MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER

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MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER

• Deficits in social attachments and behavior
• Deficits in verbal and nonverbal
  communication
• Presence of perseverative, stereotyped,
  repetitive, behaviors

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Social Interaction Differences

• Kids with autism smile!
• Social interaction may be desired but difficult
• Poor reciprocity in social interaction
• Relationship with care providers may be most
  strongly developed
• Peer relationships difficult

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Autistic Types
Unknown
Aloof
Passive
Interactive but odd
Dr. Lorna Wing
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Communication Differences

• Delayed/Different Communication
• Speech without communication vs. communication
  without speech
• Echolalia
• Poor gesture use
• Instrumental hand leading
• Playlalia and lack of symbolic play

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Stereotyped Behavior

• Perseverative Interests or play
• Motor stereotopies in preschool and beyond
• Insistence on sameness/routine
• Need for prediction and control
• Preoccupation with parts of objects

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What is not addressed in the DSM-IV

• Sensory Processing
• Temperament
• Motor Planning
• Imitation
• Anxiety and Avoidance
• Adaptive Skills
• Impact of intellectual functioning

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OTHER FEATURES OF AUTISM

• Incidence is cited at rate of between 1 in 2500
  to 1 in 500 births.
• 41 boys to girls ratio
• Lifespan disorder
• No known etiology although known to be organic
  in nature.
• Commonly accompanied by mental retardation
• Heterogeneous disorder

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Treatment

• Although current push towards identifying
  biological bases of the disorder, no treatment
  implications are on the horizon.
• The form of treatment with the greatest
  empirical validation is treatment based upon a
  behavioral model.

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Behavioral Model
Treatment based on the systematic application of
the principles of learning Consitently
empirically demonstrated to be effective in
improving the behavior of children with autism
Developed via the methodology of applied
behavior analysis Initial demonstrations were
the first to show these children could learn in a
systematic manner
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Components of Discrete Trial Training

• Instruction gt Response gt Consequence
• Presenting Instructions and Questions
• Child attending
• Easily discriminable
• Short and consistent
• Child responds or fails to respond
• Consequences
• Types of consequences
• Manner of presenting consequences

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Results of Early Behavioral Intervention

• Initial demonstrations involved highly
  structured discrete trial format
• Proved to be very effective in establishing a
  wide range of behaviors in these children
• Provided basis for all behavioral treatments to
  follow
• Can lead to substantial improvement in many
  children with autism

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Problem Areas

• Generalization
• Stimulus
• Response
• Lack of spontaneity
• Robotic responding
• Prompt dependency
• Slow progress
• Time consuming
• Difficult to implement
• Children and treatment provider may not
  like

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Naturalistic Strategies

• Developed in response to needed improvements
• Arose from a number of different laboratories
• Called incidental teaching, pivotal
  response
• training, milieu treatment, etc.
• All share many of the same components

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Components of Pivotal Response Training

• Motivation
• Child Choice
• Reinforce Attempts
• Direct Reinforcement
• Intersperse Maintenance Tasks
• Frequent Task Variation
• Turn Taking
• Responsivity
• Tasks Involve Simultaneous Multiple Cues

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Results of Naturalistic Treatment Strategies
Greater generalization More positive
affect More positive home interactions Mor
e enjoyable for both children and treatment
provider
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Parental AffectSubject Means
Negative/Neutral Affect ? ? Positive Affect
Overall Rating
Subject
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Parent-Child Interaction Measures
Positive Neutral Negative
Individual Target Behavior
Pivotal Response Training
Interaction Scales
Parent Training Conditions
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Developing Individualized Treatments

• Important child variables
• Important parent and family variables
• Important cultural variables
• Important treatment/behavior interactions

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Factors that Influence Treatment Efficacy
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Child Characteristics
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PRT DATA SET
JODO
CHLI
NOFO
JOCO
ZATA
THBL
AIAC
ADMI
CHDE
ALKO
YOTK
DAGL
CANE
DABO
PACH
ROBE
STWI
JOTO
KYMA
KYBR
DYRE
JBBA
BESM
SASI
JECI
KASU
ROTO
JASA
ELTU
JOTA
BOBA
ANCR
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BEST RESPONDERS
JODO
CHLI
NOFO
JOCO
ZATA
THBL
AIAC
ADMI
ALKO
CHDE
YOTK
DAGL
CANE
DABO
PACH
ROBE
STWI
JOTO
KYMA
KYBR
DYRE
JBBA
BESM
JECI
SASI
KASU
ROTO
JASA
ELTU
JOTA
BOBA
ANCR
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NON RESPONDERS
JODO
CHLI
NOFO
JOCO
ZATA
THBL
AIAC
ADMI
CHDE
ALKO
YOTK
DAGL
CANE
DABO
PACH
ROBE
STWI
JOTO
KYMA
KYBR
DYRE
JBBA
BESM
SASI
JECI
KASU
ROTO
JASA
ELTU
JOTA
BOBA
ANCR
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Profile Behaviors

• Toy Play
• Approach Behavior
• Avoidance Behavior
• Verbal Self-Stimulatory Behavior
• Nonverbal Self-Stimulatory Behavior

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Best Responders Profile
Mean Percent Interval Occurrence
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Non Responders Profile
Mean Percent Interval Occurrence
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Language Data - Responders
Mean Percent Interval Occurrence
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Responders
Toy Play
Mean Percent Interval Occurrence
Social Skills
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Language Data Non-Responders
Mean Percent Interval Occurrence
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Non-Responders
Toy Play
Mean Percent Interval Occurrence
Social Skills
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What about other treatments?

• 6 children 5 boys, 1 girl
• Age range 24-47 mo.
• 6 children matching original nonresponder profile
  except for one area
• 3 matching profile EXCEPT had lower avoidance
• 3 matching profile EXCEPT had higher toy play

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Experimental Conditions

• Baseline
• Varying length of baseline
• Child had free access to a variety of toys
• Opportunities to respond once per minute
• No contingencies
• PRT
• 3 weeks
• Specific aims imitation of sounds/words eye
  contact, appropriate play
• DTT
• 3 weeks
• Specific aims imitation of sounds/words eye
  contact, imitation of actions (with objects)
  receptive commands

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Conclusions

• Change of either of two elements of the original
  (Sherer Schreibman, 2005) profile led to
  changes in PRT treatment outcome.
• Children responded at a level in between the
  original responders and nonresponders
• PRT profile was not predictive of treatment
  outcome with DTT suggesting specificity of PRT
  profile

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Family Characteristics
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Parental Stress

• Parents experience significant stress in areas
  related to child with autism
• Long-term care
• Limits on family opportunity
• Koegel, Schreibman, Loos, Dirlich-Wilhelm,
  Dunlap, Robbins Plienis (1992)

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Parental Stress Cont

• Different types of training have a differential
  effect on stress of parents
• Naturalistic strategies reduce stress more than
  highly structured techniques
• Parental stress is correlated with progress of
  child in family-oriented programs
• Parents under high degree of parent domain
  stress (PSI) may not benefit from parent training.

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Parent Support

• Parents enrolled in parent training programs
  report that social support would be likely to
  reduce stress.
• Gallagher, Beckman Cross, 1983
• Moes, Koegel, Schreibman Loos, 1993

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Parent Support/Information Group

• Purpose
• Does participation in a parent group reduce
  stress in parents of children recently diagnosed
  with Autistic Spectrum Disorders?
• Do parents enrolled in a parent group learn the
  training techniques better than parents not
  enrolled in a parent group?

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Individualizing Placement Type

• Which children will benefit most from early
  inclusion programming?

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Peer Social Avoidance Attempts
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Language Use
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Conclusions

• Autism is a complex disorder
• One treatment methodology, placement type or
  parent program will not be optimally effective
  for all children or families.
• Continued individualization of intervention
  necessary.