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Early Intervention for Toddlers with Autism Spectrum DisordersIs It a Special Case?<br />		Hannah Schertz, Ph.D.<br />
Autism Spectrum Disorders (ASD)<br />Social communication disorder with repetitive or stereotypical behavior and/or fixed ...
ASD in Toddlers<br />All<br />	Difficulty with preverbal social communication<br />Looking at others’ faces<br />Reciproca...
Causes<br />Genetic influence<br />Connected to vaccines?  <br />     Disproved in multiple studies<br />Brain differences...
Early Identification<br />Why is it important?<br />Improved outcomes with early intervention <br />Early support and educ...
Early Identification<br />How can early educators help? <br />Know red flags<br />Listen and respond to parents’ concerns<...
Red flags for toddlers <br />Not “showing” objects or following points<br />No ‘pretend play’ by 18 months<br />Avoiding l...
Communicating with Families<br />Responding to family suspicion of ASD<br />Take seriously:  Parents often raise first con...
Communicating with Families<br />If you have concerns before the family does:<br />Offer screening to all families<br />Av...
Screening<br />Modified Checklist for Autism in Toddlers (MCHAT; Robins, Fein, Barton, & Green, 2001):  Free parent questi...
Evidence-based Intervention<br />Approaches reported for toddlers with ASD<br />Traditional behavioral<br />Naturalistic b...
Evidence-based Intervention<br />Consider each approach for:<br />Intensity:  Implications for each<br />Effectiveness : T...
Traditional Behavioral<br />Lovaas: Traditional Applied Behavioral Analysis (ABA); Discrete Trial Training<br />Learning t...
Naturalistic Behavioral<br />Similar to traditional behavioral view that children learn by modifying behaviors in response...
Developmental<br />Child brings internal competency to learning<br />Adults follow child’s lead to promote spontaneity, in...
Early Intervention: Core Principles<br />Family-centered and strengths-based <br />Natural and inclusive environments<br /...
Intervention for Toddlers with ASD<br />Observing practices for toddlers with ASD:<br />How do current practices fit with ...
Principle 1:  Family-centered & Strengths-based<br />Family-centered<br />Incorporates family priorities<br />Supports par...
Principle 1:  Family-centered & Strengths-based <br />Which best promotes an active family role?  <br />Child participates...
Principle 2:  Natural & Inclusive Environments<br />Part C requirement<br />Groups mirror the general population in propor...
Principle 2:  Natural & Inclusive Environments<br />Which best promotes learning that is meaningful in the everyday world?...
Principle 3:  Developmentally Sound Intervention<br />Follow natural developmental sequences<br />Address preverbal social...
Principle 3:  Developmentally Sound Intervention<br />Which belief(s) about learning challenge the child just above curren...
Principle 4:  Active, Functional Child Engagement<br />Social communication is more than a collection of isolated skills<b...
Principle 4:  Active, Functional Child Engagement<br />Which promote(s) meaningful engagement?<br />Activities selected & ...
Principle 5:  Coordinated & Systematic<br />Team members provide systematic background support rather than side-by-side se...
Principle 5:  Coordinated & Systematic<br />Which are coordinated & systematic?<br />Specialists organize services around ...
Is toddler intervention in ASD a special case? <br />Yes<br />   Focus on preverbal social communication<br />No<br />Todd...
Online Resources<br />Association for Science in Autism Treatment http://www.asatonline.org/<br />Autism Society of Americ...
References	<br />Boyd, B. A., Odom, S. L., Humphrey, B. P., & Sam, A. M. (2010).  Infants and toddlers with autism spectru...
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  1. 1. Early Intervention for Toddlers with Autism Spectrum DisordersIs It a Special Case?<br /> Hannah Schertz, Ph.D.<br />
  2. 2. Autism Spectrum Disorders (ASD)<br />Social communication disorder with repetitive or stereotypical behavior and/or fixed interests<br />Wide-ranging in severity<br />4-5 times more prevalent in boys than girls<br />Prevalence in 8-year-olds is nearly 1:100 http://www.cdc.gov/ncbddd/autism/data.html#prevalence<br />Increase due to broader diagnostic criteria, awareness, improved screening and diagnosis<br />(Odom, Schertz, Wong, in press)<br />
  3. 3. ASD in Toddlers<br />All<br /> Difficulty with preverbal social communication<br />Looking at others’ faces<br />Reciprocal back-and-forth interaction with a partner<br />Sharing attention about mutual interests<br />Some <br />Fixed or repetitive interests and behaviors (may not appear until later)<br />Challenging behaviors related to communication difficulties and/or fixed interests<br />(Boyd, Odom, Humphreys, & Sam, 2010)<br />
  4. 4. Causes<br />Genetic influence<br />Connected to vaccines? <br /> Disproved in multiple studies<br />Brain differences: Effect or cause?<br />
  5. 5. Early Identification<br />Why is it important?<br />Improved outcomes with early intervention <br />Early support and education for parents<br />
  6. 6. Early Identification<br />How can early educators help? <br />Know red flags<br />Listen and respond to parents’ concerns<br />Provide prompt access to screening and diagnostic evaluation <br />Be vigilant<br />
  7. 7. Red flags for toddlers <br />Not “showing” objects or following points<br />No ‘pretend play’ by 18 months<br />Avoiding looks to others’ faces<br />Repeating actions over and over <br />Difficulty adjusting to new routines<br />http://firstsigns.org/<br />http://firstwords.fsu.edu/<br />http://www.ddhealthinfo.org/documents/ASDquickguide.pdf<br />
  8. 8. Communicating with Families<br />Responding to family suspicion of ASD<br />Take seriously: Parents often raise first concern; want prompt answers<br />Facilitate screening<br />Refer for diagnostic evaluation if screen shows high risk<br />Avoid suggesting ASD before diagnosis<br />
  9. 9. Communicating with Families<br />If you have concerns before the family does:<br />Offer screening to all families<br />Avoid using “autism” terminology <br />Avoid writing off reticence as “denial”<br />Keep in touch for support and follow-up <br />Proceed on parents’ terms –when ready.<br />Do not wait for diagnosis to address social communication needs <br />
  10. 10. Screening<br />Modified Checklist for Autism in Toddlers (MCHAT; Robins, Fein, Barton, & Green, 2001): Free parent questionnaire & instructions<br />http://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D..html<br />Who can administer? <br />Parent completed<br />Simple scoring procedures<br />Follow-up interview for greater reliability<br />
  11. 11. Evidence-based Intervention<br />Approaches reported for toddlers with ASD<br />Traditional behavioral<br />Naturalistic behavioral<br />Developmental<br />
  12. 12. Evidence-based Intervention<br />Consider each approach for:<br />Intensity: Implications for each<br />Effectiveness : The big picture, not just narrow skills (Buysse & Wesley, 2006)<br />Outcomes: Socially grounded, meaningful in everyday life, developmentally appropriate<br />Process : How it fits with principles of practice for toddlers and families’ values/priorities <br />
  13. 13. Traditional Behavioral<br />Lovaas: Traditional Applied Behavioral Analysis (ABA); Discrete Trial Training<br />Learning theory: Modify what comes before or after to elicit, change, eliminate behaviors <br />Adult directed (; prescribed learning tasks)<br />Intensive (35-40 h/w)<br />Prompting, reinforcement, fading, time-delay<br />Research counters unqualified effectiveness claims<br />In widespread use<br />
  14. 14. Naturalistic Behavioral<br />Similar to traditional behavioral view that children learn by modifying behaviors in response to environmental contingencies<br />Considers child interests & motives (more child centered); natural reinforcers<br />Gaining ground over traditional ABA<br />Examples: Pivotal response treatment (emphasizes behaviors important for broader learning); incidental teaching<br />
  15. 15. Developmental<br />Child brings internal competency to learning<br />Adults follow child’s lead to promote spontaneity, initiative, & self-directed learning <br />Promotes internal motivation, natural consequences<br />Emphasizes social relationships, affect sharing<br />Examples: Developmental Social Pragmatic, Joint Attention Mediated Learning (JAML), Early Start Denver Model (hybrid)<br />
  16. 16. Early Intervention: Core Principles<br />Family-centered and strengths-based <br />Natural and inclusive environments<br />Developmentally sound<br />Active and functional child engagement<br />Coordinated and systematic<br />Schertz, H. H. (in press)<br />
  17. 17. Intervention for Toddlers with ASD<br />Observing practices for toddlers with ASD:<br />How do current practices fit with each principle?<br />How can we reconcile differences or make changes when there is not a fit? <br />
  18. 18. Principle 1: Family-centered & Strengths-based<br />Family-centered<br />Incorporates family priorities<br />Supports parent-child relationship rather than replacing it with professional-child interaction<br />Strengths-based<br />Views families as capable <br />Enables (rather than trains) families to promote toddler social development<br />
  19. 19. Principle 1: Family-centered & Strengths-based <br />Which best promotes an active family role? <br />Child participates in prescribed, highly structured intervention <br />Train parents in specific behavioral strategies <br />Support families to use their knowledge of the child to embed learning throughout everyday activities<br />
  20. 20. Principle 2: Natural & Inclusive Environments<br />Part C requirement<br />Groups mirror the general population in proportion of children with disabilities<br />Benefits <br />It is where most learning occurs<br />Facilitates natural family role<br />Embeds learning in natural everyday activities with familiar people<br />Naturally facilitates generalization of learning <br />
  21. 21. Principle 2: Natural & Inclusive Environments<br />Which best promotes learning that is meaningful in the everyday world? <br />Clinic-based or segregated settings<br />Professionally implemented in natural settings with expectation that learning will carry over<br />Natural settings with learning embedded into natural activities with familiar people<br />
  22. 22. Principle 3: Developmentally Sound Intervention<br />Follow natural developmental sequences<br />Address preverbal social communication first<br />Build on natural precursors <br />Motivate, prevent behavior challenges with:<br />Developmentally appropriate activities<br />Activities that match development & interests<br />Respect for child’s tolerance level<br />
  23. 23. Principle 3: Developmentally Sound Intervention<br />Which belief(s) about learning challenge the child just above current skill levels?<br />Learning occurs by modifying behaviors<br />Learning occurs by modifying behaviors with consideration for child interests<br />Learning builds on current competencies; considers foundational competencies that can take child to a new level<br />
  24. 24. Principle 4: Active, Functional Child Engagement<br />Social communication is more than a collection of isolated skills<br />Follow child’s lead rather than prescribing highly structured activities & materials<br />Encourage child initiative, not just responding<br />Avoid dependency on external rewards<br />Promoting foundational competencies helps children learn on their own <br />
  25. 25. Principle 4: Active, Functional Child Engagement<br />Which promote(s) meaningful engagement?<br />Activities selected & directed by adults with structured protocols; child engagement is maintained through reinforcers<br />Activities incorporate child interests, create opportunities for natural reinforcers<br />Activities follow child’s lead; goals promote meaningful social engagement in everyday interactions; passive responding is less valued<br />
  26. 26. Principle 5: Coordinated & Systematic<br />Team members provide systematic background support rather than side-by-side services<br />Guidelines for developmental approaches: <br />Intervene in the “zone of proximal development”<br />Embed learning within meaningful social contexts <br />“Scaffold” learning <br />Mediate learning (planfully) rather than “train”<br />Guidelines for behavioral approaches: <br />Promote pivotal (foundational) learning<br />Use tested strategies; follow child interests<br />Avoid focus on narrow skills with limited relevance to everyday life or to meaningful future goals<br />Support generalization by working in natural environments<br />
  27. 27. Principle 5: Coordinated & Systematic<br />Which are coordinated & systematic?<br />Specialists organize services around areas of delay; team defers decisions to specialists; may be intrusive, inefficient, and at cross purposes<br />Team members (including parents) share expertise, encouraging others to consider their goals. <br />Team members systematically support each other’s learning, fading support as expertise is gained<br />Outcomes and intervention processes are planned and delivered systematically considering evidence of effectiveness and developmental research<br />
  28. 28. Is toddler intervention in ASD a special case? <br />Yes<br /> Focus on preverbal social communication<br />No<br />Toddlers with ASD are children first<br />Principles of good early intervention apply<br />
  29. 29. Online Resources<br />Association for Science in Autism Treatment http://www.asatonline.org/<br />Autism Society of America http://www.autism-society.org/site/PageServer<br />Autism Speaks. http://www.autismspeaks.org/<br />Centers for Disease Control: Autism Spectrum Disorders (ASDs) http://www.cdc.gov/ncbddd/autism/index.html<br />Indiana Resource Center for Autism (IRCA). http://www.iidc.indiana.edu/irca/<br />National Early Childhood Technical Assistance Center (NECTAC): Autism spectrum disorders. http://www.nectac.org/topics/autism/autism.asp<br />National Research Council (2001). Educating children with autism.http://www.nap.edu/openbook.php?isbn=0309072697<br />
  30. 30. References <br />Boyd, B. A., Odom, S. L., Humphrey, B. P., & Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention, Journal of Early Intervention, 32(2), 75-98.<br />Buysse, V., & Wesley, P. W. (Eds.; 2006). Evidence-based practice in the early childhood field. Washington, D.C.: Zero to Three.<br />Odom, S. L., Schertz, H. H., & Wong, C. (in press). Autism spectrum disorders in young children. In H. H. Schertz, C. Wong, & S. L. Odom (Eds.). Young Exceptional Children Monograph 12: Supporting Young Children with Autism and Their Families. Missoula, MT: Division for Early Childhood.<br />Robins, D. L., Fein, D., Barton, M.L., Green, J.A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31, 131-144.<br />Schertz, H. H. (in press). Principles of intervention for young children: Implications for toddlers and preschoolers with autism spectrum disorders. In H. H. Schertz, C. Wong, & S. L. Odom (Eds.). Young Exceptional Children Monograph 12: Supporting Young Children with Autism and Their Families. Missoula, MT: Division for Early Childhood.<br />

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