Video training materials for parents on behavioral principles: A project in development

1. Video training materials for parents on behavioral principles: A project in development Lynn Brennan, Ed.D., BCBA-D Consultant to the University of Connecticut Parent Training Project Conference: Autism Spectrum Disorder:from clinical practice to educational provision Centre for Autism and Developmental DisordersNational University of Ireland, Galway Galway Ireland January 13, 2012

2. Parent Mediated Intervention • Various approaches – some behavioral and others developmental, social-communication, eclectic • Goals vary - Some target very specific and discrete behaviors/skills (i.e. imitation, compliance, joint engagement, etc.) others have a broader focus. A few examples: • Ingersoll & Dvortcsak, 2006 (Combination of Developmental [Indirect] and Naturalistic Behavioral [Direct] Tx Models) • Ingersoll & Gergans, 2006 (Reciprocal Imitation Training - RIT) • Bahadourian & Greer, 2005 (CABAS Model PT) • Johnson et al., 2007; Aman et al., 2009 (Multi-site Randomized Controlled Trial; Meds Alone vs. Meds + PT) • Vismara, Colombi & Rogers, 2009 (Early Start Denver Model) • Kasari et al., 2010 (Joint engagement) • Smith, Groen & Wynn, 2000 (EIBI vs Parent Training) • Green, J., et al., 2010 (PACT) (Parental Synchrony, Child Initiation, Shared Attention Time) & Alred, Green & Adams, 2004

3. Commercially Available ABA Video Based Parent Training Programs Examples: Simple Steps Autism - Mickey Keenan Ph.D., BCBA-D*, KarolaDillenburger Ph.D., BCBA-D, * Stephen Gallagher, Ph.D., BCBA-D*, Neil Martin Ph.D., Ph.D., BCBA-D  *University of Ulster Rethink Autism - Daniel A. Etra, Eran Rosenthal, Jamie Pagliaro, Bridget A. Taylor, Psy.D., BCBA-D, Robyn Catagnus, Ed.D., BCBA-D Maximum Potential Kids - Coby Lund Ph.D., BCBA, and Janet Lund, Ph.D., BCBA

4. University of Connecticut Parent Training Project Teaching Skills To Toddlers: A Program for Caregivers Three year project funded by the U.S. National Institute of Health (NIH) Principal Investigator is Deborah Fein, Ph.D. University of Connecticut Board of Trustees Distinguished Professor of Psychology and Pediatrics

5. Project Aims Design and produce an effective, primarily video-based, parent training program Training in basic behavioral principles Application of these principles to some common problems of young children with ASD The DVD package will be offered free of charge. Designed to be accessible to individuals with a wide range of education or literacy levels.

6. Project Aims - Continued • The DVD's are NOT designed as a substitute for professionally delivered Intensive Early Behavioral Education (EIBI). • Primary prevention strategy to reduce the likelihood and/or severity of the problem behaviors that are so often concomitant with ASD • Give parents a set of tools that enable them to: • Promote social engagement • Teach fundamental communication skills and other foundational learning skills • Manage interfering behavior

7. Target Consumers • Caregivers with developmental concerns with or without an ASD diagnosis. • Caregivers waiting for early intervention to start • Caregivers wanting to supplement sparse early intervention • Behavior therapists who want to provide supplemental teaching materials to caregivers • Caregivers who have little or no access to early intervention • American consumers will primarily be in the first three groups

8. International Outreach Project also under development for use in developing countries where little or no intervention is available Physicians and researchers from Albania, Bangladesh, Mexico, India, Japan and Turkey have expressed interest in collaborating on development of international versions of the training materials

9. Pilot Project with the Albanian Children’s Foundation (ACF) Vodafone Project: Year-long therapist training program with the ACF and Autism Speaks. Limited parent training was provided as a part of the Vodafone project. New Autism Speaks grant will include the development and testing of an Albanian version of the DVD training program in conjunction with ACF.

10. MOTHER’S RATINGS 2010-2011 TRAININGWORKSHOPS Adapted from TreatmentEvaluation Inventory– ShortForm (TEI-SF) 5-Point Likert Scale As a result of this year’s training program, I believe that I have a better understanding of my child’s learning challenges. 5 After a year of participation in this training project, I believe that I am more skilled at helping my child. 4.2 I find this treatment to be an effective way of teaching important skills. 5 I would be willing to use these procedures to change my child’s problem behavior. 5 I like the procedures used in this treatment. 4.8

11. MOTHER’S RATINGS2010-2011 TRAININGWORKSHOPS Continued… I believe this treatment to offer an effective means of helping with problem behavior. 4.2 I believe the treatment is likely to result in permanent improvement. 4 I believe it would be acceptable to use this treatment with individuals who cannot choose treatments for themselves. 4 Overall, I have a positive reaction to this treatment. 5 I attended the workshops on feeding problems, toilet training and/or incidental teaching methods in the home environment, and I found the information useful and helpful. 4.8

12. Parents’ Comments Periodic clinic meetings seen as very helpful Eager to continue participating in their children’s intervention Desire for more focus on generalization of skills from therapy environment to home Desire for more focus on problem behavior at home and in community More on the Albanian Pilot Project later…

13. DVD Format • Experts will describe basic evidence-based principles and techniques using simple, non-technical language • Input from in-country experts to ensure that material is culturally sensitive • For example, in some versions, the diagnostic label of autism or ASD will not be used in an effort to increase acceptability of the DVD’s. • Concepts will be packaged in short, easy-to-digest modules or tool-kits • Instruction will be accompanied by illustrative video clips, which are currently being filmed and culled.

14. DVD Format Continued Caregivers can move at their own pace Modules can be viewed individually and reviewed Caregivers will be encouraged to discuss the concepts and practice the techniques with other adults before trying them with their children. Major concern is the minimal amount (in some cases absence) of expert feedback at regular intervals Will need to provide self-assessment strategies and possibly oral quizzes after each module May provide homework and quizzes for parents in formal studies

15. Content • The instruction will be based on principles of Applied Behavior Analysis (ABA), with specific application to: • Social Reciprocity • Functional Communication • Receptive and Expressive Language • Cognitive Skills • Play Skills • Activities of Daily Living (i.e., feeding, toilet training, etc.) • A Basic Understanding of Functional Behavior Assessment • Structured and naturalistic behavioral teaching strategies will be presented. • Adaptations for children under the age of three will be specifically addressed. • Typical developmental milestones will also be reviewed.

16. Scope and Sequence of the DVD ProgramPart One Section 1 – Introduction Section 2 – Normal Milestones Section 3 - Some Basic Principles of Teaching Section 4 – Teaching Social Interaction to Very Young Children Section 5 – Using Visual Supports to Jump Start Communication Section 6 – Teaching Daily Living Skills Section 7 - Some basic ideas about preventing and handling problem behavior. Section 8 - Play

17. Scope and Sequence of the DVD ProgramPart Two Section 1 - Getting started with more intensive teaching sessions with child over 2 years of age. Section 2 - Let’s Review - A review of some important lessons from Part 1 Section 3 - More about Reinforcement Section 4 - More about Shaping and Chaining Section 5 – More about Naturalistic Teaching Methods Section 6 - More about Structured Teaching Methods Section 7 – Teaching more Advanced Language and Communication Skills

18. Shaping Eye Contact During Mealtime • Timing is everything! • Wait for eye contact before delivering bites. • Prompt by holding the food up near your eyes.

19. Pick-up Games of Peek-a-boo After Lunch! • Condition YOURSELF as a reinforcing agent… • YOU can be more fun than ANY toy! • Make eye contact fun ~ The element of surprise!

20. Bubble Fun in the Bathtub • Teaching “Nose & All Gone” in the Natural Environment • Repetition – Creating routines • Fill in the blanks • Make small changes to the routines

21. At Playtime, Select Toys that Enable you to Embed Yourself into the Play • Working on eye contact with a set of tops that the child cannot operate on her own. • Note the use of simple language

22. Toys with multiple pieces can easily be used to promote eye contact. Access to the balls is contingent upon eye contact.

23. What to do when the child is over-focused on a toy that is not conducive to joint engagement. • If the child has selected a toy that is not conducive to joint engagement it may be preferable to select a different toy. • BEFORE removing a toy that is drawing attention away from you, present the replacement. • Remove pieces BEFORE you give the child the toy. • Embed yourself in the play by controlling access to the pieces which can function as natural reinforcers.

24. Shaping a Request Point Series of prompted to independent request points.

25. Shaping Imitation Notice the progression from a fully prompted response to a partially prompted response, followed by an independent response which can now be shaped for accuracy.

26. The Albanian Pilot Project • Current plan is for 3 groups of 15 families each, matched for age & family income • Professionally Delivered Center-Based Intervention Alone • Parent Training DVD with Minimal Home Support • Combined Treatment

27. Project Evaluation: Pre- and post-intervention • Early Intervention Parenting Self-Efficacy Scale (Guimond et al, 2008). • Modified version of the Treatment Evaluation Inventory – Short Form (TEI-SF) (Kelley et al., 1989) • Home Situations Questionnaire (HSQ) – PDD Version (Chowdhury et al., 2010) • Selected sections from the ABLLS-R (Partington, 2006)

28. Project Evaluation Continued • Treatment Fidelity will be rated blind to group from a video-taped teaching session, using relevant items from the Performance Evaluation Form (PEF) (adapted from Leaf & McEachin, 1999) to assess key instructional skills including: • Ensuring child is attending prior to speaking • Use of clear instructional commands using language appropriate to child’s skill level • Use of prompts and prompt fading procedures • Delivery of contingent consequences

29. “Film at 11:00” Remember…This is a project in development. Please stay tuned… As they say on the 6:00 news… “Film at 11!” Thank you!