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The CARD Treatment Program

The CARD Treatment Program. Doreen Granpeesheh, Ph.D. GPL Conference Anaheim, California. C enter for A utism and R elated D isorders, Inc. Today’s Discussion. What is ABA? The CARD Treatment Model The CARD Curriculum Case Study and Data.

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The CARD Treatment Program

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  1. The CARD Treatment Program Doreen Granpeesheh, Ph.D. GPL Conference Anaheim, California Center for Autism and Related Disorders, Inc

  2. Today’s Discussion What is ABA? The CARD Treatment Model The CARD Curriculum Case Study and Data

  3. ABA is based on principles of Operant Conditioning Theory Operant Conditioning Theory: Human Behavior is affected by events that precede it (antecedents) and events that follow it (consequences) What is ABA

  4. Symptoms Classified as: Deficits Language Play Social Skills Theory of Mind Executive Functions Excesses Self Stimulatory Behs Maladaptive Behs Tantrums Aggression Noncompliance Application of ABA to the Treatment of Autism Behavior Management Skill Repertoire Building

  5. The CARD Treatment Model • ABA Foundation • Serve children from 18 mo – 8 yrs • Intensive treatment • Bi-Weekly supervision • Shift from home-based 1:1 learning to peer & community based learning opportunities

  6. The CARD Treatment Model:Beginning Level Services: • 30-40 hours of 1:1 in-home behavioral intervention Targets: • Build a relationship with the child • Increase child’s initiation with us • Increase Compliance • Language Training - Requests (Mand Training) • Language Training - Receptive & expressive object & action labeling (Tact Training) • Imitation, toy play, & pretend play • Self-help skills

  7. The CARD Treatment Model:Intermediate Level Skills Taught • Asking Wh Questions • Conversational language • Generalize language to play & peer situations • Emotion recognition • Sociodramatic & imaginary play • Basic cause and effect • Emphasis on generalization & playdates begin Services • 20-30 hours of 1:1 in-home intervention • 5-10 hours of preschool with a CARD shadow targeting social skills & generalization

  8. The CARD Treatment Model:Intermediate Advanced Level Services • 20 hours of therapy per week: • Includes 1:1 & playdates in home & in the community • 20 hours school with shadow Skills Taught • Classroom routines • Following complex & group instructions • Making inferences • Observational learning • Social skills and peer interaction • Pragmatic Language (e.g., introducing a topic, maintaining a conversation) • Self-monitoring, Planning and Problem Solving

  9. Services 5 - 10 hours per week at home (fading out) Gradual fading of school shadow Skills Taught Social perspective taking Academics Continued self- monitoring Advanced pragmatics (e.g., detecting sarcasm) Completion of parent and teacher training The CARD Treatment ModelAdvanced Level

  10. The CARD Curriculum

  11. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Social Skills Theory of Mind Play Language

  12. The child’s individual learning style is considered before particular skills are introduced Visual Modification suggestions in each program, for visual learners Verbal Behavior framework used in all language programs Generalization Emphasized from very early on At least 5 generalization ideas for each skill taught Flexibility worksheets for each Language program to ensure generalization The CARD Curriculum: Some general points

  13. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Social Skills Theory of Mind Play Language

  14. Language The CARD Curriculum Sample Program: Colors Function Antecedent Child’s Behavior Imitation Mom says, “blue” Jody says, “blue” Requesting (Mand) Jody is ready to finger paint, but no paint Jody says, “blue paint” Matching 3 color cards on table Jody matches blue cards Receptive 3 crayons present & mom says, “give me blue” Jody hands mom the blue crayon Labeling (Tact) Jody sees a blue car Jody says, “blue” Conversatn (Intraverbal) Mom asks, “What color is the sky?” Jody says, “blue”

  15. Language The CARD Curriculum • Emphasis on ensuring spontaneity in language use • Emphasis on teaching language that is functional in everyday situations • Emphasis on generalization Overall Goals in Teaching Language

  16. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Social Skills Theory of Mind Play Language

  17. Play The CARD Curriculum Target Areas Functional Pretend Play

  18. The CARD Curriculum Play • Features of a Comprehensive Play Skills Program • Modeled after the development of play skills in typically developing children • Breaks down each type of play into its own systematic and comprehensive program • Sequential format • Programs may be used individually, concurrently, or cumulatively

  19. The CARD Curriculum Play Typical Development of Play Skills Progression of play targets within CARD program The child observes & explores Our client imitates therapist/ parent in a 1:1 setting The child rehearses the skill on their own Reinforce independent practice of play skill & track Independent Play to ensure spontaneity The child generalizes the skill to social situations Target mastered solitary play in Social Play program, to generalize with peers

  20. Play The CARD Curriculum • Pretend Imitation with Functional Objects • Pretend Receptive Commands with Functional Objects • Vocalization of Pretend Play with Functional Objects • Expressive Identification / Narration • Creation and Initiation of Pretend Play with Functional Objects • Requesting Pretend Play with Functional Objects Sample: Functional Pretend Play

  21. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Language Play Theory of Mind Social Skills

  22. Theory Of Mind The CARD Curriculum • Theory of mind or Social Cognition is concerned with how children learn to conceptualize other people, growing an understanding of others’ • Viewpoints • Thoughts • Emotions • Intentions

  23. Theory Of Mind The CARD Curriculum • Social Cognitive Impairment in Autism • Inability to infer or empathize others’ desires / feelings • Inability to consider what others know • Inability to consider what others are thinking • Inability to infer others’ beliefs / opinions • Inability to consider unintentional behavior • Inability to infer communicative intent • Inability to understand or engage in deception • Inability to coordinate multiple social cues in a given social scenario

  24. Theory of Mind The CARD Curriculum 9 Target Areas

  25. Theory Of Mind The CARD Curriculum Sample Program: Knowing • The child learns that people know things based on the following tenets: • Knowing from Seeing • Knowing from Hearing • Knowing from Smelling • Knowing from Feeling • Knowing from Tasting • Multi sensory Knowing • Knowing from remembering • Knowing from asking • Self Knowledge (First Person) • Others’ Knowledge (Third Person)

  26. Knowing Program: Sd’s 4-6 • Sd 4a: “Do I know what (label/attribute/feature/etc?”) R 4a: “Yes/No” Sd 4b: “Why?”/ “How do I know?”/ “Why Not?” R 4b: “Because you can/can’t see/hear/smell/feel/taste it”/” • Sd 5a: “Does 3rd person know what (label/attribute/feature/etc?”) R 5a: “Yes/No” Sd 5b: “Why?”/ “How does he/she know?”/ “Why Not?” R 5b: “Because 3rd person can/can’t see/hear/smell/feel/taste it”/” • Sd 6a: “Who Knows what (label/attribute/feature/etc?)” R 6a: Child identifies appropriate person Sd 6b: “How does person know?” R 6b: “Because person can see/hear/smell/feel/taste it”/”

  27. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Language Play Theory of Mind Social Skills

  28. Choral Activities Community Social Behavior Social Play Following Rules Sharing Tattling Group Discussions Levels of Friendship Self Esteem Apologizing Cooperative Work Dealing with Conflict Safety Awareness Winning and Losing Social Skills The CARD Curriculum What skills are taught?

  29. Social Skills The CARD Curriculum Sample Program • Levels of Friendship • Child learns to identify the degree of relationship he experiences with people in his environment • Child learns to identify and rehearse behaviors that are appropriate to each relationship Best Friends Friends Acquaintances Strangers

  30. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Language Play Theory of Mind Social Skills

  31. Self-Help Eating & drinking Toileting Dressing Bathing Household Chores Self Help & Motor Skills The CARD Curriculum Components • Fine Motor Skills • Arm/hand/finger strength • Drawing • Cutting • Coloring • Writing • Gross motor skills • Walking & running • Ball skills • Riding a bike

  32. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Language Play Theory of Mind Social Skills

  33. Processes that underlie goal directed behavior Executive Function The CARD Curriculum What is Executive Function?

  34. Visualizing situation Identifying desired objective Determining plan to meet objective Monitoring progress to goal Executive Function The CARD Curriculum Goal Directed Behavior Involves…

  35. Executive Function The CARD Curriculum Inhibition Planning & Problem Solving Flexibility Self- Monitoring Working Memory Attention

  36. The CARD Curriculum School Skills Executive Function Self Help & Motor Skills Play Theory of Mind Social Skills Language

  37. Math Addition & Subtraction Advanced Counting Money Telling Time Reading Comprehension Book Topography Story Comprehension Story Summarizing Text Comprehension Spelling Copying and Dictation Rhyming Vocabulary Synonyms and Antonyms Thematic Vocabulary School Skills The CARD Curriculum Scope

  38. Joey’s Story: A Case Study

  39. A case study: Joey • Joey was diagnosed with Autistic Disorder in December of 1995. • CARD Treatment was initiated in February of 1996 at the age of 3 years, 6 months. • Treatment intensity ranged from 30 to 40 hours per week of 1:1 in-home and school based behavioral intervention for approximately 2 ½ years

  40. Deficits: Profound Delays in Joint Attention Minimal Language Inability to Interact Socially with Peers No Purposeful Concrete or Imaginative Play Excesses: Frequent Non-compliance Frequent Tantrum Behavior Self-Stimulatory Behaviors: Lining objects, “video talk”, obsessions with trains, hand flapping and gazing Echolalia Joey’s Repertoire at Intake: Skills: • One word expressive labels • Simple imitation • One step receptive instructions • Some single word responses to social questions

  41. At Intake…

  42. Services: Year One • Full inclusion in general education pre-school (12 hours p/w). • Full-time CARD shadow in the classroom. • 25 hours per week home based behavioral intervention.

  43. Intervention: Year One • Play Skills • Identifying emotions • Following instructions (increasing complexity) • Functions • Gender • Categories • Academic skills (Letters and Numbers) • Plurals, tenses, pronouns • Acquiring stimulus control of pre-existing behaviors • Increasing compliance to requests • Mands • Increasing attending behavior • Reducing maladaptive behaviors • Object labels (including names, animals, places) • Actions / verbs • Attributes (including colors)

  44. At 3 Months…

  45. At 4 Months…

  46. At 5 months…

  47. At 6 Months…

  48. Year-One Progress Chart: Mastered Programs

  49. Year-One Progress Chart: Mastered Sub-skills

  50. Year-One Progress Chart: Mastered Responses

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