Identifying Effective Practices

S O R T I N G T H R O U G H T H E C L A I M S O F E V I D E N C E B A S E D P R A C T I C E S

L A S A R D P R O J E C T

O C T O B E R , 2 0 1 0

Autism Spectrum Disorders

Characterized by:

Difficulty with communication

Difficulty with social interaction

Repetitive behaviors/restricted interests

Educational programming should address core characteristics

(American Psychiatric Association [DSM-IV-TR], 2000)

Identifying student needs

Assessment

Standardized

Functional/Ecological

Addressed in LABS later today!

Alberto & Troutman, 2009

LAQI Key Areas

Communication

Social Interaction Behavior

Curriculum & Instruction

Environment Inclusive Practices

Collaboration

Transition

http://www.hdc.lsuhsc.edu/

Evidence-Based Practices

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Evidence-based Practice is defined as:

“Educational Practices that have been demonstrated effective based on quality research.”

Odom, Brantlinger, Gersten, Horner, Thompson, and Harris (2005) p. 116

www.hdc.lsuhsc.edu

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Core Components

1. Individualized supports and services for students and families

2. Systematic instruction

3. Comprehensible and/or structured environments

4. Specialized curriculum content

5. A functional approach to problem behaviors

6. Family involvement

Iovannone, Dunlap, Huger, Kincaid (2003)

Evidence-Based Practices

www.hdc.lsuhsc.edu

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Systematic Instruction includes:

Carefully planning for instruction by identifying valid educational goals,

Carefully outlining instructional procedures for teaching,

Implementing the instructional procedures,

Evaluating the effectiveness of the teaching procedures,

Adjusting instruction based on data

Iovannone, Dunlap, Huger, Kincaid (2003)

Evidence-Based Practices

Successful Outcomes

Effective treatments that are:

Systematically and objectively verified

Replicated

Tailored to needs of student and team

Family

School

Implemented with fidelity

Simpson, 2005

•N A T I O N A L I N I T I A T I V E S

•R E S E A R C H S Y N T H E S I S

Determining Evidence-Based Practices

Terminology in identification of Evidence-based Practices

US DOE NPDC-ASD NAC Other criteria (Simpson, 2008)

Meets evidence standards

Evidence-based practices

Established Scientifically based practices

Meets evidence standard with reservations

Emerging Promising practices

Does not meet evidence based standards

Unestablished Practices with limited supporting information

Ineffective/ Harmful

Not recommended

US DOE What Works Clearinghouse

What Works Clearinghouse, 2008, p. 13

National Professional Development Center on Autism Spectrum Disorder

autismpdc.fpg.unc.edu

Definition of EBP

LSU-HSC Human Development Center

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To be considered an evidence-based practice (EBP) by The National Professional Development Center on ASD, efficacy must be established through peer-reviewed research in scientific journals using: randomized or quasi-experimental design studies. Two high quality

experimental or quasi-experimental studies, single-subject design studies. Three different researchers must have

conducted five high quality single subject design studies, or combination of evidence. One high quality randomized or quasi-

experimental group design study and three high quality single subject design studies conducted by at least three different investigators or research groups.

National Professional Development Center on Autism Spectrum Disorders, 2010

Evidence Based Practices

Computer-aided instruction Differential reinforcement Discrete trial training Extinction Functional behavior assessment Functional communication training Naturalistic interventions Parent-implemented intervention Peer-mediated

instruction/intervention Picture Exchange Communication

System ™ Pivotal response training Prompting

Reinforcement Response interruption/redirection Self-management Social narratives Social skills training groups Speech generating devices Stimulus control Structured work systems Task analysis Time delay Video modeling Visual supports

National Professional Development Center on Autism Spectrum Disorders

National Autism Center

www.nationalautismcenter.org

National Autism Center Ratings

Strength of evidence based on Scientific Merit Rating Scale:

Research design

Measurement of the dependent variable

Measurement of independent variable

Treatment fidelity

Participant ascertainment

Generalization

NAC, 2009

National Autism Center: Established Treatments

Antecedent Package

Behavioral Package

Comprehensive Behavioral Treatment for Young Children

Joint Attention Intervention

Modeling

Naturalistic Teaching Strategies

Peer Training Package

Pivotal Response Treatment

Schedules

Self-management

Story-based Intervention Package

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Scientifically-based Practices Applied behavior analysis (ABA) Pivotal response training (PRT) Discrete trial training (DTT)

Promising Practices PECS Incidental Teaching Structured Teaching (TEACCH)

Visual Supports

SCERTS Social Stories Video Modeling Peer Support Strategies Assistive Technology

Simpson (2005)

Evidence-Based Practices

Selected Evidence-Based Practices

www.hdc.lsuhsc.edu

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Systematic application of behavioral principles to change behavior.

Behavior, both adaptive and maladaptive, is learned.

Learning occurs as a result of the consequences of the behavior.

Behavior refers to a student’s response and can be academic skills/knowledge or social/emotional responses.

Alberto & Troutman (2009)

Applied Behavior Analysis (ABA)

Discrete Trial

Incidental Teaching

Peer Mediated Strategies

21 www.hdc.lsuhsc.edu

Lowrey, 2008

Response Prompting Strategies

www.hdc.lsuhsc.edu

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Based on the principles of ABA

Prompting strategies provide a systematic delivery system that increases the likelihood the student will respond correctly

Include:

Least-to-Most Prompting Systems

Most-to-Least Prompting Systems

Graduated Guidance Prompting Systems

Constant & Progressive Time Delay Systems

Naturalistic Prompting Procedures Alberto & Troutman, 2009

www.hdc.lsuhsc.edu

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Based on principles of ABA

The discrete trial method has four distinct parts:

1. the trainer's presentation,

2. the child's response,

3. the consequence

4. a short pause between the consequence and the next instruction (between interval trials).

Discrete Trial Training

Lovaas, O. I. (1981)

NPDC on ASD Checklist

http://autismpdc.fpg.unc.edu/content/discrete-trial-training-0

WWC on DTT

http://ies.ed.gov/ncee/wwc/reports/ece_cd/lovaas_model/index.asp

1/28/2008 www.hdc.lsuhsc.edu

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Based on principles of ABA Focus on 2 pivotal behaviors:

Motivation Response to multiple cues

Positive changes in these behaviors have widespread effects on other behaviors.

The question / instruction / opportunity to respond should: · Be clear, uninterrupted and appropriate to the tasks · Be interspersed with maintenance tasks · Include child choice · Include multiple components when appropriate

Reinforcers should be: · Contingent upon behavior · Administer following any reasonable attempt to respond · Related to the desired behavior in a direct way

Koegel & Koegel, 2006

Pivotal Response Training (PRT)

www.hdc.lsuhsc.edu

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Based on principles of ABA

Individuals exchange a picture of a desired item for that desired item

Later phases teach individuals to discriminate pictures, put together simple sentences, comment, answer direct questions

Frost & Bondy, 2002

Picture Exchange Communication System (PECS)

1/28/2008 www.hdc.lsuhsc.edu

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TEACCH

Treatment and Education of Autistic and Communication related handicapped CHildren

Uses Systematic Instruction Principles

Based on the principles of Structured Teaching: Principle 1: Physical Structure

Principle 2: Scheduling

Principle 3: Work System

Principle 4: Routine

Principle 5: Visual Structure

Not behavior modification (like ABA), but more reliant on environmental stabilizers

www.teacch.com

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Visual schedules

Allows students to:

Make sense of environment

Predict scheduled events

Comprehend expectations

Anticipate changes throughout the day Heflin & Simpson, 1998

Choice boards

Assists students to:

Know what choices are available

Participate in the decision making process Hodgdon, 1995

Visual Supports

Social Communication Emotional Regulation Transactional Supports (SCERTS)

“SC” - Social Communication – the development of spontaneous, functional communication, emotional expression, and secure and trusting relationships with children and adults;

“ER” - Emotional Regulation - the development of the ability to maintain a well-regulated emotional state to cope with everyday stress, and to be most available for learning and interacting;

“TS” – Transactional Support – the development and implementation of supports to help partners respond to the child’s needs and interests, modify and adapt the environment, and provide tools to enhance learning (e.g., picture communication, written schedules, and sensory supports). Specific plans are also developed to provide educational and emotional support to families, and to foster teamwork among professionals.

Can incorporate practices from other approaches including contemporary ABA (e.g., Pivotal Response Treatment, LEAP), TEACCH, Floortime, RDI, Hanen, and Social Stories®.

Prizant, Wetherby, Rubin, Laurent, & Rydell, 2006

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www.hdc.lsuhsc.edu

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Social Stories ™

Carol Gray Describes a situation, skill, or concept in terms of relevant social cues,

perspectives, and common responses in a specifically defined style and format.

Goal is to share accurate social information in manner that is easily understood by its audience.

Goal should never be to change the individual’s behavior, rather that the individual’s improved understanding of events and expectations may lead to more effective responses.

1/28/2008 www.hdc.lsuhsc.edu

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Billy’s Snack Book

When I am at school, we take a break called snack time. At snack time all of the kids usually go outside. I usually go outside too! There are lots of kids outside at snack time. Some of the kids are standing. Some of the kids are sitting, but they are talking to each other. The kids like to talk to each other at snack time. I will try to talk to the other kids too!

There are many things I can talk to the other kids about: I can ask them what kinds of things they like to do after school. I can tell them what kinds of things I like to do after school. I can talk about what Disney movies I like. I can ask about what Disney movies they watched. I can ask them if they have pets. The kids will like me if I talk to them. They will want to be my friend!

Scattone, D., Tingstrom, D., & Wilczynski, S. (2006)

Sample Social Story

NAC Evidence Level - Established

1/28/2008 www.hdc.lsuhsc.edu

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Video modeling interventions involve a child watching videotapes of positive examples of adults, peers, or him- or herself engaging in a behavior that is being taught.

Can refer to interventions that use the self as model (video self-modeling) and interventions that use another as model (e.g., peer or adult).

May be created for a wide array of skills (e.g., social, communication, functional) and in a variety of settings (e.g., home, school, community).

Delano, M. (2007).

Video Modeling

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Peer-mediated interventions are effective in increasing social interactions between typical peers and students with ASD and related disabilities.

May include Peer training

Peer tutoring

Peer networking

PALS (systematic)

Owen-DeSchryver, J., Carr, E., Cale, S., & Blakeley-Smith, A. (2008).

Peer Support Strategies

http://kc.vanderbilt.edu/pals/

NPDC on ASD Checklist

http://autismpdc.fpg.unc.edu/content/peer-mediated-instruction-and-intervention

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AT – Used to support or enhance the functional capabilities of individuals with disabilities

May include computer-assisted instruction, mobility devices, high and low tech adaptations, and AAC

AAC – Supporting existing speech or developing independent use of a non-speech symbol system

May include sign language, PECS, voice output devices

• National Research Council (2001)

Augmentative/Alternative Communication (AAC) Assistive Technology (AT)

What evidence-based practice to use?

One size does not fit all!

Consider:

The student’s needs

The student’s learning style, temperament, and interests

Your program strengths/needs

Supports already in place

History of what has and has not worked

Your professional knowledge

Adapted from Odom, S. & Cox, A. (2009)

Data Based Decision Making

Let data be your guide to practices that are effective for each student.

Baseline

Intervention

Maintenance

Alberto & Troutman, 2009

Summary

Identify and use evidence-based practices

Identify an area of individual student need

Consider the research base of practices that address that need by consulting national resources and professional journals

Match the practice to the needs of each individual student

Make decisions on efficacy from data

Bennie is a 12 year old student in your class who has no verbal communication. He is very interested in computers

and can navigate programs easily. Which strategies may you consider to promote communication?

Piv

otal r

espon...

TEA

CCH

AAC

Vid

eo modelin

g

25% 25%25%25%

1. Pivotal response training

2. TEACCH

3. AAC

4. Video modeling

Nicole is a 3 year old preschool student who has not been around peers much before entering your class. What

strategy would you consider for introducing social routines to her?

TEA

CCH

Disc

rete

Tria

l...

Socia

l Sto

ries

33% 33%33%

1. TEACCH

2. Discrete Trial Training

3. Social Stories

Marcus is a high school student with advanced verbal communication. He hovers near peers in social situations, but does not appear to know how to initiate a conversation

with peers. What strategy may you consider to support social interaction?

Vid

eo modelin

g

Disc

rete

tria

l...

PECS

33% 33%33%1. Video modeling

2. Discrete trial training

3. PECS

Emily is 4 years old, and one of her goals is to identify colors. Which strategy may you consider to teach her color

identification?

Vid

eo modelin

g

Socia

l sto

ries

Disc

rete

tria

l...

33% 33%33%

1. Video modeling

2. Social stories

3. Discrete trial training