10/17/2014 Brian A. Boyd, Ph.D. University of North Carolina at - - PDF document

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 

Brian A. Boyd, Ph.D. University of North Carolina at Chapel Hill

Supported by OSEP #H325G070004 and IES #R324B090005 (PI: Odom)

 Colleagues at FPG & beyond

• Sam Odom, Connie Wong, Suzanne Kucharczyk & Kara Hume – FPG Child

Development Institute, UNC-CH

• Laura Hall (SDSU)
• National Professional Development Center on ASD
• http://www.fpg.unc.edu/~autismPDC/

 National Standards Project

• Susan Wilczynski
• http://www.nationalautismcenter.org/about/national.php

 Autism Guidelines Project funded by the State of California Department of

Development Services  Much of this work is cited from:

• Boyd, B.A., Odom, S., L., Humphreys, B., & Sam, A. (2010). Infants and

toddlers with autism spectrum disorder: Early identification and early

• intervention. Journal of Early Intervention, 32, 75-98.
• Odom, S. L., Boyd, B. A., Hall, L. J., & Hume, K. (2010). Evaluation of

comprehensive treatment models for individuals with Autism Spectrum

• Disorders. Journal of Autism and Developmental Disorders, 4, 425-436.
• Odom, S., Collet-Klinenberg, L., Rogers, S., & Hatton, D. (2010). Evidence-

based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure, 54, 275-282.

• Wong, C., Odom, S. L., Hume, K. Cox, A. W., Fettig, A., Kucharczyk, S., ...

Schultz, T. R. (2013). Evidence-based practices for children, youth, and young adults with Autism Spectrum Disorder. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, Autism Evidence-Based Practice Review Group. http://fpg.unc.edu/sites/fpg.unc.edu/files/resources/reports-and-policy- briefs/2014-EBP-Report.pdf

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 Worked in the field for 17 years

• Assistant Classroom teacher (self-contained)
• Classroom teacher (inclusive setting)
• District consultant
• Trainer in TEACCH Model
• Researcher at UNC

 Evidence based practices

• What are they?
• Why are they important?

 Determining EBP in ASD

• Process of NPDC

 Selecting & using EBP  Case study on use of EBP?

• Visual Supports

 Understand criteria and process for identifying EBPs in autism  Become familiar with the evidence based practices identified by

the National Professional Development Center on Autism

 Identify the practices that have proven to be effective with

students of specific age ranges and/or with specific characteristics

 Learn practical ways to implement practices across the

classroom setting with a number of students

 Discover a number of resources designed to assist in high quality

implementation, data collection, and troubleshooting

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 75% are male  Multiple etiologies

related to neurobiological causes

 Unrelated to

socioeconomic status or race

 Range of IQ scores, but

stretches across the continuum

 Autism

tism h has s hist storica ically lly been s been shroud uded in m misi sinf nform

• rmati

tion

• n
• In the 1940s-1950s, prevailing professional and scientific opinion was

that the disease was caused by the families (Bruno Bettleheim’s refrigerator mother theory)

 Othe

her i r interven enti tion

• ns

s wi with th v very l little ttle or n no e evid idence ce

• f e
• f effect

ctiv iven enes ess inc include

• Antifungal treatment
• Hyperbaric oxygen
• Medical marijuana
• Sound therapy

 Trea

eatm tmen ent t an and p d progra

• gram

m practice actices s need eed to be be based based o

• n s

scie ienti ntific ev eviden ence

Siri and Lyons, 2012.

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10

Best available empirical evidence

Individualized practice decisions

Family wisdom & values Professional wisdom & values

11

Many challenges impede the integration of different sources of evidence &/or translation &/or access to EB services

Best available empirical evidence

Individualized practice decisions

Family wisdom & values Professional wisdom & values

Result: Empirically based interventions often are not implemented in the “real world”

Evidence- based Education Professional Wisdom Individual Experience Consensus Empirical Evidence Scientifically- based Research Empirical Information

Grover J. (Russ) Whitehurst Assistant Secretary Educational Research and Improvement United States Department of Education

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 Without professional wisdom education cannot

• adapt to local circumstances
• operate intelligently in the many areas in which research evidence is

absent or incomplete

 Without empirical evidence education cannot

• resolve competing approaches
• generate cumulative knowledge
• avoid fad, fancy, and personal bias

Grover J. (Russ) Whitehurst Assistant Secretary Educational Research and Improvement United States Department of Education

 Challenge of sorting among effective and

ineffective interventions, discriminating between new & promising and deceptive & improbable

 To rule out placebo effects  Cause of ASD is still largely a mystery

Simpson, R., McKee, M., Teeter, D., Beytien, A. (2007) Evidence- based methods for children and youth with ASD: Stakeholder issues and perspectives. Exceptionality, 15, 203-217.

 Take a moment to write down (or at least think about)

several practices you use with your students/individuals with ASD.

 Rate them from 1-5 on the level of evidence you think they

have (1=no empirical evidence to 5=strong empirical evidence)

 Describe why you selected to use the practices that have

the lowest ratings.

Example:

• Discrete Trial Training= 5
• Weighted vest=3

Use it because the family has seen benefits from using it

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Co Comprehens rehensiv ive e Treatment M tment Models ls set of practices designed to achieve a broad learning or developmental impact on the core deficits of ASD Fo Focused I Inte tervention Pr Practices designed to address a single skill or goal of a student with ASD

 Translation of the

intervention research literature

 Most based on

applied behavior analysis

 Some from other

theoretical perspectives

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 

Published between 1990-2011 in English

Population/Participants: Have clear inclusion criteria for individuals

with ASD between birth and 22 years of age

Interventions: Focused interventions that must be behavioral,

developmental, or educational in nature and could be implemented in typical educational intervention settings (school, home, community)

Comparison: Interventions were compared to no intervention or

alternate interventions

Outcomes: Generate behavioral, developmental, or academic outcomes. Study Design: Employed an experimental or quasi-experimental group

design or single-case design

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Application

• Experience with/ knowledge about ASD
• Previous training related to group design/ SCD

methodology

Training

• Online training module
• Review protocols for article inclusion
• Coding descriptive features of articles

Inter-rater Agreement

• Evaluate one article- compared to master code file
• 80% accuracy
• Correctly determine if the article met inclusionary criteria

Reviewer Demographics # Degree level Masters Degree or Current Graduate Students 65 Doctorate 94 Degree area Applied Behavior Analysis 9 Education 11 Occupational Sciences 3 Psychology 28 School Psychology 5 Special Education 97 Speech/Language 3 Other (music, neurology, social work) 3 Reviewer Demographics # Position Faculty 68 Researcher 14 Graduate Student 46 Practitioner/ Administrator 31 Experience with ASD Teaching in classroom setting 109 Providing intervention in clinical setting 76 Providing intervention in home setting 103 Conducting ASD research 117 Teaching college level course on ASD 84

 Criteria for Qualification as an Evidence-Based Practice

• At least two high quality experimental group or quasi-experimental

design articles

• Conducted by at least two different researchers or research groups

OR

• At least five high quality single case design articles
• Conducted by at least three different researchers or research groups
• Having a total of at least 20 participants across studies

OR

• A combination of at least one high quality group experimental or

quasi-experimental design article and at least three high quality single case design articles

• Conducted by at least two different research groups

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 

29,105 Published articles 1,090 Potentially eligible intervention articles 3,449 Potentially eligible articles 25,656 Excluded based on title review 2,359 Excluded based on abstract review 90 Excluded based on full- text review (after final check by NPDC review team) 456 Intervention articles included in evidence base 544 Excluded based on full- text review (by external reviewers) 546 Potentially eligible intervention articles

27 Evidence-Based Practices Antecedent –Based Interventions Functional Communication Training Prompting Structured Play Groups Cognitive Behavior Intervention Modeling Reinforcement Task Analysis Differential Reinforcement Naturalistic Interventions Response Interruption/ Redirection Technology-Aided Instruction/ Intervention Discrete Trial Teaching Parent-Implemented Interventions Scripting Time Delay Exercise PECS Self-Management Video Modeling Extinction Peer-Mediated Instruction/ Intervention Social Narrative Visual Supports Functional Behavioral Assessment Pivotal Response Training Social Skills Training

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50 100 150 200 250 300 0 to 2 3 to 5 6 to 11 12 to 14 15 to 18 19 to 22 # o

• f Studi

udies SCD group

Table 5. Nature of Literature Base: Participants n Diagnosis* Autism 383 PDD/ PDD-NOS 64 Autism Spectrum Disorder 57 Asperger Syndrome/HFA 40 *Studies may have reported more than one diagnosis &/or co-occurring condition.

Co-occurring Conditions* No co-occurring conditions reported 285 Intellectual disability 116 Speech/language impairment 21 Sensory impairment 14 Epilepsy/seizure disorder 14 ADHD 11 Physical disability 8 Genetic syndrome 6 Learning disability 5 Developmental delay 5 Mental Illness 3 Other (i.e., neurological disorder, hyperthyroidism, Tourette syndrome, otitis media) 16

*Studies may have reported more than one diagnosis &/or co-occurring condition.

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20 40 60 80 100 120 140 160 180 200 Evidence-Based Practices Empirical Support 0-22 years 0-5 years Group SCD Group SCD Antecedent-based interventions (ABI)

• 32
• 10

Cognitive behavioral intervention (CBI) 3 1

• Differential reinforcement (DRA/I/O)
• 26
• 8

Discrete trial teaching (DTT)

• 13
• 11

Exercise (ECE) 3 3

• 3

Extinction (EXT)

• 11
• 1

Functional behavior assessment (FBA)

• 10
• 4

Functional communication training (FCT)

• 12
• 7

Modeling (MD) 1 4 1 2 Naturalistic intervention (NI)

• 10
• 10

Parent-implemented intervention (PII) 8 12 8 10 Peer-mediated instruction and intervention (PMII)

• 15
• 8

Picture Exchange Communication System (PECS) 2 4 1 2 Pivotal Response Training (PRT) 1 7 1 3 Prompting (PP) 1 32

• 16

Reinforcement (R+)

• 43
• 16

Response interruption/redirection (RIR)

• 10
• 5

Scripting (SC) 1 8 1 2 Self-management (SM)

• 10
• 1

Social narratives (SN)

• 17
• 4

Social skills training (SST) 7 8 1 4 Structured play groups (SPG) 2 2

• Task analysis (TA)
• 8
• 2

Technology-aided intervention and instruction (TAII) 9 11 3

• Time delay (TD)
• 12
• 6

Video modeling (VM) 1 31 1 12 Visual supports (VS)

• 18
• 7

Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Social Communi

• cation

Behavior Joint Attention Play Cognitive School- Readiness Academic Motor Adaptive Vocationa l Mental Health 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

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How does your list of practices

measure up to the findings?

• Look again at your list…were the

practices you identified as EB on the list?

• What are the discrepancies?

Ask: What is our targeted goal/objective for

this student?

• Consider the specific goals and related
• bjectives

Ask: What are our options?

• Look at the domain of behavior to which

the specific goal relates

36

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Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Social Communi

• cation

Behavior Joint Attention Play Cognitive School- Readiness Academic Motor Adaptive Vocationa l Mental Health 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

 First step is high quality programming– the foundation for

implementing EBP

Pr Progra ram Quali Quality

 The actual learning

environment needs to address the core deficits of autism.

 EBP are used to promote skill

development.

 Program quality as the house

in which practices are employed

EBP EBP

 Evidence-based practices as

specific tools for specific skills

 EBP as the furniture or

appliances selected & designed for specific functions

Gen General Qu ral Quality ty Indic Indicators rs

Structure Positive Learning

Climate

Assessment

EBP EBP

Visual supports,

structured work systems

Peer-mediated

intervention

Functional behavior

assessment

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 What indicators of general program quality do you think are

necessary when programming for individuals with ASD ?

• Example: Collaboration among team members

 Learning Environment  Positive Learning Climate  Assessment  Social Competence  Personal

Independence/Competence

 Promoting Appropriate

Behavior

 Family Involvement  Teaming  Transition Planning  http://pdc.fpg.unc.edu/usi

ng-apers-proficiency

Ask: What is our goal/objective targeting?

 Consider the specific treatment or individualized

goals and related objectives Ask: What are our options?

 Look at the domain that the specific goal relates

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Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Social Communi

• cation

Behavior Joint Attention Play Cognitive School- Readiness Academic Motor Adaptive Vocationa l Mental Health 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

Ne Next, mak make a a dec decision bas based on:

• n:

The skills being taught Your professional wisdom The learner’s learning style The learner’s temperament The learner’s interests and motivators Supports already in place History of what has and hasn’t worked Goal: Sam will improve expressive communication skills across the school day. Related Benchmark: Sam will request a desired item during snack and/or free choice time three times per day for two consecutive weeks.

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Ask: What is the goal targeting?

 Expressive Language

Ask: What are the options?

Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Communication 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

Let’s say we know this…

 Sam is 4 years old and in an inclusive preschool setting.  Sam is already using pictures for a visual schedule at

school.

 One of Sam’s classmates uses PECS, and Sam is

interested in the pictures.

 Sam does not like talking to most people and he is

difficult to understand.

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Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Communi-cation 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Communi-cation 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

Goal: Rosita will express frustration with words, signs, or pictures rather than physical aggression. Related benchmark: When Rosita experiences frustration with difficult or challenging academic tasks, she will use words to request a break or assistance.

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Ask: What is our objective targeting?

 Expressive Language  Behavior Management

Ask: What are our options?

Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Communication Behavior 0-5 6-14 15- 22 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

Ne Next, mak make a a dec decision bas based on:

• n:

 Your professional wisdom  The learner’s learning style  The learner’s temperament  The learner’s interests and motivators  Supports already in place  History of what has and hasn’t worked

10/17/2014 19 Let’s Let’s sa say w y we kno know this… this…

 The school team has determined that Rosita was using

aggression when she became frustrated with her academic workload.

 Rosita does have language, but tends to not talk very much.  Rosita is captivated by print and is a voracious reader.

Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Communi-cation Behavior 0-5 6-14 15- 22 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

 Frankie will play cooperatively with peers on the playground

during recess.

• (related benchmark) Frankie will engage appropriately (i.e., without

earning a yellow slip for inappropriate language or actions) in self- selected recreation activities with one or more peers during both recess times for two consecutive weeks.

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 4th grade student  With supports,

academically successful

 Often chooses solo

activities during recess and free time

 Enjoys looking at comic

books and drawing

 Has recently begun to

show signs of puberty and increased incidents

• f aggression

 Is involved in Circle of

Friends program at school

 A goal identified by

Frankie’s parents is for him to make friends with children outside of school

Table 8. Matrix of Evidence-Based Practices by Outcome and Age (years). EBP Social 0-5 6-14 15- 22 ABI CBI DRA/I/O DTT ECE EXT FBA FCT MD NI PII PMII PECS PRT PP R+ RIR SC SM SN SST SPG TA TAII TD VM VS

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 Must be implemented with fidelity  How do I learn how to implement them?

• http://www.autisminternetmodules.org/

Visual supports

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Shaw, E., Meredith, K., Boman, M, & Hume, K. (2009). Visual Supports. Chapel Hill: National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, The University of North Carolina.

Vi Visual Suppor sual Supports

Definition: Any tool presented visually that supports an individual as he/she moves through the day Includes: Pictures, written words, objects, arrangement of the environment (visual boundaries), schedules, maps, labels,

• rganization systems, timelines, and scripts

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 Meets our EBP criteria  Can be effectively implemented with learners from early

childhood through middle school with children across the spectrum

• Early childhood settings: visual schedules to increase

task engagement, visual scripts to encourage social interaction, and picture cues to support play skill development

• Elementary and middles school: visual schedules and

pictures cues to reduce transition time, increase on-task behavior, and complete self-help in the home

 Skills and intervention goals that can be addressed by visual

supports include:

• Targeting adaptive behavior (e.g., task engagement,

independent performance, transitions across activities, and increasing response chain length)

• Increasing skills across curriculum areas: play skills, social

interaction skills, and social initiation

• Reducing self-injurious behavior

 May be used in classroom and home settings as one

component of comprehensive programming

 Complete more tasks by themselves therefore increasing

their independence

 Learn more rapidly  Demonstrate decreased levels of frustration, anxiety, and

aggression related to task completion

 Adjust more readily to changes in their environments

(Savner & Myles, 2000)

 Proclivity towards visual processing of information

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 Determine what information should be presented visually.  What activity, event, or concept

• causes frustration and or anxiety,
• requires a great deal of adult support for success, or
• is difficult for the learner to understand when information verbally

presented?



Conduct an individualized assessment of learner’s (1) comprehension level, (2) attention span, and (3) sequencing abilities in order to select the appropriate:

• form of representation,
• schedule length and presentation format,
• method of manipulating the schedule,
• location of the schedule, and
• method to initiate schedule use.

 Functional objects used in activities  Object that is symbolic of activity  Photograph  Photograph with words

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 Drawing or picture symbol

with words

 Word  Phrase or sentence  One item – signifies

upcoming transition

 Two items (left to right or

top to bottom)

 Three to four items (left to

right or top to bottom)

 Half day (left to right or

top to bottom)

 Full day (left to right or

top-to-bottom)

Te Teacher Ar Art Lu Lunch Co Computer Libra Library

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 Learner carries an object to be used in upcoming activity  Learner caries an object/visual cue and it is matched in the

corresponding location

 Learner turns over visual schedule cue/puts cue in a

finished location when activity completed

 Learner marks off visual cue on schedule as completed Te Teacher Ar Art  Schedule information is brought to the learner.  Schedule is stationary at a central location.  Portable schedule.

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 Additional elements may be added to visual schedules as

necessary such as:

• Color coding
• Times
• Alignment with school bells
• Motivational components (e.g., pictures of favorite characters) or
• Behavior cues (reminders about specific expectations)

 Teach

ach the learn the learner how to transition to the schedule with a visual cue and/or how to transition to location with schedule information

 Minimize prompts once learner has learned how to use the

schedule

 Have learner use schedule consistently throughout the day  Visual transition cue use is consistent throughout the day  Prepare the learner for changes in scheduled activities  Individual schedules move with learner across settings or

elements of visual schedules are located across settings

 Use a data collection system to record learners use of

visual schedules

 Monitor your fidelity of implementation

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 Visual supports must be age appropriate and individualized.  Visual schedules will have different forms, lengths,

presentations, locations, and methods of manipulation based

• n individual needs.

 Visual supports may be used in all settings and across

environments.

 Visual supports should be used consistently, implemented

with fidelity, and monitored through data collection to determine effectiveness.

 

 Review of objectives



Understand criteria and process for identifying EBPs in autism 



Become familiar with the evidence based practices identified by the National Professional Development Center on Autism and established practices of the National Standards Project



Identify the practices that have proven to be effective with students of specific age ranges and/or with specific characteristics



Learn practical ways to implement practices across the classroom setting with a number

• f students



Discover a number of resources designed to assist in high quality implementation, data collection, and troubleshooting

• NPDC
• NSP
• AIM modules

10/17/2014 29

 Practitioners can build “technical eclectic”/ evidence-

supported programs

 More research is needed to address focused intervention

practices for infants and toddlers with ASD as well as adolescents and young adults with ASD

 Better child outcomes dependent on translation of EBPs

• Implementation science
• Professional development models

Thank you to the NPDC EBP Workgroup and

the volunteer efforts of many individuals, including our NPDC EBP reviewers.

Supported by OSEP #H325G070004 and

IES #R324B090005 (PI: Odom)

http://autismpdc.fpg.unc.edu/content/ebp-update