ED 553: Assessing Effective Treatments for Children with Autism

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ED 553 Assessing Effective Treatments for
Children with Autism

• Presentation 1BCBA
• Pervasive Developmental Disorders
• Science

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Behavior Analyst Certification Board (BACB)

• Board Certified Behavior Analyst (BCBA) or
  eligible
• Masters degree
• course work in behavior analysis
• supervised experience in behavior analysis
• www.bacb.com
• Supervised training by a doctoral level
  professional specifically in teaching children
  with autism

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What is a Pervasive Developmental Disorder (PDD)?

• Pervasive developmental disorders are
  characterized by severe and pervasive impairment
  in several areas of development
• Reciprocal social interaction skills
• Communication skills
• Presence of stereotyped behavior, interests, and
  activities

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What is a Pervasive Developmental Disorder (PDD)?

• These disorders are usually evident in the first
  years of life and are often associated with some
  degree of mental retardation.
• These disorders may be observed with a diverse
  group of other general medical conditions (e.g.,
  chromosomal abnormalities, congenital infections,
  structural abnormalities of the central nervous
  system).

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Specific Pervasive Developmental Disorders

• Autistic Disorder (299.00)
• Retts Disorder (299.80)
• Childhood Disintegrative Disorder (299.10)
• Aspergers Disorder (299.80)
• Pervasive Developmental Disorder Not Otherwise
  Specified (299.80)

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How Common are Pervasive Developmental Disorders?

• Autism 4.5 per 10,000 live births
• All Spectrum Disorders May be as high as 1 per
  150-300 (CDC)
• http//www.asatonline.org/resources/library/autism
  _rise.html
• 31 Male-to-Female Ratio
• Increase in perceived prevalence may be due to
• Increases in requests for service
• Changes in diagnostic criteria
• An actual increase in prevalence

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Possible Etiologies

• Brain and Nervous System
• defects that occur during initial brain
  development
• abnormalities in the brain structures that make
  up the limbic system. Inside the limbic system,
  an area emotional behavior. One study of
  high-functioning children with autism found that
  the amygdala was indeed impaired but that another
  area of the brain, the hippocampus, was not.
• In a study of younger children, researchers
  observed low levels of activity in the parietal
  areas and the corpus callosum.
• high levels of the neurotransmitter serotonin
  have been found in a number of people with
  autism.

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Possible Etiologies

• Each of these differences has been seen in some
  but not all the people with autism who were
  tested.
• What could this mean?
• Perhaps the term autism actually covers several
  different disorders, each caused by a different
  problem in the brain.
• Or perhaps the various brain differences are
  themselves caused by a single underlying disorder
  that scientists have not yet identified.
• Discovering the physical basis of autism should
  someday allow us to better identify, treat, and
  possibly prevent it.
• http//www.asatonline.org/resources/library/causes
  _autism.html

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Possible Etiologies

• Genetic
• Prenatal/Perinatal complications
• Maternal Rubella 10 risk of Autism
• Environmental
• Psychogenic
• refrigerator mother
• Immunizations
• http//www.immunize.org/mmrautism/index.htm

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Current Research Areas

• Intervention technologies to improve
  characteristics
• Etiology
• Nervous system changes associated with autism

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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)
• (1) Qualitative impairment in social interaction
• (2) Qualitative impairment in communication
• (3) Restricted repetitive and stereotyped
  patterns of behavior, interests and activities

Adapted from Diagnostic and Statistical Manual,
4th Ed., APA, 1994
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I. Qualitative Impairment in Social Interaction

• Marked impairment in the use of non-verbal
  behaviors such as eye contact, facial expression
  or gestures to regulate social interaction
• Failure to develop appropriate peer relationships
• Lack of spontaneous seeking to share enjoyment or
  interests
• Lack of social/emotional reciprocity
  

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II. Qualitative Impairments in Communication

• Delay in, or total lack of, the development of
  spoken language
• In individuals with adequate speech, marked
  impairment in the ability to initiate or sustain
  conversation
• Stereotypic and repetitive use of language
• Lack of varied, spontaneous pretend or social play

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Restrictive Repetitive and Stereotyped Patterns
of Behavior or Interests

• Preoccupation with one or more stereotyped and
  restricted pattern of interest that is either
  abnormal in intensity or focus
• Inflexible adherence to non-functional routines
• Stereotyped and repetitive motor mannerisms
• Persistent preoccupation with parts of objects

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Autistic Disorder (299.00)

• B. Delays or abnormal functioning in at least
  one of the following areas social interaction,
  social communication, or symbolic or imaginative
  play, with onset prior to the age of three.
• C. The disturbance is not better accounted for
  by Retts Disorder or Childhood Disintegrative
  Disorder.

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Diagnostic Criteria for 299.80 Pervasive
Developmental Disorder Not Otherwise Specified
(PDD-NOS)

• This category should be used when there is severe
  and pervasive impairment in the development of
  reciprocal social interaction or verbal and
  nonverbal communication skills or when
  stereotyped behaviors are present but the
  criteria are not met for a specific PDD

Adapted from Diagnostic and Statistical Manual,
4th Ed., APA, 1994
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Learning Characteristics of Children with Autism

• Stimulus overselectivity
• Difficulty responding to natural contingencies
• Difficulty generalizing skills
• May rely on rote memory
• May memorize information rather than comprehend
  it
• May demonstrate proficient performance on tasks
  demanding visual spatial judgment and pattern
  recognition
• Splinter skills

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Learning Characteristics of Children with Autism

• Difficulty in all dimensions of language
  including expressive/receptive language and
• Phonology - Rules determining how sounds can be
  sequenced
• Morphology - Rules for meaning of sounds (e.g.,
  un, pro, con)
• Syntax - Rules for a languages grammar
• Semantics - Rules for meaning of words
• Pragmatics - Rules for communication
• especially difficult for a child with autism

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Why does Autism Need Such a Specialized Treatment?

• Because its is 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)

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Why does Autism Need Such a Specialized Treatment?

• 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

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Why does Autism Need Such a Specialized Treatment?

• Attention deficits
• Lack of eye contact, availability of learning,
  unaware of danger
• Emotional impairments
• Non-contextual emotions, lack of self-concept
• Social impairments
• Eye contact, gestures, facial expression,
  greetings, awareness of other children,
  friendships,
• Play skills deficits
• Imaginative, pre-occupations with
  objects/activities, general content knowledge

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Why does Autism Need Such a Specialized Treatment?

• Sleep disturbances
• Going to sleep late, getting up early, getting up
  during the night
• Toileting impairments
• Lack of awareness of accidents
• Eating disabilities
• Texture, appearance, gustatory

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How do we help?It All Begins with Knowledge!

• Knowledge lets us know how things work
• That information is only useful if it is accurate
• My brothers cousins landscapers uncle told me
  that this plant derivative cures acne!
• Unfortunately lots of knowledge sources can have
  inaccuracies and biases
• So how do we know which knowledge is accurate?

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Ah Ha! Science!

• Science is nothing more than a certain way to
  gather knowledge
• strives to minimize bias and maximize accuracy
• Uses objective, systematic, and direct
  observation of phenomena being studied
• Likely to be most accurate source of knowledge
  for how things work in the world

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What Does Science Look At?

• Test tubes and lab coats?
• Specifically, how does the environment we live in
  affect what we do, think and feel?
• Various things affect me and what I do affects
  others
• Im a teacher and Im most interested in knowing
  how what Im doing is affecting a childs
  learning
• Specifically, what is going to be the most
  effective educational strategy for each
  particular child?

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How Can We Use Science to Study What How a
Child Learns?

• We have a scientific branch of psychology that
  has been developing for SEVENTY years
• Its called.
• Applied Behavior Analysis

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What is Applied Behavior Analysis? (Cooper,
Heron, Heward, 1987)

• Applied behavior analysis is the science in which
• procedures derived from the principles of
  learning
• are systematically applied to improve socially
  significant behavior
• and to demonstrate experimentally that the
  procedures employed were responsible for the
  improvement in behavior
• Why?

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Scientifically Validated Treatment Applied
Behavior Analysis (ABA)(a/k/a Behavior
Management Intensive Behavioral Intervention
IBI)

• The use of non-validated treatment approaches
  for children with autism may be ineffective and
  possibly harmful to your child and may take time
  away from treatments that have shown to be
  effective. (Green, 1996 New York State
  Department of Health, 1999)
• 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.
• U.S. Surgeon General, David Satcher, M.D., Ph.D.