Evidence based practices(what are they)


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Evidence based practices(what are they)

  1. 1. What are they, and what does that mean? By Keith Hersh M.S. BCBA
  2. 2. •Word of Mouth•Books•Journal Articles•Peer Reviewed Journal Articles
  3. 3. •No Research•Case Study•Citing  Other’s  Research•Group Design•Single Subject Design
  4. 4. •Prediction•Control•Research must include changing somethingand measuring the outcome.•Best measurement is repeatedmeasurement over time•Less reliable research uses pre and post testsurveys.
  5. 5. •There  is  no  “best”  type  of  research.•Different tools for different jobs.•As a parent, what can I do to figure out if Iam looking at good or bad research?
  6. 6. •Is it peer reviewed?•Did it measure behavior or use surveys?•How many subjects?•Is there replication?•Have external agencies reviewed theliterature?•The National Research Council, TheSurgeon General, The American Academy ofPediatrics, The National Autism Center, TheNPDCASD
  7. 7. •11 Established Treatments – thoroughlyresearched and have sufficient evidence forus to confidently state that they are effective.•22 Emerging Treatments – some evidence ofeffectiveness, but not enough for us to beconfident that they are truly effective.•Unestablished – No evidence at this time.•Ineffective/Harmful – Research shows thetreatment is not effective, and may even beharmful.
  8. 8. •Antecedent Package•Behavioral Package•Comprehensive Behavioral Treatment forYoung Children•Joint Attention•Modeling•Naturalistic Teaching Strategies•Peer Training Packing
  9. 9. •Pivotal Response Training•Schedules•Self-Management•Story-Based Interventions
  10. 10. •Effective With:•Communication skills•Social skills•Play Skills•Problem Behaviors•Sensory and emotional regulation
  11. 11. •Example:•Data are taken that show when Bob gets asmall lunch at 12:00 p.m., he is much morelikely to hit people during his work skillsprogram at 3:00 p.m.•Norman will ruminate (bring up partiallydigested food) if he drinks liquids during hismeal. Norman does not ruminate if hedrinks 30-40 minutes after a meal.
  12. 12. •Effective With:•Academic Skills•Communication Skills•Personal Responsibility•Problem Behavior•Self-Stimulatory Behavior
  13. 13. •Examples•In the last example, Bob was moreaggressive when he was hungry. In abehavioral package, staff teach Bob to say“I’m  Hungry”  to  get  a  snack  and  “Break”  to  take a break, instead of aggression.•John has problems with finishing his workin school. His behavioral package says, ifyou finish your work, you go to recess, if youdon’t  finish  your  work,  you  stay  back  until  the work is finished.
  14. 14. •Effective With:•Children 0-9 with Autism•Settings that can have high teacher tostudent ratio•Experts in ABA strategies•Communication Skills•Motor Skills•Problem Behaviors•General Symptoms Associated with ASD
  15. 15. •Example:•John attends an ABA center for 30 hours perweek•The program is run by a Board CertifiedBehavior Analyst•John has 2 other therapists that workdirectly with him at the center•John’s  parents  attend  bi-weekly teammeetings, and implement the behavior planat home•Focuses on deficits and excesses
  16. 16. •Works With:•Ages 0-5 with Autism•Children  who  don’t  share  attention  with  another focused on an object or activity.•Increasing eye gaze at same object•Increasing pointing to same object•Increasing talking about a same object
  17. 17. •Example:•Teaching student to look at the same objectand interact with it or talk about it. Studentis not allowed to go play alone or next toanother student without sharing an item.Many times starts with sharing an object,taking turns, then both having an object,and imitating each other, or doing the sameactivity. (parachute, throwing a ball,commenting)
  18. 18. •Works With:•Ages 3-18 with Autism•Communication Skills•Higher Cognitive Skills•Play Skills•Problem Behaviors•Multiple Step Tasks
  19. 19. •Examples:•An 16 year old student is taught to wash hisclothes. The therapist shows a video ofdoing the laundry. The therapist shows eachsegment of the video, before the student cancomplete that step. Feedback is given eachtime the student performs a step.•A student is learning to leave the computerwhen the timer goes off. Two other peers areat the computer table. When the timer goesoff, the other two peers go back to their seat.
  20. 20. •Works With:•Shown Effective for ages 0-9 with Autism•Communication Skills•Interpersonal Skills•Play Skills•Usually requires learning in structuredsetting first then more natural setting.
  21. 21. •Examples:•Every day before snack and lunch allstudents in the classroom must wash theirhands. A task analysis is designed tomonitor progress and independence everytime hands are washed. The student seesother students wash their hands before, andhears other students being praised for thesteps. Prompting is slowly faded for the lastsuccessful step in the chain.
  22. 22. •Examples:•Dee enjoys playing with princesses. As partof her program, she is learning to labelcolors. After she can identify colors on cardsat the table, the teacher then gets 5princesses with different color gowns. Thestudent requests each the colors of thegowns, and gets to play with the princess forcorrectly identifying that color.
  23. 23. •Works With:•Ages 3-14 with Autism•Communication Skills•Play Skills•Sharing•Social Interactions•Asking for help
  24. 24. •Examples:•Nathan is in a Physical Education class withtypical peers. He seems to enjoy praise andinteraction with his peers, but oftenstruggles to participate in games such assoccer or basketball. Peers are taught toprompt (physically and verbally) and toreinforce (verbal and tangible) participationin the games.•Notes: Keep ages/skill levels similar.Contingencies for peers. Siblings are great!
  25. 25. •Works With:•Ages 3-9 with Autism•Communication Skills•Interpersonal Skills•Play Skills
  26. 26. •Examples: Note that PRT is very similar toABA. It can be very difficult to determineexactly what constitutes PRT.•Teaching by varying materials to avoidboredom, using natural reinforcers andmaking sure they are available for attemptsto communicate, teaching in the naturalenvironment.•PRT heavily focuses on using existingmotivation and naturally occurringsituations to teach and reinforce behavior.
  27. 27. •Works With:•EVERYONE!!!!!•Transitions (sometimes)•Predicting what comes next•Independent living
  28. 28. •Examples:•A picture of each classroom activity isplaced on a Velcro board. Each time anevent is completed, the picture symbol isremoved  and  placed  in  a  “finished”  box  or  side of the board.•A day planner is used to document alloutings or variances from the normalschedule. (Lucas and his daily schedule).
  29. 29. •Works With:•Ages 3-18 with Autism•Academic skills•Interpersonal skills•Self-regulation•Teaching awareness of learners behavior•Recording your own data
  30. 30. •Examples:•Student is first taught rules from a list.Student  is  taught  to  label  when  other’s  follow the rules in video and role play.Student is asked to evaluate their ownbehavior.•Travis  and  the  “Changing  my  behavior  plan”
  31. 31. •AKA Social Stories•Works With:•Ages 6-14 with Autism•Favorable  with  Asperger’s  and  students  with  more developed language skills•Choice and play skills•Self-regulation (predicting consequences)•Social behavior•Understanding emotions
  32. 32. •Examples:•Not just a story!•Must be specific about actual behaviors•Identifies social consequences for behavior•A learner is staring at girls in the classroomexcessively and classmates are reportingbeing uncomfortable. A story outlines onlylooking at someone briefly and lookingaway. The story focuses on socialconsequences for staring.
  33. 33. •A student does not engage in choice makingor engaging with materials. The teacherdesigns stories about how to use materialsand combines the story with modeling andreinforcement.•An adolescent takes 8 pills a day. The familydesigns a story about when to take pills, andsets a wrist watch to have 3 alarms to remindthe student. Social stories with pictures ofthe watch and pill containers are used toteach the student to take pills independently.
  34. 34. •There are many interventions that havebeen shown to be effective to changebehavior of individuals with autism.•These interventions are based on principlesof behavior.•Professional BCBA expertise•Data collection is mandatory•Family input is crucial to success
  35. 35. •The  National  Autism  Center,  “Evidence-Based  practice  and  Autism  in  the  Schools.”    2009.•Wait  there’s  more!!!!!•The National Professional DevelopmentCenter on Autism Spectrum Disorders,“Evidence  Based  Practices.”    •“ABA  Resources”  at  www.i-aba.com