Evidence-Based Practices for Supporting Students with Autism Spectrum Disorder Kathy Gould, Program Manager Illinois Autism Partnership at Easter Seals Metropolitan Chicago kgould@eastersealschicago.org Briana Weiner Illinois Statewide Technical Assistance Collaborative briana.weiner@istac.net

DSM IV vs DSM 5 SUMMARY No separate categories / levels of severity Communication and social deficits are merged Restrictive interests/repetitive behaviors include sensory Decrease emphasis on actual language delay Increase emphasis on social behavior Later onset of symptoms with increased social demands

Major Changes DSM IV DSM 5 Social Communication Social Interaction Restricted Interests/Repetitive Behaviors/Sensory Social Interaction Communication Repetitive/ Restrictive Behaviors

National Prevalence Between 2000 to 2008, autism prevalence has grown from 1 in 150 children to 1 in 68* from the year 2000 until 2010. (Centers for Disease Control Report, 2014). Between1998 to 2010, the number of 6 to 21 year old children receiving services for an ASD in public special education programs increased from 54,064 to 370,011. In 2010, 370,011 children 6 through 21 years of age and 49,251 children 3 through 5 years of age were served under the "autism" classification for special education services.

PBIS Outcomes for Students with Disabilities Students with disabilities in the US are being suspended at twice the rate of students w/o disabilities – resulting in loss of time in school (instructional time) and often resulting in more segregated placements. In a sample of 166 Illinois schools, students with disabilities had a 72% reduction in out of school suspensions (OSSs) from 2010 to 2013. (59% reduction for students without disabilities).

PBIS Outcomes for Students with Disabilities The impact of PBIS implementation on elementary school students with disabilities is being found to be even greater than on those students without disabilities!

Why Evidence-Based Practices? Promotes positive outcomes for individuals with ASD IDEIA (2004) requires that educational strategies be used that are based on “scientifically based research” Accountability for schools and teachers for instructional practices employed Data driven decision making for instructional practice choices

National Standards Project National Autism Center Published 2009 National Standards Report Educational and Behavioral Interventions (Comprehensive Treatment packages) Designed to achieve a broad learning or developmental impact on the core deficits of ASD Strength of Evidence Ratings 11 Established 22 Emerging 3 Unestablished 0 Ineffective/harmful

Criteria for Inclusion in the Study Population/ Participants-Individuals with ASD between birth and 22 years of age Interventions-Behavioral, developmental, or educational in nature and could be implemented in typical educational intervention settings (school, home, community) Comparison-Interventions compared to no intervention or alternate intervention conditions Outcomes-Behavioral, developmental, or academic outcomes Study Design-Experimental group design, quasi- experimental group design, or single-case design

Strength of Evidence Classification System used to determine how confident we can be about the effectiveness of a treatment. Ratings reflect the level of quality, quantity, and consistency of research findings for each type of intervention. Established. Sufficient evidence is available to confidently determine that a treatment produces favorable outcomes for individuals on the autism spectrum. That is, these treatments are established as effective. Emerging. Although one or more studies suggest that a treatment produces favorable outcomes for individuals with ASD, additional high quality studies must consistently show this outcome before we can draw firm conclusions about treatment effectiveness. Unestablished. There is little or no evidence to allow us to draw firm conclusions about treatment effectiveness with individuals with ASD. Additional research may show the treatment to be effective, ineffective, or harmful. Ineffective/Harmful. Sufficient evidence is available to determine that a treatment is ineffective or harmful for individuals on the autism spectrum.

2009 NSP - 11 Established Comprehensive Treatments Antecedent Package Behavior Package Comprehensive Behavioral Treatment for Young Children Joint Attention Intervention Modeling Naturalistic Teaching Strategies Peer Training Package Pivotal Response Package Story-based Intervention Package Schedules Self-Management How many are you currently implementing?

2008 NPDC 24 Focused Interventions Prompting Antecedent- Based Intervention Time Delay Reinforcement Task Analysis Discrete Trial Training Response Interruption/Redirection Differential Reinforcement Social Narratives Video Modeling Naturalistic Interventions Peer Mediated Intervention Pivotal Response Training Visual Supports Structured Work Systems Self-Management Parent Implemented Intervention Social Skills Training Groups Speech Generating Devices Computer Aided Instruction Picture Exchange Communication Extinction

Newly Updated 2014 NPDC EBP Incorporate more recent studies (2007-2011) 456 articles Expand timeframe (to 1970-1990) Broader more rigorous review of studies 2014-EBP-Report

Updated NPDC EBP What’s IN What’s OUT Cognitive Behavior Intervention Structured Play Groups Modeling including Video - Modeling Exercise Scripting Technology based instruction and intervention* What’s OUT Structured work systems Do you have specific knowledge of the focused interventions and when/why to use them?

Intervention Approaches National Standards Project Comprehensive Treatment Model (CTMs) consist of a set of practices designed to achieve a broad learning or developmental impact on the core deficits of ASD. National Professional Development Center for ASD Focused Intervention Practices are designed to address a single skill or goal of a student with ASD. These practices are operationally defined, address specific learner outcomes, and tend to occur over a shorter time period than CTMs.

Selecting EBP Professional Expertise Individual Best Available Research Individual Characteristics Evidence Based Practice Autism Spectrum Disorders: Guide to Evidence-based Practice Missouri Guidelines Autism Initiative

Selecting EBP Consider Age of student Environment/Setting Individual characteristics Skills to be taught Capacity to implement Include families Involve students Non-examples Pick a package and go with it Do what feels right This is what we have staff trained in Parents are asking for this

Supporting Family Involvement in EBP Serve as a classroom volunteer Maintain frequent communication Attend school-sponsored events Incorporate learning activities into home routines (working on greetings at grocery store) Secure student input Consider family culture, values, and socioeconomic status

Building Sustainability with EBP Step 1: Establish the Planning Team Step 2: Problem Clarification and Needs Assessment Step 3: Evaluating Outcomes Step 4: Developing a Training Plan and a method to assess implementation fidelity Step 5: Sustainability

Taken from… Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder Autism Evidence-Based Practice Review Group Frank Porter Graham Child Development Institute University of North Carolina at Chapel Hill The National Autism Center’s Evidence-Based Practice and Autism in the Schools A guide to providing appropriate interventions to students with autism spectrum disorders The purpose of this report is to describe a process for the identification of evidence-based practices (EBPs) and also to delineate practices that have sufficient empirical support to be termed “evidence-based.”