Presentation on theme: "Working with parents The Early Start Denver Model"— Presentation transcript:
1Working with parents The Early Start Denver Model Costanza Colombi & Sally RogersM.I.N.D. Institute, UC Davis
2This work is based onRogers & collaborators, University of Colorado DenverDawson & Rogers, University of WashingtonRogers, Vismara, & Colombi, M.I.N.D. Institute at UC Davis
3Topics Parent Training, introduction and experimental evidence The Early Start Denver Model (ESDM) Parent TrainingA single subject study of ESDM
4Recommendations for the Education of Children with Autism (NRC, 2001) “…Across primarily preschool programs, there is a very strong consensus that the following features are critical: …Inclusion of a family component, including parent training (p. 219)…”
6Benefits of Parent Training Trained parents continuous gains in children (Lovaas et al., 1973)Increased generalization and maintenance overtime (Koegel et al, 1982)Reduced stressIncreased quality of life in family (Koegel et al., 1996)More leisure time (Koegel et al., 1982)More optimism about child’s development (Koegel et al., 1982)
7Procedures successfully taught Discrete Trial Training (DTT)Pivotal Response Training (PRT)Relationship Development Training (RDI)Denver Model
8A new intervention need: infants and toddlers with autism Are infants “special”? Where do we look for models of infant therapy?Are maternal relationships with infants “special”? Parent training/parent supportWho should deliver tx?Treatment intensity?Delivery settings?Level of directiveness?
9Partnerships with families in Denver Model Parents are part of all activities and meetingsParents help set goalsParents determine focus of home interventionsParent deliver intervention at homeParent/family needs are part of planParent supports actively fostered
10M.I.N.D. Parent-Toddler Intervention Study (Vismara, Colombi, & Rogers, in press) Intervention right after diagnosis before intensive treatmentEffective tools for helping child’s development in all areasA positive experience of self as teacher, child as learnerTo develop a manualized intervention for coaching parents in ESDMTo examine parents’ acquisition of ESDMTo examine changes in children’s social communication
11Children age ethnic Rec MA Exp MA ADOS Child 1 26 m Cauc 10 m 11 m 14 Eight consecutive referrals, diagnosis of AD, no health or medical problems, interest in objectsageethnicRec MAExp MAADOSChild 126 mCauc10 m11 m14Child 231 m9 m14 m19Child 3Latino13 m18Child 427 m8 m17Child 535 m22Child 66 m--Child 736 m12 mChild 829 m17 m
12Research Design Single subject design across 8 subjects 17 1 hour contacts across a 26 week periodEvaluateTreatFollow-upWeeks 1 and 2EvaluateGather baseline dataDevelop treatment planWeeks 3 – 15Provide 1 hr of parent-Child treatment per weekGather behavior samples weeklyWeeks 16 – 264 follow-up visitsGather maintenanceand generalization data
13Fidelity to treatment delivery Progress on Objectives What do we measure?Fidelity to treatment deliveryTherapist – ChildParent – ChildTherapist - ParentProgress on Objectives% of objectives masteredDependent VariablesStandardized measures (e.g, Mullens, Vineland, CARS, ADOS)Frequency of target behaviors (words, imitative acts, child attention, child initiation)Data gathered in two 10 min play samples per sessionOne with parent, one with therapistCoded from videos by coders blind to date and order
15Step 1: Curriculum Assessment Autism affects all aspects of developmentReceptive languageExpressive languageJoint attentionSocial interactionFine motorGross motorImitationCognitionPlayPersonal independenceEatingDressingGroomingchores
16Curriculum Checklist Level 1 Observed TA Report Parent Report Code Receptive Communication1Localizes to sounds by turning toward sound source2Looks to playful vocal sounds (raspberry, whistle)3Responds to voice by turning toward person4Looks at indicated pictures as adult points to pictures in books5Follows a proximal point to place objects in containers, puzzle pieces, etc6Looks when shown an object and told, “Name, look”7Looks to partner when name is called8Follows proximal point to object or location9Follows distal point to retrieve toy10Looks, reaches, or smiles in response to adult gestures and voice in social games
17Step 2: Writing Specific Treatment Objectives 12 week objectives developed with parents; 2-3 per developmental areaObjectives define interventions across people and settingsObjectives target functional,adaptive actions-in-context
18Treatment ObjectivesObjectives written in ABC format; measurable, targeting generalization and independent or spontaneous performanceA: What is the antecedent or stimulus that is to cue the behavior?B: What is the behavior, defined measurably?C: What is the criterion for mastery of this objective?
19Objective - example(A) In sensory social routines, when adult says the names of five different games (e.g. so big, peekaboo, little piggies, here comes a mousey, pattycake) unaccompanied by gestures, (B) the child will respond with an appropriate gesture or body movement (C)75% of the first four opportunities both in therapy and at home with parents over 3 consecutive days.
20Step 3: Developmental Task Analysis of Each Objective Each objective is broken down into 4-6 teaching stepsFirst step: baseline level of skillLast step: mastery level of skillIntermediate steps defineprogress towards mastery
21Step 4: Build the Data Sheet Daily data sheet constructed from task analysis for each objectiveData collected at 15 minute intervalsData used to adjust daily teaching practicesGoal: measurable progresswithin three instructional sessions
22Daily Data Sheet Example RECEPTIVE COMMUNICATIONLooks to adult vocal. in 5 minutes of play : 1X 2X 3XStops activity, turns and looks to name : looks no distractions turns and looks looks while playing turns and looks while playing from 5 feet across roomResponds to give gesture and verbal request: extends towards hand makes contact with hand places no release places and releasesFollows proximal point to retrieve object: looks at object touches object takes objectFollows proximal point to place object: looks at indicated target makes contact with indicated target inconsistently places on target consistently places on target
24Parent Manual Chapters Attention and motivationSensory social routinesTaking turns during playJoint activity routinesImitationTalking bodiesSpeech developmentABC’s of learningUnderstanding and managing unwanted behaviorsPrompting, shaping, fading, chaining
25Intervention Session 5-10 minutes – review of past week 5-10 minutes – play sample with parent5-10 minutes – discuss new concept5-10 minutes – demonstrate new concept5-10 minutes – parent practices new concept with coaching until mastered5-10 minutes – review of objectives, discussion of practice in varying environsgoodbye
34Will parent skills improve child engagement? Higher levels of child engagement to adult (i.e., attention, persistence, cooperation, interest) compared to baseline levels.Gains are maintained during follow up with parent
35Will parent skills improve child initiations? Higher levels of initiation to adult (i.e., joint attention, affect) compared to baseline levels.Gains are maintained during follow up with parent and unfamiliar therapist.
37Effects of the intervention: Parents learned play based intervention strategieslearned principles of behavior change and learned how to apply themused these skills in real-life contexts and interactionstaught children their developmental objectivesmaintained skills for 12 weeks after treatment ended
38Effects of the intervention: children increased attention and engagement with othersincreased spontaneous social initiations and responsesincreased number of words more than 10 foldincreased number of imitations more than 10 foldcontinued to develop and generalize skills 12 weeks after the end of treatment
39ConclusionsShort term parent based interventions begun soon after diagnosis can:Provide parents with powerful teaching skillsAddress their motivation to act immediately after diagnosisStimulate changes in child developmentProvide an important intervention while waiting for other treatments to beginPrepare children for participation in more intensive therapist based interventions
40ThanksTo all the contributorsTo the participating familiesTo YOU!