Current Best Practices For Students With Autism Spectrum ...


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  • An allele is one member of a pair or series of different forms of a gene. Usually alleles are coding sequences,
  • Leadership Education in Neurodevelopmental and Related Disabilities…provide long-term, graduate level interdisciplinary training as well as interdisciplinary services and care. The purpose of the LEND training program is to improve the health of infants, children, and adolescents with disabilities.
  • The CDC has been tracking the prevalence of autism since 1998 when they looked at the Brick Township area of NJ and found that 6.7 per 1,000 3-10 year old children had a diagnosis of ASD. In 2000, another study came out of a multi-site network looking at 6 states and focused only on 8 year olds. This study showed 6.7 per 1,000 children had ASD. In 2002, there was an updated report published with an expansion of states represented (14) that indicated 6.6 per 1,000 children at 8 years of age were diagnosed with ASD. These numbers, although consistent in the last several years demonstrate a marked increased from previous decades. It is to be determined whether this is due to better diagnosis and awareness or whether it truly represents a significant increase in the number of children that have ASD. In addition, we have seen a declining trend in the diagnosis of mental retardation. We can speculate that this inverse relationship does suggest better evaluation tools used by trained professionals have impacted the diagnosis a child receives.
  • So why is this information important? Think about your students who don’t give eye contact, or may not respond appropriately to teacher instruction.
  • The researchers are looking at defining types of sleep issues that children with autism present
    Sally Ozonoff from UC Davis is studying autism in infancy and trying to develop a set of behavioral criteria that can predict which infants will later be diagnosed with autism. Studies indicate that a 5-10% risk of having a second child diagnosed with autism spectrum disorder and a risk of up to 35% for a third child.
    Sally Rogers, also at UC Davis indicates that longitudinal studies of autism from toddlerhood to middle childhood are only now being carried out. Her study will try to determine to what extent later symptoms and symptom severity can be predicted at the time of first diagnosis, and which early features seem most predictive of later outcomes.
    Sally Rogers explains that no studies have thus far been published that involved prospective information on infants in the first 6 months of life who later develop autism. The purpose of her pilot study in this area is to examine social and motoric behavior of neonatal siblings of children with autism compared to siblings of typically developing children up to 12 months
    Marjorie Solomon at UC Davis has the goal of using behavioral measures and functional MRI to test hypotheses about gender differences in the manifestation of social and cognitive deficits and symptoms of psychopathology in a high functioning sample of girls with ASDs.
    The behavioral intervention literature suggests that learning is dysregulated in individuals with ASD since skill acquisition may depend on multiple discrete learning trials with very specific reinforcement schedules. While some rewards are not motivating enough, others may be too motivating or attractive to children with ASD. We see this in the case of a child who finds spinning wheels on a car more reinforcing than the task the teacher is wanting him to work on. This can become disruptive and interfere with learning. Marjorie Solomon is investigating the non-social aspects of reward processing in children with ASDs using behavioral and neuro-imaging measures.
  • These terms are sometimes used in advertisements, brochures, and websites to sell a particular method. The products of these methods or approaches may claim to be supported by research and evidence gathering but may not be at all. Practices must pass rigorous and objectively measured standards. The biggest issue in judging the merits of a particular method is whether there is objectively verifiable supporting evidence that is appropriate for the issue, circumstances and conditions that are under investigation. Autism is a spectrum disorder there are many levels to of academic learning styles to address. One method used for a class of several kids with autism will not be appropriate. Therefore, An appraisal of the extent the outcomes match the individual needs of the student is essential.
  • For example, if a teacher or school adopts a particular method then decide to drop that method for another “flavor of the month” it could have damaging effects. Some methods are very intensive and focused on using long term. For example, discrete trial training involves much time and energy. All parties need to be organized, trained, committed for this type of approach. Cost may be a factor for particular methods as well.
  • Students may develop habits that are unintential but may be brought on by a method. (explain DTT) For example, in discrete trial training, a child may develop a need for prompts. The teacher may not have initiated the fading technique. The ultimate goal of any practice in the classroom is to achieve the highest success for the student. Data should be taken, different personnel in the classroom need to know their roles during class time, etc.
  • It starts from the superintendent on down. Create plan for choosing an approach(es), identify the roles/responsibilities of each district person
  • Current Best Practices For Students With Autism Spectrum ...

    1. 1. Current Best Practices For Students With Autism Spectrum Disorders Dr. Karen A. Berkman Mindy Stevens
    2. 2. Today’s Presentation Agenda • Review current research in the field of ASD • Provide an overview of best practices in education for students diagnosed with ASD • Discuss implementation fidelity and review administrator observation tool for classrooms
    3. 3. Where We’ve Been and Where We’re Going “Autism research has been primarily focused on discovery for the past decade, but now the field is turning a corner such that movement toward development, refinement, translation, and delivery will be possible.” (Clara Lajonchere, Autismspeaks, 2008)
    4. 4. Current Theories Genetic – Genetics contributes to ~60-90% – No single gene has been found with increased risk of 10-20 fold – Current thinking: common alleles, possibly in uncommon combinations – Environment: Recent evidence to suggest a gene x environment interaction
    5. 5. Current Trends in Autism Bulk of the current research is on basic causes and psychological processes – Genetics – Neurobiology and Physiology – Developmental course – Etiology – Theory of Mind – Language and Communication – Perception and Cognition » Matson, JL. & LoVullo, SV.(2008)
    6. 6. Treatment Research • Autism Speaks-funded research – GI – Sleep – Quality of Life • Combating Autism Initiative – Diet and Nutrition – Parent-Based Sleep Education Program – Hormonal Factors in Adolescents – Novel Screening Methods (EEG) • Partnerships: – LEND Network (Education and Training) – American Academy of Pediatrics (Education and Dissemination)
    7. 7. CDC Autism Activities • Focus is on prevalence studies for 8 year children across 14 states • Updated statistics forthcoming from 2004- 2006 • Studies on relationship between MMR immunizations and autism
    8. 8. Collaborative Programs of Excellence in Autism (CPEA) Conducts research in the following areas: – Causes of autism – Early detection – Behavioral and communication characteristics – Treatment
    9. 9. CPEA Network Project Autism Spectrum Disorder in the Second Year: Stability and Change in Syndrome Expression – Results indicate stability of clinical diagnosis and syndrome expression in the second year – Highlights advantages and limitations of the ADI-R and ADOS-G for diagnosing and documenting symptoms of ASD in infants (Chawarska, Klin, Volkmar, in press)
    10. 10. Studies to Advance Autism Research and Treatment (STAART) Network • 8 centers funded by 5 NIH Institutes • Focus of STAART Network is; – Causes – Diagnosis – Early Detection – Prevention – Treatment
    11. 11. STAART Network Project Abnormal functional connectivity in autism spectrum disorders during face processing – A significant relationship between abnormal functional connectivity and clinical severity in the ASD group was observed – Results suggest that abnormal neural connection within the limbic system may contribute to the social impairments observed in ASD (Kleinhans, Richards, Sterling, Stegbauer, Mahurin, Johnson, Greenson, Dawson, Aylward, in press)
    12. 12. Other Studies of Interest • Autism and Sleep Disorders • Autism in Infancy • Definition and development of the phenotype in autism • Neonatal social responses of infant siblings • Girls with autism spectrum disorders • Non-social rewards and autism
    13. 13. Other Studies of Interest CeFAR (University of Pittsburgh) findings to date: – Difficulty tracking faces extends to objects, although more subtle – The cause may, in part be due to general difficulties grouping parts to make a whole – The difficulty extends to all facial expressions, but mostly those which are expressed in the eye region of the face – This may be related to difficulty zooming out to focus on the bigger picture instead of one small detail – Brain activation is more than normal to common objects and less activated when looking at faces
    14. 14. Other Studies of Interest Kennedy Krieger Studies underway are: – Early diagnosis and intervention (R. Landa) – Brain activity and motor tasks (S. Mostofsky) – Metabolic disorders and ASD (E. Tierney)
    15. 15. What Determines Best Practice?
    16. 16. Key Questions • What are the anticipated outcomes from using a particular practice and do the outcomes match the student’s needs? • “evidence-based” “research-based” terms used loosely to sell products • Pass rigorous and objectively measured standards • Appraisal of the extent of the outcomes match needs of students
    17. 17. Key Questions Are there potential risks associated with implementing a practice? – Dropping an existing method – Time/cost constraints
    18. 18. Key Questions What are the most effective ways of evaluating a particular method or approach? – Evaluate negative outcomes and undesired side effects – Evaluation responsibilities
    19. 19. Educational Best Practices
    20. 20. Best Practices • DTT (Discrete Trial Training) • TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) • Incidental Teaching • Pivotal Response Training • Verbal Behavior Training
    21. 21. Discrete Trial Training • Breaking a task down into its smallest units • Teaching a unit with a distinct beginning and end, separated by a brief interval • One teaching unit is called a “trial” • Trials can be “massed” or “distributed” • Reinforcing each correct response
    22. 22. Advantages of DTT • Can assure massive numbers of opportunities/trials • Teacher controlled • Little thought involved • Easy to assess the data
    23. 23. Disadvantages of DTT • Prompt dependency • Cost • Generalization • Need to reprogram for spontaneous skill use • Requires specific programming time blocks • Doesn’t build fluency (% correct)
    24. 24. TEACCH • Person-centered support of individuals of all ages and skill levels. • Employs approach known as “Structured Teaching” – Work systems – Independence – Predictability – Visual Cues
    25. 25. Advantages of TEACCH • Independence • Predictability • Routine • Structure • Consistency
    26. 26. Disadvantages of TEACCH • Social interaction and verbal communication are not emphasized • Does not promote interaction with typical peers
    27. 27. Incidental Teaching • Developed by Hart and Risley, and adapted for autism by McGee, Charlop, McClanahan • Child-initiated, activity based instruction • Appropriate for use with inclusive groups • Natural activity-based contexts • Promotes generalization and spontaneous skill use • Reinforcer built into the episode • Targets speech, play, social and academic skills
    28. 28. Advantages Of Incidental Teaching • Can be done anywhere, any time, by anyone • Does not require massive training • Inherent generalization built-in • Consistent with developmentally appropriate teaching and inclusion • Workable in a developmental classroom setting • Short episodes • Natural, activity-based • Spill-over to play skills • Less protest/escape/aversive control • Encourages spontaneous skill use
    29. 29. Disadvantages of Incidental Teaching • Depends on engagement • Cannot control number of trials/data analysis issues • Teacher must remain hyper vigilant or created opportunities • Must create opportunities
    30. 30. Pivotal Response Training • Pivotal Responses central to wide area of function and will produce change across a number of behaviors – Ex: motivation, self-initiation • Involves discrete trial format • Uses natural reinforcement • Intersperse mastery and teaching trials • Use child selected materials • Actively teaches child-initiated responses
    31. 31. Advantages of PRT • Child initiates • Natural reinforcers • Increased motivation • Deters inappropriate behavior
    32. 32. Disadvantages of PRT • Labor intensive • Staff must be adequately trained in the method
    33. 33. Verbal Behavior Training • Language as a behavior • Find out what the child wants then teaching them how to request it • Child led • ABLLS (Assessment of Basic Language and Learning Skills)
    34. 34. Advantages of Verbal Behavior Training • ABLLS allows for tracking of a child’s progress • Useful verbal operators • May be used at school and in the home
    35. 35. Disadvantages of Verbal Behavior Training • Cost may be high to the school districts • Labor intensive • Requires small staff to pupil ratios
    36. 36. Characteristics of Effective Programs* • Early implementation • Systematic teaching • Functional skills (core deficits) • Specified curriculum, evaluation methods • Supportive environments and routines • Family involvement • Inclusion opportunities • Inensity • Staff and program development • *Caveat emptor: programs=designed for preschoolers
    37. 37. Administrators’ Role in Choosing and Evaluating Best Practices • A team approach • Make a commitment to the method • Provide district training(s) on the method • Consider using the “Observation Instrument for Autism Classrooms” and tying it with a teacher’s Professional Development Plan (PDP) or any other type of evaluation • Create a process for conducting yearly reviews and evaluations of the methods in designated time frame
    38. 38. Observation Instrument for Autism Classrooms • Brief overview • Instruction and Interaction • Classroom staff responsibilities
    39. 39. References • Evidence-Based Practices and Student’s With Autism Spectrum Disorders. Simpson, Richard. Focus on Autism and Other Developmental Disabilities; Fall 2005; Proquest Education Journal • NCLB, 2002 • Dawson & Osterling, 1997; Izeman & Strain, 1995; Harris and Handelman, 1992 • CARD, University of Central Florida • Frequently Asked Questions Regarding Verbal Behavior by Mary Barbera, RN, MSN, BCBA • Mesibov, G.B., Shea, V., & Schopler, E. (with Adams, L., Burgess, S., Chapman, S.M., Merkler, E., Mosconi, M., Tanner, C. & Van Bourgondien, M.E.). (2005). The TEACCH approach to autism spectrum disorders. New York: Kluwer Academic/Plenum.
    40. 40. References • HOW TO TEACH PIVOTAL BEHAVIORS TO CHILDREN WITH AUTISM: A TRAINING MANUAL, Robert L Koegel • AutismWeb • Autism Research Institute, Stephen Edelson, Ph.D.
    41. 41. CARD Center for Autism and Related Disabilities