  Language  Group:   groups  better  language   JA  group  best  outcomes   Kasari, Paparella, Freeman & Jahromi , 2008, JCCP
  8. 8. Pay  off  from  early  focus  on  joint  attention/joint  engagement    Follow  up  of  children  in  original  study,  5  years  later    40  out  of  the  58  children    32  became  verbal  and  8  minimally  verbal    Predicting  Expressive  Language:     Treatment  group     CA     IJA     Play  Level     Expressive  Language     DQ     Gender  
  9. 9. Pay  off  from  early  focus  on  joint  attention/ joint  engagement  9   Follow  up  of  children  in  original  study,  5  years  later     40  out  of  the  58  children     32  became  verbal  and  8  minimally  verbal     Predicting  Expressive  Language:     Treatment  group     CA     Initiates  joint  attention     Play  Level     Expressive  Language     DQ     Gender   Kasari, Gulsrud, Freeman, Paparella, Hellemann, 2012, JAACAP
  10. 10. What  did  we  learn  from  this  study?    Active  ingredient  to  early  intervention  is  a  focus  on  early   developing  core  de?icits     Joint  attention     Play    Results  suggest  the  mechanism  is  likely  engagement  as  JA   and  SP  interventions  led  to  similar  outcome    Suggestion  that  APPROACH  also  matters-­‐-­‐-­‐the  fusion  of   developmental  and  behavioral  approaches   JASPER
  11. 11. Difference  between  preverbal  and  nonverbal  children    Most  young  children  are  preverbal…..we  can  get  them  to   talk    Concern  is  for  the  children  who  remain  nonverbal  at  age   5-­‐-­‐-­‐entering  kindergarten  (about  30%  of  all  children)    Best  social  and  adaptive  outcomes  are  often  found  for   children  who  are  verbal  by  school  age    Children  who  are  nonverbal  (minimally  verbal)  at  school   age  are  UNDERSERVED,  UNDER-­‐STUDIED  
  12. 12. Access  to  Communication  Important  JASPER-­‐EMT  studies   Boy 5 ½ years; No words or sounds
  13. 13. School  aged  Studies:  What  is  the  Issue?    For children with ASD:   More issues about social inclusion/acceptance than academic support for some children   Others---issues about intervention in general—minimally verbal, low verbal, learning  Level of support needed (or if it is needed)   1:1 assistant?  Concerns mostly about feeling connected, belonging for ASD   Intervention for ASD---or for those around ASD?
  14. 14. UCLA  School  aged  Studies:  Children  have  different  views  about  friends,  relationships    Important to ask children  Gives you window into their world  Provides clues as to what is needed for intervention, and if intervention is needed
  15. 15. Information  gained  from  asking    How  connected  child  is  to  other  children  in  the   class     How  popular  (salient)  the  peer  group  is    If  children  they  nominate  as  best  friends  nominate   them  back  (reciprocity)    How  many  children  they  nominate  as  friends      How  many  children  nominate  them  as  a  friend  
  16. 16. Charlotte (8) 4.5 Erick (6) Luke (5) Cori (7) 7.5 Adam (3) Len (7) Olive (9) 8 Alex (4)Ellen (7) 5.5 Leah (4) Stan (4) Nancy (2) Thomas (4) 2 Miguel (4) 5 Gerry (6) Maggie (3) Nora (1) Alejandro (4) Lonnie (2)Isolate: Nick (3), Noel (4)
  17. 17. Connection to Social Groups at School— few children with ASD are isolated!   First  to  Fifth  Graders  (n=60  ASD;   matched  TYP  Second, Third Graders (n=17 ASD; matched TYP)Chamberlain, Kasari, Rotheram-Fuller, 2007, JADD; Kasari et al, 2011, JADD; Rotheram- Fuller et al, 2010, JCPP
  18. 18. Friends and Reciprocity Reciprocity is limited ……Nearly all children can identify a 20 to 34% of children with friend and/or best friend ASD have a reciprocal friendship depending on studyOver 90% of children with ASD can identify a friend during 60% for typical children elementary ages, but this drops to less than 50% for adults
  19. 19. What  about  children  who  are  doing  well  (socially  connected)?    20%  of  children  had  a  reciprocal  friendship  (best  or  top  3)    These  same  children  had  higher  social  network  status    Were  they  also  more  engaged  on  the  playground?    NO…..playground  may  be  just  too  difficult  an  environment  
  20. 20. UCLA  study  on  peer  intervention  study  in  the  schools  
  21. 21. Modular,  individualized  approach    Child  Assisted     Peer  Mediated    Observed  child  on     3  peers  willing  from  the   playground,  obtained   class   teacher  reports,  peer     Had  peers  identify  some   networks,  self  reports   children  who  had  difficulty    Determine  top  3  problems   on  playground   for  child  engaging  with     Had  peers  generate  ideas   peers   to  help  engage  all  children    Worked  on  1  at  at  time   on  the  playground  
  22. 22. Summary  of  UCLA  Peer  Study   CHILD   PEER   •  PEER  Mediated   (1:1)   (3  peers)   Interventions  >  CHILD   Assisted  Interventions   NO  Treatment   CHILD+PEER   •  Primary  Outcome   •  Social  Network  Salience   (d=.79)   6 WEEK TREATMENT (12 SESSIONS) 12 WEEK FOLLOW UPKasari, Rotheram-Fuller, Locke, & Gulsrud, 2012, JCPP
  23. 23. Social Network Centrality Second Grade –T2 Second Grade - T1 I9 (7) 2.5 G7 (1) A1 (2) H8 (8) E5 (3)*** C3 (2) F6 (1) K11 (1) 6.5 8 D4 (6) B2 (3) 2 I9 (3) 3 J10 (8) 3 N14 (3) 6 L12 (3) N14 (6) O15 (5) G7 (3) Q17 (6)M13 (1) R18 (6) P16 (6) H8 (7) P16 (7) 6 6.5 5 M13 (2) R17 (5) 6.5 K11 (1) 7 J10 (7) S18 (6) F6 (2) 2.5 D4 (1) O15 (4) 1.5 L12 (4)Isolates: A1, C3, E5*** B2 (1) Second Grade -T3 E5 (3) G7 (6) R18 (5) A1 (3) H8 (3) Q17 (5) 7 8 7 P16 (1) I9 (9) C3 (4) 3.5 J10 (3) 1 F6 (1) D4 (2) K11 (5)Isolates: L12, M13, N14, S19 T20 (10) O15 (1)
  24. 24. Summary  of  UCLA  Peer  Study  CHILD   PEER   •  Other  Findings  favoring  Peer  (1:1)   (3  peers)   Mediated  Interventions:  NO  Treatment   CHILD+PEER   •  Number  of  Received   Friend  Nominations   (d=74)   •  Less  isolated  on   playground  (growth   6 WEEK TREATMENT curves  over  tx)   (12 SESSIONS) •  Improved  rating  of  social   12 WEEK FOLLOW UP skills  (by  Teachers)  (d=.44)  
  25. 25. Other  Findings    Effect  of  the  1:1  assistant     About  half  of  the  children  had  a  1:1  assistant    They  were  the  least  engaged  on  the  playground  (with  peers   or  with  the  aide)    Need  to  think  about  how  to  train  aides  better     Just  completed  para-­‐educator  intervention  on  the  playground     Can  change  adult  behavior  and  improve  child  engagement  
  26. 26. What  Needs  to  Happen  to  deploy  evidence  based  interventions  into  schools    Researchers  need  to  conduct  research  in  school  settings;   effectiveness  research  from  beginning  not  last  step    Distillation  and  matching  approaches  to  intervention     Isolating  active  ingredients  of  intervention     Matching  to  needs  of  child  in  context    New  approaches:    Researchers  and  school  staff  need  to  work   together….community  partnered  research  (balance  of   power)     NEW:    partnered  research  with  LAUSD  for  low  resourced  schools     Testing  playground  intervention     Functional  routines  in  special  education  classrooms  
  27. 27. Next  Steps/New  Studies    Determine  active  ingredients  of  intervention     Importance  of  building  adaptive  strategies  (a  potential  sequence  of   interventions  for  particular  children…new  ACE  network  project  as   example)    Deploying  interventions  into  the  community  that  can  be   sustained     Preschools     Teaching  teachers  to  engage  children  in  ways  to  increase  social  and   communication  skills     Elementary  schools     Playground  intervention     Functional  routines  in  special  education  classrooms  
  28. 28. Acknowledgements  Funding!    NIH,  HRSA,  Autism  Speaks,  Private  donors   Jason  Lee  Current   Caity  McCracken  Gail  Fox  Adams   Charlotte  Mucchetti  Kathleen  Berry   Chris  Osborn  Ya-­‐Chih  Chang,  PhD   Jonathan  Panganaban  Michelle  Dean   Stephanie  Patterson  Amy  Fuller   Wendy  Shih  Lizzy  Fuller   Shawna  Ueyama  Jordan  Gibson  Hilary  Gould   •  Community  Kelly  Stickles  Goods,  PhD   Sonia  Dickson-­‐Bracks,  MBUSD  Amanda  Gulsrud,  Phd   Carolyn  Gelfand,  LAUSD  Alison  Holbrook  Nancy  Huynh,  PhD  Eric  Ishijima,  PhD  Dahlia  Kabab  Mark  Kretzmann,  PhD  Kelley  Krueger