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EARLY INTERVENTION PROGRAM
FOR CHILDREN WITH AUTISM
Jaruwan Kittisopit, M.D.
The Walden Program
• Research based Early Childhood Program• Established 1985• Emory Autism Center, Department of
Psychiatry and Behavioral Science, Emory Medical School, Atlanta, Georgia, USA
• Systematic replication of the Toddler Center Model for typical children’s day care by O’Brien, Porterfield, Herbert-Jackson, Risley 1979.
The Walden Program Hallmarks
• Naturalistic ABA approach“Incidental Teaching concepts”
Behavioral approach : Applied Behavior Analysis,
ABA Traditional ABA
Discrete-trial procedure ( Lovaas 1981)
Comprehensive or Naturalistic ABAIncidental Teaching (McGee
et.al.,1983,1999)
Pivotal Response Training ( Koegel,1999)
Peer-mediated strategies ( Strain and Kohler,1998)
Program
Mean Ageat entry (range)in months
Hoursper weeks
UsualSetting a
ConceptsOrientation b
PrimaryTeachingProcedure
Children’s unit 40(13-57)
27.5 School (s) t-B Discrete trial
Denver communityBased approach
46(24-60)
20 School(I),home,community
D Playschoolcurriculum
Developmental Intervention model
36(22-48)
10-25 Home, clinic D Floor timetherapy
Douglass 47(32-74)
30-40 School (S, I),home
t-B Discrete trial, naturalistic
LEAP 43(30 -64)
25 School (I),home c-B Peer-mediated interventionnaturalistic
Pivotal Response Training 36(24-47)
varies School(I),home,community, clinic
c-B Pivotal response training
TEACCH 36(24 up)
25 School (s), clinic M Structured teaching
UCLA Young Autism Project 32
-30(46)
-204
0
Home t-B Discrete trial
Walden 30(18-36)
36 School(I), home c-B Incidental teaching
a (S) Segregated classroom; (I) Inclusive classroomb(t-B) Traditional Behavioral approach; (c-B) Comprehensive Behavioral approach; (M) Mixed approach
Lord C, McGee JP, eds. National Research Council (2001). Educating Children with Autism. Committee on Educational Intervention for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press, 2001.
The Incidental Teaching
• Definition: A systematic protocol of instruction that is delivered in the context of natural stimulus conditions of everyday environments
• Origin: Teaching complex language in the disadvantaged, typical children
• ABA concept • Peer Incidental Teaching & Inclusion
settingHart & Risley 1968,1974, 1975,1982McGee GG, Almeida MC, Sulzer-Azaroof B, Feldman RS. Promoting reciprocal interactions via peer incidental teaching. J Appl Behav Anal 1992; 25:117-26.
The Incidental Teaching Procedure
• Environmental is arranged • Child initiates • Teacher prompts : Use least to most prompts• Child responds• Teacher immediately provide
Access to the desired item/activity ( Contingent Reinforcer)
Praise and Confirm the correct response
• Child enjoys the desired item :Keep interaction enjoyable
• Teacher keeps looking for child initiation, or Create the next Teachable Moment
Incidental teaching Discrete Trial
• Child friendly session• Natural setting• Child initiated • Correlation of the
response and the reinforcer ( internal reinforcer)
• Slower to master the skill
• Overcome generalization and initiation problem
• Highly structured session
• Distract free setting• Teacher directed• No correlation btw
the response and the reinforcer
(external reinforcer)• Faster to master the
skill• Less generalization
and initiation
The Walden Program Hallmarks
• Naturalistic ABA approach“Incidental Teaching concepts”
• Positive Behavioral Interventions and Supports
• Promote Social and Language development “Verbal-only-program”
• Early inclusion• Active family collaboration
Family training 2 hr/ 2 wk for Home based-program 10 hr/wk
The Walden Program Hallmarks• Environmental
arrangement : Cubby, Toy shelves, Hobby boxes, Name tags, Seats, Gates, Physical zones
• Toy rotation system & Teaching theme
• Reinforcer assessment system
The Walden Program Hallmarks
• Overlapping activities schedules
• Designated teaching zones & Goal & Individual goal Free play – Play skill, Vocabulary Snack – CommunicationOutdoor – Peer interactionTable – Peer interaction & Academic readiness
The Walden Program Structure
• Combined Center and Home-based Program ( 25-30 hr plus 10 hr/ wk)
• Classrooms : Toddler, Preschool, Pre-Kindergarten
• 5 d/ wk, Full day , 8:30-15:30 , all year• Teacher : Child 1:3 1:4 1:5• CWA : TYP 1:2 (total 12-15)• Staff
Individual Educational Plan, IEP
Sequences of Social Goals across
the Walden treatment continuum
• Toddler
• Preschool
• Pre-K
• Social Responsiveness• Play Skills • Tolerance of Peer Proximity
• Focus on Peers• Synchrony of Play• Response to Peer interaction
• Conversation with peers• Peer Negotiation• Attraction of Peer bids• Initiation of Interactions• Sustained Interactions• Community Participation
Sequences of Communication Goals across
the Walden treatment continuum
•Toddler
•Preschool
•Pre-K
• Initial Verbalizations• Verbal Requests• Vocabulary
• Pragmatics of Conversation• Amount of talking• Complexity of Language• Correct of Syntax• Elaborated Vocabulary
• Vocabulary and Corrections
Sequences of Behavioral Goals across
the Walden treatment continuum
• Toddler • Preschool
• Pre-K
• Engagement• Independent Daily Living• Decreased Behavior
Problems
• Conventional School Behaviors
• Academic Readiness
The Walden Program Structure
• Ongoing Objective AssessmentEntry-Exit VDODaily probes1:1 recordsBiweekly review of individual
case • Program Evaluation
TeachersClassrooms
Outcomes of The Walden Graduates
McGee GG, Morrier MJ, Daly T. Walden Early Childhood Program. In:
Handleman JS, Harris SL. eds. Preschool Education Programs for Children with Autism 2nd ed. Austin: Pro-ed, 2001:157-90.
N = 34 (10 @ Neuro Dx)
Entry Exit
Age, yr 3.6 ( 2.0-5.6)
6.0 ( 4.11- 7.4)
% Peer Interactio
n
3 11 (1 -27 )( 17/34 in TYP range 6-39)
% Verbal cases
0 80% NV- 4/34 ¾ NeuroDx
% of Verbalizat
ion
6 16
Regular School
26/33