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Autism Interventions Picture Exchange Communication System (PECS) Applied Behavior Analysis (ABA) Assistive Technology (AT) Treatment and Education of.

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Presentation on theme: "Autism Interventions Picture Exchange Communication System (PECS) Applied Behavior Analysis (ABA) Assistive Technology (AT) Treatment and Education of."— Presentation transcript:

1 Autism Interventions Picture Exchange Communication System (PECS) Applied Behavior Analysis (ABA) Assistive Technology (AT) Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) Cognitive Behavior Modification (CBM)

WHAT IS PICTURE EXCHANGE COMMUNICATION SYSTEM (PECS)? Picture Exchange Communication System (PECS) is a form of augmentative and alternative communication. It is typically used as an aid in communication for children with autism and other special needs. The system has been used with a variety of ages including preschoolers, adolescents and adults who have a wide array of communicative, cognitive and physical difficulties. The Picture Exchange Communication System (PECS) is among the most commonly used with children and adults who have little or no verbal ability. A child can be trained in PECS by a parent, caregiver, or therapist who has learned about the method. An ABA approach is used, in which prompts are given to guide the picture exchange. Further, in the early phases of PECS training, the child chooses a picture of a desired food, and receives the food in exchange for the picture. Getting the food is the positive reinforcement for using the picture to communicate.

3 What does the Research Say?
The effectiveness of the Picture Exchange Communication System (PECS) for children with autism spectrum disorder (ASD): A South African pilot study Study investigated the effects of introducing the Picture Exchange Communication System (PECS) on the frequency of requesting and commenting and the length of verbal utterances of two children with autism spectrum disorder (ASD). Participants Two participants were recruited. Both were children diagnosed with autism who presented with some spoken language, but had a limited use of language in communicative exchanges. Methodology A mixed research design was used, including a quantitative component – a single-subject multiple-baseline design (MBD) across three behaviors, repeated with two participants – and a qualitative component. Data was collected in the PECS pre-training, training, post-training and follow-up stages, in both structured and unstructured settings. Results The findings indicated highly effective treatment for requesting and mixed results for commenting and length of verbal utterances. There were considerable increases in intentional communicative acts (ICAs) for both participants, with marked increases in requesting (function) and the development of forms of communication (Travis & Geiger, 2010).

4 What does the Research Say?
The impact of the Picture Exchange Communication System on requesting and speech development in preschoolers with autism spectrum disorders and similar characteristics This study reported the results of a multiple baseline across participants investigating the implementation of the PECS with three preschool children with characteristics of ASD. Three children were recruited to participate in the study. The first four phases of PECS were taught to the participants: (1) basic picture exchange, (2) increasing distance use of PECS, (3) discriminating among a variety of pictures, and (4) communicating in sentences composed of pictures. Results indicated that two of the three participants mastered PECS. However, participants did not significantly increase in use of word approximations and intelligible words. (Ganz, Simpson, & Corbin-Newsome, 2008) Teaching Children With Autism to Ask “What’s That?” Using a Picture Communication With Vocal Results This study investigated how augmentative and alternative communication users learn to communicate, with methods of how vocal individuals with autism spectrum disorders have been taught to ask wh-questions, to teach non-vocal individuals with autism spectrum disorders to ask the question “What’s that?” using PECS. Eight preschool-aged children were recruited to participate in the study. Age ranged between 3-to-5 years of age. The results showed that all 3 participants learned to vocally ask “What’s that?” without requiring the communication picture, and the training for all participants was completed within 1 to 2 days. Secondary findings included the successful generalization of this question to non-trained settings, communicative partners, and stimuli. (Ostryn & Wolfe, 2011)

5 What does the Research Say?
Effectiveness of the Picture Exchange Communication System (PECS) on Communication and Speech for Children With Autism Spectrum Disorders: A Meta-Analysis This meta-analysis reviewed the current empirical evidence for PECS in affecting communication and speech outcomes for children with ASD (Flippin, Recska, & Watson, 2010). A systematic review of the literature on PECS w between 1994 and June 2009 was conducted. Eight single-subject experiments (18 participants) and 3 group studies (95 PECS participants, 65 in other intervention/control) were included. Results indicated that PECS is a promising but not yet established evidence-based intervention for facilitating communication in children with ASD ages 1–11 years. Small to moderate gains in communication were demonstrated following training. Gains in speech were small to negative . (Flippin, Recska, & Watson, 2010). A Communication-Based Intervention for Nonverbal Children With Autism: What Changes? Who Benefits? This study examined the form and function of spontaneous communication and outcome predictors in nonverbal children with autism using PECS. Eighty-four children from 15 schools participated in a randomized controlled trial of PECS. They were aged 4–10 years (73 boys). Spontaneous communication using picture cards, speech, or both increased significantly following training. Spontaneous communication to request objects significantly increased, but spontaneous requesting for social purposes did not. Less severe baseline autism symptomatology was associated with greater increase in spontaneous speech and less severe baseline expressive language impairment , with larger increases in spontaneous use of speech and pictures together. (Gordon et al., 2011).

Studies observing the effects of the picture exchange communication system (PECS) have shown promising practices. However, consistency of the effectiveness of PECS has not be fully established. Individuals with least severe symptomatology have been observed as benefiting from PECS while others with more severity have not seen benefits. Therefore, I believe that interventions created for individuals with autism can use PECS as a n extra resource or in combination with another empirically-based alternative in the intervention process. Studies have shown positive results; however, using this intervention as solely. Click on the picture to view the video. Right-click, and then select open hyperlink.

WHAT IS APPLIED BEHAVIOR ANALYSIS (ABA)? Applied behavior analysis was originally described by B.F. Skinner in the 1930's. The principles and methods of behavior analysis have been applied effectively in many circumstances to develop a wide range of skills in learners with and without disabilities. Behavior analysis is a scientific approach to understanding behavior and how it is affected by the environment. The science of behavior analysis focuses on principles (general laws) about how behavior works, or how learning takes place. By functionally assessing the relationship between a targeted behavior and the environment, the methods of ABA can be used to change that behavior. Research in applied behavior analysis ranges from behavioral intervention methods to basic research which investigates the rules by which humans adapt and maintain behavior.

8 What does the Research Say?
Some Generalization and Follow-Up Measures on Autistic Children in Behavior Therapy In this study 20 children with autism were treated by applied behavior analysis. At intake, most of the children were severely disturbed, having symptoms indicating an extremely poor prognosis. The children were treated in separate groups, and some were treated more than once, allowing for within- and between-subject replications of treatment effects. The findings can be summarized as follows: Inappropriate behaviors (self-stimulation and echolalia) decreased during treatment appropriate behaviors (appropriate speech, appropriate play, and social non-verbal behaviors) increased Spontaneous social interactions and the spontaneous use of language occurred about eight months into treatment for some of the children. 1 to 4 yr after treatment showed that large differences between groups of children depended upon the post-treatment environment (those groups whose parents were trained to carry out behavior therapy continued to improve, while children who were institutionalized regressed). (Lovaas, Koegel, Simons, & Long, 1973). Okay on date, seminal study

9 What does the Research Say?
Effects of Non-contingent Reinforcement on Problem Behavior and Stimulus Engagement: The Role of Satiation, Extinction, and Alternative Reinforcement This study examined the effects of non-contingent reinforcement (NCR) with and without extinction on problem behavior. Four participants were recruited to participate in the study. They were children who had been admitted to an inpatient behavioral unit for the assessment and treatment of severe behavior problems. Frequency data were collected on target problem behaviors during Phases 1 (functional analysis) and 2 (treatment analysis) and are presented as number of responses per minute. Results found that problem behavior was reduced to near-zero levels during NCR without extinction (Hagopian, Corckett, Van Stone, De Leon, & Bowman, 2000). Social Stories, Written Text Cues, and Video Feedback: Effects on Social Communication of Children with Autism This study investigated the effects of written text and pictorial cuing with supplemental video feedback on the social communication of 5 students with autism and social deficits. Five children with social impairments (with ASDs) and 10 of their peers without disabilities participated in the study. Treatment was implemented twice per week and consisted of 10 min of systematic instruction using visual stimuli, 10 minutes of social interaction, and 10 minutes of self-evaluation using video feedback. Results showed increases in targeted social communication skills when the treatment was implemented. Some generalized treatment effects were observed across untrained social behaviors, and 1 participant generalized improvements within the classroom. In addition, naive judges reported perceived improvements in the quality of reciprocal interactions. (Thierman & Goldstein, 2011).

10 What does the Research Say?
Self-Control in Children with Autism: Response Allocation During Delays of Reinforcement This study examined the use of a progressive-delay schedule of reinforcement to increase self-control and decrease disruptive behavior in children with autism. Three children with autism served as participants. All children were able to follow simple instructions, speak in two- and three-word phrases and make requests. When initially given the choice between an immediate smaller reinforcer and a larger delayed reinforcer, all participants chose the smaller reinforcer. When access to the larger reinforcer required either no activity or engaging in a concurrent task during the delay, all participants demonstrated both self-control and preference for a response requirement. Disruptive behavior decreased during delays that required a concurrent task compared to sessions without an activity requirement (Dixon & Cummings, 2001). Too old Choices Between Positive and Negative Reinforcement During Treatment For Escape-Maintained Behavior In this study, they examined the relative effects of positive and negative reinforcement for compliance, without extinction, on levels of compliance and escape-maintained problem behavior. One participant 10-year old girl diagnosed with autism, had been admitted to an inpatient unit for the assessment and treatment of severe behavior disorders. A combined multi-element and reversal design was used to compare the relative efficacy of providing negative (a 30-s break) or positive (a potato chip) reinforcement for compliance while problem behavior continued to produce a 30-s escape. Positive reinforcement was more effective than negative reinforcement in promoting compliance and reducing escape-maintained problem behavior for a child with autism. Reference too old (DeLeon, Neidert, Anders, & Roriguez-Catter, 2000).

Many published studies have shown that specific ABA techniques can help individuals with autism learn specific skills, such as how to communicate, develop relationships, play, care for themselves, learn in school, succeed at work, and participate fully and productively in family and community activities, regardless of their age. A number of peer-reviewed studies have examined the effects of combining multiple ABA techniques into comprehensive, individualized, intensive early intervention programs for children with autism. Therefore, I believe that the use of ABA to help children with autism is the gold standard. Families, teachers, and therapists can all use ABA techniques to help children in a variety of different settings. Click picture to access the video


WHAT IS ASSISTIVE TECHNOLOGY (AT)? Assistive technology (AT) is an umbrella term that includes assistive, adaptive, and rehabilitative devices for people with disabilities and also includes the process used in selecting, locating, and using them. AT promotes greater independence by enabling people to perform tasks that they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks. According to the Technology-Related Assistance for Individuals with Disabilities Act of 1988 (Public Law ), an assistive technology means any item, piece of equipment, or product system, whether acquired commercially, off-the-shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. Assistive technology service is any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.

14 What does the Research Say?
Key factors mediating the use of a mobile technology tool designed to develop social and life skills in children with Autistic Spectrum Disorders This study used a qualitative design to examine intergenerational relationships facilitated by an intervention employing Google Sketc-hUp, a freeware 3D design program . Seven high-functioning boys (ages 8–17) with autism spectrum disorders (ASD) participated in computer workshops. The investigators capitalized on the boys’ strengths in visual–spatial skills. The interdisciplinary team structured the workshops to facilitate computer skill development as well as social interaction. Qualitative analysis involved thematic analysis of transcripts from focus groups with parents and grandparents. The two key themes that emerged were as follows: reframing expectations (parental efficacy and creating a safe environment) building intergenerational bridges among parents, children, siblings, and grandparents. These findings indicate that technology can build on the strengths of children with ASD and promote social engagement of the children with their families (Mintz, Branch, March, & Lerman, 2012).

15 What does the Research Say?
Effects of Peer-Mediated Instruction to Teach Use of Speech-Generating Devices to Students with Autism in Social Game Routines This study investigated the effects of a peer-mediated intervention designed to teach two students with ASD to use speech-generating devices (SGDs) to engage in interactions with peers at school. Six peer confederates (three from each student with ASD’s general education classroom) were taught to support SGD use during game activities. A multiple baseline design was used to examine the relationship between peer-mediated instruction and an increase in total communicative acts (CAs) by the two students with ASD. Results provide evidence that the confederates acquired the skills needed to support SGD use by students with ASD. The results also suggest that the intervention was effective at increasing total appropriate CAs by students with ASD. In addition, social validity ratings by all of the confederates were positive. (Trottier, Kamp, & Mirenda, 2011). Use of Computer-Based Interventions to Teach Communication Skills to Children with Autism Spectrum Disorders: A Systematic Review Study evaluates intervention outcomes, appraises the certainty of evidence, and describes software and system requirements. This review has three main aims: to evaluate the evidence-base regarding CBI to inform and guide practitioners interested in using CBI (assistive technology) to stimulate and guide future research aimed at improving the efficiency and effectiveness of CBI in communication for individuals with ASD. 10 studies provided intervention to a total of 70 participants. The sample size of individual studies ranged from 1 to 14. Participant ages ranged from 3 to 14 years. Fifty-four (77%) of the participants were male and 16 (23%) were female. Results suggest that CBI should not yet be considered a researched-based approach to teaching communication skills to individuals with ASD. (Ramdoss et al., 2011).

16 What does the Research Say?
Extending Research on a Computer-Based Sight-Word Reading Intervention to a Student with Autism The study, initiated by a special education teacher who requested assistance in enhancing reading in a student with autism, was designed to replicate and extend the CBSWRI research base. A multiple-baseline design across tasks (i.e., word lists) was used to evaluate the effects of a computer-based sight-word reading intervention (CBSWRI) on the sight-word reading of a sixth-grade student with Autism. The study was conducted in a rural elementary school in the Southeastern United States. One 12-year-old boy was selected to participate in the study. Across 3 lists of primer and first-grade Dolch words, the student showed immediate increases in sight-word reading after the CBSWRI was applied. As the student learned 25 words in 16 brief (i.e., 200 s) sessions. Results suggested that the assistive technology was effective at teaching the participant 25-words. (Yaw et al., 2011). Caregiver Perspectives About Assistive Technology Use With Their Young Children With Autism Spectrum Disorders The purpose of the study was to examine how caregivers of children with autism spectrum disorder view their daily activities and in what way, if any, assistive technology (AT) acts as a support. A total of 134 families who reported their child’s disability as autism spectrum disorder completed a survey designed to gain information about activities (e.g., mealtime) and potential use of AT to support a child’s participation in the routine. Frequency counts were utilized to determine the percentage of caregiver responses in each activity/routine category. Results indicated that caregivers reported difficulties with all sampled activities. The problem reported most frequently (39.9%) was a child’s inability to participate in the routine. Less than half of the caregivers reported being able to find solutions that incorporated the use of AT. Although some caregivers reported using AT, actual use of AT was minimal. (Cardon, Wilcox, & Campbell, 2011).

17 VIDEO The use of assistive technology does seem a promising practice that warrants future research. Assistive technologies in general, however, have a history of problems in their adoption and continued use. Families have reported problems with its usage. However, when people are trained, results have proven effective. Using devices to help children on the spectrum should be used when applicable. But, training people who will be involved with the process is a necessary.

18 Treatment and education of autistic and related communication-handicapped children (TEACCH)
WHAT IS TREATMENT AND EDUCATION OF AUTISTIC AND RELATED COMMUNICATION-HANDICAPPED CHILDREN (TEACCH)? Treatment and education of autistic and related communication handicapped children (TEACCH) is a service, training, and research program for individuals of all ages and skill levels with autism spectrum disorders. It was developed at the University of North Carolina, originating in a child research project begun in 1964 by Dr Eric Schopler and Dr Robert Reichler. The TEACCH philosophy recognizes autism as a lifelong condition and does not aim to cure but to respond to autism as a culture. Core tenets of the TEACCH philosophy include an understanding of the effects of autism on individuals; use of assessment to assist program design around individual strengths, skills, interests and needs. TEACCH methodology is rooted in behavior therapy, more recently combining cognitive elements, guided by theories suggesting that behavior typical of people with autism results from underlying problems in perception and understanding.

19 What does the Research Say?
Effects of an Individual Work System on the Independent Functioning of Students with Autism This study examined the effects of a work system on the independent work and play skills of students with autism. Work systems, an element of structured teaching developed by Division TEACCH, are organized sets of visual information that inform a student about participation in work or play areas. A single subject withdrawal of treatment design, with replications across three participants, was used to assess the on task behavior and work completion skills of the students in classroom and employment settings as a result of the intervention. Three students with autism participated in this study. Each was selected on the recommendation of school district special education personnel. Students were selected according to the following criteria: formal diagnosis of autism, teacher report of difficulty completing tasks independently (confirmed by researcher observation), familiarity with visual schedules and/or following visual sequences of information, and no prior experience with the use of work systems. Observational data indicated that all students showed increases in on-task behavior, increases in the number of tasks completed or play materials utilized, and reduction of teacher prompts. The results were maintained through the 1-month follow-up. (Hume & Odom, 2007).

20 What does the Research Say?
Effectiveness of a Home Program Intervention for Young Children with Autism This study evaluated the effectiveness of a TEACCH-based home program for young children with autism. Parents were taught how to work with their preschool child in the home setting, focusing on cognitive, academic, and prevocational skills essential to later school success. Two matched groups of children were compared, a treatment group and a no-treatment control group, each consisting of 11 subjects. The treatment group was provided with approximately 4 months of home programming and was tested before and after the intervention . The control group did not receive the treatment but was tested at the same 4-month interval. Results demonstrated that children in the treatment group improved significantly more than those in the control group on the PEP-R subtests of imitation, fine motor, gross motor, and nonverbal conceptual skills. (Ozonoff & Cathcart, 1998). Okay on date/Intervention is dated Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) Programme as Compared with a Non-Specific Approach Two educational treatments were compared, the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) program and the integration program for individuals with disabilities. Two groups of eight subjects were matched by gender, chronological and mental age, and nosographic diagnosis (i.e. autism associated with severe intellectual disability, DSM-IV criteria and Childhood Autism Rating Scale scored. The TEACCH program was applied to the experimental group, while the control group was integrated in regular schools with a support teacher. The Psycho-Educational Profile – Revised and the Vineland Adaptive Behaviour Scale were administered twice with a one-year interval between assessments. The scores of the experimental group increased more than the control group scores. Statistically significant differences were obtained in both groups because of the differences in the two approaches. (Panerai, Ferrante, & Zingale, 2002).

21 What does the Research Say?
Special Education Versus Inclusive Education: The Role of the TEACCH Program This study aimed at comparing, over a period of 3 years, the effectiveness of three different educational approaches addressed to children with autism and severe mental retardation. The first one was a treatment and education of autistic and related communication handicapped children (TEACCH) program implemented in a residential center; the second was a TEACCH program implemented at home and at mainstream schools, after a specific parent psycho-educational training; the third approach referred to inclusive education in mainstream schools, in which a nonspecific approach was implemented. Each subject was assessed twice, using the Psycho- Educational Profile-Revised (PEP-R) and Vineland Adaptive Behavior Scale (VABS)-survey form. Effectiveness of TEACCH appeared to be confirmed, showing positive outcomes in the natural setting, and revealing its inclusive value. (Panerai et al., 2009). Preschoolers with Autism Spectrum Disorders: Evaluating the Impact of a Home-Based Intervention to Promote Their Communication An early intervention program based mainly around Treatment and Education of Autistic and Related Communications Handicapped CHildren (TEACCH), Picture Exchange Communication System (PECS) and Hanen approaches, was delivered to 35 families through 15–18 home visits over a nine-month period. In addition, 26 families acted as a contrast group. A range of measures were used on a pre–post basis along with qualitative data from participants. The children as a whole showed significant improvements on different indices of communication and these were greater than those reported in the contrast group. Mothers too improved on measures of health but not of stress. These findings add to the accumulating evidence that family-delivered, communication-based interventions are effective. Lesson for service-based evaluations are drawn; in particular the reasons for the individual variation in children’s and parental responses require closer investigation. (McConkey et al., 2010).

Studies have shown the effectiveness of TEACCH. Children who were treated by TEACCH techniques have shown improvements. The program utilizes structured and continuous interventions , needed in the lives of children with autism, which attempts to minimize the child’s difficulties. Follow-up studies have shown that treatment effects have lasted post-treatment.

WHAT IS COGNITIVE BEHAVIOR MODIFICATION (CBM)? Donald Meichenbaum is a psychologist noted for his contributions to cognitive behavioral therapy (CBT). He developed a therapeutic technique called cognitive behavior modification (CBM), which focuses on identifying dysfunctional self-talk in order to change unwanted behaviors. Cognitive behavior modification is a method of mental health therapy commonly used to treat a range of neuroses and anxiety disorders. In cognitive behavior modification, the patient or client is trained to recognize destructive or harmful thought patterns or behaviors, then replace them with helpful or constructive thoughts and behaviors. Cognitive behavior modification is administered in the course of treatment by a licensed mental health professional. Cognitive behavior modification works on a principle called "thought stopping." By making thought patterns conscious, the patient is able to recognize when she is about to perform an undesirable behavior, such as compulsive hand-washing, or when she is engaging in negative thoughts that are not supported by logic or reality.

24 What does the Research Say?
Cognitive, Behavior and Intervention Outcome in Young Children with Autism The relations between cognition and autism severity, head size and intervention outcome, were examined. Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities (DD). Eighty-one children with autism (n = 44) and DD (n = 37) were assessed at pre- and post 1 year of intervention. Cognitive abilities and autism severity were measured by standardized tests. Three pre-intervention cognitive level groups: normal (IQ > 90), borderline (70 < IQ < 89) and impaired (50 < IQ < 69) were examined. The impaired group had more severe autism symptoms than the borderline and the normal cognitive groups. IQ scores increased significantly more in the autism group than in the DD group. IQ improvements correlated significantly with reduction in autism symptoms and mostly in stereotyped behaviors. Cognitive ability in autism is associated with autism severity. Two distinct subtypes based on cognitive level are identified. However, baseline cognitive level cannot predict the progress rate in autism symptoms with intervention. Improvement of social–communicative behaviors and the intensive intervention are related to significant cognitive increments in autism. (Itzchak, Lahat, Burgin, & Zachor, 2008).

25 What does the Research Say?
Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial The study looked at the effects of a 16-week Cognitive-Behavioral program and a Social Recreational (SR) program on anxiety in children with Autism Spectrum Disorders. Seventy children (9–16 years old) were randomly assigned to either of the programs. Measures on child’s anxiety using the Spence Child Anxiety Scale—Child (SCAS-C) and the Clinical Global Impression— Severity scale (CGI-S) were administered at pre-, post-treatment, and follow-ups (3- and 6-month). Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as ‘‘Normal’’ and ‘‘Borderline’’ for both programs. (Drahota, Wood, Sze, & Van Dyke, 2011). Anxiety Disorders in Typically Developing Youth: Autism Spectrum Symptoms as a Predictor of Cognitive-Behavioral Treatment Symptoms of autism spectrum disorder (ASD) were assessed (Social Responsiveness Scale-Parent (SRSP); coded in-session behavior) in typically-developing, anxiety-disordered children (N = 50) treated with cognitive- behavioral therapy (CBT). Study 1: children with moderate autistic symptomology (per SRS-P) were significantly more likely to improve from family CBT (FCBT) than individual CBT (ICBT; OR = 8.67). Coded behavior did not predict outcome. Study 2: CBT components were compared by treatment and ASD symptom status. At-home exposure completion was greater in FCBT and there was an interaction in child involvement for treatment and ASD status. Though both treatments reduced anxiety, FCBT outperformed ICBT for children with moderate ASD symptoms, a benefit potentially linked to more at-home exposures and greater child involvement in FCBT. (Puleo & Kendall, 2011).

26 What does the Research Say?
Anxiety problems in young people with autism spectrum disorder: A case series This study reports a case series of children and adolescents with ASD and an anxiety disorder who were treated with a standard cognitive behavior therapy (CBT). The participants were drawn from consecutive referrals to a neuro-developmental disorders clinic for cognitive behavioral treatment of anxiety. All had a diagnosis of ASD. Treatment was delivered by the same therapist in all cases. A standard cognitive behavioral package was delivered, using individualized case conceptualizations based on the cognitive model of anxiety arising from increased threat perception and decreased perceptions of control over threat, as well as considering environmental and parental factors in the maintenance of anxiety. (Sung et al., 2011). Cognitive-behavioral group treatment for social phobia: Effectiveness at five-year follow up. The researchers reported on the follow-up evaluation of cognitive-behavioral group therapy (CBGT) for social phobia. Patients who received CBGT or a credible alternative treatment were re-contacted aider a period of 4.5 to 6.25 years and completed a battery of self-report questionnaires, an individualized behavioral test, and a structured interview with an independent assessor. Examined 19 patients who received cognitive-behavioral group therapy (CBGT) for social phobia. The 15 patients who received CBGT improved greatly compared to the 4 individuals who received an alternative treatment. One of the most effective treatments for social phobia is an intervention package called cognitive-behavioral group treatment (CBGT), which includes exposure, cognitive restructuring, and homework assignments. (Heimberg, Salzman, Holt, & Blendell, 1993).

Cognitive behavior modification has been proven to help children with ASDs cope with their anxiety. Studies have shown the benefits of the treatment. Presently, cognitive-behavior therapists have started to use behavior modification techniques to improve overt behavior by helping their clients to change their maladaptive thought processes. Using these techniques with children on the spectrum can help ease feelings of anxiety for children and/or adolescents who have fears.

28 References 1. Cardon, T. A., Wilcox, M., & Campbell, P. H. (2011). Caregiver perspectives about assistive technology use with their young children with autism spectrum disorders. Infants & Young Children, 24(2), doi: /IYC.0b013e31820eae40 2. DeLeon, I. G., Neidert, P. L., Anders, B. M., & Rodriguez-Catter, V. (2001). Choices between positive and negative reinforcement during treatment for escape-maintained behavior. Journal Of Applied Behavior Analysis, 34(4), doi: /jaba 3. Dixon, M. R., & Cummings, A. (2001). Self-control in children with autism: Response allocation during delays to reinforcement. Journal Of Applied Behavior Analysis, 34(4), doi: /jaba 4. Drahota, A., Wood, J. J., Sze, K. M., & Van Dyke, M. (2011). Effects of cognitive behavioral therapy on daily living skills in children with high-functioning autism and concurrent anxiety disorders. Journal Of Autism And Developmental Disorders, 41(3), doi: /s 5. Flippin, Reszka, & Watson (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal Of Speech-Language Pathology, 19(2), doi: / (2010/ )

29 References 6. Ganz, J. B., Simpson, R. L., & Corbin-Newsome, J. (2008). The impact of the Picture Exchange Communication System on requesting and speech development in preschoolers with autism spectrum disorders and similar characteristics. Research In Autism Spectrum Disorders, 2(1), doi: /j.rasd 7. Gordon, K., Pasco, G., McElduff, F., Wade, A., Howlin, P., & Charman, T. (2011). A communication-based intervention for nonverbal children with autism: What changes? Who benefits? Journal Of Consulting And Clinical Psychology, 79(4), doi: /a 8. Itzchak, E., Lahat, E., Burgin, R., & Zachor, A. (2008). Cognitive, behavior and intervention outcome in young children with autism. Research In Developmental Disabilities, 29(5), doi: /j.ridd 9. Hagopian, L. P., Crockett, J. L., van Stone, M., DeLeon, I. G., & Bowman, L. G. (2000). Effects of noncontingent reinforcement on problem behavior and stimulus engagement: The role of satiation, extinction, and alternative reinforcement. Journal Of Applied Behavior Analysis, 33(4), Retrieved from &hid=10&sid=30ebbf35-64a f620d8b546f1f03%40sessionmgr13&bdata=JnN pdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN= 10. Heimberg, R. G., Salzman, D. G., Holt, C. S., & Blendell, K. A. (1993). Cognitive-behavioral group treatment for social phobia: Effectiveness at five-year follow up. Cognitive Therapy And Research, 17(4), Retrieved from?

30 References 11. Hume, K., & Odom, S. (2007). Effects of an individual work system on the independent functioning of students with autism. Journal Of Autism And Developmental Disorders, 37(6), doi: /s 12. Lovaas, O., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal Of Applied Behavior Analysis, (1), doi: /jaba 13. McConkey, R., Truesdale-Kennedy, M., Crawford, H., McGreevy, E., Reavey, M., & Cassidy, A. (2010). Preschoolers with autism spectrum disorders: Evaluating the impact of a home-based Intervention to promote their communication. Early Child Development And Care, 180(3), doi: / 14. Mintz, J., Branch, C., March, C., & Lerman, S. (2012). Key factors mediating the use of a mobile technology tool designed to develop social and life skills in children with autistic spectrum disorders. Computers & Education, 58(1), doi: /j.compedu 15. Ostryn, C., & Wolfe, P. S. (2011). Teaching children with autism to ask 'what's that?' using picture communication with vocal results. Infants & Young Children, 24(2), doi: /IYC.0b013e31820d95ff

31 References 16. Ozonoff, S., & Cathcart, K. (1998). Effectiveness of a home program intervention for young children with autism. Journal Of Autism And Developmental Disorders, 28(1), doi: /A: 17. Panerai, S., Ferrante, L. L., & Zingale, M. M. (2002). Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme as compared with a non-specific approach. Journal Of Intellectual Disability Research, 46(4), doi: /j x 18. Panerai, S., Zingale, M., Trubia, G., Finocchiaro, M., Zuccarello, R., Ferri, R., & Elia, M. (2009). Special education versus inclusive education: The role of the TEACCH Program. Journal Of Autism And Developmental Disorders, 39(6), doi: /s 19. Puleo, C. M., & Kendall, P. C. (2011). Anxiety disorders in typically developing youth: Autism spectrum symptoms as a predictor of cognitive-behavioral treatment. Journal Of Autism And Developmental Disorders, 41(3), doi: /s 20. Ramdoss, S., Lang, R., Mulloy, A., Franco, J., O'Reilly, M., Didden, R., & Lancioni, G. (2011). Use of computer- based interventions to teach communication skills to children with autism spectrum disorders: A systematic review. Journal Of Behavioral Education, 20(1), doi: /s

32 References 21. Sung, M., Ooi, Y., Goh, T., Pathy, P., Fung, D. S., Ang, R. P., & ... Lam, C. (2011). Effects of cognitive- behavioral therapy on anxiety in children with autism spectrum disorders: A randomized controlled trial. Child Psychiatry And Human Development, 42(6), doi: /s 22. Thiemann, K. S., & Goldstein, H. (2001). Social stories, written text cues, and video feedback: Effects on social communication of children with autism. Journal Of Applied Behavior Analysis, 34(4), doi: /jaba 23. Travis, J., & Geiger, M. (2010). The effectiveness of the picture exchange communication system (PECS) for children with autism spectrum disorder (ASD): A South African pilot study. Child Language Teaching And Therapy, 26(1), doi: / 24.  Trottier, N., Kamp, L., & Mirenda, P. (2011). Effects of peer-mediated instruction to teach use of speech-generating devices to students with autism in social game routines. AAC: Augmentative And Alternative Communication, 27(1), doi: / 25. Yaw, J. S., Skinner, C. H., Parkhurst, J., Taylor, C. M., Booher, J., & Chambers, K. (2011). Extending research on a computer-based sight-word reading intervention to a student with autism. Journal Of Behavioral Education, 20(1), doi: /s

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