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Early Intervention in Autism DR. PRADEEP DUBEY MD. (Ped.) DCH Aadiguru Neuropediatric Centre, Near Prem Mandir Wright Town, Jabalpur.

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Presentation on theme: "Early Intervention in Autism DR. PRADEEP DUBEY MD. (Ped.) DCH Aadiguru Neuropediatric Centre, Near Prem Mandir Wright Town, Jabalpur."— Presentation transcript:

1 Early Intervention in Autism DR. PRADEEP DUBEY MD. (Ped.) DCH Aadiguru Neuropediatric Centre, Near Prem Mandir Wright Town, Jabalpur

2 Autism and Childhood Schizophrenia Once thought to be a form of schizophrenia Once thought to be a form of schizophrenia Differs from schizophrenia in terms of symptoms, age of onset, family history, etiology, and response to treatment Differs from schizophrenia in terms of symptoms, age of onset, family history, etiology, and response to treatment

3 Definition of Autism markedly abnormal or impaired development in: markedly abnormal or impaired development in: social interaction social interaction communication communication and markedly restricted repertoire of activities and interests. and markedly restricted repertoire of activities and interests.

4 Definition of Autism (continued) n n Definitions are cheap, but explanations are dear, and we must be careful not to confuse them. –David Palmer, 2004

5 Autism Spectrum Disorders Neurological disorders characterized by "severe and pervasive impairment in several areas of development Neurological disorders characterized by "severe and pervasive impairment in several areas of development Autistic Disorder Autistic Disorder Asperger's Disorder Asperger's Disorder Childhood Disintegrative Disorder (CDD) Childhood Disintegrative Disorder (CDD) Rett's Disorder Rett's Disorder PDD-Not Otherwise Specified (PDD-NOS) PDD-Not Otherwise Specified (PDD-NOS)

6 Prevalence of Autism Typically diagnosed within first three years Typically diagnosed within first three years 2 to 6 in 1,000 individuals (Centers for Disease Control and Prevention, 2001) 2 to 6 in 1,000 individuals (Centers for Disease Control and Prevention, 2001) Four times more prevalent in boys than girls Four times more prevalent in boys than girls

7 NIH Research Dollars Devoted to Autism n When compared with other serious childhood conditions, autism is much more common, but fewer dollars per case are spent on autism.

8 AutismJuvenile DiabetesMuscular DystrophyLeukemiaCystic Fibrosis Prevalence of Autism and Other Conditions (Number of Cases per 10,000 Children)

9 $- $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 AutismJuvenile DiabetesMuscular DystrophyLeukemiaCystic Fibrosis NIH Research Dollars for Autism and Other Conditions (Number of Dollars per Case)

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11 Demographics of Autism Knows no racial, ethnic, or social boundaries Knows no racial, ethnic, or social boundaries Family income, lifestyle, and educational levels do not affect the chance of autism's occurrence Family income, lifestyle, and educational levels do not affect the chance of autism's occurrence Diagnosis of autism is growing at a rate of Diagnosis of autism is growing at a rate of 10-17% per year (U.S. Department of Education, 2002)

12 Assessment and Diagnosis of Autism No medical tests for diagnosing autism No medical tests for diagnosing autism Accurate diagnosis is based on observation of the individual's communication, behavior, and developmental levels. Accurate diagnosis is based on observation of the individual's communication, behavior, and developmental levels. Autism Diagnostic Interview-R (ADI-R) Autism Diagnostic Interview-R (ADI-R) Home and/or school observation Home and/or school observation Video analysis of behavioral observation Video analysis of behavioral observation

13 Identifying the Genetic Bases of Autism Spectrum Disorders n Etiologic workups identify specific genetic causes for autism in about 20% of cases. n At the Munroe-Meyer Institute, Dr. Schaefer and colleagues (2006) developed a 3-Tiered Approach that identifies genetic causes in 40% of cases.

14 Early Screening for Autism (NICHD) Does not babble or coo by 12 months Does not babble or coo by 12 months Does not gesture (point, wave, grasp) by 12 months Does not gesture (point, wave, grasp) by 12 months Does not say single words by 16 months Does not say single words by 16 months Does not say two-word phrases on his or her own by 24 months Does not say two-word phrases on his or her own by 24 months Has any loss of any language or social skill at any age Has any loss of any language or social skill at any age

15 Early Screening for Autism (CHAT) Does not display pretend play (e.g., pretending to drink from a toy cup) Does not display pretend play (e.g., pretending to drink from a toy cup) Does not point at objects to indicate interest Does not point at objects to indicate interest Does not show interest in other children Does not show interest in other children Does not enjoy peek-a-boo hide-and-seek or other social games Does not enjoy peek-a-boo hide-and-seek or other social games Does not bring and show objects to parents Does not bring and show objects to parents

16 Associated Disorders Mental Retardation 70% 15% Mental Retardation 70% 15% Seizure Disorder 35% 10% Seizure Disorder 35% 10% Self-Injury, Aggression 50% Self-Injury, Aggression 50% Tourette Disorder Tourette Disorder Bipolar Disorder Bipolar Disorder Autism ASD

17 Associated Etiologic Diagnoses Fragile-X syndrome Fragile-X syndrome Tuberous Sclerosis Tuberous Sclerosis Williams syndrome Williams syndrome Landau-Kleffner syndrome Landau-Kleffner syndrome Congenital Rubella Congenital Rubella Smith-Magenis syndrome Smith-Magenis syndrome Neurofibromatosis Neurofibromatosis

18 Genetics and Twin Studies Autism runs in families Autism runs in families Heritability for autism is about 90% Heritability for autism is about 90% Monozygotic twin concordance, 60%-100% Monozygotic twin concordance, 60%-100% Dizygotic twin concordance, 10% Dizygotic twin concordance, 10% Associated with abnormalities on chromosomes 7q, 2q, and 15q Associated with abnormalities on chromosomes 7q, 2q, and 15q

19 Applied Behavior Analysis (ABA) What is ABA? What is ABA? How is it different from other approaches? How is it different from other approaches? How is it done? How is it done?

20 Baer, Wolf, & Risley (1968) APPLIEDstrives to produce rapid and clear benefit to problems of social importance; BEHAVIORALuses objective and accurate measurement of the behavior of interest; ANALYSISuses controlled (single-case) methods to understand the environmental variable(s) that influence an individuals behavior.

21 Historical Roots of Behavior Analysis 1911 Thorndike-Law of effect 1911 Thorndike-Law of effect 1924 Watson-Behaviorism 1924 Watson-Behaviorism 1927 Pavlov-Conditioned Reflexes 1927 Pavlov-Conditioned Reflexes 1938-Skinner Behavior of Organisms 1938-Skinner Behavior of Organisms 1950s-Behavioral applications reported in scientific journals 1950s-Behavioral applications reported in scientific journals 1968-Journal of Applied Behavior Analysis 1968-Journal of Applied Behavior Analysis

22 How 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. 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.

23 Outcomes of ABA for Autism Hours per Week of Treatment Increases in IQ Scores r =.79 p <.02

24 How Effective is ABA for Autism? Early Intervention of Autism using ABA has been recommended by: Early Intervention of Autism using ABA has been recommended by: New York State Dept. of Health New York State Dept. of Health U.S. Surgeon General U.S. Surgeon General National Research Council National Research Council Association for Science in Autism Treatment Association for Science in Autism Treatment

25 Why is ABA Effective? ABA developed from and remains closely linked to basic research on the principles of learning and behavior. 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. 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. In a given environment, behaviors that produce favorable outcomes are selected (or continue to occur) and those that produce unfavorable consequences are extinguished.

26 Why is ABA Effective? (continued) ABA has developed a wide variety of procedures for identifying the antecedents and consequences that influence behavior. 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. We rearrange the antecedents and consequences in the environment so that appropriate behavior is selected (or re-occurs) and problem behavior is extinguished.

27 Why is ABA Effective? (continued) Specific procedures include Specific procedures include Shaping Shaping Chaining Chaining Prompting Prompting Fading Fading Extinction Extinction Reinforcement Reinforcement Generalization strategies, etc. Generalization strategies, etc.

28 Why is ABA Effective with Autism? Comprehensive: Teaches all skills (e.g., sitting, attending, imitating, direction following, language, social skills, self-help skills). 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. Goal and Data Driven: The focus on objective measurement and analysis of behavior provides ongoing feedback on progress and setbacks.

29 Example of Individual Goals for Billy n Decease self-injurious behavior n Increase eye contact n Increase spontaneous requesting n Increase labeling skills n Increase use of yes and no n Increase imitation skills n Increase matching skills n Increase letter identification n Increase self-feeding skills

30 Teaching Imitation Using Discrete Trials Starts with simple responses (e.g., clapping). 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. 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). Any approximation of clapping, results in delivery of a preferred reinforcer (e.g., toy). Otherwise, the therapist guides the childs hands to complete the response and then begins the next trial. Otherwise, the therapist guides the childs hands to complete the response and then begins the next trial.

31 Teaching 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). 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]). 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. Over time, additional responses are added until the child immediately imitates any new action the therapist does following the prompt, Do this.

32 Generalization of Skills Skills taught during discrete trials are then generalized to natural settings. 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., 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. e.g., Waving to another person when entering or leaving a room.

33 Billy: Imitating a Model

34 Why is ABA Effective with Autism? (continued) Empirical Emphasis: Treatments are based on principles and procedures supported by research. Empirical Emphasis: Treatments are based on principles and procedures supported by research. Intensity Level: 25 to 40 hours per week for 3 years. Intensity Level: 25 to 40 hours per week for 3 years.

35 Early Behavioral Intervention for Autism n Lovaas, 1987; McEachin et al., 1993; Smith et al., 2000 n Year 1--reduce aberrant behavior, teach attending, imitation, instruction following, speaking in short phrases, play skills, and self-help skills

36 Early Behavioral Intervention for Autism (continued) n Year 2--extend expressive vocabulary, more abstract concepts, extend treatment to group and community settings n Year 3--pre-academic and academic skills, appropriate emotional expression, observational learning, and interactions and friendships with normally developing peers

37 Cost-Benefit Analysis of Early, Intensive ABA for Autism n n Average lifetime cost for a person with autism is over $4 million n n Average cost of Early, Intensive ABA is $150,000 over about 3 years n n Average lifetime savings from ABA Treatment is between $1.6 and $2.7 million

38 Assessing Children with Autism n Periodic assessment for diagnosis and management n Ongoing assessment for intervention

39 Periodic Assessment for Diagnosis and Management Identify the childs overall strengths and limitations Identify the childs overall strengths and limitations Determine the appropriate diagnosis or diagnoses Determine the appropriate diagnosis or diagnoses Set the global goals for treatment Set the global goals for treatment

40 Components of a Diagnostic Assessment Genetic/Etiologic workup Genetic/Etiologic workup Assessment of behavior/symptoms Assessment of behavior/symptoms Formal audiologic evaluation Formal audiologic evaluation Cognitive testing Cognitive testing Assessment of adaptive behavior Assessment of adaptive behavior Speech/Language evaluation Speech/Language evaluation

41 Ongoing Assessment for Intervention Identify the specific behaviors to be increased Identify the specific behaviors to be increased Identify the specific behaviors to be decreased Identify the specific behaviors to be decreased Identify effective reinforcers Identify effective reinforcers

42 Assessment of Skills to Increase Attending Skills Attending Skills Compliance Compliance Following Simple Instructions Following Simple Instructions Motor Imitation Motor Imitation Vocal Imitation Vocal Imitation Matching Matching Play Skills Play Skills Social Skills Social Skills Self-Help Skills Self-Help Skills

43 Skill Assessment Areas Imitating Behavioral Chains Imitating Behavioral Chains Following Multi-Step Instructions Following Multi-Step Instructions Categorization Categorization Verbal Behavior-Listener Skills Verbal Behavior-Listener Skills Verbal Behavior-Speaker Skills Verbal Behavior-Speaker Skills Pre-academic and Academic Skills Pre-academic and Academic Skills

44 Matching Skills Progression Identity matching with objects Identity matching with objects Identity matching with pictures Identity matching with pictures Matching pictures to objects Matching pictures to objects Matching objects to pictures Matching objects to pictures Matching shapes, colors, letters, numbers Matching shapes, colors, letters, numbers Matching on 2 dimensions (color-shape) Matching on 2 dimensions (color-shape) Matching by categories (e.g., animals, vehicles) Matching by categories (e.g., animals, vehicles) Matching objects with their spoken names Matching objects with their spoken names Matching pictures with their spoken names Matching pictures with their spoken names

45 Social Skills Progression Shaking hands Shaking hands Making eye contact during greetings Making eye contact during greetings Imitating a smile Imitating a smile Smiling reciprocally Smiling reciprocally Appropriately getting someones attention Appropriately getting someones attention Appropriately exchanging toys with a peer Appropriately exchanging toys with a peer Playing a simple interactive game (roll ball) Playing a simple interactive game (roll ball) Showing appropriate affection (e.g., hugs) Showing appropriate affection (e.g., hugs) Taking turns during a simple game Taking turns during a simple game Making polite statements (e.g., Bless you. Your welcome.) Making polite statements (e.g., Bless you. Your welcome.) Initiating a conversation (e.g., Did you watch the Huskers game?) Initiating a conversation (e.g., Did you watch the Huskers game?)

46 Preference 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. 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. Researchers have developed preference assessments to identify what things people with disabilities like.

47 Steps of Preference Assessments Step 1: Interview the parent with the RAISD to list the kinds of things that the child likes Step 2: Get the actual items the parent nominated as highly preferred Step 3: Allow the child to select items from the group Step 4: Rank the items from high to low based on what the child chose

48 Types of Preference Assessments Single-item type – Present each item from the group one at a time Single-item type – Present each item from the group one at a time Choice type – Present all items 2 at a time and let the child choose between the 2. Choice 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 Group type – Present all items together and let the child select items from the group

49 Single-item Preference Assessments n Developed by Pace et al. (1985) 16 stimuli16 stimuli Each stimulus presented individually 10 times for 5 seconds eachEach stimulus presented individually 10 times for 5 seconds each –The SI method identified highly preferred stimuli for all participants in the study –However, subsequent research has shown that the SI method may also yield a high number of false positives

50 Toy Telephone Radio Barney Doll Ball Action Figures Items Percentage of trials chosen

51 Paired-Choice Preference Assessment n Developed by Fisher et al. (1992, 1996) Take 5-10 top stimuli from the RAISDTake 5-10 top stimuli from the RAISD Each stimulus paired once with every other stimulusEach stimulus paired once with every other stimulus Two stimuli presented concurrently; the participant was prompted to choose oneTwo stimuli presented concurrently; the participant was prompted to choose one –The participants had to emit a choice

52 Items Percentage of trials chosen Toy Telephone Radio Barney Doll Ball Action Figures

53 Group Preference Assessment- MSWO n Multiple Stimulus without replacement (MSWO) developed by DeLeon and Iwata (1996) Compared three different preference assessments (PC method, MSWR, & MSWO)Compared three different preference assessments (PC method, MSWR, & MSWO) Results obtained from MSWO were comparable to that obtained by the PC methodResults obtained from MSWO were comparable to that obtained by the PC method

54 Items Percentage of trials chosen Toy Telephone Radio Barney Doll Ball Action Figures

55 Preference Assessment Outcome n Items that the child chooses are usually the most effective positive reinforcer.

56 Ongoing Preference Assessments n Paired-choice assessment conducted once every 4-6 months n Mini-MSWO assessments conducted daily or more frequently

57 Compliance and Cooperation Training n Individuals on the autism spectrum often display problem behaviors in a variety of contexts including: when instructional requests are presentedwhen instructional requests are presented when asked to surrender an unusual object (e.g., piece of dirt) they are holding during instructionswhen asked to surrender an unusual object (e.g., piece of dirt) they are holding during instructions

58 Compliance and Cooperation Training (continued) n Teaching a child to accept removal of a preferred object using delay fading. n Teaching compliance using least-to-most prompts.

59 Teaching Tolerance for Instructional Task n The traditional approach to treating these problems involves extinction n Extinction often produces deprivation from reinforcement, which in turn, may evoke bursts of problem behavior

60 Teaching Tolerance for Instructional Task (continued) n Bouxsein and Fisher (in press) evaluated an alternative to extinction. n The alternative involved the provision of a choice between surrendering the preferred object or completing the instructional tasks while retaining the object.

61 Session Percentage of Trials with Compliance 3-Step Prompting w/ Extinction BaselineChoice 29 3-Step Prompting w/ Extinction

62 Session Percentage of Intervals of Aggression and Disruption 3-StepChoice3-StepChoiceBaseline

63 Session Percentage of Intervals of Choice Allocation Baseline3-StepChoice3-StepChoice Task Choice Item Choice

64 Compliance Training n This case illustrates a simple and effective way to increase compliance while decreasing problem behavior associated with presentation of instructions n This 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

65 Improving Vocabulary Skills in Children with Autism n 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).

66 Vocabulary as a Critical Skill n 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). n Correlation of.78 between parents use of non- business words with their kids and later IQ n This discrepancy between advantaged and disadvantaged children is not ameliorated through schooling.

67 Age Vocabulary Size Advantaged Children Disadvantaged Children

68 Vocabulary as a Critical Skill (continued) n Vocabulary in the early school years is the single, best predictor of SAT scores and adult literacy. n This is why Andy Biemiller has called vocabulary the Missing Link between reading mechanics and reading comprehension or literacy.

69 Vocabulary and Reading n Read the following word and raise your hand when you know what it is: supercalifragilisticexpialidocioussupercalifragilisticexpialidocious

70 Individualized Vocabulary Lists with Normative Relevance Normative word lists provide information on words that most children know Normative word lists provide information on words that most children know Individualized word lists contain words that a child contacts on a routine basis Individualized word lists contain words that a child contacts on a routine basis Identifying words common to both types of lists may produce the larger increases in the childs working vocabulary Identifying words common to both types of lists may produce the larger increases in the childs working vocabulary

71 Developing an Individualized Vocabulary List Begin with a word list with a developmental progression Begin with a word list with a developmental progression Living Word Vocabulary; ( Living Word Vocabulary; (Dale & O'Rourke, 1981) (Dale & Fenson, 1996) (Dale & Fenson, 1996)

72 Developing an Individualized Vocabulary List (continued) Identify words that the child is likely to contact on a daily basis Identify words that the child is likely to contact on a daily basis Morning Routine Morning Routine Places, people, activities, items Places, people, activities, items Mealtime Mealtime Foods, utensils, kitchen and dining room items Foods, utensils, kitchen and dining room items Playtime Playtime Toys, activities, people Toys, activities, people

73 Developing an Individualized Vocabulary List (continued) Daycare or school Daycare or school People, actions, objects People, actions, objects Places like church, stores, restaurants Places like church, stores, restaurants What is done there, What they sell, What you buy What is done there, What they sell, What you buy Household chores and activities Household chores and activities What they are called, Who does them What they are called, Who does them

74 Developing an Individualized Vocabulary List (continued) Special events Special events Birthdays, holidays, vacations Birthdays, holidays, vacations Sports and hobbies Sports and hobbies Materials used, players, positions, What they do Materials used, players, positions, What they do Things in the yard and neighborhood Things in the yard and neighborhood Animals, trees, vehicles, names of neighbors Animals, trees, vehicles, names of neighbors

75 Developing 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 Keep a 3-day diary and write down the names of people, objects, activities, and actions and add any new words to your list

76 Developing an Individualized Vocabulary List (continued) Enter the individualized list into a spreadsheet next to the normative word list Enter the individualized list into a spreadsheet next to the normative word list Sort both lists alphabetically Sort both lists alphabetically Identify words common to both lists Identify words common to both lists Re-sort the lists developmentally Re-sort the lists developmentally Begin teaching common words ordered developmentally Begin teaching common words ordered developmentally

77 Jack's ListNormative WordsDev Lev in Months aa26.5 a lot 29.5 aboutafter29 acheall18 airall gone17 airplanealligator25 allam28 all gonean aloneand26 andanimal24 animalankle30 antanother29 appleant24 areany29 armapple14

78 Jack's ListNormative WordsDev Lev in Months beltball9 blockbath9 book10 batbaby11 bibballoon12 bicyclebanana12 bookbathtub12 bye12 bananabaa 12.5 brushbed13 buttonbelly button13 breakfast13 armapple14 boatbathroom14 block14

79 Behavior Analytic Approaches to Vocabulary Development n 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.

80 Conditional Discriminations Involving Deictic Words n Children with autism have particular difficulty learning deictic words because they require conditional discriminations (or have shifting referents). n Examples: I, you, me; first, last; this, that; here, there.

81 Conditional 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). 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. Interactive play and joint attention require the child to simultaneously attend to objects and people.

82 Three- and Four-Term Contingencies Stimulus – Response – Reinforcer Conditional Stimulus – Stimulus – Response – Reinforcer With 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. With 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.

83 Spoken-Word-to-Picture Discriminations Point to Dog

84 Building Working Vocabularies Building Working Vocabularies n Spoken-word-to-picture discriminations are critical to the development of vocabulary skills.

85 Functional Approaches to Teaching Conditional Discriminations in Autism n Unmotivated learners n Learners requiring extra-stimulus prompts n Inattentive learners n Severely limited learners

86 Sessions Percent Correct Baseline CB Sr+Sr+ + Prompt Prompted correct responses s

87 Sessions Percentage of Attending Baseline CB Sr+Sr+ + Prompt

88 Teaching Conditional Discriminations to Inattentive Learners n 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.

89 Treatment and Control Conditions n Control Verbal prompt to point to test stimulusVerbal prompt to point to test stimulus No feedback for correct or incorrect responses No feedback for correct or incorrect responses n Graduated prompting Sequential verbal, modeled, and physical promptsSequential verbal, modeled, and physical prompts Praise and edible delivered for correct response following the verbal prompt Praise and edible delivered for correct response following the verbal prompt n Identity-matching Identical to graduated-prompting except the modeled prompt was replaced with an identity-matching taskIdentical to graduated-prompting except the modeled prompt was replaced with an identity-matching task ID prompt: Therapist held up a picture identical to the test stimulus and said, This is Alex. Point to Alex ID prompt: Therapist held up a picture identical to the test stimulus and said, This is Alex. Point to Alex

90 Percent Correct Graduated Prompting Identity Matching Control Jane Sessions

91 Percent Correct Danny Sessions Identity Matching Graduated Prompting Control

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94 Teaching Vocabulary in Autism n These cases illustrate how identifying the functional deficit responsible for a childs poor performance on spoken-word-to-picture relations can be used to develop an effective intervention to improve the childs working vocabulary.

95 Vocal Mand Assessment and Training (Bourret et al., 2004) Conducted a preference assessment to identify a high preference item Conducted a preference assessment to identify a high preference item Conducted mand assessment to identify the appropriate training procedure Conducted mand assessment to identify the appropriate training procedure Conducted mand training using the identified procedure Conducted mand training using the identified procedure

96 Behavioral 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). 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). Behavioral approaches focus on the functional aspects of verbal behavior (e.g., echoic, mands, tacts, intraverbal, autoclitic).

97 Behavioral 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: 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

98 Echoic Responses, Mands, Tacts, Intraverbals Antecedent Behavior Consequence Ball Ball Good job Ball Ball Good job Ball on shelf Ball Ball given Ball shown Ball Thats right What is round Ball Thats right and bounces?

99 Vocal Mand Assessment Each session involved 10 1-minute trials Each session involved 10 1-minute trials 0 s: No Prompt 0 s: No Prompt Hold the high preference item in front of the child Hold the high preference item in front of the child 10 s: Nonspecific Prompt: 10 s: Nonspecific Prompt: If you want this, ask me for it. If you want this, ask me for it. 20 s: Modeled Prompt: 20 s: Modeled Prompt: If you want this, say chip. If you want this, say chip. 30 s: Phoneme Prompt: 30 s: Phoneme Prompt: If you want this, say ch. If you want this, say ch. Give the high preference item for the remainder of the trial following a correct response. Give the high preference item for the remainder of the trial following a correct response.

100 PROPORTION OF TRIALS Nonspecific Prompt

101 Nonspecific Prompt | FADING | Nick Ni PROPORTION OF TRIALS

102

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104 Social Skills Training Identify one or more peers who are willing to help promote social behavior Identify one or more peers who are willing to help promote social behavior Identify activities that both your child and the peer enjoy Identify activities that both your child and the peer enjoy n Possible activities include: rolling a ball, n Possible 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

105 Social Skills Training (continued) Practice the activity with your child and note any prompts, reinforcers, or assistance you provide. 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. Before the activity starts, teach the peer to deliver the same prompts, reinforcers, and assistance as you did when you practiced with your child.

106 Social Skills Training (continued) Supervise the initial session closely and deliver praise and preferred items for appropriate social behaviors like, Supervise the initial session closely and deliver praise and preferred items for appropriate social behaviors like, Smiling Smiling Initiations, spoken or gestured (Look, Watch me, Your turn, My turn) Initiations, spoken or gestured (Look, Watch me, Your turn, My turn) Turn-taking and sharing Turn-taking and sharing

107 Initial Toilet Training Prompt the child to go into the bathroom and pull down their pants. 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 (dont talk to the child) and then leave the bathroom. If the child is wet or soiled, clean and change them with minimal attention (dont 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.) 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. 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.

108 Initial Toilet Training (continued) Keep a log and record whether the child was wet, soiled, or dry, and whether they voided in the toilet. 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. 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. 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). 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. 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.

109 Initial Toilet Training (continued) Get the child used to the toilet (cont.). 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). 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. 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 childs 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). When ½ of the childs 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).

110 THANKS


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