Autism and the Necessary Components for Effective Treatment

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Autism and the Necessary Components for Effective
Treatment

• Sharon A. Reeve, Ph.D., BCBA
• John L. Brown, M.A., BCBA
• Caldwell College

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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)
• 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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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).
  

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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

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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.

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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.

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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.

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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.

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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.

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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

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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.

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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