Current Best Practices For Students With Autism Spectrum ...
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Current Best Practices For Students With Autism Spectrum Disorders
Dr. Karen A. Berkman
Mindy Stevens
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Today’s Presentation Agenda
• Review current research in the field of ASD
• Provide an overview of best practices in education for students diagnosed with ASD
• Discuss implementation fidelity and review administrator observation tool for classrooms
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Where We’ve Been and Where We’re Going
“Autism research has been primarily focused on discovery for the past decade, but now
the field is turning a corner such that movement toward development,
refinement, translation, and delivery will be possible.”
(Clara Lajonchere, Autismspeaks, 2008)
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Current TheoriesGenetic
– Genetics contributes to ~60-90%
– No single gene has been found with increased risk of 10-20 fold
– Current thinking: common alleles, possibly in uncommon combinations
– Environment: Recent evidence to suggest a gene x environment interaction
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Current Trends in AutismBulk of the current research is on basic
causes and psychological processes
– Genetics– Neurobiology and Physiology– Developmental course– Etiology– Theory of Mind– Language and Communication– Perception and Cognition
» Matson, JL. & LoVullo, SV.(2008)
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Treatment Research• Autism Speaks-funded research
– GI
– Sleep
– Quality of Life
• Combating Autism Initiative– Diet and Nutrition
– Parent-Based Sleep Education Program
– Hormonal Factors in Adolescents
– Novel Screening Methods (EEG)
• Partnerships:– LEND Network (Education and Training)
– American Academy of Pediatrics (Education and Dissemination)
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CDC Autism Activities
• Focus is on prevalence studies for 8 year children across 14 states
• Updated statistics forthcoming from 2004-2006
• Studies on relationship between MMR immunizations and autism
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Collaborative Programs of Excellence in Autism (CPEA)
Conducts research in the following areas:
– Causes of autism– Early detection– Behavioral and communication characteristics– Treatment
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CPEA Network ProjectAutism Spectrum Disorder in the Second
Year: Stability and Change in Syndrome Expression
– Results indicate stability of clinical diagnosis and syndrome expression in the second year
– Highlights advantages and limitations of the ADI-R and ADOS-G for diagnosing and documenting symptoms of ASD in infants
(Chawarska, Klin, Volkmar, in press)
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Studies to Advance Autism Research and Treatment (STAART)
Network
• 8 centers funded by 5 NIH Institutes
• Focus of STAART Network is;– Causes– Diagnosis– Early Detection– Prevention– Treatment
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STAART Network ProjectAbnormal functional connectivity in autism
spectrum disorders during face processing
– A significant relationship between abnormal functional connectivity and clinical severity in the ASD group was observed
– Results suggest that abnormal neural connection within the limbic system may contribute to the social impairments observed in ASD
(Kleinhans, Richards, Sterling, Stegbauer, Mahurin, Johnson, Greenson, Dawson, Aylward, in press)
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Other Studies of Interest
• Autism and Sleep Disorders
• Autism in Infancy
• Definition and development of the phenotype in autism
• Neonatal social responses of infant siblings
• Girls with autism spectrum disorders
• Non-social rewards and autism
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Other Studies of InterestCeFAR (University of Pittsburgh) findings to date:
– Difficulty tracking faces extends to objects, although more subtle
– The cause may, in part be due to general difficulties grouping parts to make a whole
– The difficulty extends to all facial expressions, but mostly those which are expressed in the eye region of the face
– This may be related to difficulty zooming out to focus on the bigger picture instead of one small detail
– Brain activation is more than normal to common objects and less activated when looking at faces
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Other Studies of Interest
Kennedy Krieger Studies underway are:
– Early diagnosis and intervention (R. Landa)
– Brain activity and motor tasks (S. Mostofsky)
– Metabolic disorders and ASD (E. Tierney)
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What Determines Best Practice?
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Key Questions• What are the anticipated outcomes from using
a particular practice and do the outcomes match the student’s needs?
• “evidence-based” “research-based” terms used loosely to sell products
• Pass rigorous and objectively measured standards
• Appraisal of the extent of the outcomes match needs of students
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Key Questions
Are there potential risks associated with implementing a practice?
– Dropping an existing method
– Time/cost constraints
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Key Questions
What are the most effective ways of evaluating a particular method or approach?
– Evaluate negative outcomes and undesired side effects
– Evaluation responsibilities
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Educational Best Practices
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Best Practices
• DTT (Discrete Trial Training)
• TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children)
• Incidental Teaching
• Pivotal Response Training
• Verbal Behavior Training
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Discrete Trial Training
• Breaking a task down into its smallest units
• Teaching a unit with a distinct beginning and end, separated by a brief interval
• One teaching unit is called a “trial”
• Trials can be “massed” or “distributed”
• Reinforcing each correct response
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Advantages of DTT
• Can assure massive numbers of opportunities/trials
• Teacher controlled
• Little thought involved
• Easy to assess the data
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Disadvantages of DTT
• Prompt dependency
• Cost
• Generalization
• Need to reprogram for spontaneous skill use
• Requires specific programming time blocks
• Doesn’t build fluency (% correct)
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TEACCH
• Person-centered support of individuals of all ages and skill levels.
• Employs approach known as “Structured Teaching” – Work systems– Independence– Predictability– Visual Cues
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Advantages of TEACCH
• Independence
• Predictability
• Routine
• Structure
• Consistency
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Disadvantages of TEACCH
• Social interaction and verbal communication are not emphasized
• Does not promote interaction with typical peers
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Incidental Teaching• Developed by Hart and Risley, and adapted for autism
by McGee, Charlop, McClanahan
• Child-initiated, activity based instruction
• Appropriate for use with inclusive groups
• Natural activity-based contexts
• Promotes generalization and spontaneous skill use
• Reinforcer built into the episode
• Targets speech, play, social and academic skills
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Advantages Of Incidental Teaching
• Can be done anywhere, any time, by anyone• Does not require massive training• Inherent generalization built-in• Consistent with developmentally appropriate teaching and
inclusion• Workable in a developmental classroom setting• Short episodes• Natural, activity-based• Spill-over to play skills• Less protest/escape/aversive control• Encourages spontaneous skill use
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Disadvantages of Incidental Teaching
• Depends on engagement
• Cannot control number of trials/data analysis issues
• Teacher must remain hyper vigilant or created opportunities
• Must create opportunities
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Pivotal Response Training• Pivotal Responses central to wide area of function and will produce change
across a number of behaviors– Ex: motivation, self-initiation
• Involves discrete trial format
• Uses natural reinforcement
• Intersperse mastery and teaching trials
• Use child selected materials
• Actively teaches child-initiated responses
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Advantages of PRT
• Child initiates
• Natural reinforcers
• Increased motivation
• Deters inappropriate behavior
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Disadvantages of PRT
• Labor intensive
• Staff must be adequately trained in the method
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Verbal Behavior Training
• Language as a behavior
• Find out what the child wants then teaching them how to request it
• Child led
• ABLLS (Assessment of Basic Language and Learning Skills)
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Advantages of Verbal Behavior Training
• ABLLS allows for tracking of a child’s progress
• Useful verbal operators
• May be used at school and in the home
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Disadvantages of Verbal Behavior Training
• Cost may be high to the school districts
• Labor intensive
• Requires small staff to pupil ratios
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Characteristics of Effective Programs*
• Early implementation• Systematic teaching• Functional skills (core deficits)• Specified curriculum, evaluation methods• Supportive environments and routines• Family involvement• Inclusion opportunities• Inensity• Staff and program development
• *Caveat emptor: programs=designed for preschoolers
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Administrators’ Role in Choosing and Evaluating Best Practices
• A team approach• Make a commitment to the method• Provide district training(s) on the method• Consider using the “Observation Instrument for
Autism Classrooms” and tying it with a teacher’s Professional Development Plan (PDP) or any other type of evaluation
• Create a process for conducting yearly reviews and evaluations of the methods in designated time frame
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Observation Instrument for Autism Classrooms
• Brief overview
• Instruction and Interaction
• Classroom staff responsibilities
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References• Evidence-Based Practices and Student’s With Autism Spectrum Disorders.
Simpson, Richard. Focus on Autism and Other Developmental Disabilities; Fall 2005; Proquest Education Journal
• NCLB, 2002
• Dawson & Osterling, 1997; Izeman & Strain, 1995; Harris and Handelman, 1992
• CARD, University of Central Florida
• Frequently Asked Questions Regarding Verbal Behavior by Mary Barbera, RN, MSN, BCBA
• Mesibov, G.B., Shea, V., & Schopler, E. (with Adams, L., Burgess, S., Chapman, S.M., Merkler, E., Mosconi, M., Tanner, C. & Van Bourgondien, M.E.). (2005). The TEACCH approach to autism spectrum disorders. New York: Kluwer Academic/Plenum.
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References
• HOW TO TEACH PIVOTAL BEHAVIORS TO CHILDREN WITH AUTISM: A TRAINING MANUAL, Robert L Koegel
• AutismWeb
• Autism Research Institute, Stephen Edelson, Ph.D.
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CARDCenter for Autism and Related
Disabilities
http://card-usf.fmhi.usf.edu