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Autistic Spectrum Disorders: Linking Assessment

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Title: Autistic Spectrum Disorders: Linking Assessment


1
Autistic Spectrum Disorders Linking Assessment
Educational Planning California Association of
School Psychologists Los Angeles, CA March 10,
2007
  • Bryna Siegel, Ph.D.
  • Adj. Professor Director, Autism Clinic
  • University of Calif., San Francisco
  • San Francisco, Calif. 94143-0984
  • bryna.siegel_at_ucsf.edu

2
Defining the Issues
  • What Does Autistic Spectrum Imply?
  • Seeing the Spectrum as a Collection of
    Autism-Specific Learning Weaknesses and Relative
    Strengths
  • What is a Developmental-Behavioral Approach?
  • Teaching/ Treating Developmentally
  • And…Teaching/Treating Behaviorally
  • And…Getting the Child to Want to Learn

3
Autistic Spectrum Disorders are a SyndromeLike
a Cold
  • Its Multi-Factorial (Its Poly-Genetic)
  • If Everybodys Autism is Different Everybodys
    Treatment Needs to be Different

4
Syndromes Autism and the Common Cold
  • The Autistic Spectrum
  • Social Isolation
  • Low Interest in Peers
  • Echolalic Speech
  • Non-conversational
  • Perseveration
  • Poor Toy Play
  • Odd Motor Movements
  • The Common Cold
  • Runny Nose
  • Stuffed Sinuses
  • Hacking Cough
  • Sneezing
  • Sore Throat
  • Feverish
  • Headache

5
What Does This Mean For Epidemiology? (When is a
sneeze a cold?) The Latest from the CDC
  • 2007
  • 6.71,000 1160
  • 1 Language concerns, 2 Social
  • Earlier Studies
  • 1101 to 1222 (2000)
  • 1303 to 194 (2002)
  • 51-88 w/ signs lt 3 years old
  • 50 _at_ 4½-5½ years old

6
Lets Just Treat Whats Wrong
  • Importance (or Not) of Diagnosis
  • Identifying Learning Processes
  • Identification of What Needs to be Learned
  • Figuring Out How to Teach so the Child becomes an
    Independent Learner

7
Whats Inside the World of the Autistic Spectrum
Child?
  • Imagine the world of a blind child by closing
    your eyes.
  • Imagine the world of a deaf child by putting
    hands tightly over your ears.
  • How do you imagine autism?

8
The Child with ASD Perceives Differently
  • Sensory Threshold Modulation Problems
  • Audition
  • Covers Ears Appears Deaf
  • Tactile
  • Clothes Sensitivities Diminished Pain
    Response
  • Visual
  • Gaze Avoidance Visual Scrutiny
  • Olfactory
  • Pica Gags at Smells

9
The Child with ASD Processes Differently
  • Sensory threshold differences lead to
    misrepresentation of inputs
  • Processing speed delays lead to loss of
    information
  • What you get what you can think (perceive
    plus process)
  • Swiss cheese understanding

10
The Child with ASD Stores Differently
  • Constructive memory borrows from more fully
    represented data sources
  • Retention is probably better where comprehension
    is better

11
The Challenges
  • How do alterations in the way a child with autism
    perceives, processes, stores, and retrieves
    information create an altered world view?
  • How can these alterations be regarded as a
    cluster of autistic learning disabilities
    (ALDs) so specific symptoms point to specific
    treatments?

12
How Do We Start to Recognize ASDs?
  • Early Screening with the PDDST-II
  • Specific Qualities of an Early Childhood Screener
  • Screening vs Diagnosis
  • Diagnostic Best Practices

13
PDDST-II Pervasive
Developmental Disorders Screening Test-II
(Siegel, 2004, Psych Corp/ Harcourt)
  • Three Stages of Screening
  • Primary Care Screener
  • (PDDST-II/PCS)
  • Developmental Clinic Screener
  • (PDDST-II/ DCS)
  • Autism Clinic Severity Screener
  • (PDDST-II/ACSS)

14
Who Can Use the PDDST-II?
  • Stage I- PCS
  • Primary care providers such as pediatricians and
    family practitioner
  • What Question Does It Answer?
  • Should this child be referred from my primary
    care practice to a developmental specialist?
    Should I mention concerns about autism?

15
Who Can Use the PDDST-II?
  • Stage II-DCS
  • Any clinician or teacher involved in special
    education or DDS intake/ any trans-disciplinary
    team member/ SLPs/ OTs
  • What Question Does It Answer?
  • We know this child has some sort of
    developmental problem. Should we include
    autism-specific measures in our work-up?

16
Who Can Use the PDDST-II?
  • Stage III-ACSS
  • Specialty clinic where information is sought
    regarding likely longer-term severity
  • What Question Does It Answer?
  • The parents have been told the child has an ASD.
    They want to know how bad it is going to be.
    Can I give a data-based guess-timate?

17
Administering the PDDST-II
  • The PDDST-II detects concerns around 15 m. of age
  • Each question is Yes, Usually True or No,
    Usually Not True.
  • If score ? cut score Use Glossary, as needed to
    validate responses.
  • If validated, refer for further assessment.

18
Scoring the PDDST-II
  • Allow parent to self-administer (5-10 minutes).
  • Teacher can independent fill in own version.
  • Teacher may also want to administer Supplemental
    Items (Pgs. 40-41) from Manual for further
    description.
  • Score items by reviewing Glossary (if needed) and
    tallying total/ Refer a positive case for
    further assessment.

19
Components of the PDDST-II Kit
  • Separate scoring forms for Stage I, Stage II,
    Stage III
  • PDDST-II Manual
  • Explains psychometrics
  • Supplemental Items add to description ( Se,
    but Spif added to screening algorithms,
    would Sp)
  • Provides Glossary with Qualities, Thresholds, and
    Probes for each item at each stage.
  • Supplemental Items for more full clinical
    description

20
How the PDDST-II Glossary Works
  • Qualities
  • What does this behavior look like compared to
    what is expected
  • Threshold
  • Is this behavior so marked as to be
    qualitatively or quantitatively abnormal?
  • Probe
  • Specific questions the clinician can ask to
    elicited targeted information about item.

21
The PDDST-II Comparison to Other Screeners
  • CHAT
  • Norms Identifies autismand other severe DD
    needs interview follow-up.
  • CARS
  • Norms Children gt 5, most screening lt 5
    score w/ MR and NV.
  • GARS
  • Norms Self-diagnosed sample, low specificity,
    over-includes other DD.

22
Working to Develop Evidence-Based Practice
23
How Do You Judge A Treatments Efficacy?
  • Tiers of Evidence

24
Making Treatment Decisions The Difficult Issues
  • Determining the Validity of Treatment Approaches
    from the Studies Backing It
  • Weighing Qualitatively Different Kinds of
    Evidence
  • Weighing Evidence from Different Theoretical
    Perspectives

25
Making Autism Treatment Decisions Tiers of
Evidence
  • BEST
  • EMPIRICAL STUDIES OF GROUPS
  • Matched groups
  • Representative samples
  • Sufficient sample sizes
  • Pre- and post-testing
  • Longitudinal outcome data
  • Assessment of responder characteristics

26
Making Autism Treatment Decisions Tiers of
Evidence
  • NEXT BEST
  • THEORY on the Brain, Behavior, Social Policy
  • Child Development Theory and Research
  • On Typical Development
  • On Learning Disabilities Mental Retardation
  • Behavioral Theory and Research
  • Social Policy Guided Treatment Decisions

27
Making Autism Treatment Decisions Tiers of
Evidence
  • NEXT BEST
  • CLINICAL EXPERIENCE
  • Autism-Specific Expertise
  • Experience with More than One Method
  • Developmental Disability Expertise
  • Special Education Expertise
  • Child Development Expertise

28
Issues in Recognizing Quality
29
National Research Council Effective
Interventions for Autism I
  • Program Design
  • Intensity Hours/ Week? Interactions?
    Correct Responses?
  • An Early Start (ideally before 30 months)
  • Direct Instruction/ Highly Structured
  • Teacher-Therapist Training/ Supervision
  • Parent Training/ Involvement

30
National Research Council Effective
Interventions for Autism II
  • Curriculum Content
  • Developmental Appropriateness
  • Opportunities for Functional Use
  • Language Emphasis

31
Smell Tests Treatment Validity, Fidelity
Consistency
  • Face Validity
  • Does this treatment make sense?
  • Fidelity
  • True to the model that had good results?
  • Consistency of Implementation
  • Is this treatment what it once was?

32
The Big Dilemma in Designing Autism Treatment
  • If no two children have the same exact needs, how
    can they benefit from the exact same treatment?
  • If each child gets a different treatment how do
    we learn whats best?

33
Understanding Responder Characteristics
  • What is A Responder Characteristic?
  • Specific Autistic Learning Disabilities
  • Developmental Level
  • Language Level
  • Maladaptive Behaviors

34
Upon What Do We Base Practice?
  • We need to treat, even if we dont have all the
    empirical studies.
  • We need to have Best Practice guidelines based
    on evidence, theory, and experience.
  • We need to know if what we do helps as much as we
    hope it does.

35
The ALD/ALS Approach A New Heuristic
  • ALD Autistic Learning Disabilities
  • ALS Autistic Learning Styles
  • The Concepts of ASDs and ALSs can be used to
    classify autistic alterations in Perception,
    Cognition, Information-Processing, Motivation and
    Expression

36
Mapping DSM Criteria for Autism onto Autistic
Learning Disability Profile
  • Social
  • Autistic Learning Disabilities
  • Communicative
  • Autistic Learning Disabilities
  • Non-Social
  • Autistic Learning Disabilities
  • Qualitative Impairments in Social Interaction
  • Qualitative Impairments in Communication
  • Restricted, Repetitive Stereotyped Patterns of
    Behavior, Interests, or Activities

37
How Social Deficits Affect Learning
  • Lack of socio-emotional reciprocity
  • Lack of desire to please others
  • Low response to social reinforcers
  • Lacks concern re effect on others
  • Lack of awareness of others
  • Motive to please self is foremost
  • Instrumental learning style
  • Lack of social imitation
  • Low incidental learning via copying others
  • No drive to follow group norms

38
How Non-Verbal Communication Deficits Affect
Learning
  • Low comprehension of facial cues such as
  • Smiles of Encouragement
  • Gaze toward topic of conversation
  • Ignores gestures that should be the first
    language such as
  • Warnings or Displeasure
  • Tone of voice to mark meaning

39
How Verbal Communication Deficits Affect Learning
  • Receptive language
  • Signalnoise problem for verbal signal
  • -H Noisy social-linguistic field
  • -H Limitations to pure memory buffer
  • Language processing with poor parsing
  • Expressive language
  • Without theory of mind, no drive to share
    ideas
  • Oral-motor apraxia synergistic w/ low expressive
    drive

40
How Play and Exploration Deficits Affect
Learning
  • Lack of imagination in play
  • No consolidation of experience via play linking
    action and language
  • No symbolic actions to link to language to
    abstract thinking
  • Stereotyped and repetitive interests
  • Averse to novelty/ low curiosity
  • Limited learning through exploration
  • Repetitive interests mental down time

41
What Is the Developmental-Behavioral Approach?
  • APPLYING THE ALD/ ALS MODEL
  • Determine ALD/ALS Profile (ALD-I)
  • Establish curriculum content based on
    developmental level/ what comes next.
  • Uses behavioral methodology to teach
    developmentally-based curriculum.
  • Enhancing motivation by differentially rewarding
    self-initiative in learning

42
Step I Develop An ALD-Specific Treatment Plan
  • 1) Whats the child missing (ALDs)?
  • 2) What compensatory strategies (ALSs) can
    provide needed inputs and information?
  • 3) How do you match ALDs and ALSs to available
    treatments?

43
The Autism Learning Disabilities Inventory
(ALD-I, Siegel, 2003)
  • MECHANICS
  • Questionnaire
  • 3 Point Frequency Scale
  • Parent or Teacher Completed
  • 7 Scales
  • Social Scales
  • Awareness
  • Reciprocity
  • Imitation
  • Communication Scales
  • Receptive Para-linguistics
  • Expressive Paralinguistics
  • Receptive Oral Language
  • Spoken Oral Language
  • World of Objects
  • Sensory Processing
  • Repetitions/ Novelty Response
  • Play

44
ALD-I Social ALDS Awareness and Social Motive
  • Acts as if in own little world.
  • Foremost motivation is usually to please self.
  • More readily learns things that result in meeting
    own needs.
  • Fails to notice certain things that others this
    age usually notice.

45
ALD-I Social ALDS Imitation and Affiliative Drive
  • Apparent lack of concern about the effect of his
    behavior on others.
  • Uninterested in trying to do new things just to
    earn approval of others.
  • Does not seem to be motivated to copy actions or
    attitudes of others.
  • Does not readily learn by being shown by others
    must figure it out on own.
  • Low level of interest in peers

46
ALD-I Communication ALDs Receptive Gesture Body
Language
  • Doesnt look to where something is pointed out.
  • Doesnt look back after seeing something to see
    if youve seen it, too.
  • Stops an action when receiving a stern look.
  • Knows that a nod of the head yes means that
    what s/hes doing is OK.

47
ALD-I Communication ALDs Expressive Gesture
Body Language
  • Doesnt points with index finger at things he
    wants.
  • …or that are interesting, but not wanted.
  • Doesnt smiles when someone smiles at him.
  • Doesnt looks happy if others act happy.
  • Cant clearly read guilt on childs face.
  • Cant tell when child feels proud of actions.

48
ALD-I Communication ALDs Use of Spoken Language
  • Echoes some of your speech to show you hes
    with the conversation.
  • Uses echolalic (exact, repeated speech) to
    re-enact play from videos.
  • Uses odd, not-quite-right, but understandable
    phrasing in speech.

49
ALD-I ALDs- World of Objects Sensory Processing
  • Seems not to hear (not just ignores) some sounds/
    speech.
  • Seem over-sensitive to some sounds, as too loud.
  • Very positive response to movement
  • Very negative about tactile irritations
  • Puts non-food items in mouth, as if to learn
  • Picky about textures in mouth ( what is
  • chewed or swallowed.

50
ALD-I ALDs- World of Objects Repetitions/ Novelty
  • Prefers old familiar toys to new toys.
  • Initially fearful of something he now loves,
    e.g., vacuum, carousel.
  • Once something is done one way, its always done
    the same way.
  • Has odd little ritualslike only drinking from
    one cup, for no reason.
  • Very focused in play with one thing, showing good
    concentration.

51
Step II Include a Developmental Perspective
  • Evolution has worked out the most efficient
    sequence for skill acquisition.
  • 2) Research in developmental psychology maps
    that sequence.
  • 3) Children learn at different rates and in
    different ways, but the sequence of
    skills-building needs to be developmentally-ordere
    d to provide a solid foundation.

52
Separating Curriculum From Method
  • A Brief History of ABA/DTT How many autistic
    children learned stand-up/ sit down before
    mama and dada.
  • The concept of teaching horizontally, not
    vertically 10 barnyard animals versus 10 faces
    of mommy
  • Lets not throw the baby out with the bath water
    Keeping the ABA principles pairing them with a
    developmental curriculum.

53
EnterA Curriculum that is Developmental and
Behavioral
  • Based on where the child is developmentally (e.g.
    18 month receptive language)teach the next set
    of skills.
  • Calibrate growth trajectory based on learning
    history re-calibrate annually.
  • Do teach using validated behavioral principles.
  • Dont teach from a cookbook dog-training
    manual.

54
Step III Make the Curriculum Motivating
  • Ask What Does He Want to Learn?
  • NOT
  • What Do I Want to Teach?

55
Strategies for Enhancing Motivation
  • Develop Response to Social Praise (to expand
    possible LREs)
  • Develop An Interest in Affiliation/ Modeling
  • Develop An Interest in Learning Materials/
    Objectives (Thin Edge of Wedge)
  • Using Predictability via Routines Schedule
  • Make Comprehensible through Visuals

56
Reward Strategies Develop a Reward Hierarchy
  • Primary Reinforcement (e.g., in DTT)
  • Establishes learning contract
  • Can schedule rewards according to task
    difficulty, novelty and childs persistence
  • Intrinsic Reinforcement (e.g., in PRT)
  • Materials as reward
  • Context as reward
  • Successful problem-solving leads to internalized
    drive

57
Modifying Time Outs for ASDs
  • Functions of Time-Out
  • Use of an accompanied time out
  • Isolation as cool down not as deterrent
  • Criteria for when and how long to time out
  • Calming down is a behavior to be shaped

58
Modifying Negative Reinforcement and
Over-Correction for ASDs
  • Negative Reinforcement
  • Why should Ignoring work if you dont mind
    being ignored?
  • Over-Correction
  • Changing the intrinsic reward valence by
    controlling access through over-exposure
  • (Examples Light-switches, doors)

59
An ALD/ALS Specific Approach to Motivation
  • Two Tiered Reinforcement
  • First Tier
  • Part reward for Necessary, but not sufficient
    behavior
  • Second Tier
  • Full reward for attaining goal
  • (Examples Potty-training, seat belts)

60
Social ALDs Working to Increase Interaction and
Social Understanding
61
Prerequisite, Developmental Considerations in
Peer Play
  • Receptiveness (to Play)
  • Peers and their activities must present a
    replicable model
  • Play content must hold intrinsic interest
  • Expressive (Engagement in Play)
  • Childs play is supported by language level/
    internal capacity to represent
  • Teach play the way others the same age do it

62
Strategies for Peer Integration
  • Preschoolers
  • Play pre-teaching (11) with adult
  • Play pre-teaching w/ 1 peer
  • Putting the included child at the center
  • Pre-verbal parallel play (group)
  • School Aged
  • Reverse mainstreaming (11)
  • Integrated peer play groups (group)
  • PALS threesomes

63
Strategies for Facilitating Interaction
  • Para-Professional Aides
  • Shadow Aides Being Jiminy Cricket
  • Fading One-to-two Aides obscured Aide
  • Behavioral vs Social Skills vs Academic Aides
  • Peers as Facilitators (More naturalistic play)
  • Teen Tutors
  • Junior Babysitters/ Bossy 9-year-old girls
  • Ideal Play Partners Altruistic, initiators, good
    theory of mind

64
Communicative ALDs Working on Initial
Communication
65
What Is VIA (Visual Interaction Augmentation)?
  • VIA is a visually augmentative communication
    program like PECS
  • VIA is based on teaching communication in context
  • VIA is based on teaching language development in
    a step-by-step sequence laid out by principles of
    psycho-linguistics

66
VIA Rationale
  • Emphasizes teaching integrated para-linguistics
    as foundational to linguistics
  • Developmentally focused on increasing spontaneity
    over MLU or speech clarity
  • Focused on increasing inter-subjectivity by
    sharing of desired object of communication

67
Underpinnings of VIA Developmental
Psycholinguistics
68
Para-linguistics Concepts Implications for Design
of VIA
  • Pragmatics
  • Communication regulation via topic selection,
    topic initiation, and topic maintenance.
  • VIA
  • Teach reciprocity in communication non-verbally
    before/ alongside oral communication/ semantics
    as in typical neurodevelopment.

69
Para-linguistics Concepts Implications for Design
of VIA
  • Non-Verbal Communication
  • "Body language", micro-expressions, physical
    proximity and contact to modify communication.
  • VIA
  • Pair with visually augmented communication to
    classically condition meaning.

70
Para-linguistics Concepts Implications for Design
of VIA
  • Motherese
  • Style of talking characterized by accentuated
    inflection, repetitions, and simplification. May
    include recasts (repetition of key semantics to
    along with "new" info.)
  • VIA
  • Pair with visual augmentation (gesturally and
    orally) to make communicative signal enhanced
    and multi-sensory as in typical neurodevelopment.

71
Concepts Related to Intent-I Implications for
Design of VIA
  • Proto-imperative Communication
  • Use of a gesture to issue a command or request.
  • Proto-declarative Communication
  • Use of gesture to call attention to an event.
  • VIA
  • Teach imperative before declarative intent.
  • Teach prerequiste paralinguistics alongside.

72
Concepts Related to Intent-II Implications for
Design of VIA
  • Turnabouts
  • Elements requesting a response
  • VIA
  • Teach by creating set-ups.
  • Turn-taking
  • Contingent, alternating vocalizations
  • VIA
  • Play around mastered communicative intents

73
Concepts Related to Acquisition Implications for
Design of VIA
  • Semantic Bootstrapping Hypothesis
  • Idea that children learn syntax from semantics.
  • VIA
  • No SD speak such as Good touching nose!
  • Using inflection to mark novel, semantic and
    syntax of utterance such as Good! You touched
    your NOSE! OR Good! YOU touched YOUR nose!

74
Concepts Related to Acquisition Implications for
Design of VIA
  • Fast-mapping
  • Deriving the meaning of words from context
    'mutual exclusivity bias (e.g. new words go with
    novel objects.
  • VIA
  • Use specific and multiple icons with same nominal
    class to form semantic prototype as in typical
    neurodevelopment (e.g., red dog, big dog, fuzzy
    dog, Clifford the Dog).

75
Concepts Related to Acquisition Implications for
Design of VIA
  • Pivot grammar
  • Early language characterized by repetitive
    formulation, e.g. "no___", "more___", "all
    gone____".
  • VIA
  • Teach language developmentally, i.e.
    MLU1?MLU2?MLU3 ?MLU4?etc.
  • Not Juice (icon) ?I want (juice icon) please.

76
Mechanics of Setting Up A VIA Program
77
VIA Procedures
  • Photographic (or 3-D) icons only
  • Photos of exactly what the child has in mind
  • Icons with words labels to promote auditory
    recognition
  • Icons located when and where the child has the
    object or action in mind
  • Orally Speak motherese
  • Gesturally Motherese para-linguistics

78
Developing Icons
  • Simple photos of specific examples of high value
    items to show child you see what he has in mind
  • Consider 3-D icons (e.g., goldfish crackers glued
    shut in a clear box) if non-verbal MA lt about 9
    months.

79
Shape Non-Verbal Communication
  • Step 1
  • Follow speakers point to icon
  • Step 2
  • Gaze shift from icon to speakers eyes
  • Step 3
  • Attend (briefly) to speakers facial affect

80
Selecting Things to Request
  • Develop hierarchy of reinforcers
  • Introduce photos of high reinforcement icons
    first
  • Set up pivotal requests (i.e., to get something
    wanted)
  • Put away high value objects to create
    communicative press
  • Train with single photo and brief exposure to
    requested item

81
VIA Prompting Requests
  • Full prompting fully faded prompt to help
    child hand over icon to listener.
  • Listener adds gaze directs between child icon
    held close beside listeners face
  • Add gesture (e.g., shoulder shrugWhat?)/ point
    to icon
  • Add exaggerated facial expression to mark Q/ Yes/
    No
  • Motherese inflection and pitch

82
VIA Choice-Making
vs
  • High contrast choices (Speak N Say v broccoli)
  • After simple choice-making established, sequence
    icons (e.g., bring open door icon, plus ball
    icon from toy chest)
  • Model/ link pivotal grammar natural grammar

83
VIA Icons in Context
  • Icons located in natural environment where child
    sees them in his minds eye (e.g., sippy cup on
    fridge)
  • Icons create an opportunity to communicate
  • After mastery in natural environment, consider
    portable belt loop/ key ring of small icons-to-go

84
Communicative ALDs Working on Spoken Language
85
ALSs How the Child with ASDs Can Compensate for
Verbal Deficits
  • Promote sight-reading first
  • Pairing pictures with spoken words
  • Slow speech to auditory processing time
  • Pairing pictures with written words, turn on
    close-captioning
  • Using motherese (voice gesture)
  • Talking about things the child visualizes

86
Teaching Verbal Communication Playing to
Autistic Learning Styles
  • The Language-Learning Brain Listens to
  • High Inflection/ Developmental Use of Natural
    Grammar (What the Research Says)
  • Visual Augmentation
  • Picture Schedules/ Visual Schedules/ Activity
    Schedules
  • Make it Easy to Succeed with Words
  • Require only as much as needed for meaning

87
Verbal Children Strategies for Auditory
Processing Difficulties
  • Increasing Semantic Salience
  • Slowing Down
  • Pairing Visual and Auditory
  • Computer Assisted Instruction
  • Address SignalNoise Problems
  • (Earobics, Fast Forward, Laureate Learning
    Seeing Language, TeachTown)
  • Working with Echolalia
  • Recognize as functional, Simplify MLU, Prompt
  • w/o interfering with pragmatics

88
Verbal Children Strategies for Increasing
Spontaneity
  • Moving from Instrumental to Expressive
  • Conversation while window of interest is
    open
  • Creating Opportunities to Increase Press
  • Pivotal Response Training
  • Moving from Elicited to Spontaneous
  • Scripted dramatic play, taking videos off-road
  • Letting the Child Lead

89
Working to Increase Meaningful Play and
Exploration
90
ALSs How the Child with ASDs Can Compensate for
Deficits in Exploration
  • Play Modeling at Developmental Level
  • Build In Repetition As Reinforcer, E.g., Lego.
  • Child-led Play to Build in Intrinsic
    Reinforcement
  • Choice-Making to Re-direct Away from
    Perseverative Playing
  • Scripted Play to Provoke Playlalia
  • Start With Narrow Interests As The Thin Edge Of
    The Wedge

91
Expanding Social Play
  • Video-modeling to develop
  • New play schema
  • Pre-teaching for group instruction
  • Child-centric play to develop
  • Self-efficacy through lead-following
  • Expanded exploration
  • Inclusion to develop
  • Spontaneity, motivation, expanded repertoire

92
Expanding Play with Toys (Sensory and Concrete
Levels)
  • Titrating/ varying / expanding use w/
  • materials used perseveratively/ narrowly
  • Pair functional use with classification
  • Single themes playlalia (Adult and child
  • with same toy)model parallel play

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Expanding Play with Toys (Representational
Symbolic Levels)
  • Use of theme toy sets FP, Playmobiles and
    elaborate beyond logical themes
  • Going Off-Road with familiar scripts
  • Promoting Play Private Speech
  • Introducing symbolic play with as if play
    materials (symbolic referents)

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Summary ALDs in the Context of Specific
Treatment Strategies
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Lots of Little Strategies…. How Do You Pull It
All Together?
  • Selecting Main Features of Curriculum for A
    Classroom

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Approaches to Autism Treatment
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ADULT-LED/ Behavioral Strengths
  • Pairs primary and social reinforcers to increase
    value of social reinforcers
  • Develops cause and effect responding
  • Develops attention with use of salient
    reinforcers
  • Teaches schema for imitative learning
  • Bringing vocalization under imitative control as
    prerequisite for speech learning
  • PRT Develops self-initiative through choice

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ADULT-LED/ Behavioral Quality Assurance
Considerations
  • Separate curriculum from method
  • Teach in developmental sequence
  • (e.g., Vocabulary horizontally, not
    vertically)
  • Teach age-appropriate functional and pre-academic
    skills
  • Provide choice/ self-initiative (e.g.,activity
    schedules)

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The Developmental-Behavioral Approach Development
al DT v DT (c.f.Lovaas)
  • Teach linguistic prototypes, not verbal SDs
  • Periodic data, not trial-by-trial data
  • Build in more child choice
  • Dynamically inter-leaf adult-led and
    child-initiated trials by consistently
    reinforcing (any) lead-taking by child

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The ALD/ALS Profile That Fits Adult-led/
Behavioral Interventions
  • No Instruction Contract Yet
  • No Response to Social Reinforcers
  • No Imitative Learning
  • Maladaptive Behaviors Are Instrumentally
    Successful

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GROUP-ORIENTED TEACCH/ Structured Teaching
Strengths
  • Culture of autism (like culture of deafness)
  • Task-choosing as intrinsic reinforcer
  • Supports move to self-initiated learning
  • High visual cueing, lower language press
  • Defined work spaces to decrease
  • sensory over-responding
  • Stepping stone to inclusive classrooms

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GROUP-ORIENTED TEACCH/ Structured Teaching
Quality Assurance Considerations
  • Use photos not icons promotes thinking in
    pictures/ increases motivation
  • Use work stations for maintenance skills
  • Have children put away not throw away
    completed task, to increase sensory-motor
    involvement
  • Use activity schedules visual token boards at
    work stations
  • Supervise work stations sufficiently (one-to-two)

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The ALD/ALS Profile That Fits Group-Oriented/Stru
ctured Teaching
  • Imperative to function adaptively as part of
    group
  • Prefers routines to makes sense of daily events
  • Prefers visual over linguistic organizing
    structures
  • Reinforced by predictability

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CHILD-CENTRIC Floor-time/ RDI Strengths
  • Child engagement sustained by self-choice of
    activity i.e, intrinsically reinforcing
  • Very slow-to-warm, very anxious or very avoidant
    child is gradually desensitized to over-arousing
    aspects of social contact
  • Gradual change in learning contingencies
    circumscribes sensory over-responding.
  • No battle for instructional control

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CHILD-CENTRIC Floor-time/ RDI Quality Assurance
Considerations
  • Outcomes Is there initiative/ spontaneity
  • (child) or just better scaffolding (adult)?
  • Does increased engagement in play drive language/
    problem-solving/exploration?
  • Are improvements in joint attention reflected
  • in language/pragmatic gains?
  • Is there really a relation between sensory
  • issues and learning (cognitively? socially?)

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The ALD/ALS Profile That Fits Child-Centric
Teaching
  • Sensory over-responding impairs engagement with
    learning experiences that are otherwise
    accessible.
  • Responds well to desensitization to novelty which
    is hard to tolerate
  • Low motivation, needs intrinsic rewarding

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INCLUSIVE Strengths
  • Child is exposed to a (meaningfully) adapted
    core curriculum.
  • Goal for peer models will stimulate age-
    appropriate functioning.
  • Goal for children to decrease inappropriate
    behavior if segregated from others who behave
    similarly.
  • Child more likely to attend neighborhood school/
    develop natural friendships

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INCLUSIVE Quality Assurance Considerations
  • Prerequisite imitation for peer modeling?
  • Developmentally relevant inclusion?
  • Functional analyses of disruptive behavior where
    inclusion may be the antecedent
  • Some maladaptive behavior is hard-wired not
    modeled
  • Smooth transitions? One-to-one teaching ?
    special day class ? integration ? full inclusion
    (one-to-one) ? full inclusion (one-to-two) ?
    obscured aide

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The ALD/ALS Profile That Fits Inclusive Education
  • Able/ interested to learn new things from model.
  • Motivated by some social contingencies.
  • Incidental learner.
  • Developmentally within reach of instruction.

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Treatment Approaches Cross-Tabulated by ALDs to
Be Addressed
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Defining Eclectic
  • Eclectic is having a toolbox with a variety of
    tools
  • Eclectic is not letting everyone choose what
    they like best
  • Eclectic treatment is knowing what tool to use
    for which jobbased on the best available
    evidence.

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Bibliography
  • Siegel, B (2007-in press). Parenting the Child
    with Autism, New York Guilford Press.
  • Siegel, B (2003). Helping Children with Autism
    Learn Treatment Approaches for Parents and
    Professionals, New York Oxford University
    Press.
  • Siegel, B (1996). The World of the Autistic
    Child Understanding and Treating Autistic
    Spectrum Disorders, New York Oxford University
    Press.
  • Siegel, B. and Silverstein, S. (1994). What
    About Me? Siblings of Developmentally Disabled
    Children New York Perseus Press
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