1. Effective Practices in Early Intervention
by Ilene S. Schwartz & Bonnie J. McBride
Chapter 3

2. Autism Prevalence
As of 2007, the CDC estimates that in 150 children have an autism spectrum disorder (ASD)

3. Early Intervention
There is overwhelming evidence that the earlier autism is diagnosed and intervention begins, the better the outcome
BUT
Although ASD can be reliably diagnosed by age 2, average age of diagnosis is 3-6 years
Even later for children who are culturally or linguistically diverse

4. Red Flags No words by 16 months
No smiles by 6 months
No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
No back-and-forth gestures (e.g., pointing, showing, waving) by 12 months
No words by 16 months
No two-word meaningful phrases by 24 months
A loss of speech or babbling or social skills at any age

5. Who can diagnose autism?
A clinical evaluation should be done by a specialist who is experienced with ASDs
Psychologist
Developmental pediatrician
Psychiatrist
Neurologist

6. Identification Through the School System
IDEA criteria are similar, but not identical, to clinical criteria
Some states use broad classification of “developmentally delayed” until child is age 6 or 9
Educational classification may not entitle child to services through health or social services agencies
Instruments used may not be appropriate for detecting the kinds of difficulties children with ASDs experience

7. Challenge of Diagnosis
In many areas, there is a shortage of professionals--both clinical and educational--who have expertise in autism
Vital that parents and professionals are actively involved in the diagnostic process and ask questions

8. Recommendations of the National Research Council
Children should begin receiving specialized, intensive early intervention as soon as child is diagnosed w/ ASD or is suspected to be at risk for an ASD
Never delay intervention while awaiting an evaluation
Never “wait and see”

9. Vital Referrals Assessment process must include:
Helping families locate services
Publicly funded services (early intervention or school-based services)
Parent training
Parent support groups

10. Vital Information
Assessment process must include vital information for parents
Characteristics of effective programming for young children with ASDs
Info on child’s strengths and challenges
Should NOT include a statement on child’s long-term prognosis
No way of knowing how an individual child will respond to intervention

11. Effective Programming
No single educational strategy is best for all children with ASDs
ABA (applied behavior analysis) most researched
Many different interventions have led to improved outcomes for children and families
Intervention can include home-, center-, and community-based services

12. Key Elements in Effective Programs
Sufficient hours/intensity of services
Comprehensible environments with access to typical peers
Specialized, appropriate curriculum
Family involvement
Problem-solving approach to challenging behaviors
Appropriate evaluation tools to monitor progress

13. Sufficient Hours/Intensity of Services
National Research Council recommends 25 hours per week
Should include some 1:1 instruction
Also look at:
Training & expertise of the professionals implementing the program
Child’s level of engagement in the instructional tasks

14. Comprehensible Environments with Access to Typical Peers
Child must be able to understand:
Organization of physical space
Organization of materials
Scheduling of activities
Planned opportunities for adult-supported interaction with typical peers
Just putting child w/ autism together with typical peers is not sufficient

15. Family Involvement
Family the most consistent influence in a child’s life
Children with ASDs often have difficulty generalizing skills from one setting to another
Interventions are more effective when professionals and families collaborate to implement strategies in multiple settings

16. Problem-Solving Approach to Challenging Behaviors
Challenging behaviors (screaming, crying, aggression) are common in children with ASDs
Look at not just the behavior itself, but its function (What does the behavior accomplish for the child?)
Teach child proactive behavior to replace challenging behavior

17. Appropriate Evaluation Tools to Monitor Progress
Progress must be monitored repeatedly and systematically
If child is not learning, programming must be changed
Many ways to monitor progress--checklists, observation tools, rating scales, etc.
Evaluation tools must be easy to use, or they won’t be used consistently

18. Putting Together a Comprehensive Program
Most families don’t use a single “brand name” program like Lovaas, TEACCH, or Floor Time
Instead, most combine service providers with different theoretical orientations to create an eclectic program
Some publicly funded, some through private insurance or out-of-pocket

19. Questions Parents Should Ask About Any Program
What are your primary concerns for your child?
Does the intervention (or collection of interventions) address those concerns?
Are the intervention procedures acceptable to you?
Is it a good match for your child/family?
What is the evidence of effectiveness?
How will the interventionists communicate with you and demonstrate your child’s progress?

20. Meaningful Outcomes for Young Children with ASDs
All young children need to learn to:
Follow simple directions
Imitate
Communicate wants and needs
Perform basic self-care skills (e.g., toilet training)
Beyond these, opinions vary on what should be top priority

21. Outcome-Oriented Approach
Some programs overemphasize specific, discrete skills
Meaningful outcomes help a child become more independent or achieve a better quality of life
Don’t underestimate importance of belonging, having friends, happiness, good health

22. Curriculum-Based Assessment (CBA)
One way to identify appropriate skills to target
Identifies functional skills across multiple domains (adaptive, communicative, cognitive, social, and motor)
Two options
Use one developed especially for ASDs (e.g., ABLLS)
Use a general one plus checklists that assess core deficit areas for students with ASDs

23. Project DATA (Developmentally Appropriate Treatment for Autism)
Model program at University of Washington since 1997
12 hours per week in integrated early childhood program
12 hours per week of intensive instruction, 1-on-1 or small group
5+ hours per week of parents working with kids at home

24. 5 Components of Project DATA
Extended, Intensive Instruction
Technical and Social Support for Families
Integrated Early Childhood Experience
Transition Planning and Support
Collaboration and Coordination

25. 6 Elements of Integrated Early Childhood Program
Structuring the classroom to promote independence, participation, and successful interactions with typically developing peers
Well-designed traffic pattern
Centers and activities that are interesting, relevant and engaging
Centers with adequate, age-appropriate materials
Activities that promote or require peer interaction
Materials that are well organized and in good working order
Materials that are rotated frequently

26. 6 Elements of Integrated Early Childhood Program
Developing and using a consistent schedule
Use pictures, symbols, and objects to increase understanding
Children must be taught to use the schedules
Teachers must use the schedules consistently
Use strategies to signal upcoming activity change (timers, counting, songs, etc.)
Teach children to handle unexpected changes in schedule

27. 6 Elements of Integrated Early Childhood Program
Creating the need to communicate with adults and peers
Every child must have a functional communication system
Every activity is a language-learning and language-using opportunity
Example: At snack time, child can use language to request something he wants, reject something he doesn’t want, or respond to request of a peer

28. 6 Elements of Integrated Early Childhood Program
Using preferred materials and activities to promote learning
Identify child’s preferred items and make them available as part of classroom activities
Make sure every center has a wide range of items--something for everyone

29. 6 Elements of Integrated Early Childhood Program
Providing embedded and explicit instruction on valued skills
All teachers and interventionists must know the different techniques and how to measure progress
Same skills must be practiced across settings, activities, people, and materials

30. 6 Elements of Integrated Early Childhood Program
Providing frequent reinforcement and developing effective motivation
A reinforcer is anything (good or bad) that increases the probability of a behavior happening again
Early on, artificial reinforcers may need to be used (favorite toy, food, bubbles, etc.)
Advance to using natural reinforcers (logical consequences) only when they’re sufficient to promote skill development and appropriate behavior

31. Project DATA’s Extended, Intensive Instruction
12 hours a week
One-on-one or small groups
Varies, depending on child’s needs and objectives being worked on
5+ hour a week
Parents work with child at home

32. Project DATA’s Technical and Social Support
Monthly home visit
Families must attend 6 or more hours of educational programming per year

33. Project DATA’s Collaboration and Coordination of Services
Almost every family uses some type of family negotiated service (i.e., services not paid for by school district)
Once a year, hold a team meeting of ALL service providers
Purpose: To foster communication and collaboration (NOT joint planning or eval)

34. Project DATA’s Transition Planning & Support
Transitions are especially difficult for children with ASDs
Work with school district, preschool, and family to ensure adequate planning for smooth transition to school
Teach new skills
Transfer visual support
Visit new school and meet teacher

35. Conclusion
Project DATA is just one example of an effective early intervention program
Over 50% of students move on to inclusive kindergartens
Remember that there is no one “right” way to educate a child with an ASD
A program’s success is measured by the child’s progress

36. First Signs www.firstsigns.org Organization founded by parents
Excellent info on early diagnosis and intervention