MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER

1. MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER Deficits in social attachments and behavior Deficits in verbal and nonverbal communication Presence of perseverative, stereotyped, repetitive, behaviors

2. Social Interaction Differences • Kids with autism smile! • Social interaction may be desired but difficult • Poor reciprocity in social interaction • Relationship with care providers may be most strongly developed • Peer relationships difficult

4. Autistic Types Unknown Aloof Passive Interactive but odd Dr. Lorna Wing

5. Communication Differences • Delayed/Different Communication • Speech without communication vs. communication without speech • Echolalia • Poor gesture use • Instrumental hand leading • Playlalia and lack of symbolic play

7. Stereotyped Behavior • Perseverative Interests or play • Motor stereotopies in preschool and beyond • Insistence on sameness/routine • Need for “prediction” and “control” • Preoccupation with parts of objects

9. What is not addressed in the DSM-IV • Sensory Processing • Temperament • Motor Planning • Imitation • Anxiety and Avoidance • Adaptive Skills • Impact of intellectual functioning

12. OTHER FEATURES OF AUTISM Incidence is cited at rate of between 1 in 2500 to 1 in 500 births. 4:1 boys to girls ratio Lifespan disorder No known etiology although known to be organic in nature. Commonly accompanied by mental retardation Heterogeneous disorder

13. Treatment Although current push towards identifying biological bases of the disorder, no treatment implications are on the horizon. The form of treatment with the greatest empirical validation is treatment based upon a behavioral model.

14. Behavioral Model Treatment based on the systematic application of the principles of learning Consitently empirically demonstrated to be effective in improving the behavior of children with autism Developed via the methodology of applied behavior analysis Initial demonstrations were the first to show these children could learn in a systematic manner

15. Components of Discrete Trial Training Instruction > Response > Consequence Presenting Instructions and Questions: Child attending Easily discriminable Short and consistent Child responds or fails to respond Consequences: Types of consequences Manner of presenting consequences

16. Results of Early Behavioral Intervention Initial demonstrations involved highly structured discrete trial format Proved to be very effective in establishing a wide range of behaviors in these children Provided basis for all behavioral treatments to follow Can lead to substantial improvement in many children with autism

17. Problem Areas Generalization Stimulus Response Lack of spontaneity Robotic responding Prompt dependency Slow progress Time consuming Difficult to implement Children and treatment provider may not like

18. Naturalistic Strategies Developed in response to needed improvements Arose from a number of different laboratories Called “incidental teaching,” “pivotal response training,” “milieu treatment,” etc. All share many of the same components

19. Components of Pivotal Response Training Motivation Child Choice Reinforce Attempts Direct Reinforcement Intersperse Maintenance Tasks Frequent Task Variation Turn Taking Responsivity Tasks Involve Simultaneous Multiple Cues

22. Results of Naturalistic Treatment Strategies Greater generalization More positive affect More positive home interactions More enjoyable for both children and treatment provider

23. Parental AffectSubject Means Negative/Neutral Affect   Positive Affect OverallRating Subject

24. Parent-Child Interaction Measures Positive Neutral Negative Individual Target BehaviorPivotal Response Training Interaction Scales Parent Training Conditions

25. Developing Individualized Treatments Important child variables Important parent and family variables Important cultural variables Important treatment/behavior interactions

26. Factors that Influence Treatment Efficacy

27. Child Characteristics

28. PRT DATA SET JODO CHLI ZATA NOFO JOCO THBL AIAC ADMI CHDE ALKO YOTK DAGL CANE DABO PACH STWI ROBE JOTO KYMA KYBR JBBA DYRE BESM SASI JECI KASU ROTO JASA ELTU JOTA BOBA ANCR

29. BEST RESPONDERS JODO CHLI ZATA NOFO JOCO THBL AIAC ADMI ALKO CHDE YOTK DAGL CANE DABO PACH STWI ROBE JOTO KYMA KYBR JBBA DYRE BESM JECI SASI KASU ROTO JASA ELTU JOTA BOBA ANCR

30. NON RESPONDERS JODO CHLI NOFO ZATA JOCO THBL AIAC ADMI CHDE ALKO YOTK DAGL CANE DABO PACH STWI ROBE JOTO KYMA KYBR JBBA DYRE BESM SASI JECI KASU ROTO JASA ELTU JOTA BOBA ANCR

31. Profile Behaviors Toy Play Approach Behavior Avoidance Behavior Verbal Self-Stimulatory Behavior Nonverbal Self-Stimulatory Behavior

32. Best Responders Profile Mean Percent Interval Occurrence

33. Non Responders Profile Mean Percent Interval Occurrence

34. Language Data - Responders Mean Percent Interval Occurrence

35. Responders Toy Play Mean Percent Interval Occurrence Social Skills

36. Language Data Non-Responders Mean Percent Interval Occurrence

37. Non-Responders Toy Play Mean Percent Interval Occurrence Social Skills

38. What about other treatments? 6 children: 5 boys, 1 girl Age range: 24-47 mo. 6 children matching original nonresponder profile except for one area: 3 matching profile EXCEPT had lower avoidance 3 matching profile EXCEPT had higher toy play

39. Experimental Conditions Baseline Varying length of baseline Child had free access to a variety of toys Opportunities to respond once per minute No contingencies PRT 3 weeks Specific aims – imitation of sounds/words; eye contact, appropriate play DTT 3 weeks Specific aims – imitation of sounds/words; eye contact, imitation of actions (with objects); receptive commands

42. Conclusions Change of either of two elements of the original (Sherer & Schreibman, 2005) profile led to changes in PRT treatment outcome. Children responded at a level in between the original responders and nonresponders PRT profile was not predictive oftreatment outcome with DTT suggesting specificity of PRT profile

43. Family Characteristics

44. Parental Stress • Parents experience significant stress in areas related to child with autism • Long-term care • Limits on family opportunity • Koegel, Schreibman, Loos, Dirlich-Wilhelm, Dunlap, Robbins & Plienis (1992)

45. Parental Stress Con’t • Different types of training have a differential effect on stress of parents • Naturalistic strategies reduce stress more than highly structured techniques • Parental stress is correlated with progress of child in family-oriented programs • Parents under high degree of “parent domain” stress (PSI) may not benefit from parent training.

46. Parent Support • Parents enrolled in parent training programs report that social support would be likely to reduce stress. • Gallagher, Beckman & Cross, 1983 • Moes, Koegel, Schreibman & Loos, 1993

47. Parent Support/Information Group • Purpose: • Does participation in a parent group reduce stress in parents of children recently diagnosed with Autistic Spectrum Disorders? • Do parents enrolled in a parent group learn the training techniques better than parents not enrolled in a parent group?