Lynn Brennan, - PowerPoint Presentation

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Lynn Brennan, Ed.D., BCBA-DConsultant to the University of Connecticut Parent Training ProjectConference:Autism Spectrum Disorder:from clinical practice to educational provisionCentre for Autism and Developmental DisordersNational University of Ireland, GalwayGalway IrelandJanuary 13, 2012

Video training materials for parents on behavioral principles:

A project in developmentSlide2

Parent Mediated InterventionVarious approaches – some behavioral and others developmental, social-communication, eclecticGoals 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, 2004Slide3

Commercially Available ABA Video Based Parent Training ProgramsExamples:Simple Steps Autism - Mickey Keenan Ph.D., BCBA-D*, Karola Dillenburger 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., BCBASlide4

University of Connecticut Parent Training ProjectTeaching Skills To Toddlers: A Program for CaregiversThree 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 Slide5

Project AimsDesign and produce an effective, primarily video-based, parent training program Training in basic behavioral principlesApplication 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.Slide6

Project Aims - ContinuedThe 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 ASDGive parents a set of tools that enable them to:Promote social engagement Teach fundamental communication skills and other foundational learning skillsManage interfering behavior Slide7

Target ConsumersCaregivers with developmental concerns with or without an ASD diagnosis.Caregivers waiting for early intervention to startCaregivers wanting to supplement sparse early interventionBehavior therapists who want to provide supplemental teaching materials to caregiversCaregivers who have little or no access to early interventionAmerican consumers will primarily be in the first three groupsSlide8

International OutreachProject 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 materialsSlide9

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.Slide10

MOTHER’S RATINGS

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– Sh

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(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.

4.8Slide11

MOTHER’S RATINGS20

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2011

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Continued…I believe this treatment to offer an effective means of helping with problem behavior. 4.2I believe the treatment is likely to result in permanent improvement. 4I 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.

4.8Slide12

Parents’ CommentsPeriodic clinic meetings seen as very helpfulEager to continue participating in their children’s intervention Desire for more focus on generalization of skills from therapy environment to homeDesire for more focus on problem behavior at home and in communityMore on the Albanian Pilot Project later…Slide13

DVD FormatExperts will describe basic evidence-based principles and techniques using simple, non-technical languageInput from in-country experts to ensure that material is culturally sensitiveFor 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.Slide14

DVD Format ContinuedCaregivers can move at their own pace Modules can be viewed individually and reviewedCaregivers 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 intervalsWill need to provide self-assessment strategies and possibly oral quizzes after each moduleMay provide homework and quizzes for parents in formal studiesSlide15

ContentThe instruction will be based on principles of Applied Behavior Analysis (ABA), with specific application to:Social ReciprocityFunctional CommunicationReceptive and Expressive LanguageCognitive SkillsPlay 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.Slide16

Scope and Sequence of the DVD ProgramPart OneSection 1 – IntroductionSection 2 – Normal MilestonesSection 3 - Some Basic Principles of TeachingSection 4 – Teaching Social Interaction to Very Young ChildrenSection 5 – Using Visual Supports to Jump Start CommunicationSection 6 – Teaching Daily Living SkillsSection 7 - Some basic ideas about preventing and handling problem behavior.

Section 8 - Play Slide17

Scope and Sequence of the DVD ProgramPart TwoSection 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 1Section 3 - More about ReinforcementSection 4 - More about Shaping and ChainingSection 5 – More about Naturalistic Teaching MethodsSection 6 - More about Structured Teaching MethodsSection 7 – Teaching more Advanced Language and Communication SkillsSlide18

Shaping Eye Contact During Mealtime Timing is everything! Wait for eye contact before delivering bites. Prompt by holding the food up near your eyes.Slide19

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!Slide20

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 routinesSlide21

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 languageSlide22

Toys with multiple pieces can easily be used to promote eye contact.Access to the balls is contingent upon eye contact. Slide23

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.Slide24

Shaping a Request PointSeries of prompted to independent request points.Slide25

Shaping ImitationNotice the progression from a fully prompted response to a partially prompted response, followed by an independent response which can now be shaped for accuracy.Slide26

The Albanian Pilot ProjectCurrent plan is for 3 groups of 15 families each, matched for age & family incomeProfessionally Delivered Center-Based Intervention AloneParent Training DVD with Minimal Home SupportCombined Treatment Slide27

Project Evaluation: Pre- and post-interventionEarly 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)Slide28

Project Evaluation ContinuedTreatment 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 speakingUse of clear instructional commands using language appropriate to child’s skill levelUse of prompts and prompt fading proceduresDelivery of contingent consequencesSlide29

“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!