Outcome Data from a Variety of Early Intervention Programs for Children with Autism

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Outcome Data from a Variety of Early Intervention
Programs for Children with Autism

• Paul Coyne - Coyne Associates, San Diego
• Nicholas Weatherly Richard Malott - Western
  Michigan Unv.
  
• Carmen May Jonaitis - Croyden Ave. School,
  Kalamazoo, Michigan.
  
• John Youngbauer - North Los Angeles Regional
  Center.

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Outcome Data From an In-Home Early Intervention
Program Serving Children with Autism Younger than
3 Years Old

• Paul Coyne, Katherine Calarco,
• Len Levin, M. Alice Coyne
• Coyne Associates
• Data Analysis by Justin Prost Ph.D.
• Lumir Research Institute

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Coyne Associates

• In-home program started in 1999 funded by San
  Diego Regional Center 2002 RC Orange County
  2006 Inland Regional Center -San Bernardino
  Riverside Counties.
• Todays presentation covers outcome data from a
  sample of children located within San Diego
  Orange County.
  
• pdcoyne_at_mac.com

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Purpose of Early Intervention Programs

• Children who are at risk of developmental delays
  be placed on a normative developmental trajectory
  and thus continue to show optimal development
  after early intervention ends.
• Ramey Ramey 1998

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Literature ReviewIntensive ABA Early
Intervention Programs 25-40 hours per week
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From Gina Green Applied Behavior Analysis in the
Treatment of Autism 2007
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Better Treatment Outcomes

• Treatment was intensive 20-30 hours week.
• Ample use of incidental teaching outside of
  sessions.
  
• Delivered 11
• Treatment was comprehensive.
• Used DTT and NET
• Supervisors teachers had advanced training in
  ABA.
  
• Training Program followed normal developmental
  sequences.
  
• Parent Participation.
• Home and Community.
• Two or more years.

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Literature ReviewLow Intensity ABA Early
Intervention Programs Less than 20 hours per
week.
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Controlled Studies of Low-intensity ABA
From Gina Green, 2007.
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Low vs High Intensity Professional ABA Programs

• Low Intensity
• Gains in IQ (7-8.2), language, and social skills
  but smaller gains than intensive ABA. - 13.6 in
  the normal range.
  
• Larger gains than controls and eclectic services.

• High Intensity
• Large gains in IQ (16-29.7), language, social
  skills and other areas. 47 -normal range
  
• Parent managed programs had mixed results.

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More information is needed

• Intensity of intervention outcome.
• Duration of intervention outcome.
• Type of early intervention outcome.
• Type of children outcome.
• Onset of intervention outcome.

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Our Questions

• Can a 12 hour a week (54 hours a month) produce
  improvement in young children with autism?,
  compared to a control group?, to results
  published elsewhere?
• If so, where are those improvements seen?
• What about children who receive more or less than
  a 54 hour a month program?
  
• Do the children continue to improve the longer
  they are in the program? Are the effects
  cumulative over time?
  

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Description of the Early Intervention Program

• .

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Assessment

• Bayley Scales of Infant Development II
• Brigance Inventory of Early Development
• Verbal Behavior Assessment Form Level 1 Sunberg.
  
  
• Probe skill areas to determine placement.

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Brigance Inventory of Early Development II

• Preambulatory Motor Skills Behaviors
• Gross Motor Skills and Behaviors
• Fine Motor Skills and Behaviors
• Self Help Skills
• Speech Language
• General Knowledge Comprehension
• Social and Emotional Development
• Academic Readiness

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Curriculum

• Teaching Individuals with Developmental Delays
  Lovaas 2003
  
• Behavioral Intervention for Young Children with
  Autism Maurice et. al., 1996
  
• A Work in Progress Leaf McEachin 1999
• Give Your Child a Superior Mind Engelmann 1966
• PECS Training Manual Frost Bondy 2002
• Language for Learning Engelmann (2000)

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Curriculum

• Assessment of Basic Learning Abilities (ABLA)
  Martin, Yu, 2000
  
• Eye Contact (Levin 2006)
• Level 1. Imitation
• Level 2. Position Discrimination
• Level 3. Visual Discrimination
• Level 4. Visual Match to Sample
• PECS Verbal Operants Mands
• Level 5. Auditory Discrimination
• Auditory Match to Sample
• Vocal Verbal Operants Echoics
• Level 6. Auditory / Visual Discrimination
• Vocal Verbal Operants Echoics, Mands, Tacts,
  Intraverbals.

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Teaching Techniques

• Eye Contact Procedure (Levin 2006)
• Discrete Trial Teaching
• Errorless Teaching (Touchette Howard 1984)
• Time Delay Procedure (Heckaman et. al. 1998)
• Error Correction Procedure (Rodgers Iwata
  1991)
  
• Natural Environment Teaching
• Pivotal Response Teaching (Koegel Koegel 2006)
• Incidental Teaching (Obrien et. al. 1979)
• Mand Training (Sunberg Partington 1998)
• Independent Activity Schedules (McClannahan
  Krantz 1999)
  

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Staff Training

• 60 hours of initial hands on in-service
  training with a 90 day review then reviews every
  6 months.
  
• Mastery criterion for advancement. Pass a test.
• Minimum of 2 hours of Supervision each week (2
  hours for every 10 hours of instruction).
  
• 10 additional in-service trainings per year.

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Methods

• Investigate the effectiveness of an In-Home early
  intervention program for children with autism
  younger than 3 years old using the following
  outcome measures
• Bayley MDI
• Brigance Receptive Language Composite,
  Expressive Language Composite, Self-Help Skills
  Composite, Social Skills Composite, and General
  Communication Composite.
• Regression analyses were conducted in order to
  identify the relationships between the outcomes
  measures and participation in the program.

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Participants

• For the analyses presented there were two
  samples
  
• 42 children that completed pre- and post-test MDI
  measures and participated in the intervention
  program. 18 children that completed an MDI
  measure, but did not participate in the program
  (control). Total N60.
• 186 children that competed pre- and post-test
  Brigance measures and participated in the
  program. 20 children that completed the Brigance
  measure, but did not participate in the program
  (control). Total N206.
• The samples were taken from children
  participating in the early childhood intervention
  for approximately 54 hours per month during the
  years 2000 to 2006.

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Variables Included in Analyses

• Participation Duration The amount of time in
  months a child participated in the intervention
  program.
  
• Average Adjusted Gross Income The average AGI
  for each participant was identified using the
  zipcode of each participant and census records.
  
• Bayley Mental Development Index

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Variables Included in Analyses

• Brigance Outcomes There were five composite
  scores computed from the instrument.
  
• Expressive Language Expressive Colors,
  Expressive Body Parts, and Expressive Vocabulary
  
• Receptive Language Receptive Colors, Receptive
  Body Parts, and Receptive Vocabulary
  
• Self-Help Skills Undressing, Dressing,
  Feeding/Eating, Toileting, Bathing, and Grooming
  
• Social Skills General Social, Play Skills
• General Communication Gestures, Vocalization,
  General Speech, Sentence Length, Personal Data
  Response, and Verbal Directions

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Bayley Sample DemographicsMeans (SDs)
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Brigance Sample DemographicsMeans (SDs)
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Hierarchical Regression Analyses

• Hierarchical regression analyses were conducted
  to determine the relationship between
  participation in the intervention program and the
  outcomes of interest.
• The regressions involved two steps of entry
• For the Bayley In the first step the pre-test
  scores were entered, and for the Bayley analyses
  average income was also entered. For the
  Brigance Age at post-test was entered.
• In the second step Participation Duration was
  entered.
  
• This method provided a means of identifying the
  unique contribution of Duration in the Program.
  

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Results of the Bayley

• The results of the regression analyses with the
  Bayley MDI outcome showed
  
• Average income was not related to changes in MDI
  scores.
  
• Program Duration was significantly related to the
  changes in MDI scores.
  
• The R2 change for the step in which Program
  Duration was introduced was .271. indicating
  program duration explained 27 of the variance in
  MDI scores, controlling for pre-test and average
  income.
• The unstandardized regression coefficient was
  2.1, indicating an increase of approximately 2
  points on the MDI for each month spent in the
  program.

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Results of the Bayley MDI Regression
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Results of the Brigance

• The results of the regression analyses with the
  Brigance outcomes showed the significant
  relationships with program duration

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Results of the Brigance Regressions
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Effects of Fewer Hours per Month

• Additional analyses were conducted to determine
  the impact of less time per month in the program.
  
  
• A regression with children receiving less than
  the modal number of hours was conducted and then
  compared to results from the full or larger
  sample.
• For the Bayley the samples compared were the 54
  hours per month participants and the less than 54
  hours per month. The smaller sample size of the
  Bayley, prompted using only the 54 hour per month
  children in the initial analyses. Although the
  comparison group is small (N8), it merits some
  consideration in support of the Brigance findings.

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Effects of Fewer Hours per Month

• Additional analyses were conducted to determine
  the impact of less time per month in the program.
  
  
• A regression with children receiving less than
  the modal number of hours was conducted and then
  compared to results from the full or larger
  sample.
• For the Brigance the samples compared were the
  full sample of children participating in the
  program and the sub-sample of children receiving
  less than 54 hours per month (the most common
  participation level in the program).

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Effects of Fewer Hours per Month

• Results indicated that
• For the Bayley, the slope was still significant
  for the participants with less than 54 hours per
  month, but did not represent nearly as much
  improvement as those in the program for 54 hours
  per month.
• For the Brigance, the sample size was 32 for the
  participants with less than 54 hours, only Social
  Skills had a marginally significant relationship
  to Program Duration (p.062).
• The smaller sample also had higher intercepts
  than the full sample, indicating that those
  children brought in for less time per month might
  have lower levels of impairment.

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Effects of Fewer Hours per Month

• Results indicated that
• For the Brigance, the unstandardized regression
  coefficient for 3 out of the 4 areas was larger
  for the sample with more hours per month in the
  program.

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Regression Slope Comparison for BMI
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Regression Slope Comparison for Brigance
Self-Help Skills
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Regression Slope Comparison for Brigance Social
Skills
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Regression Slope Comparison for Brigance
Communication Skills
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Regression Slope Comparison for Brigance
Receptive Language Skills
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Interpretation of the Results

• The results provide evidence for developmental
  improvements in multiple areas for children
  spending approximately 12 hours/week in the
  intervention program.
• Improvements were seen in scores on the Bayley
  and in composite scores calculated for four areas
  on the Brigance.
  
• Results indicate discriminant validity, as seen
  in the lack of improvements seen in expressive
  language skills, which the Brigance was designed
  to identify in children older than 3-years-old.
• Greater improvements are seen the longer children
  spent in the program before testing at
  3-years-old.
  
• Improvements were found to be greater for
  children spending more time per month in the
  program, although the children spending less time
  did tend to show less impairment in general.

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Conclusions

• Intervention programs for children can be
  effective at 12 hours/week.
  
• The developmental impact of the program in the
  current study can be seen in multiple areas and
  was found using two separate measurement
  instruments.
• Early intervention is important, particularly
  with programs in which children spend less time
  per week, as greater improvements were found the
  longer a child had spent in the program.