Randomized Comparison of Randomized Comparison of Parent- -Teacher Teacher Parent 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- -funded agencies. funded agencies. from public ► 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 solely the ely the from the National Institute of Mental Health. The content is sol responsibility of the authors and does not necessarily represent the official the official responsibility of the authors and does not necessarily represent views of the National Institute of Mental Health or the National Institutes Institutes views of the National Institute of Mental Health or the National of Health. of Health. ► Co Co- -Investigators, Dr. John McGrew & Nancy Investigators, Dr. John McGrew & Nancy ► Dalrymple Dalrymple
Why do we need autism- -specific specific Why do we need autism 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 to achieve to achieve environmental and personal resources 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 & Dalrymple Dalrymple, 1996 , 1996 Ruble & Quality of Life Risk Factors Protective Factors Personal & Personal & Environmental Environmental Competence
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
Collaborative llaborative M Model for odel for P Promoting romoting Co Competence a and nd S Succes uccess s Competence (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 & Dalrymple Dalrymple, 2002) , 2002) (Ruble & � 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 20 males (83% ) Gender 20 males (83% ) 4 females (17% ) 4 females (17% ) Mean Age 6 yr, 2 months Mean Age 6 yr, 2 months Race/Ethnicity 81% Caucasian Race/Ethnicity 81% Caucasian 14% African American 14% African American 5% Biracial 5% Biracial Parent Income 39% $25,000 – – $50,000 $50,000 Parent Income 39% $25,000 44% $51,000 - - $100,000 $100,000 44% $51,000
Child Measures Child Measures Measure Mean (SD) Measure Mean (SD) Differential Abilities Scale Tscore= 36.0 = 36.0 Tscore Picture Similarities (19.8) (19.8) Oral and Written Language Scales Sscore= 46.9 = 46.9 Sscore (8.6) (8.6) Vineland Adaptive Behavior Scales Sscore= 60.1 = 60.1 Sscore (teacher report) (7.5) (7.5) Behavior Assessment System for Children-2 Tscore= 60 = 60 Tscore Externalizing Composite (teacher report) (7.6) (7.6) Childhood Autism Rating Scale 39.6 (7.3) 39.6 (7.3) (severe symptoms)
Teacher Participants Teacher Participants Years Teaching Mean (SD) Years Teaching Mean (SD) In general 11 (SD= 8) In general 11 (SD= 8) Students with autism 7 (SD= 7) Students with autism 7 (SD= 7) Demographics Urban Demographics 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) ►
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