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Autism and the Necessary Components for Effective Treatment

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Title: Autism and the Necessary Components for Effective Treatment


1
Autism and the Necessary Components for Effective
Treatment
  • Sharon A. Reeve, Ph.D., BCBA
  • John L. Brown, M.A., BCBA
  • Caldwell College

2
Diagnostic Criteria for 299.00 Autistic Disorder
  • A. A total of six (or more) from (1), (2), and
    (3), with at least two from (1) and one each from
    (2) and (3)
  • Qualitative Impairment in social interaction
  • Qualitative impairment in communication
  • Restricted repetitive stereotyped patterns of
    behavior, interests, activities
  • Adapted from Diagnostic Statistical Manual,
    TR., APA, 2000

3
Autism and Pervasive Developmental Disorders
  • A type of Pervasive Developmental Disorder (PDD)
  • A child with autism is affected along multiple
    dimensions
  • Unlike certain other single dimension problems
  • learning disability, communication disorder,
    emotional and behavioral disorders

4
The Characteristics of Children with Autism
  • learning deficits
  • Affects every aspect of childs education
  • language disabilities
  • Articulation, expressive, receptive, spontaneous,
    conversation, non-contextual vocalizations
  • behavioral disorders
  • Stereotypic behavior motor, visual, tactile,
  • compulsive behaviors
  • rigidity of routine, intolerant of change

5
The Characteristics of Children with Autism
  • attentional deficits
  • Lack of eye contact, availability of learning,
    unaware of danger
  • emotional disabilities
  • Non-contextual emotions, lack of self-concept
  • social disabilities
  • Eye contact, gestures, facial expression,
    greetings, awareness of other children,
    friendships,
  • play skills deficits
  • Imaginative, pre-occupations with
    objects/activities, general content knowledge

6
The Characteristics of Children with Autism
  • sleep disturbances
  • Going to sleep late, getting up early, getting up
    during the night
  • toileting deficiencies
  • Lack of awareness of accidents
  • eating disabilities
  • Texture, appearance, gustatory

7
Effective Treatment Intervention for Children
with Autism
  • Applied behavior analysis was specifically
    designed and researched for children with autism
  • (Lovass, 1960 Fenske, Zalenski, Krantz,
    McClannahan, 1985 Lovaas, 1987 Harris,
    Handleman, Gordon, Kristoff, Fuentes, 1991
    McEachin, Smith, Lovaas, 1993).
  • Treats the entire child
  • Every aspect/dimension of the disorder

8
Applied Behavior Analysis
  • Applied behavior analysis is
  • A science
  • Teaching procedure are derived from learning
    principles
  • Teaching procedures are systematically applied
  • Teaching procedure geared to improve socially
    significant behavior
  • Requires experimental demonstration that the
    teaching procedures employed were responsible
    for the improvement in behavior
  • requires accountability

9
Necessary Components of Effective Intervention
for Children with Autism
  • Individualized Teaching Procedures
  • Individualized Curriculum
  • Individualized Data Collection Assessing Progress
    of each Skill
  • On-going Hands-on Staff Training
  • Parent Training

10
Team Membership
  • Consultant
  • doctoral level of academic expertise and
    experience in both applied behavior analysis and
    all aspects of autism
  • Helps teacher develop individualized educational
    programs for each child
  • Helps teacher develop data management system to
    evaluate effectiveness of each childs program
  • Provides direction for the development of
    individualized curriculum
  • Trains teacher in effective individualized
    teaching procedures
  • Provides frequent hands-on training to each team
    member for each child

11
Team Membership
  • Teacher
  • Training in applied behavior analysis and autism
  • Writes 30-40 individualized programs for each
    child
  • Manages all data collection systems to ensure
    program effectiveness for each child
  • Creates individualized curriculum to accompany
    each program for each child
  • Provides hands-on training to instructional aides
    and the implementation of individualized programs
    for each child
  • Provides hands-on training to parents and any
    person that frequently interacts with the child
  • Teaches each child

12
Team Membership
  • Instructional Aides
  • Training in applied behavior analysis and autism
  • Continually receives hands-on training
  • Prepares individualized curriculum for child with
    teachers guidance
  • Teaches each child
  • Parents
  • Training in applied behavior analysis
    specifically in how to effectively keep their own
    child engaged in productive activity

13
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • Use principles of applied behavior analysis for
    intervention
  • It is recommended that principles of applied
    behavior analysis (ABA) and behavior intervention
    strategies be included as an important element of
    any intervention program for young children with
    autism.

14
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • Frequency, intensity, and duration of
    intervention
  • It is recommended that intensive behavioral
    programs include as a minimum approximately 20
    hours per week of individualized behavioral
    intervention using applied behavioral analysis
    techniques (not including time spent by parents).

15
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • Frequency, intensity, and duration of
    intervention
  • It is recommended that the precise number of
    hours of behavioral intervention vary depending
    on a variety of child and family characteristics.
    Considerations in determining the frequency and
    intensity of intervention include age, severity
    of autistic symptoms, rate of progress, other
    health considerations, tolerance of the child for
    the intervention, and family participation

16
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • In deciding upon the frequency and intensity of a
    behavioral intervention, it is important to
    recognize that
  • In the studies reviewed, effective interventions
    based on ABA techniques used between 18 and 40
    hours per week of intensive behavioral
    intervention by a therapist trained in this
    method.

17
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • In deciding upon the frequency and intensity of a
    behavioral intervention, it is important to
    recognize that
  • It is recommended that the number of hours of
    intensive behavioral intervention be periodically
    reviewed and revised. Monitoring the child's
    progress may lead to a conclusion that hours need
    to be increased or decreased.
  • It is important to consider revising the
    intervention plan when the child shows either
    significant improvement or a lack of improvement.

18
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • Supervision of Therapists
  • It is recommended that all professional and
    paraprofessionals who function as therapists in
    an intensive behavioral intervention program
    receive regular supervision from a qualified
    professional with specific expertise in applied
    behavioral approaches.

19
NYS Department of Health Early Intervention
Guidelines Intensive Behavioral and Educational
Intervention Programs
  • Parent involvement and training
  • It is recommended that parents be trained in
    behavioral techniques and encouraged to provide
    additional hours of instruction to the child.
    Parent training is important to help the family
    incorporate these techniques into the daily
    routines of the child and family and to ensure
    consistency in the intervention approach.
  • It is recommended that training of parents in
    behavioral methods for interacting with their
    child be extensive and ongoing and include
    regular consultation with a qualified
    professional.

20
Applied Behavior Analysis(Behavior Management
Intensive Behavioral Intervention)
  • Intensive, behavioral intervention early in life
    can increase the ability of the child with autism
    to acquire language and ability to learn.
  • Thirty years of research demonstrated the
    efficacy of applied behavioral methods in
    reducing inappropriate behavior and in increasing
    communication, learning, and appropriate social
    behavior. A well-designed study of a psychosocial
    intervention was carried out by Lovaas and
    colleagues (Lovaas, 1987 McEachin et al., 1993).
    Up to this point, a number of other research
    groups have provided at least a partial
    replication of the Lovaas model (see Rogers,
    1998).
  • U.S. Surgeon General David Satcher, M.D., Ph.D.

21
Applied Behavior Analysis
  • All programs educating children with autism
    should include intensive behavioral interventions
    and year-round education.
  • The US Dept. of Education and the
  • National Research Council's Report
  • 'Educating Children with Autism
  • Since intensive behavioral programs appear to be
    effective in young children with autism, it is
    recommended that principles of applied behavior
    analysis and behavioral intervention strategies
    be included as an important element of any
    intervention program.
  • NYS Department of Health Early Intervention
  • Clinical Practice Guidelines

22
Estimated Savings Per ChildFrom 3-22 Years
  • An analysis was conducted by Jacobson, Mulick,
    and Green (1998) using information from the state
    of Pennsylvania available to us at the end of
    1996.
  • In any group of children receiving EIBI, between
    20 and 50 will achieve normal functioning and
    require no specialized services after entering
    elementary school. About 10 will make small
    gains and require intensive special education and
    adult services (minimal effect group). The
    remainder will make moderate gains and need
    nonintensive special education and adult services
    (partial effect group).
  • Without EIBI, most people with autism need
    lifelong special services.

23
Estimated Savings Per Child3-22 Years
  • The average annual cost of EIBI is estimated at
    33,000 per child. The average duration is
    estimated to be three years.
  • Children who realize partial or minimal effects
    will use family support services to age 22, i.e.
    for 18 years.
  • Average savings to the educational system per
    child from age 3 to 22 range from 298,651 to
    274,709 depending upon the proportion of
    children - 20, 30, 40 or 50 - who achieve normal
    functioning levels.
  • Jacobson, J.W., Mulick, J.A., Green, G (1998)
    Behavioral Interventions, 13, 201-226
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