Solution Focused Interventions for Children with Autism

1. Solution Focused Interventions for Children with Autism Rose Iovannone, Ph.D., BCBA-D University of South Florida iovannone@fmhi.usf.edu 813-974-1696

2. Objectives • Participants will: • Describe the standards for establishing an intervention as “evidence-based” • Use guiding questions to determine the level of evidence held by various interventions • Describe the features of several interventions with established efficacy for young students and explain how to implement them in their environments

3. Agenda • What is evidence? • Examples of strategies with evidence • Resources

4. “If you’ve seen one child with Asperger’s Syndrome or autism, you have seen one child with Asperger’s Syndrome or autism.” Brenda Smith Myles November 14, 2000

5. Evidence-BasedWhat is it?

6. Evidenced-Based Practice An instructional strategy that: • Has a base of high quality research over a range of different students, in a range of places, and over a range of behavior • Has been shown to result in measurable educational, social, or behavioral benefit

7. Identifying Evidence-Based Interventions • “Reliance on sources such as expert opinion is contrary to evidence-based practice approach because such alternatives have many sources of potential bias.” • Gambrell, 2003 (page 13)

8. Identifying Interventions • Internet as a source is overwhelming: • Example: term “autism cure” Google search 2 time points (Feb. 2005-Feb. 2006) • Change in number of web pages—528,000 to 5,290,000 (Long, 2006) • Many not evaluated nor provide reliable information about their claims (or outcomes) • Training programs (for practitioners) do not consistently disseminate evidence-based practices

9. Identifying Interventions • No single research method can answer all questions • Experimental: Manipulating variables systematically—quantitative • Descriptive: Description of naturally occurring relations between 2 or more variables—qualitative • Experimental provides the answer about an intervention’s impact on behaviors • Descriptive provides directions for research; does not demonstrate causal relationships

10. Two Methods of Establishing Evidence • Threshold (restrictive) • Number of randomized clinical trials (standard = 2) • Hierarchy of Evidence (more inclusive) • Continuum (4-5 points) of evidence • Example: Well established to no supporting evidence • Evaluating evidence • Randomized control trials = gold standard • Well designed quasi-experimental studies = acceptable but weak • Single-participant—not clear

11. Identifying Interventions • Currently, there is no reliable database for validated autism interventions • Alternative—construct interventions that contain principles of behavior—Formative • E.g., antecedent control, positive reinforcement, shaping, fading

12. Implementing the Intervention • Match to sample • Training of intervention agents • Characteristics of students • Environmental context • Training and fidelity issues

13. Evaluating the Intervention • Measuring progress should occur frequently and systematically • Two questions: • Is the behavior changing? • At what rate is behavior changing?

14. Guidelines for Consumers (Detrich, 2008) • Decisions about interventions should be based on the best available experimental evidence • In the absence of clear evidence-based information, interventions should be developed that use strategies from the established principles of behavior • When modifying an intervention, base it on the established principles of behavior • Select interventions that were tested situations similar to those of the specific student • Direct training should be provided to practitioners • Fidelity measures should be collected regularly • Systematic evaluation of progress should be conducted

15. What are Evidence-Based Practices?

16. Guides • National Research Council (2001) • National Standards Report (2009) • Iovannone et al., (2008, 2003)

17. National Research Council • Practices recommended: • Curriculum focus on social interaction, play and communication • Specialized services—speech/language & occupational therapy • Family involvement • Consistent and ongoing communication between team members • Capacity to address behavioral challenges • Specialized and ongoing training and support to staff

18. http://www.nationalautismcenter.org/about/national.php

19. NSP Evidence-Based Interventions • 2009 Report is the first. Future reports will expand focus of criteria for inclusion • -Looked only at educational and behavioral interventions (excluded biomedical with exception of curative diets) • -Looked at only two classes of research design (group and single-subject) • -Limited scope to strict diagnostic criteria

20. NSP Strength of evidence • Strength of Evidence Classification System used by National Standards Project • Established • Emerging • Unestablished • Ineffective/Harmful

22. Established interventions 1. Antecedent Package 2. Behavioral Package 3. Comprehensive Behavioral Treatment for Young Children 4. Joint Attention Intervention

23. Established interventions 5. Modeling 6. Naturalistic Teaching Strategies 7. Peer Training package 8. Pivotal Response Treatment

24. Established interventions 9. Schedules 10. Self-management 11. Story-based Intervention Package

25. Unestablished interventions • Academic Interventions • Auditory Integration Training • Facilitated Communication • Gluten-and-Casein-Free Diet • Sensory Integrative Package

26. Effective Educational Strategies (Dunlap, Iovannone, & Kincaid, 2008; Iovannone, Dunlap, Huber, & Kincaid, 2003) • Individualized Supports and Services • Systematic Instruction • Comprehensible/Structured Learning Environments • Specific Curriculum Content • Functional Approach to Problem Behavior • Active Family Involvement

27. Evaluative Questions for Interventions • Will the intervention • impair or detract? • cause frustration or regression? • What happens if method proves ineffective? • Is method balanced with other components? • Is the intervention developmentally appropriate?

28. Evaluative Questions for Interventions • Has the intervention been validated scientifically? • How will the intervention be integrated into the individual’s current program? • Have appropriate outcomes and assessment methods been identified? • Does it lead to increased independence? • What is impact on quality of life?

29. Examples of evidence-based strategies Activity Matrices Prompting Hierarchy Data FUNN Positive Behavior Support

30. Characteristics of Critical Skills • Broad classes of behaviors • Variety of contexts • Required to complete part or all of activity • Not THE activity • Not sweeping, taking out trash, washing dishes • Instead—communicating need for materials, using both hands together to complete task, initiate social interactions • Repeated use throughout all daily activities and routines • Activity-based goals may limit opportunities for student to practice skill throughout day (e.g., sweeping) • Examples—expressing concerns, bilateral coordination, response to social interactions

31. Identifying What to Teach: Critical Skills • Broad classes of behaviors • Variety of contexts • Required to complete part or all of activity • Not THE activity • Not sweeping, taking out trash, washing dishes • Instead—communicating need for materials, using both hands together to complete task, initiate social interactions • Repeated use throughout all daily activities and routines

32. Use an Activity Matrix to: • Plan for specialized instruction • Assess individual needs in classroom setting • Plan when data collection will occur • Plan activities and materials necessary for incidental teaching or embedded instruction

33. Activity-Based Intervention Matrix adapted from Grisham-Brown and Hemmeter, 1998

35. Classroom Activity Matrix

38. Activity-Based Intervention Matrix A adapted from Grisham-Brown and Hemmeter, 1998

39. Activity-Based Intervention Matrix B adapted from Grisham-Brown and Hemmeter, 1998

40. Activity-Based Intervention Matrix C adapted from Grisham-Brown and Hemmeter, 1998

41. Activity-Based Intervention Matrix D adapted from Grisham-Brown and Hemmeter, 1998

42. Activity-Based Intervention Matrix E adapted from Grisham-Brown and Hemmeter, 1998

43. Activity-Based Intervention Matrix F adapted from Grisham-Brown and Hemmeter, 1998

49. Activity Matrix

50. Prompting Hierarchy Natural Cue Gesture Verbal LEAST TO MOST Visual/Picture MOST TO LEAST Model Physical (partial, full) Full Physical