Presentation on theme: "Early Intervention in Autism"— Presentation transcript:
1Early Intervention in Autism DR . PRADEEP DUBEY MD. (Ped.) DCHAadiguru Neuropediatric Centre,Near Prem Mandir Wright Town, Jabalpur
2Autism and Childhood Schizophrenia Once thought to be a form of schizophreniaDiffers from schizophrenia in terms of symptoms, age of onset, family history, etiology, and response to treatment
3Definition of Autism markedly abnormal or impaired development in: social interactioncommunicationand markedly restricted repertoire of activities and interests.
4Definition of Autism (continued) Definitions are cheap, but explanations are dear, and we must be careful not to confuse them.David Palmer, 2004
5Autism Spectrum Disorders Neurological disorders characterized by "severe and pervasive impairment in several areas of developmentAutistic DisorderAsperger's DisorderChildhood Disintegrative Disorder (CDD)Rett's DisorderPDD-Not Otherwise Specified (PDD-NOS)
6Prevalence of Autism Typically diagnosed within first three years 2 to 6 in 1,000 individuals (Centers for Disease Control and Prevention, 2001)Four times more prevalent in boys than girls
7NIH Research Dollars Devoted to Autism When compared with other serious childhood conditions, autism is much more common, but fewer dollars per case are spent on autism.
8Prevalence of Autism and Other Conditions (Number of Cases per 10,000 Children)706050403020Autism is a debilitating disorder that affects 1 in 166 children. It is 10 times more common than juvenile diabetes, muscular dystrophy, childhood leukemia, and cystic fibrosis combined, yet over 100 times more research dollars per case are spent on these other conditions than are spent on autism. Awareness of the need to increase funding for both basic and applied research on autism is rapidly growing in both the public and private sectors. We are at a unique juncture, …a point in time that provides a rare opportunity to realize our vision of developing one of the premier centers of excellence in the study and treatment of autism. We have ongoing collaboration with colleagues at major medical centers like Johns Hopkins and Emory University, and we are developing new area of collaboration with experts at Boston University, and the Universities of North and South Dakota. Our strategy is to build upon our current strengths and to add key areas of expertise that will complement one another and create a heightened level of synergy and innovation.10AutismJuvenile DiabetesMuscular DystrophyLeukemiaCystic Fibrosis
9NIH Research Dollars for Autism and Other Conditions (Number of Dollars per Case)$140,000$120,000$100,000$80,000$60,000Before discussing operant mechanisms that may be directly relevant to the diagnosis of autism, I will first briefly describe how functional analysis methods have recently been extended to the examination of complex relations involving multiple operant mechanisms. READ SLIDE.$40,000$20,000$-AutismJuvenile DiabetesMuscular DystrophyLeukemiaCystic Fibrosis
11Demographics of Autism Knows no racial, ethnic, or social boundariesFamily income, lifestyle, and educational levels do not affect the chance of autism's occurrenceDiagnosis of autism is growing at a rate of10-17% per year (U.S. Department of Education, 2002)
12Assessment and Diagnosis of Autism No medical tests for diagnosing autismAccurate diagnosis is based on observation of the individual's communication, behavior, and developmental levels.Autism Diagnostic Interview-R (ADI-R)Home and/or school observationVideo analysis of behavioral observation
13Identifying the Genetic Bases of Autism Spectrum Disorders Etiologic workups identify specific genetic causes for autism in about 20% of cases.At the Munroe-Meyer Institute, Dr. Schaefer and colleagues (2006) developed a 3-Tiered Approach that identifies genetic causes in 40% of cases.We are already a leader in genetic diagnosis among children with autism. Most centers are able to identify a specific genetic cause for autism in only about 20% of cases. Our experts at the Munroe Meyer Institute have doubled that figure and continue to make further advances.
14Early Screening for Autism (NICHD) Does not babble or coo by 12 monthsDoes not gesture (point, wave, grasp) by 12 monthsDoes not say single words by 16 monthsDoes not say two-word phrases on his or her own by 24 monthsHas any loss of any language or social skill at any age
15Early Screening for Autism (CHAT) Does not display pretend play (e.g., pretending to drink from a toy cup)Does not point at objects to indicate interestDoes not show interest in other childrenDoes not enjoy peek-a-boo hide-and-seek or other social gamesDoes not bring and show objects to parents
18Genetics and Twin Studies Autism runs in familiesHeritability for autism is about 90%Monozygotic twin concordance, 60%-100%Dizygotic twin concordance, 10%Associated with abnormalities on chromosomes 7q, 2q, and 15q
19Applied Behavior Analysis (ABA) What is ABA?How is it different from other approaches?How is it done?
20Baer, Wolf, & Risley (1968)APPLIED—strives to produce rapid and clear benefit to problems of social importance;BEHAVIORAL—uses objective and accurate measurement of the behavior of interest;ANALYSIS—uses controlled (single-case) methods to understand the environmental variable(s) that influence an individual’s behavior.
21Historical Roots of Behavior Analysis 1911 Thorndike-Law of effect1924 Watson-Behaviorism1927 Pavlov-Conditioned Reflexes1938-Skinner Behavior of Organisms1950’s-Behavioral applications reported in scientific journals1968-Journal of Applied Behavior Analysis
22How Effective is ABA for Autism? About 50% of Children with autism and mild mental retardation who received early intervention with ABA attain normal IQs and are educated in regular classrooms with minimal assistance.
23Outcomes of ABA for Autism 35302520Increases in IQ Scores15r = .79p < .0210To date, ten peer-reviewed studies have reported reported clinically significant improvements in IQ following intensive early behavioral intervention. There has been considerable variation across studies with regard to the specific behavioral components included in these studies and also in the amount of treatment provided. Nevertheless, across these studies, the median IQ gain was about 20 points.. Not quite as large as those reported by Lovaas, but still impressive. In addition, the general trend across studies is that the number of hours of treatment per week is significantly correlated with gains in IQ scores.551015202530354045Hours per Week of Treatment
24How Effective is ABA for Autism? Early Intervention of Autism using ABA has been recommended by:New York State Dept. of HealthU.S. Surgeon GeneralNational Research CouncilAssociation for Science in Autism Treatment
25Why is ABA Effective?ABA developed from and remains closely linked to basic research on the principles of learning and behavior.A central principle of ABA is called “Selection by Consequences.”In a given environment, behaviors that produce favorable outcomes are selected (or continue to occur) and those that produce unfavorable consequences are extinguished.
26Why is ABA Effective? (continued) ABA has developed a wide variety of procedures for identifying the antecedents and consequences that influence behavior.We rearrange the antecedents and consequences in the environment so that appropriate behavior is selected (or re-occurs) and problem behavior is extinguished.
27Why is ABA Effective? (continued) Specific procedures includeShapingChainingPromptingFadingExtinctionReinforcementGeneralization strategies, etc.
28Why is ABA Effective with Autism? Comprehensive: Teaches all skills (e.g., sitting, attending, imitating, direction following, language, social skills, self-help skills).Goal and Data Driven: The focus on objective measurement and analysis of behavior provides ongoing feedback on progress and setbacks.
29Example of Individual Goals for Billy Decease self-injurious behaviorIncrease eye contactIncrease spontaneous requestingIncrease labeling skillsIncrease use of yes and noIncrease imitation skillsIncrease matching skillsIncrease letter identificationIncrease self-feeding skillsBilly is a 3-year-old male diagnosed with autism. Billy receives hours of therapy using Applied Behavior Analysis (ABA). Prior to treatment implementation the following goals were developed. The following goals are addressed multiple times a day. Data are collected on all goals prior to the implementation of treatment. Progress is assessed on a daily basis.
30Teaching Imitation Using Discrete Trials Starts with simple responses (e.g., clapping).Sessions consisting of 10 trials; each trial starts with the therapist saying “Do this” and then modeling the target response.Any approximation of clapping, results in delivery of a preferred reinforcer (e.g., toy).Otherwise, the therapist guides the child’s hands to complete the response and then begins the next trial.
31Teaching Imitation Using Discrete Trials (continued) Once the first response is mastered, the same procedure would be used to teach a second response (e.g., waving).After two responses are mastered in individual sessions, they would alternately be presented in the same session (e.g., “Do this” [clapping]; “Do this” [waving]).Over time, additional responses are added until the child immediately imitates any new action the therapist does following the prompt, “Do this.”
32Generalization of Skills Skills taught during discrete trials are then generalized to natural settings.e.g., Clapping when another child answers correctly during group instruction or at a recital or school assembly.e.g., Waving to another person when entering or leaving a room.
33Billy: Imitating a Model 10203040506070809010012345678911121314151617SESSIONSPERCENTAGE CORRECT (TOTAL)BaselineDifferential Reinforcement + FeedbackThis is an example of how Billy’s progress is monitored with a particular goal. Prior to implementing an intervention, baseline data were collected on correct responding. During baseline, Billy was presented with 20 2D cards with pictures of items (e.g., car, book, airline, candy ect.) he was able to identify. For example, the therapist held up a picture of a car and said “Is this a truck?” or the therapist held up a picture of a book and said “Is this a book?”. During baseline Billy responded “no” to every instruction that was presented. The therapist did not present any differential consequences during baseline. During baseline Billy was unable to make a discrimination between yes and no. Once treatment (e.g., differential reinforcement + feedback) was initiated correct responses increased to acceptable levels.
34Why is ABA Effective with Autism? (continued) Empirical Emphasis: Treatments are based on principles and procedures supported by research.Intensity Level: 25 to 40 hours per week for 3 years.
35Early Behavioral Intervention for Autism Lovaas, 1987; McEachin et al., 1993; Smith et al., 2000Year 1--reduce aberrant behavior, teach attending, imitation, instruction following, speaking in short phrases, play skills, and self-help skillsThere are a variety of different ABA treatments for autism, but I will illustrate the general approach by describing the program that has received the most attention in the literature and in the press. It involves the application of learning and behavioral principles in a highly intensive and structured approach designed to decrease problem behaviors and increase appropriate behaviors and skills. This approach generally involves 20 to 40 hours per week of one-on-one and small group instruction from highly trained therapists and parents, usually starting during the preschool years and lasting about 3 years. Specific sets of individualized target skills and preferred items or activities (i.e., reinforcers) are developed for each child. The reinforcers are presented to the child following correct responses and appropriate behavior in order to motivate the child to learn new skills and repeat positive behaviors. Aberrant behaviors are prevented or discouraged (i.e., extinguished). Complex skills or tasks are divided into small, simpler steps using techniques such as task analysis and shaping. The child repeatedly practices these tasks either in a series of “discrete trials” or under more naturalistic conditions until the skill is mastered. Because there is a strong emphasis on success, and reinforcement of success, systematic prompts or cues are introduced to increase correct responding and then gradually withdrawn (or faded) to promote independence. Data on target behaviors are collected during each training session and graphed frequently to assess the child’s progress and the effectiveness of the individualized treatment program. These data are reviewed regularly by a senior behavior analyst to help insure that ineffective treatment components are refined or replaced until treatment goals are achieved.Again, although there is variation among programs, the initial goals are often to reduce aberrant behaviors, such as aggression, self-injurious behavior, and stereotypy, and to increase a variety of basic skills, including attending skills, imitation, and following verbal requests from others, speaking in short phrases, appropriate play skills, and self-help skills.
36Early Behavioral Intervention for Autism (continued) Year 2--extend expressive vocabulary, more abstract concepts, extend treatment to group and community settingsYear 3--pre-academic and academic skills, appropriate emotional expression, observational learning, and interactions and friendships with normally developing peersThe major goals of the second year are generally to extend the child’s expressive vocabulary, including more abstract concepts, and to extend the treatment to group activities in classrooms and other community settings. When feasible, the children are enrolled in regular or special preschool programs during the second year with trained therapist serving as one-on-one aids. During the third year, the focus of the program shifted toward pre-academic and academic skills, appropriate emotional expression, observational learning, and interactions and friendships with normally developing peers.
37Cost-Benefit Analysis of Early, Intensive ABA for Autism Average lifetime cost for a person with autism is over $4 millionAverage cost of Early, Intensive ABA is $150,000 over about 3 yearsAverage lifetime savings from ABA Treatment is between $1.6 and $2.7 million
38Assessing Children with Autism Periodic assessment for diagnosis and managementOngoing assessment for interventionBefore discussing operant mechanisms that may be directly relevant to the diagnosis of autism, I will first briefly describe how functional analysis methods have recently been extended to the examination of complex relations involving multiple operant mechanisms. READ SLIDE.
39Periodic Assessment for Diagnosis and Management Identify the child’s overall strengths and limitationsDetermine the appropriate diagnosis or diagnosesSet the global goals for treatment
40Components of a Diagnostic Assessment Genetic/Etiologic workupAssessment of behavior/symptomsFormal audiologic evaluationCognitive testingAssessment of adaptive behaviorSpeech/Language evaluation
41Ongoing Assessment for Intervention Identify the specific behaviors to be increasedIdentify the specific behaviors to be decreasedIdentify effective reinforcers
42Assessment of Skills to Increase Attending SkillsComplianceFollowing Simple InstructionsMotor ImitationVocal ImitationMatchingPlay SkillsSocial SkillsSelf-Help Skills
43Skill Assessment Areas Imitating Behavioral ChainsFollowing Multi-Step InstructionsCategorizationVerbal Behavior-Listener SkillsVerbal Behavior-Speaker SkillsPre-academic and Academic Skills
44Matching Skills Progression Identity matching with objectsIdentity matching with picturesMatching pictures to objectsMatching objects to picturesMatching shapes, colors, letters, numbersMatching on 2 dimensions (color-shape)Matching by categories (e.g., animals, vehicles)Matching objects with their spoken namesMatching pictures with their spoken names
45Social Skills Progression Shaking handsMaking eye contact during greetingsImitating a smileSmiling reciprocallyAppropriately getting someone’s attentionAppropriately exchanging toys with a peerPlaying a simple interactive game (roll ball)Showing appropriate affection (e.g., hugs)Taking turns during a simple gameMaking polite statements (e.g., “Bless you. “Your welcome.”)Initiating a conversation (e.g., “Did you watch the Huskers game?”)
46Preference Assessments Children with developmental disabilities sometimes are not able to tell you what things they like or tell you when they want one thing instead of another.Researchers have developed preference assessments to identify what things people with disabilities like.
47Steps of Preference Assessments Step 1: Interview the parent with the RAISD to list the kinds of things that the child likesStep 2: Get the actual items the parent nominated as highly preferredStep 3: Allow the child to select items from the groupStep 4: Rank the items from high to low based on what the child chose
48Types of Preference Assessments Single-item type – Present each item from the group one at a timeChoice type – Present all items 2 at a time and let the child choose between the 2.Group type – Present all items together and let the child select items from the group
49Single-item Preference Assessments Developed by Pace et al. (1985)16 stimuliEach stimulus presented individually 10 times for 5 seconds eachThe SI method identified highly preferred stimuli for all participants in the studyHowever, subsequent research has shown that the SI method may also yield a high number of false positives*One of the first assessments developed for identifying preferred stimuli was a single-stimulus presentation (SS method) preference assessment developed by Pace et al. (1985).*With this preference assessment, 16 stimuli had been previously identified as potential reinforcers based on caregiver verbal report.*Each stimulus was then presented individually 10 times for 5 s each. If the participant reached for the stimulus, the observer scored an approach response and the participant received access to the stimulus for 5 s. At the end of the 5 s, the chosen stimulus was removed and a new stimulus was presented. Using this approach, Pace et al. found that the SS method identified highly preferred stimuli for all participants in their study. However, subsequent research has shown thatthe SS method may also yield a high number of false positives (i.e., stimuli that appear highly preferred but do not function as positive reinforcers). The SS method may have a high percentage of approach responses because of the tendency for participants to approach any stimulus placed in front of them regardless of preference.
50Percentage of trials chosen 10090807060Percentage of trials chosen5040302010ToyTelephoneBarneyDollActionFiguresRadioBallItems
51Paired-Choice Preference Assessment Developed by Fisher et al. (1992, 1996)Take 5-10 top stimuli from the RAISDEach stimulus paired once with every other stimulusTwo stimuli presented concurrently; the participant was prompted to choose oneThe participants had to emit a choice*To control for false-positive results, Fisher et al. (1992) extended the procedures developed by Pace et al. with a paired-choice preference assessment. During the PC method, the therapist used 16 stimuli, each paired with one another twice. The therapist presented 2 stimuli concurrently then verbally prompted the participant to choose one stimulus. If the participant reached for a stimulus, the observer scored an approach response and the participant received that stimulus for 5 s while the other stimulus was removed. At the end of the 5 s, the chosen stimulus was removed and two new stimuli were presented. If the participant approached both stimuli simultaneously, the therapist blocked the response and represented the two stimuli after a 5-s delay. One benefit of the PC method is that two stimuli are presented concurrently such that participants had to emit a choice response. Choice paradigms have often been used to establish relative preference; thus by having the items available concurrently, Fisher et al. developed a more reliable preference assessment. Despite the utility of the PC method, this procedure has two notable limitations. First, the PC method requires a long time to conduct, which may affect its practicality in some settings. Secondly, the PC method has been noted to occasion destructive behavior in some individuals.
52Percentage of trials chosen 102030405060708090100ToyTelephoneRadioBarneyDollBallActionFiguresPercentage of trials chosenItems
53Group Preference Assessment- MSWO Multiple Stimulus without replacement (MSWO) developed by DeLeon and Iwata (1996)Compared three different preference assessments (PC method, MSWR, & MSWO)Results obtained from MSWO were comparable to that obtained by the PC methodDeLeon and Iwata (1996) evaluated an extension of the procedures described by Windsor et al. (1994). Whereas Windsor et al. replaced stimuli in subsequent trials following the trials in which those items were selected, DeLeon and Iwata did not replace previously chosen stimuli. As a result, participants were required to choose among less preferred alternatives, which resulted in a more discrete ranking of preferred stimuli (based on comparisons between less preferred stimuli). Preferred stimuli were evaluated as reinforcers through a reversal design. Participants were first given 30-s access to each item and then asked to choose one item from the entire array of items. Once an item was chosen it was not replaced in the array and the participants had to chose until all items were selected or until 30 s went by without a selection occurring. All participants showed increases in responding when preferred stimuli were presented contingently.Also compared to Fisher et al and Windsor at al.Results: Windsor et al was the quickest followed by Deleon then Fisher
54Percentage of trials chosen 10090807060Percentage of trials chosen5040302010ToyTelephoneBarneyDollActionFiguresRadioBallItems
55Preference Assessment Outcome Items that the child chooses are usually the most effective positive reinforcer.
56Ongoing Preference Assessments Paired-choice assessment conducted once every 4-6 monthsMini-MSWO assessments conducted daily or more frequently
57Compliance and Cooperation Training Individuals on the autism spectrum often display problem behaviors in a variety of contexts including:when instructional requests are presentedwhen asked to surrender an unusual object (e.g., piece of dirt) they are holding during instructions
58Compliance and Cooperation Training (continued) Teaching a child to accept removal of a preferred object using delay fading.Teaching compliance using least-to-most prompts.
59Teaching Tolerance for Instructional Task The traditional approach to treating these problems involves extinctionExtinction often produces deprivation from reinforcement, which in turn, may evoke bursts of problem behavior
60Teaching Tolerance for Instructional Task (continued) Bouxsein and Fisher (in press) evaluated an alternative to extinction.The alternative involved the provision of a choice between surrendering the preferred object or completing the instructional tasks while retaining the object.
61Percentage of Trials with Compliance Choice1003-StepPromptingw/ Extinction3-StepPromptingw/ ExtinctionBaselineChoice8060Percentage of Trials with Compliance402013579111315171921232527293133Session
62Percentage of Intervals of Aggression and Disruption 100Baseline3-StepChoice3-StepChoice8060Percentage of Intervals of Aggression and Disruption40201356810111315171921222426283133Session
63Percentage of Intervals of Choice Allocation Baseline3-StepChoice3-StepChoice100Task Choice8060Percentage of Intervals of Choice AllocationItem Choice402013579111315171921232527293133Session
64Compliance TrainingThis case illustrates a simple and effective way to increase compliance while decreasing problem behavior associated with presentation of instructionsThis may be a result of decreasing the aversiveness of the instruction by allowing the child to choose whether to surrender a object or complete an alternative demand
65Improving Vocabulary Skills in Children with Autism Recent behavior analytic work in autism has focused on teaching critical skills, ones that facilitate the acquisition of many subsequent skills (e.g., pivotal responses, behavioral cusps).
66Vocabulary as a Critical Skill Children in advantaged homes are exposed to, and learn two to three times as many words as those in disadvantaged homes (Hart and Risley, 1995).Correlation of .78 between parents use of “non-business” words with their kids and later IQThis discrepancy between advantaged and disadvantaged children is not ameliorated through schooling.
67Disadvantaged Children 2000400060008000100001200014000160001800020000123456789101112131415161718AgeVocabulary SizeAdvantaged ChildrenDisadvantaged Children
68Vocabulary as a Critical Skill (continued) Vocabulary in the early school years is the single, best predictor of SAT scores and adult literacy.This is why Andy Biemiller has called vocabulary the Missing Link between reading mechanics and reading comprehension or literacy.
69Vocabulary and Reading Read the following word and raise your hand when you know what it is:supercalifragilisticexpialidocious
70Individualized Vocabulary Lists with Normative Relevance Normative word lists provide information on words that most children knowIndividualized word lists contain words that a child contacts on a routine basisIdentifying words common to both types of lists may produce the larger increases in the child’s working vocabulary
71Developing an Individualized Vocabulary List Begin with a word list with a developmental progressionLiving Word Vocabulary; (Dale & O'Rourke, 1981)(Dale & Fenson, 1996)
72Developing an Individualized Vocabulary List (continued) Identify words that the child is likely to contact on a daily basisMorning RoutinePlaces, people, activities, itemsMealtimeFoods, utensils, kitchen and dining room itemsPlaytimeToys, activities, people
73Developing an Individualized Vocabulary List (continued) Daycare or schoolPeople, actions, objectsPlaces like church, stores, restaurantsWhat is done there, What they sell, What you buyHousehold chores and activitiesWhat they are called, Who does them
74Developing an Individualized Vocabulary List (continued) Special eventsBirthdays, holidays, vacationsSports and hobbiesMaterials used, players, positions, What they doThings in the yard and neighborhoodAnimals, trees, vehicles, names of neighbors
75Developing an Individualized Vocabulary List (continued) Keep a 3-day diary and write down the names of people, objects, activities, and actions and add any new words to your list
76Developing an Individualized Vocabulary List (continued) Enter the individualized list into a spreadsheet next to the normative word listSort both lists alphabeticallyIdentify words common to both listsRe-sort the lists developmentallyBegin teaching common words ordered developmentally
77Jack's ListNormative WordsDev Lev in Monthsa26.5a lot29.5aboutafter29acheall18airall gone17airplanealligator25am28analoneand26animal24ankle30antanotherappleareanyarm14
78Jack's ListNormative WordsDev Lev in Monthsbeltball9blockbathbook10batbaby11bibballoon12bicyclebananabathtubbyebaa baa12.5brushbed13buttonbelly buttonbreakfastarmapple14boatbathroom
79Behavior Analytic Approaches to Vocabulary Development From a behavior analytic perspective, teaching vocabulary involves the establishment of specific types of conditional discriminations, ones involving a spoken or written word as component of the four-term contingency.
80Conditional Discriminations Involving Deictic Words Children with autism have particular difficulty learning deictic words because they require conditional discriminations (or have shifting referents).Examples: I, you, me; first, last; this, that; here, there.
81Conditional Discriminations Involving Social Skills Social approaches to other individuals are likely to produce reinforcement under certain conditions and not others (e.g., requests to play when a parent is busy or not).Interactive play and joint attention require the child to simultaneously attend to objects and people.
82Three- and Four-Term Contingencies Stimulus – Response – ReinforcerConditional Stimulus – Stimulus – Response – ReinforcerWith spoken-word-to-picture discriminations, a spoken word is the conditional stimulus that specifies which of the comparison stimuli the individual should respond to produce reinforcement.
83Spoken-Word-to-Picture Discriminations “Point to Dog”
84Building Working Vocabularies Spoken-word-to-picture discriminations are critical to the development of vocabulary skills.
85Functional Approaches to Teaching Conditional Discriminations in Autism Unmotivated learnersLearners requiring extra-stimulus promptsInattentive learnersSeverely limited learners
86102030405060708090100246812141618SessionsPercent CorrectBaselineCBSr+Sr+ + PromptPromptedcorrectresponsessBefore discussing operant mechanisms that may be directly relevant to the diagnosis of autism, I will first briefly describe how functional analysis methods have recently been extended to the examination of complex relations involving multiple operant mechanisms. READ SLIDE.
87Percentage of Attending Baseline Sr+ Sr+ + Prompt 102030405060708090100246812141618SessionsPercentage of AttendingBaselineCBSr+Sr+ + PromptBefore discussing operant mechanisms that may be directly relevant to the diagnosis of autism, I will first briefly describe how functional analysis methods have recently been extended to the examination of complex relations involving multiple operant mechanisms. READ SLIDE.
88Teaching Conditional Discriminations to Inattentive Learners Extend prior work on differential observing responses (DORs) by embedding an identity-matching task into a graduated-prompting procedure to teach spoken-word-to-picture relations to children with autism.
89Treatment and Control Conditions Verbal prompt to point to test stimulusNo feedback for correct or incorrect responsesGraduated promptingSequential verbal, modeled, and physical promptsPraise and edible delivered for correct response following the verbal promptIdentity-matchingIdentical to graduated-prompting except the modeled prompt was replaced with an identity-matching taskID prompt: Therapist held up a picture identical to the test stimulus and said, “This is Alex. Point to Alex”
94Teaching Vocabulary in Autism These cases illustrate how identifying the functional deficit responsible for a child’s poor performance on spoken-word-to-picture relations can be used to develop an effective intervention to improve the child’s working vocabulary.
95Vocal Mand Assessment and Training (Bourret et al., 2004) Conducted a preference assessment to identify a high preference itemConducted mand assessment to identify the appropriate training procedureConducted mand training using the identified procedure
96Behavioral Approaches to Verbal Behavior In traditional approaches to speech and language, the focus is on the topography of verbal behavior or what it looks like (e.g., receptive, expressive, phonemes, words, phrases, sentences).Behavioral approaches focus on the functional aspects of verbal behavior (e.g., echoic, mands, tacts, intraverbal, autoclitic).
97Behavioral Approaches to Verbal Behavior (continued) Verbal behaviors are learned responses that are defined in terms of the antecedents and consequences of which the behavior is a function:Antecedent Behavior Consequence
99Vocal Mand Assessment Each session involved 10 1-minute trials 0 s: No PromptHold the high preference item in front of the child10 s: Nonspecific Prompt:“If you want this, ask me for it.”20 s: Modeled Prompt:“If you want this, say chip.”30 s: Phoneme Prompt:“If you want this, say “ch.”Give the high preference item for the remainder of the trial following a correct response.
104Social Skills Training Identify one or more peers who are willing to help promote social behaviorIdentify activities that both your child and the peer enjoyPossible activities include: rolling a ball, Lego blocks, basketball and hoop, puzzles, musical instruments, crayons, play dough, dressing up in costumes, duck-duck-goose, ring-around the rosy, trucks and cars
105Social Skills Training (continued) Practice the activity with your child and note any prompts, reinforcers, or assistance you provide.Before the activity starts, teach the peer to deliver the same prompts, reinforcers, and assistance as you did when you practiced with your child.
106Social Skills Training (continued) Supervise the initial session closely and deliver praise and preferred items for appropriate social behaviors like,SmilingInitiations, spoken or gestured (“Look”, “Watch me”, “Your turn”, “My turn”)Turn-taking and sharing
107Initial Toilet Training Prompt the child to go into the bathroom and pull down their pants.If the child is wet or soiled, clean and change them with minimal attention (don’t talk to the child) and then leave the bathroom.If the child is dry, have them feel their underwear and praise (“Good job! Your pants are dry.”)Have the child sit on the toilet and immediately deliver their most preferred reinforcer and then allow the child to get off the toilet and leave the bathroom.
108Initial Toilet Training (continued) Keep a log and record whether the child was wet, soiled, or dry, and whether they voided in the toilet.Repeat 9 more times (or trials), once every ½ hr.For the next 10 trials, set a kitchen timer and have the child sit on the toilet until the timer goes off and then deliver the reinforcer.Mix up the lengths of the toileting sits (e.g., starting with 5, 8, 6, 10, 7, 9, 6, 9, 5, 10, 8, and 7 seconds).If at any point, the child voids in the toilet, immediately praise, deliver the reinforcer and allow them to get off the toilet and leave the bathroom.
109Initial Toilet Training (continued) Get the child used to the toilet (cont.).For the next 10 trials, double the lengths of the toileting sits (e.g., 12, 14, 10, 18, 16, 20, 12, 18, 10, 16, 20, and 14 seconds).Continue doubling the lengths of the sits until the child is sitting on the toilet for 5 minutes once every ½ hr.When ½ of the child’s voids are in the toilet, stop providing reinforcement for completing 5-minute toileting sits without voiding (i.e., only voiding in the toilet produces reinforcement).
110THANKSBefore discussing operant mechanisms that may be directly relevant to the diagnosis of autism, I will first briefly describe how functional analysis methods have recently been extended to the examination of complex relations involving multiple operant mechanisms. READ SLIDE.