Helping Parents Separate the Wheat from the Chaff:

Putting Autism Treatments to the Test

Kay, S. & Vyse, S. ( 2005). Helping parents separate

the wheat from the chaff: Putting autism treatments to

the test. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick (Eds.),

Controversial Therapies for Developmental Disabilities: Fad,

Fashion, and Science in Professional Practice. Mahwah, NJ:

Lawrence Erlbaum Associates.

Overview

•Rationale for this topic•Helping parents evaluate treatments

•Parent education•Presenting the idea of data-based decision-making

•Designing and implementing the test

•Case examples•References

Rationale

•Parents of children with developmental disabilities often choose to utilize treatments which are not scientifically validated. Why?

•Testimonials from other parents•News media •Information from internet or books•Recommendations from a professional

Rationale

“Even when working with qualified professionals, parents of children with

developmental disabilities often exercise their considerable power

to alter the course of treatment.” (p.

265)

Rationale

Parent involvement__________________________________________ Treatment of Treatment of developmental disabilities medical problems________________________________________________________- Childrearing involves teaching - Parents are not expected skills to treat their child directly- Parents are heavily responsible for - Choice of treatment is their child’s educational & social typically left to the doctor development - For many common ailments,- Parents of children w/ DD are rarely there is a single (scientifically presented w/ a standard treatment validated) treatment which is approach endorsed by all practitioners widely accepted

How do we help parents separate the

wheat from the chaff?

•Parent education

•Presenting the idea of data-based decision-making

•Designing and implementing a test

Parent Education

Provide parents information on evaluating treatment options, and the available empirical evidence (or lack thereof) for “treatments” of interest

•Discussion•Reading material

*Use parent-friendly language!*Create an atmosphere in which parents will feel

comfortable talking with you re: alternative treatments!

Parent Education

Helpful Resources for Parent Education:

•“Evaluating Treatment Claims” chapter (Green, 1996)• ASAT website (www.asatonline.org) and newsletter•“The Road Less Traveled” (Celiberti, Buchanan, Bleecker, Kreiss, & Rosenfeld, 2004)

Presenting the Idea of a

Data-Based Decision

•Discuss advantages of collecting data to help make a decision about whether to continue the treatment:

•See if the treatment is helping to solve the identified problem

•See if the treatment is making things worse

•If effective, can contribute to the research literature and help other families

•See if this treatment is effective for this particular child

Designing and Implementing the

Test

1. Identify the target behavior

2. Design the test

3. Develop decision rules

4. Collect the data

5. Evaluate the results and make a decision

Designing and Implementing the

Test

1. Identify the target behavior

Which behaviors are the parents looking to change with the proposed therapy?

Work with parents to develop operational definition(s).

Decide how to measure the behavior(s).

Designing and Implementing the

Test2. Design the test

Develop a research design.

May use reversal (e.g., ABA, ABAB), multiple baseline, or alternating treatments design.

Kay & Vyse recommend alternating treatments design to compare the effects of two treatments—or of treatment vs. no treatment.

Designing and Implementing the

Test

3. Develop decision rules

Determine (in advance) the level of behavior change that would indicate the treatment is working. (While not a necessary step, this may help make decisions about continuing or stopping the treatment.)

Designing and Implementing the

Test

4. Collect the data

Collect data using the predetermined measurement system.

When possible, data collectors should be blind to the purpose of the experiment.

When possible, include measures for procedural integrity and IOA.

Designing and Implementing the

Test

5. Evaluate the results and make a decision

Visually display data on a graph.

Meet with parents and discuss findings. (Carefully explain the measurement systems and the components of the graph in parent-friendly language! )

Assist the parents in making a data-based decision.

Case Example: Prism Glasses

•8 year old boy •difficulty walking appropriately (rarely alternated feet, frequently toe-walked and galloped) •optometrist told child’s parents wearing prism glasses would improve visual processing—which would increase appropriate gait and decrease toe-walking•appropriate walking defined as taking two steps with alternating feet, using heel-toe motion•alternating treatments design examined % of appropriate walking while wearing prism glasses vs. wearing pretend glasses

Case Example: Sensory Integration

• 5 year old boy • frequently engaged in frequent falling to the floor when tasks were presented • OT told child’s parents the behavior resulted from an inadequate sensory diet—and if his vestibular system were balanced, he would not fall out of his chair• falling out of chair was defined as buttocks or stomach in contact with the floor• alternating treatments design examined frequency of falling out of chair on days when SI was administered before the data collection period vs. days when a DRL procedure was implemented

Bechner, L., Mozingo, D., & Adams, S. An Evaluation of the Effects of an Elimination Diet on Target Behaviors in a Child with Autistic Disorder. Presented as part of the symposium “Data-Based Examination of the Effects of Alternative Treatments for Autism” at the 27th Annual Meeting of the Association for Behavior Analysis, New Orleans, LA, May 2001.

Case Example: GFCF Diet

An Evaluation of the Effects of an Elimination Diet on Target Behaviors in a

Child with Autistic Disorder

Lori Bechner, MA, BCBADennis Mozingo, PhD, BCBA

Stacy Adams, BS

Rationale

• Elimination diets have been proposed for treatment of autism• Proponents of these diets suggest that autism is related to allergies to specific foods, and eliminating these foods from the diet can result in improvement in symptoms of autism• No scientifically sound studies have evaluated whether children with autism actually have trouble tolerating these foods, or whether elimination diets are helpful for them

Participant

• male• 5 years old• diagnosis of autism• student at ABA school program

Target Behavior to be increased:

• Eye Contact: Eye to eye gaze, sustained for 5 seconds, in response to the child’s name being called.

Target Behaviors to be decreased:

• Clapping: Any instance of clapping hand(s) or fist(s) together or against another object (e.g., wall or floor) more than once.

• Shaking Objects: Shaking and/or waving objects not intended to be shaken.

• Noncontextual Giggling: Giggling/laughing in the absence of an apparently funny stimulus.

• Running: Running back and forth or in circles.

Eye Contact

Measurement: per opportunity measure (5 probes throughout school day)

Clapping

Measurement: 30-second momentary time sample (two 30-minute sessions per day)

Shaking Objects

Measurement: frequency recording

Noncontextual Giggling

Measurement: frequency recording

Running

Measurement: frequency recording

Results

• Eye Contact: Diet had no apparent effect; behavioral intervention had positive effect.

• Clapping: Diet had no apparent effect; behavioral intervention had positive effect.

• Shaking Objects: Diet had no apparent effect; behavioral intervention had positive effect.

• Noncontextual Giggling: Diet had no apparent effect.

• Running: Diet had no apparent effect.

Conclusion

• The elimination diet did not lead to the desired changes in “autistic” behavior.

• Side Effects of the diet: Elimination of several edible reinforcers Decreased food consumption and variety of foods consumed Weight loss Problem behavior at snack/lunch time at school

Conclusion

When parents are unable or unwilling to evaluate evidence regarding treatment options for their child, Behavior Analysts can help them make informed treatment decisions.

References

Bechner, L., Mozingo, D., & Adams, S. An Evaluation of the Effects of an Elimination Diet on Target Behaviors in a Child with Autistic Disorder. Presented as part of the symposium “Data- Based Examination of the Effects of Alternative Treatments for Autism” at the 27th Annual Meeting of the Association for Behavior Analysis, New Orleans, LA, May 2001.

Celiberti, D. A., Buchanan, S. M., Bleeker, F., Kreiss, D., & Rosenfeld, D. (2004). The road less traveled: Charting a clear course for autism treatment. In Autism New Jersey’s Autism: Basic Information (5th ed.).

Green, G. (1996). Evaluating claims about treatments for autism. In C. Maurice , G. Green, & S. C. Luce (Eds.), Behavioral intervention for young children with autism: A manual for parents and professionals. Austin, TX: PRO-ED.

Kay, S. & Vyse, S. ( 2005). Helping parents separate the wheat from the chaff: Putting autism treatments to the test. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick (Eds.), Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice. Mahwah, NJ: Lawrence Erlbaum Associates.