Autism and the Necessary Components for Effective Treatment Sharon A. Reeve, Ph.D., BCBA John L. Brown, M.A., BCBA Caldwell College

Diagnostic Criteria for : Autistic Disorder* A. A total of six (or more) from (1), (2), and (3), with at least two from (1) and one each from (2) and (3) (1)Qualitative Impairment in social interaction (2)Qualitative impairment in communication (3)Restricted repetitive & stereotyped patterns of behavior, interests, & activities *Adapted from: Diagnostic & Statistical Manual, TR., APA, 2000

Autism and Pervasive Developmental Disorders A type of Pervasive Developmental Disorder (PDD) –A child with autism is affected along multiple dimensions –Unlike certain other single dimension problems learning disability, communication disorder, emotional and behavioral disorders

The Characteristics of Children with Autism learning deficits –Affects every aspect of child’s education language disabilities –Articulation, expressive, receptive, spontaneous, conversation, non-contextual vocalizations behavioral disorders –Stereotypic behavior: motor, visual, tactile, compulsive behaviors –rigidity of routine, intolerant of change

The Characteristics of Children with Autism attentional deficits –Lack of eye contact, availability of learning, unaware of danger emotional disabilities –Non-contextual emotions, lack of self-concept social disabilities –Eye contact, gestures, facial expression, greetings, awareness of other children, friendships, play skills deficits –Imaginative, pre-occupations with objects/activities, general content knowledge

The Characteristics of Children with Autism sleep disturbances –Going to sleep late, getting up early, getting up during the night toileting deficiencies –Lack of awareness of accidents eating disabilities –Texture, appearance, gustatory

Effective Treatment Intervention for Children with Autism  Applied behavior analysis was specifically designed and researched for children with autism  ( Lovass, 1960; Fenske, Zalenski, Krantz, & McClannahan, 1985; Lovaas, 1987; Harris, Handleman, Gordon, Kristoff, & Fuentes, 1991; McEachin, Smith, & Lovaas, 1993).  Treats the entire child  Every aspect/dimension of the disorder

Applied Behavior Analysis Applied behavior analysis is: A science Teaching procedure are derived from learning principles Teaching procedures are systematically applied Teaching procedure geared to improve socially significant behavior Requires experimental demonstration that the teaching procedures employed were responsible for the improvement in behavior –requires accountability

Necessary Components of Effective Intervention for Children with Autism Individualized Teaching Procedures Individualized Curriculum Individualized Data Collection Assessing Progress of each Skill On-going Hands-on Staff Training Parent Training

Team Membership Consultant –doctoral level of academic expertise and experience in both applied behavior analysis and all aspects of autism –Helps teacher develop individualized educational programs for each child –Helps teacher develop data management system to evaluate effectiveness of each child’s program –Provides direction for the development of individualized curriculum –Trains teacher in effective individualized teaching procedures –Provides frequent hands-on training to each team member for each child

Team Membership Teacher –Training in applied behavior analysis and autism –Writes individualized programs for each child –Manages all data collection systems to ensure program effectiveness for each child –Creates individualized curriculum to accompany each program for each child –Provides hands-on training to instructional aides and the implementation of individualized programs for each child –Provides hands-on training to parents and any person that frequently interacts with the child –Teaches each child

Team Membership Instructional Aides –Training in applied behavior analysis and autism –Continually receives hands-on training –Prepares individualized curriculum for child with teacher’s guidance –Teaches each child Parents –Training in applied behavior analysis specifically in how to effectively keep their own child engaged in productive activity

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs Use principles of applied behavior analysis for intervention –It is recommended that principles of applied behavior analysis (ABA) and behavior intervention strategies be included as an important element of any intervention program for young children with autism.

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs Frequency, intensity, and duration of intervention –It is recommended that intensive behavioral programs include as a minimum approximately 20 hours per week of individualized behavioral intervention using applied behavioral analysis techniques (not including time spent by parents).

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs Frequency, intensity, and duration of intervention –It is recommended that the precise number of hours of behavioral intervention vary depending on a variety of child and family characteristics. Considerations in determining the frequency and intensity of intervention include age, severity of autistic symptoms, rate of progress, other health considerations, tolerance of the child for the intervention, and family participation

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs In deciding upon the frequency and intensity of a behavioral intervention, it is important to recognize that: –In the studies reviewed, effective interventions based on ABA techniques used between 18 and 40 hours per week of intensive behavioral intervention by a therapist trained in this method.

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs In deciding upon the frequency and intensity of a behavioral intervention, it is important to recognize that: –It is recommended that the number of hours of intensive behavioral intervention be periodically reviewed and revised. Monitoring the child's progress may lead to a conclusion that hours need to be increased or decreased. –It is important to consider revising the intervention plan when the child shows either significant improvement or a lack of improvement.

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs Supervision of Therapists –It is recommended that all professional and paraprofessionals who function as therapists in an intensive behavioral intervention program receive regular supervision from a qualified professional with specific expertise in applied behavioral approaches.

NYS Department of Health Early Intervention Guidelines Intensive Behavioral and Educational Intervention Programs Parent involvement and training –It is recommended that parents be trained in behavioral techniques and encouraged to provide additional hours of instruction to the child. Parent training is important to help the family incorporate these techniques into the daily routines of the child and family and to ensure consistency in the intervention approach. –It is recommended that training of parents in behavioral methods for interacting with their child be extensive and ongoing and include regular consultation with a qualified professional.

Applied Behavior Analysis (Behavior Management; Intensive Behavioral Intervention) “Intensive, behavioral intervention early in life can increase the ability of the child with autism to acquire language and ability to learn.” “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993). Up to this point, a number of other research groups have provided at least a partial replication of the Lovaas model (see Rogers, 1998).” U.S. Surgeon General David Satcher, M.D., Ph.D.

Applied Behavior Analysis “All programs educating children with autism should include intensive behavioral interventions and year-round education”. The US Dept. of Education and the National Research Council's Report 'Educating Children with Autism‘Educating Children with Autism “Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis and behavioral intervention strategies be included as an important element of any intervention program”. NYS Department of Health Early Intervention: Clinical Practice Guidelines:

Estimated Savings Per Child From 3-22 Years An analysis was conducted by Jacobson, Mulick, and Green (1998) using information from the state of Pennsylvania available to us at the end of In any group of children receiving EIBI, between 20% and 50% will achieve normal functioning and require no specialized services after entering elementary school. About 10% will make small gains and require intensive special education and adult services (minimal effect group). The remainder will make moderate gains and need nonintensive special education and adult services (partial effect group). Without EIBI, most people with autism need lifelong special services.

Estimated Savings Per Child 3-22 Years The average annual cost of EIBI is estimated at $33,000 per child. The average duration is estimated to be three years. Children who realize partial or minimal effects will use family support services to age 22, i.e. for 18 years. Average savings to the educational system per child from age 3 to 22 range from $298,651 to $274,709 depending upon the proportion of children - 20, 30, 40 or 50% - who achieve normal functioning levels. Jacobson, J.W., Mulick, J.A., & Green, G (1998) Behavioral Interventions, 13,