Dir Summer Inst Research Panel

8/9/2019 Dir Summer Inst Research Panel

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Research Panel: know our data

and get involved!

Diane Cullinane, MD

Josh Feder, MDConnie Lillas, PhD, MFT, RN

Lois Black, PhD

Devin Casenheiser, PhD

Jim Stieben, PhD


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The Southern California DIR/Floortime Regional InstitutePasadena, California October 2010- May 2011

Josh Feder, MD Diane Cullinane, MD

[email protected] [email protected]

Mona Delahooke, PhD Pat Marquart, MFT

[email protected] [email protected]


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Support Parent Choice Today!www.dirfloortimecoc.com


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Top 10 Research articles to

persuade and educate legislatorsand other powers that be

Diane Cullinane, M.D.


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The Roots

Greenspan, S.I. and Wieder, S. (1997) Developmental patternsand outcomes in infants and children with disorders in relatingand communicating: A chart review of 200 cases of childrenwith autistic spectrum diagnoses. Journal of Developmentaland Learning Disorders 1:87-141

Greenspan, S.I. and Wieder, S. (2005) Can Children withAutism Master the Core Deficits and Become Empathetic,Creative and Reflective? A Ten to Fifteen Year Follow-up of aSubgroup of Children with Autism Spectrum Disorders (ASD)Who Received a Comprehensive Developmental, Individual-

Difference, Relationship-Based (DIR) Approach. The Journalof Developmental and Learning Disorders 9.


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Specifically DIR/FT

Solomon, R., Necheles, J., Ferch, C., &

Bruckman, D. (2008). Pilot study of a

parent training program for young children

with autism: the P.L.A.Y. Project Home

Consultation Program. Autism, 11(3), 205-

224.


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Parent mediated Intervention

Kasari, Gulsrud, Wong, Kwon, & Locke.

Randomized Controlled Caregiver Mediated

Joint Engagement Intervention for Toddlers

with Autism. J. Autism Dev Disord (2010)


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The Scotts

Salt, Shemilt et. al. The Scottish Centre for

Autism preschool treatment programme. II

The results of a controlled treatment

outcome study. (2002) SAGE publications

of The National Autistics Society. Vol 6(1)

33-46.


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A Hybrid

Dawson, G., Rogers, S., Munson, J., Smith, M.,

Winter, J., Greenson, J., Donaldson, A. &

Varley, J. (2009). Randomized controlled

trial of an intervention for toddlers with

autism. The Early Start Denver Model.

Pediatrics. Online verson e17-e23.


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Reviews

Odom, Boyd, Hall, & Hume. Evaluation of

Comprehensive Treatment Models for

Individuals with Autism Spectrum Disorders.

J Autism Dev Disord (2009)

Ospina, M. et al. Behavioural and

Developmental Interventions for Autism

Spectrum Disorder: A Clinical SystematicReview. (2008)


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The best is yet to come!

Drs. Devin Casenhiser, Jim Steiben, Stuart Shanker and

everyone at York / MEHRI

The York Study!

Dr. Rick Solomon

The Play Project

Dr. Josh Feder

The Bridge Project


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GettingStarted in Research

Josh Feder, MD


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But Im a clinician

Why are you HERE?

Learn more

Make friends Step gradually

Help out

Persist, and maybe perseverate


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Learn about Evidence Based Practice

Evidence Based Medicine Sackett 1995

Best Available Research combined with

Clinical Judgment and Experience

For the Purpose of Informed Consent

Parent Choice!

More from Connie later


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Understand the Challenges of Doing Research

Subjective experience (affect) is at the center

Heterogeneity: all the people are so different

More than one treatment at a time


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Overcoming Challenges

Efficiency studies (vs. Efficacy Studies)

FEAS, SEGC

Reflective Community Consensus Process BRIDGE going post-denominational (thanks

Stanley)


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Tuning Into Each OtherTuning Into Each Other

Customizing Project ImPACTCustomizing Project ImPACT

to address our key community values and reach younger children forto address our key community values and reach younger children for

the SoCal BRIDGE Collaborativethe SoCal BRIDGE Collaborative


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BRIDGE

Community collaboration

Parents, clinicians, researchers, agencies,

funders

Vetting ideas

Learning from each other

Coming to consensus


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Taking Project ImPACT..

Parent driven

Mixed developmental/ behavioral

Language focused Specific goals


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ImPACT


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And make it ours

Warm it up

Broaden the vision

Give it our context


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BRIDGE Enhancements

Engagement

Communication

Sensori-motor Reflective process


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Warmed up


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Project ImPACT


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And Make it Ours


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The Evidence Based Movement: 19thCenturyScience versus Complexity:W

elcome to the 21st Century

Connie Lillas, PhD, MFT, RN


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California Quake Crisis

Legislators do not understand the issues

DIR not on EI & DMH list of approved

therapies

Need for push back nationally


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PushingBack the Problem

Reductionist, narrow research paradigms

Outdated research models

Children are complex


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PushingBack - Solutions

Advocacy from Parent to Professional

Know and educate colleagues about the

difference between Evidence Based Practice and

Evidence Based Treatments Educate about research paradigm matches

versus mismatches

Support research that is practice-based evidence

Promote professional and parental critical thinking

and informed choice


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Insist on Clarity:

E-B

-T

reatments doNOT

equal E-B

-Practice Evidence-Based Practice is:

A decision makingprocess that holds the tension

between:

The best available clinical research (EBTs)

Professional wisdom based in sound theory and practice

Cultural and family values (with informed choice) Buysee and Wesley, 2006


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Insist on Match Between ResearchApproach & Clinical Population

Problems with Gold Standard Research:

Often simple, subclinical cases are involved in

research settings

Designed for single diagnosis, not matching co-occurring diagnoses

Lacks flexibility to account for individual

differences

Lacks flexibility for following a therapeutic alliance,

shifts in behaviors, and cultural sensitivities In Lillas and Turnbull, 2009, from Weisz &Gray, 2008


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21st Century Vision for Paradigm Shift inResearch

a critical question for the field is what

approach to empirical testing will give us the

strongest treatments that are most robust inactual clinical practice

(Weisz & Gray, 2008, p. 62)


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Get Involved!Practice-Based Evidence

Push-back with complex clinical cases that drive

scientists search for new knowledge

Attend conferences and join organizations with

child development researchers (map)

Take complex models and frameworks into

clinical research settings Search and find cutting-edge dynamic systems

research paradigms that can hold complexity


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The Importance ofAffect:Research in Support of DIR Intervention

Lois M. Black, Ph.D.

Faculty DIR Institute

Clinical Psychologist/Pediatric NeuropsychologistResearch Professor

Oregon Health & Science University


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Black, et al., IMFAR 2009: Understanding the Effects of Enhancing Vocal

Prosody on Childrens Comprehension and Retention of StoryNarratives

Participants: N=79Ages 4-8, overall IQ > 70.

ASD group N=37

TD group N=42

3 Prosodic Modes: Disconnected

Recorded words in random order,concatenated words together intosentences

Imposed synthetic pitch contouron sentences

Minimal grammatical prosody; nopragmatic or affective prosody stress correct syllable word

meaning intelligible descending or ascending

contours -- questions andstatements

Standard intact grammatical, minimal

pragmatic, affective prosody

Enhanced exaggerated grammatical,

pragmatic, affective prosody

NARRATIVES:

Affectively-rich, interpersonal

stories.

Factual + Social Cognitive

Information

Immediate and delayed questions

Goal: What are the effects of

enhancing vocal prosody affect in

ones voice -- on comprehension

and retention of information?


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Results Enhanced

Standard

Disconnectedp>0.25

p


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Findings, contd:

No such beneficial effect of prosodic mode was seen in the TDgroup. (Essentially no differences across disconnected, standardand enhanced conditions.)

TD performed better than ASD children in all prosodic modes.

Trends were found for the interaction to be more pronounced for thesocial cognitive questions.

Conclusions:

Enhanced prosody specifically targeted to highlight the multiple

levels of information in complex verbal communication helps

comprehension and retention of information in children with ASD,

in particular, social cognitive information.


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Critical Elements for DIR InterventionResearch

Pre-treatment measures

Heterogeneity/How we know who ourchildren are

Post-treatment/Outcome measures

What are we striving to achieve forour children

Treatment manual

Fidelity measures


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What we need most

Treatment manual

Fidelity measures


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The Final Frontier: Research onDIR on both Clinical and

Functional ImagingOutcomes

Devin Casenheiser, PhD

Jim Stieben, PhD

Stuart Shanker, D. Phil. Oxon


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The York MEHRI Study

2 hours per week FT coaching

Study population & controls

Ages 2;0 4;11 with diagnosis of autism

ADOS/ADI

Immediate and 12-month Delayed Treatment

Clinical measurement of effects

mChild Behavior Rating Scale PLS/CASL

Dense-Array Electroencephalography


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Findings: (redacted here because

publication pending) Clinical improvement

Brain Change


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Implications

Profound evidence

Comparison w/ other imaging studies

Next steps (studies, advocacy)


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Your Thoughts!

Documents

Dir Summer Inst Research Panel