Randomized Comparison of Randomized Comparison of Parent- -Teacher - - PowerPoint PPT Presentation

Randomized Comparison of Randomized Comparison of Parent Parent-

• Teacher

Teacher Consultation for Students Consultation for Students with Autism with Autism

Lisa Ruble, Ph.D. Lisa Ruble, Ph.D. University of Kentucky University of Kentucky

Department of Educational, School, & Counseling Psychology Department of Educational, School, & Counseling Psychology February 2008 February 2008

National Association of School Psychologists National Association of School Psychologists

New Orleans, LA New Orleans, LA

Introduction Introduction

► ► Autism remains one of the most difficult

Autism remains one of the most difficult disorders to understand, diagnose, and treat. disorders to understand, diagnose, and treat.

► ► Autism results from an alteration of normal brain

Autism results from an alteration of normal brain development. development.

► ► No single cause for autism has been identified to

No single cause for autism has been identified to date. date.

► ► A consensus is building that autism results from

A consensus is building that autism results from multiple etiologies. multiple etiologies.

► ► Therefore, any single biologic or pharmacologic

Therefore, any single biologic or pharmacologic therapeutic solution appears distant. therapeutic solution appears distant.

► ►Numbers of children served IDEA has

Numbers of children served IDEA has increased by more than 500% in the last increased by more than 500% in the last decade (GAO, 2005). decade (GAO, 2005).

► ►Average cost expenditure for educating a

Average cost expenditure for educating a student with autism is about three times the student with autism is about three times the average cost expenditure for educating a average cost expenditure for educating a student without a disability. student without a disability.

Statement of the Problem Statement of the Problem

► ►Increased numbers of children seeking services

Increased numbers of children seeking services from public from public-

• funded agencies.

funded agencies.

► ►Limited translational research.

Limited translational research.

• Move studies from lab/clinic into community

Move studies from lab/clinic into community

⇒ ⇒Community Community-

• based providers with few resources

based providers with few resources to guide service delivery and scalability. to guide service delivery and scalability.

Teacher Training Outcomes in Teacher Training Outcomes in Autism Autism

► ►Collaborative Consultation and Teacher

Collaborative Consultation and Teacher Coaching Intervention Coaching Intervention

• National Institutes of Mental Health

National Institutes of Mental Health (MH073071) (MH073071)

• The project described was supported by Grant Number R34MH073071

The project described was supported by Grant Number R34MH073071 from the National Institute of Mental Health. The content is sol from the National Institute of Mental Health. The content is solely the ely the responsibility of the authors and does not necessarily represent responsibility of the authors and does not necessarily represent the official the official views of the National Institute of Mental Health or the National views of the National Institute of Mental Health or the National Institutes Institutes

• f Health.
• f Health.

► ►Co

Co-

• Investigators, Dr. John McGrew & Nancy

Investigators, Dr. John McGrew & Nancy Dalrymple Dalrymple

Why do we need autism Why do we need autism-

• specific

specific approaches to build an individual approaches to build an individual program? program?

► ►The diagnosis does not prescribe a

The diagnosis does not prescribe a treatment that works the same way for all treatment that works the same way for all

► ►The diagnosis does not describe specific

The diagnosis does not describe specific educational/teaching goals educational/teaching goals

► ►Intervention/teaching methods are not the

Intervention/teaching methods are not the same as curriculum same as curriculum

► ►INDIVIDUALIZATION is KEY

INDIVIDUALIZATION is KEY

Competence Competence

► ► Competence results from the interaction between

Competence results from the interaction between the person and his / her environment. the person and his / her environment.

► ► Competence is when one is able to make use of

Competence is when one is able to make use of environmental and personal resources environmental and personal resources to achieve to achieve a desirable outcome. a desirable outcome.

► ► The environment may contribute or hinder

The environment may contribute or hinder competence. competence.

► ► Both the person and the environment

Both the person and the environment must be must be considered for improving outcomes. considered for improving outcomes.

An Alternative View of Outcome An Alternative View of Outcome

Ruble & Ruble & Dalrymple Dalrymple, 1996 , 1996

Competence Risk Factors Personal & Environmental Quality of Life Protective Factors Personal & Environmental

Speech and Language Therapy Social Skills Training Occupational Therapy Functional vs Academic vs Vocational Developmental vs Age Appropriate Inclusion Discrete Trial - ABA Incidental Teaching Structured Teaching - TEACCH

Co Collaborative llaborative M Model for

• del for P

Promoting romoting Competence Competence a and nd S Succes uccess s (COMPASS) (COMPASS)

► ►Building environmental supports through

Building environmental supports through understanding how autism affects a specific understanding how autism affects a specific individual individual

Other Resources on COMPASS Other Resources on COMPASS

► ►Technical Assistance Manual on Autism for

Technical Assistance Manual on Autism for Kentucky Schools, 1995 Kentucky Schools, 1995

► ►School

School-

• based consultation called COMPASS

based consultation called COMPASS (Ruble & (Ruble & Dalrymple Dalrymple, 2002) , 2002)

• Family

Family-

• centered

centered

• Process focused

Process focused

• Outcomes based framework

Outcomes based framework

Design Design

► ►Longitudinal and prospective (school year)

Longitudinal and prospective (school year)

► ►Randomized with control group (usual school

Randomized with control group (usual school program) program)

• Teachers of students with autism were recruited

Teachers of students with autism were recruited

► ►if more than 1 student, students were randomly selected

if more than 1 student, students were randomly selected

Methods Methods

► ► 24 teachers, children, parents/caregivers (35 total)

24 teachers, children, parents/caregivers (35 total)

► ► Randomized for COMPASS Consultation

Randomized for COMPASS Consultation

• 3 hour collaborative consultation

3 hour collaborative consultation

► ►Parent and teacher

Parent and teacher

• 4 teacher coaching sessions (1.5 hours each)

4 teacher coaching sessions (1.5 hours each)

► ►Parent invited, not required to attend

Parent invited, not required to attend

► ► Outcomes

Outcomes

• Evaluator is unaware of group assignment

Evaluator is unaware of group assignment

• Child Achievement of IEP Goal (direct observation)

Child Achievement of IEP Goal (direct observation)

Child Participants Child Participants

► ►All met criteria for DSM

All met criteria for DSM-

• IV

IV-

• TR of autism

TR of autism

• Autism Diagnostic Observation Schedule

Autism Diagnostic Observation Schedule-

• G

G

• Autism Diagnostic Interview

Autism Diagnostic Interview-

• R

R

• Childhood Autism Rating Scale

Childhood Autism Rating Scale

Child Participants Child Participants

Gender Gender 20 males (83% ) 20 males (83% ) 4 females (17% ) 4 females (17% ) Mean Age Mean Age 6 yr, 2 months 6 yr, 2 months Race/Ethnicity Race/Ethnicity 81% Caucasian 81% Caucasian 14% African American 14% African American 5% Biracial 5% Biracial Parent Income Parent Income 39% $25,000 39% $25,000 – – $50,000 $50,000 44% $51,000 44% $51,000 -

• $100,000

$100,000

Child Measures Child Measures

Measure Measure Mean (SD) Mean (SD)

Differential Abilities Scale Picture Similarities

Tscore Tscore= 36.0 = 36.0 (19.8) (19.8)

Oral and Written Language Scales

Sscore Sscore= 46.9 = 46.9 (8.6) (8.6)

Vineland Adaptive Behavior Scales (teacher report)

Sscore Sscore= 60.1 = 60.1 (7.5) (7.5)

Behavior Assessment System for Children-2 Externalizing Composite (teacher report)

Tscore Tscore= 60 = 60 (7.6) (7.6)

Childhood Autism Rating Scale (severe symptoms)

39.6 (7.3) 39.6 (7.3)

Teacher Participants Teacher Participants

Years Teaching Years Teaching Mean (SD) Mean (SD) In general In general 11 (SD= 8) 11 (SD= 8) Students with autism Students with autism 7 (SD= 7) 7 (SD= 7) Demographics Demographics Urban Urban Rural Rural

Outcomes Outcomes

► ► Child

Child

• Accomplishment of IEP Goals

Accomplishment of IEP Goals

► ► Goal Attainment Scaling (

Goal Attainment Scaling (Kiresuk Kiresuk, Smith, , Smith, Cardillo Cardillo, 1994) , 1994)

► ► Teacher

Teacher

• Stress

Stress

► ► Index of Teaching Stress (Part B) (Greene,

Index of Teaching Stress (Part B) (Greene, Abidin Abidin, Kmetz,1997) , Kmetz,1997)

► ► Parent/Caregiver

Parent/Caregiver

• Stress

Stress

► ► Parenting Stress Index (

Parenting Stress Index (Abidin Abidin, 1983) , 1983)

Overview of COMPASS Overview of COMPASS

Planning is process-based by helping all members reach consensus through understanding of the child The child’s ability to learn is based on environmental factors as well as factors within the child Proactive problem solving that can be done on an

• ngoing basis is demonstrated and encouraged

Research-backed practices for autism are emphasized

COMPASS cont. COMPASS cont.

Teaching plan is specific to autism (includes social, communication, and work or learning skills) Forms used during meeting are specific to autism Teaching plans are based on consensus of priority concerns Teaching strategies are linked to each specific skill

Challenges (Risk Factors) Supports (Protective Factors)

Personal Environmental Personal Environmental Competence

Holistic understanding of how autism affects a specific child

Research Supported Practices Research Supported Practices

► ►Perry, A., &

Perry, A., & Condillac Condillac, R. (2003). , R. (2003).

• Evidence

Evidence-

• based practices for children and

based practices for children and adolescents with autism spectrum disorders: Review adolescents with autism spectrum disorders: Review

• f the literature and practice guide.
• f the literature and practice guide. Toronto, ON:

Toronto, ON: Children's Mental Health. Children's Mental Health.

► ►Roberts, J.M. (2003).

Roberts, J.M. (2003).

• A review of the research to identify the most effective

A review of the research to identify the most effective models of best practice in the management of models of best practice in the management of children with autism spectrum disorders children with autism spectrum disorders. Sydney: . Sydney: Centre for Developmental Disability Studies. Centre for Developmental Disability Studies.

Examples of RSP Examples of RSP

► ►

Pro Pro-

• Social and Play Related I nterventions

Social and Play Related I nterventions

• Social Stories

Social Stories

• Peer

Peer-

• Mediated Instruction

Mediated Instruction

• Social Script Training

Social Script Training

► ►

Language and Communication Language and Communication-

• Based I nterventions

Based I nterventions

• Augmentative Communication

Augmentative Communication

• Picture Exchange Communication System (PECS)

Picture Exchange Communication System (PECS)

• Verbal Behavior Approach (VB)

Verbal Behavior Approach (VB)

• Functional Communication Training

Functional Communication Training

► ►

I ntervention for Challenging Behavior I ntervention for Challenging Behavior

• Positive Behavioral Supports (Non

Positive Behavioral Supports (Non-

• Intrusive Methods)

Intrusive Methods)

► ►

General Skill Building General Skill Building

• Behavioral Teaching (ABA)

Behavioral Teaching (ABA)

• Environmental Supports/Structure

Environmental Supports/Structure

• Picture Activity Schedules

Picture Activity Schedules

► ►

Expressive Psychotherapies Expressive Psychotherapies

• Cognitive Behavior Therapy (CBT)

Cognitive Behavior Therapy (CBT)

National Research Council National Research Council Recommendations for Recommendations for IEPs IEPs

Social skills Social skills Communication Communication Engagement in developmentally appropriate tasks Engagement in developmentally appropriate tasks Fine and gross motor skills to be utilized when engaging Fine and gross motor skills to be utilized when engaging in age appropriate activities. in age appropriate activities. Cognitive or thinking skills Cognitive or thinking skills Replacement of problem behavior with appropriate Replacement of problem behavior with appropriate behavior. behavior. “ “Work behaviors Work behaviors” ” important for classroom success important for classroom success (following instructions, completing a task) (following instructions, completing a task)

COMPASS Action Plan for Students with Autism

Step 1:

Conduct Functional Assessments

Step 2:

Identify and Discuss Personal / Environmental Challenges and Supports

Step 3:

Prioritize Teacher and Caregiver Goals

Step 4:

Write Measurable Objectives

Step 5:

Develop Teaching Plans & Identify Environmental Supports

Step 6:

Implement Plans

Step 7:.

Monitor Progress and

Make Adjustments

COMPASS COACHING

Step 1: Conduct Functional Step 1: Conduct Functional Assessments Assessments

► ►Social behaviors / skills

Social behaviors / skills

► ►Communication

Communication

► ►Learning / work skills (start a work activity;

Learning / work skills (start a work activity; work until finished; indicate finished to work until finished; indicate finished to another) another)

► ►Other areas such as fine/gross motor;

Other areas such as fine/gross motor; cognitive; academic; etc cognitive; academic; etc

Step 2: Caregivers and School Step 2: Caregivers and School Personnel Identify and Discuss Personnel Identify and Discuss Personal and Environmental Personal and Environmental Challenges & Supports Challenges & Supports

PERSONAL SUPPORTS SENSORY SUPPORTS Sound/Auditory Teacher Caregiver

Likes music Likes to sing and/or dance

Touch/Tactile Teacher Caregiver

likes to be touched likes hugs and cuddling when he/she initiates it likes to play in water likes baths or swimming pools seeks out mud, sand, clay to touch prefers certain textures of clothing likes being rolled or sandwiched between blankets/cushions likes rough and tumble play

• ther

Movement/Vestibular Teacher Caregiver

enjoys rocking, swinging, spinning likes being tossed in the air likes to run likes and needs to move

• ther

LIKES /PREFERENCES/INTERESTS Teacher Caregiver

PERSONAL CHALLENGES GENERAL CHALLENGES These skills were marked as very difficult. Personal Management Teacher Caregiver

Waiting Finishing a task Being quiet when required Performing basic self care independently Toileting Eating - utensils and a variety of foods Dressing and /or undressing Entertaining self in free time Staying within boundaries Changing activities Comments:

Responding to others

Listening Accepting “no” Answering questions Using yes/no appropriately Responding to greeting Accepting help Making a choice Sharing other's enjoyment Giving eye contact appropriately Accepting correction Comments:

Step 3: Prioritize Parent & Teacher Step 3: Prioritize Parent & Teacher Goals Goals

► ►Consensus is reached through discussion of

Consensus is reached through discussion of pivotal skills needed for future competence pivotal skills needed for future competence

• Communication (e.g., initiation of

Communication (e.g., initiation of communication) communication)

• Social behaviors (e.g.,

Social behaviors (e.g., turntaking turntaking) )

• Learning / work skills (

Learning / work skills (e.g e.g, working , working independently) independently)

Caregiver Concerns Teacher Concerns 1. 1. 2. 2. 3. 3. Other Concerns:

Step 4: Write Measurable Objectives Step 4: Write Measurable Objectives for Priority Goals for Priority Goals

► ►Describe present levels of performance

Describe present levels of performance

► ►Use formal and informal assessment

Use formal and informal assessment information information

• Teacher / parent observation

Teacher / parent observation

• Rating scales

Rating scales

• Standardized tests

Standardized tests

Goal Writing and Measurement Goal Writing and Measurement

► ►Criteria for Objectives:

Criteria for Objectives:

• Measurable

Measurable

• Observable

Observable

• Objective

Objective

IEP Goal and Objective IEP Goal and Objective

Goal: Goal: "Student will become a responsible member of "Student will become a responsible member of the family and community including the family and community including effectiveness in community service effectiveness in community service“ “ Benchmark: Benchmark: “ “Student will interact with peers in small and large Student will interact with peers in small and large group activities and special area activities." group activities and special area activities."

Step 5: Develop Teaching Plans Step 5: Develop Teaching Plans

► ►Identify Environmental Supports necessary

Identify Environmental Supports necessary for accomplishing specific goal for accomplishing specific goal

Environmental

Environmental Supports Name: _______________________

Teaching plan for ________________________________ Teaching Methods Materials Who/Where/When Data System

Step 6: Monitor Progress Step 6: Monitor Progress

► ►Coaching Sessions:

Coaching Sessions:

• Conduct semi

Conduct semi-

• structured interview

structured interview

► ►How often is skill taught

How often is skill taught

► ►Who is the primary teacher

Who is the primary teacher

► ►Are data being kept

Are data being kept

• Conduct direct observation of teacher

Conduct direct observation of teacher demonstrating skill with child demonstrating skill with child

► ►Provide feedback, modeling, problem solving as

Provide feedback, modeling, problem solving as needed needed

Step 6: Monitor Progress Step 6: Monitor Progress

► ►Data Collection

Data Collection

• Frequency, duration, intensity, latency

Frequency, duration, intensity, latency recording recording

• Goal Attainment Scaling (GAS)

Goal Attainment Scaling (GAS)

Goal Attainment Scaling Goal Attainment Scaling GAS GAS

► ►

Used as broad indicator of level of progress Used as broad indicator of level of progress

► ►

Not to replace weekly data collection methods Not to replace weekly data collection methods

► ►

Steps: Steps:

1.

• 1. Identify present levels of performance (what does the

Identify present levels of performance (what does the child do now) child do now) 2.

• 2. Identify measurable goal

Identify measurable goal 3.

• 3. Identify behaviors that indicate progress toward goal

Identify behaviors that indicate progress toward goal 4.

• 4. Identify behaviors that indicate more than expected

Identify behaviors that indicate more than expected level of progress level of progress

Example Example

Step 7: Make Adjustments Step 7: Make Adjustments

► ►Data Based Decision Making

Data Based Decision Making

Results Results

► ►Factorial Analysis of Variance

Factorial Analysis of Variance

• Independent Variables

Independent Variables

► ►Time (pre and post)

Time (pre and post)

► ►Group (exp and control)

Group (exp and control)

• Dependent Variable

Dependent Variable

► ►Child: Gas Score (Total and by learning domain)

Child: Gas Score (Total and by learning domain)

► ►Teacher: Stress

Teacher: Stress

► ►Parent: Stress

Parent: Stress

Time Time F= 34.9* * * F= 34.9* * * Group Group F= 9.0* * F= 9.0* * Time X Group Time X Group 5.7* 5.7*

* p< .05 * * p< .01 * * * p< .001

Time Time F= 18.3* * * F= 18.3* * * Group Group F= 8.0* * F= 8.0* * Time X Group Time X Group F= 2.7, F= 2.7, n.s n.s. .

* p< .05 * * p< .01 * * * p< .001

Time Time F= 16.7* * F= 16.7* * Group Group F= 1.5, F= 1.5, n.s n.s. . Time X Group Time X Group F= 0.3, F= 0.3, n.s n.s. .

* p< .05 * * p< .01 * * * p< .001

Time Time F= .48, F= .48, n.s n.s. . Group Group F= 2.0, F= 2.0, n.s n.s. . Time X Group Time X Group F= 3.3, F= 3.3, n.s n.s. .

Time Time F= .007, F= .007, n.s n.s. . Group Group F= .001, F= .001, n.s n.s. . Time X Group Time X Group F= 2.0, F= 2.0, n.s n.s. .

Time Time F= 3.7,n.s. F= 3.7,n.s. Group Group F= 6.1* F= 6.1* Time X Group Time X Group F= .07, F= .07, n.s n.s. .

* p< .05 * * p< .01 * * * p< .001

Conclusion Conclusion

► ►Child Outcomes

Child Outcomes

• Overall goal attainment was better in exp group

Overall goal attainment was better in exp group

• Social and Communication skill goal attainment

Social and Communication skill goal attainment did not differ as a function of the intervention did not differ as a function of the intervention

Conclusion Conclusion

► ►Teacher Outcomes

Teacher Outcomes

• There was no difference teacher stress

There was no difference teacher stress

► ►Need to evaluate further, teachers completed forms

Need to evaluate further, teachers completed forms when aware of group assignment when aware of group assignment

► ►Need to build in supports

Need to build in supports

► ►Parent Outcomes

Parent Outcomes

• No difference between groups on stress as

No difference between groups on stress as function of intervention function of intervention

► ►Need further study, parents completed forms when

Need further study, parents completed forms when aware of group assignment aware of group assignment

Conclusion Conclusion

► ►

Consultation with teacher is not enough Consultation with teacher is not enough

• Consultation must include follow

Consultation must include follow-

• up sessions

up sessions

• Consultation must include whole team for generalization,

Consultation must include whole team for generalization, especially parents and speech pathologists especially parents and speech pathologists ► ►

Data Collection is a challenge Data Collection is a challenge

• IEP objectives must be measurable

IEP objectives must be measurable

• Coaching sessions must include data collection training and

Coaching sessions must include data collection training and interpretation for planning interpretation for planning ► ►

Collaborative parent Collaborative parent-

• teacher consultation facilitated

teacher consultation facilitated achievement of IEP objectives achievement of IEP objectives

• Need more research on ways to impact core symptoms of autism

Need more research on ways to impact core symptoms of autism

Questions Questions

► ►Does consultation & coaching increase

Does consultation & coaching increase teacher stress teacher stress – – why and what to do? why and what to do?

• Need to build in more supports to teachers

Need to build in more supports to teachers

Future Research Future Research

► ► Consultation research is difficult!

Consultation research is difficult!

• Teacher (cognitions and behaviors)

Teacher (cognitions and behaviors)

• Parent

Parent

• Child

Child

• Other factors (School variables)

Other factors (School variables)

► ► More research conducted in schools, using real

More research conducted in schools, using real teachers and real situations teachers and real situations

► ► More studies with training school personnel as

More studies with training school personnel as consultants consultants

► ► More studies with meaningful outcomes

More studies with meaningful outcomes

• Teacher report not adequate

Teacher report not adequate – – need direct observation need direct observation

Thank you! Thank you!

► ► Parents and teachers, Indiana & Kentucky

Parents and teachers, Indiana & Kentucky

► ► Children

Children

► ► Nancy

Nancy Dalrymple Dalrymple, Consultant , Consultant

► ► Dr. John McGrew, Indiana Un.

• Dr. John McGrew, Indiana Un. –

– Purdue Un. Purdue Un.

► ► Dr. Angie Miller, Un. Kentucky

• Dr. Angie Miller, Un. Kentucky

► ► Research team

Research team

• Melissa Wheatley

Melissa Wheatley

• Alex

Alex Nounopolous Nounopolous

• April Young

April Young