Established Treatments with Favorable Outcomes Reported: Ages 3-5

1. Established Treatments with Favorable Outcomes Reported:Ages 3-5 National Standards Report National Autism Center Evidence-Based Practice Guidelines for Autism Spectrum Disorders

2. Evidence-Based Practice • Evidence-based practice involves the integration of research findings with • Professional judgment and data-based clinical decision making • Values and preferences of families, including the student when possible • Assessing and improving the capacity of the system to implement the intervention with a high degree of accuracy Collaboration is the key to achieving best outcomes!

3. Autism Spectrum Disorder • Autistic Disorder • Asperger’s Syndrome • Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS) Rett’s Disorder and Childhood Disintegrative Disorder are under Pervasive Developmental Disorder (Autism Spectrum Disorder) in the DSM-IV-TR, 2000, but are not included in this report because they are rare and sufficiently different from the above 3 disorders.

4. Treatment Targets • Many different skills or behaviors are targeted when treating individuals with ASD • Report targeted 14 treatment categories for a favorable outcome: • Skills Increase • Behaviors Decrease

5. Skills Increased • Academic- sequencing, color, letter, number identification, pre-writing • Communication- requesting, labeling, receptive, conversation, greetings, nonverbal, expressive, syntax, speech, articulation, discourse, vocabulary, pragmatics • Higher Cognitive Functions- critical thinking, IQ, problem-solving, working memory, executive functions, organizational skills, theory of mind tasks • Interpersonal- joint attention, friendship, social and pretend play, social skills, social engagement, social problem solving, appropriate participation in group activities • Learning Readiness- imitation, following instructions, sitting skills, attending to environmental sounds

6. Skills Increased (continued) • Motor Skills- cutting, coloring, writing, threading beads, sitting, standing, walking, throwing/catching a ball • Personal Responsibility- feeding, sleeping, dressing, toileting, cleaning, family and/or community activities • Placement- level of restriction in placement in school, home, or community setting • Play- functional independent play • Self-Regulation- persistence, effort, task fluency, transfer of attention, being “on schedule,” remaining in seat, adapting to changes in environment

7. Behaviors Decreased • General Symptoms- combination of symptoms directly associated with ASD or result of psycho-education needs sometimes associated with ASD • Problem Behaviors- self-injury, aggression, disruption, destruction of property, hazardous behaviors • Restricted, Repetitive, Nonfunctional Patterns of Behavior, Interests, or Activities- stereotypic and compulsive behaviors, inappropriate speech, restricted interest • Sensory or Emotional Regulation- stimulus refusal, sleep disturbance, anxiety, depression

8. Established Treatments • Evidence based interventions with sufficient research to show they are effective.

9. Treatment Summaries • The following slides include summaries of established treatments (evidence based practices) that are available to school system personnel who are working with preschool age children with an eligibility of Autism Spectrum Disorder.

10. Antecedent • Modification of situational events that typically precede the occurrence of a target behavior. • Alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. • Includes applied behavior analysis, behavioral psychology, and positive behavior supports • By concentrating on how we can modify the environment ahead of time, we can support a student’s learning and decrease the likelihood of problem behaviors.

11. Antecedent Intervention • Involve observing student in setting where problem behaviors occur • Determine which environmental changes are appropriate • Can be cost effective and require minimal time

12. Antecedent intervention may be effective with: • Communication skills • Social skills • Learning readiness • Daily living skills • Play skills • Self-regulation • Problem behaviors • Sensory and emotional regulation

13. Behavioral Intervention • Begin with an evaluation of what happens in the environment before and after the targeted behavior occurs • Use collected data to modify the environment accordingly • Goal is to maximize student success

14. Behavioral Intervention • Reduces problem behavior and teaches functional alternative behaviors or skills through the application of basic principles of behavior change • Treatments include applied behavior analysis, behavioral psychology, and positive behavior supports • Based on both antecedents and consequences

15. Behavioral interventions may be effective with: • Academic skills • Communication skills • Social skills • Learning readiness • Daily living skills • Play skills • Self-regulation • Problem behaviors • Restricted, repetitive activities or interests • Sensory or emotional regulation

16. Joint Attention Intervention • Addresses building foundational skills involved in regulating the behaviors of others. • Involves teaching a child to respond to the nonverbal social interactions of others or to initiate joint attention interactions. • Examples: pointing to objects, showing items/ activities to another person, and following eye gaze.

17. Joint Attention Intervention:Examples • A child’s eye gaze follows an adult’s gaze • A child prompts someone to look at an item • A child shows an object to another person • A child points to an object or responds when an adult points to an object • A child and an adult watch an activity together and look to the response of the other person

18. Joint Attention Intervention • May be effective for very young children • Has favorable outcomes for children diagnosed with autism and PDD-NOS • May increase communication and interpersonal skills

19. Modeling • Relies on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with ASD. • Modeling can include simple and complex behaviors. • Often combined with other strategies such as prompting and reinforcement. • Examples include live modeling and video modeling.

20. Modeling may be effective with: • Communication skills • Higher cognitive functioning • Interpersonal skills • Personal responsibility • Play skills • Problem behaviors • Sensory and emotional regulation

21. Live Modeling • Person demonstrates the target behavior in the presence of the student with ASD • Model may be an adult or peer

22. Video modeling • Model may be another student or an adult • Student may serve as own model (self-modeling) • Student should watch only successful performance of tasks and positive outcomes!

23. Advantages of Video Modeling • Cost and time effective • Unlimited repetitions available for viewing by multiple students • Teaching sessions can be quick and simple

24. NTS: Naturalistic Teaching Strategies • Involve using primarily child-directed interactions to teach functional skills in the natural environment. • Involve providing a stimulating environment, modeling how to play, encouraging conversation, providing choices and direct/natural reinforcers, and rewarding reasonable attempts. • Take advantage of naturally occurring events in a student’s day to teach and maintain new skills

25. Naturalistic Teaching Strategies • By following the child’s interests, you are more likely to: • Identify direct and natural reinforcers • Capitalize on the student’s motivation • Provide variety based on the student’s interests on a given day

26. Naturalistic Teaching Strategiesmay be effective with: • Communication skills • Interpersonal skills • Play skills

27. Peer Training • Involves teaching children without disabilities strategies for facilitating play and social interactions with children on the autism spectrum. Peers may include classmates or siblings. • Examples include peer networks, circle of friends, buddy skills package, Integrated Play Groups, peer initiation training, and peer-mediated social interactions.

28. Peer Training may be effective with: • Communication skills • Interpersonal skills • Play skills • Social interaction • Sharing • Offering and seeking assistance • Being a “good buddy”

29. Choose peers who are: • Socially skilled • Generally compliant with instructions • Have regular school attendance • Are willing to participate in training • Are able to imitate a model

30. Peers must be taught to: • Get the attention of the child with ASD • Facilitate sharing • Provide help and affection • Model appropriate play skills • Be a “good buddy” • Help organize play activities

31. After Peer Training: • Both groups of children should engage in a structured play setting • Educators should teach initiation strategies to the student with ASD • Educators should provide prompts and feedback to facilitate interaction between both groups

32. Keep these factors in mind with peer training: • Age and skill level of all participating students should be similar • Activities should address the interests and preferences of both groups of students • Expect challenges with maintenance and generalization of the targeted skills!

33. Schedules • Involve presentation of a task list that communicates a series of activities or steps required to complete a specific activity. • Examples include written words, pictures or photographs, or work stations.

34. Schedules • Provide predictability even for things that may appear reasonable and predictable to us. • Schedules target daily activities and include planning for events on a daily, weekly, or monthly basis. • Schedules presentation can vary from Boardmaker pictures, 3-D objects, “to-do” list…

35. Schedules have been shown to: • Be effective with children aged 3-14 years • Be associated with favorable outcomes for individuals with ASD • Improve self-regulation skills

36. Self Management • Widely used to promote independence in children with tasks in which adult supervision is not needed or expected • Naturally occurs with most people, but needs to be programmed in individuals with ASD

37. Self-Management • Involves promoting independence by teaching individuals with ASD to regulate their behavior by recording the occurrence/non-occurrence of the target behavior, and then obtaining reinforcement for success • Examples include the use of checklists (using checks, smiley/frowning faces), wrist counters, visual prompts, and tokens

38. Self-Management may be effective with: • Academic skills • Interpersonal skills • Self-regulation

39. Benefits of Self-Management • Builds awareness of behavior • Accountability for carrying out a procedure • Direct and immediate self-feedback • Teaches multi-tasking • Decreases social stigma that occurs when adults must assist with simple and personal tasks

40. To evaluate own efforts at self-management, student must have: • Clear established criteria to determine success • A systematic method for evaluating performance • A qualified person to provide feedback about the accuracy of recording • A qualified person who can teach the child to seek and get access to reinforcers