Effective Practices in Early Intervention by Ilene S. Schwartz & Bonnie J. McBride Chapter 3

Autism Prevalence As of 2007, the CDC estimates that 1 in 150 children have an autism spectrum disorder (ASD)

Early Intervention There is overwhelming evidence that the earlier autism is diagnosed and intervention begins, the better the outcome BUT Although ASD can be reliably diagnosed by age 2, average age of diagnosis is 3-6 years Even later for children who are culturally or linguistically diverse

Red Flags No words by 16 months No smiles by 6 months No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months No back-and-forth gestures (e.g., pointing, showing, waving) by 12 months No words by 16 months No two-word meaningful phrases by 24 months A loss of speech or babbling or social skills at any age

Who can diagnose autism? A clinical evaluation should be done by a specialist who is experienced with ASDs Psychologist Developmental pediatrician Psychiatrist Neurologist

Identification Through the School System IDEA criteria are similar, but not identical, to clinical criteria Some states use broad classification of “developmentally delayed” until child is age 6 or 9 Educational classification may not entitle child to services through health or social services agencies Instruments used may not be appropriate for detecting the kinds of difficulties children with ASDs experience

Challenge of Diagnosis In many areas, there is a shortage of professionals--both clinical and educational--who have expertise in autism Vital that parents and professionals are actively involved in the diagnostic process and ask questions

Recommendations of the National Research Council Children should begin receiving specialized, intensive early intervention as soon as child is diagnosed w/ ASD or is suspected to be at risk for an ASD Never delay intervention while awaiting an evaluation Never “wait and see”

Vital Referrals Assessment process must include: Helping families locate services Publicly funded services (early intervention or school-based services) Parent training Parent support groups

Vital Information Assessment process must include vital information for parents Characteristics of effective programming for young children with ASDs Info on child’s strengths and challenges Should NOT include a statement on child’s long-term prognosis No way of knowing how an individual child will respond to intervention

Effective Programming No single educational strategy is best for all children with ASDs ABA (applied behavior analysis) most researched Many different interventions have led to improved outcomes for children and families Intervention can include home-, center-, and community-based services

Key Elements in Effective Programs Sufficient hours/intensity of services Comprehensible environments with access to typical peers Specialized, appropriate curriculum Family involvement Problem-solving approach to challenging behaviors Appropriate evaluation tools to monitor progress

Sufficient Hours/Intensity of Services National Research Council recommends 25 hours per week Should include some 1:1 instruction Also look at: Training & expertise of the professionals implementing the program Child’s level of engagement in the instructional tasks

Comprehensible Environments with Access to Typical Peers Child must be able to understand: Organization of physical space Organization of materials Scheduling of activities Planned opportunities for adult-supported interaction with typical peers Just putting child w/ autism together with typical peers is not sufficient

Family Involvement Family the most consistent influence in a child’s life Children with ASDs often have difficulty generalizing skills from one setting to another Interventions are more effective when professionals and families collaborate to implement strategies in multiple settings

Problem-Solving Approach to Challenging Behaviors Challenging behaviors (screaming, crying, aggression) are common in children with ASDs Look at not just the behavior itself, but its function (What does the behavior accomplish for the child?) Teach child proactive behavior to replace challenging behavior

Appropriate Evaluation Tools to Monitor Progress Progress must be monitored repeatedly and systematically If child is not learning, programming must be changed Many ways to monitor progress--checklists, observation tools, rating scales, etc. Evaluation tools must be easy to use, or they won’t be used consistently

Putting Together a Comprehensive Program Most families don’t use a single “brand name” program like Lovaas, TEACCH, or Floor Time Instead, most combine service providers with different theoretical orientations to create an eclectic program Some publicly funded, some through private insurance or out-of-pocket

Questions Parents Should Ask About Any Program What are your primary concerns for your child? Does the intervention (or collection of interventions) address those concerns? Are the intervention procedures acceptable to you? Is it a good match for your child/family? What is the evidence of effectiveness? How will the interventionists communicate with you and demonstrate your child’s progress?

Meaningful Outcomes for Young Children with ASDs All young children need to learn to: Follow simple directions Imitate Communicate wants and needs Perform basic self-care skills (e.g., toilet training) Beyond these, opinions vary on what should be top priority

Outcome-Oriented Approach Some programs overemphasize specific, discrete skills Meaningful outcomes help a child become more independent or achieve a better quality of life Don’t underestimate importance of belonging, having friends, happiness, good health

Curriculum-Based Assessment (CBA) One way to identify appropriate skills to target Identifies functional skills across multiple domains (adaptive, communicative, cognitive, social, and motor) Two options Use one developed especially for ASDs (e.g., ABLLS) Use a general one plus checklists that assess core deficit areas for students with ASDs

Project DATA (Developmentally Appropriate Treatment for Autism) Model program at University of Washington since 1997 12 hours per week in integrated early childhood program 12 hours per week of intensive instruction, 1-on-1 or small group 5+ hours per week of parents working with kids at home

5 Components of Project DATA Extended, Intensive Instruction Technical and Social Support for Families Integrated Early Childhood Experience Transition Planning and Support Collaboration and Coordination

6 Elements of Integrated Early Childhood Program Structuring the classroom to promote independence, participation, and successful interactions with typically developing peers Well-designed traffic pattern Centers and activities that are interesting, relevant and engaging Centers with adequate, age-appropriate materials Activities that promote or require peer interaction Materials that are well organized and in good working order Materials that are rotated frequently

6 Elements of Integrated Early Childhood Program Developing and using a consistent schedule Use pictures, symbols, and objects to increase understanding Children must be taught to use the schedules Teachers must use the schedules consistently Use strategies to signal upcoming activity change (timers, counting, songs, etc.) Teach children to handle unexpected changes in schedule

6 Elements of Integrated Early Childhood Program Creating the need to communicate with adults and peers Every child must have a functional communication system Every activity is a language-learning and language-using opportunity Example: At snack time, child can use language to request something he wants, reject something he doesn’t want, or respond to request of a peer

6 Elements of Integrated Early Childhood Program Using preferred materials and activities to promote learning Identify child’s preferred items and make them available as part of classroom activities Make sure every center has a wide range of items--something for everyone

6 Elements of Integrated Early Childhood Program Providing embedded and explicit instruction on valued skills All teachers and interventionists must know the different techniques and how to measure progress Same skills must be practiced across settings, activities, people, and materials

6 Elements of Integrated Early Childhood Program Providing frequent reinforcement and developing effective motivation A reinforcer is anything (good or bad) that increases the probability of a behavior happening again Early on, artificial reinforcers may need to be used (favorite toy, food, bubbles, etc.) Advance to using natural reinforcers (logical consequences) only when they’re sufficient to promote skill development and appropriate behavior

Project DATA’s Extended, Intensive Instruction 12 hours a week One-on-one or small groups Varies, depending on child’s needs and objectives being worked on 5+ hour a week Parents work with child at home

Project DATA’s Technical and Social Support Monthly home visit Families must attend 6 or more hours of educational programming per year

Project DATA’s Collaboration and Coordination of Services Almost every family uses some type of family negotiated service (i.e., services not paid for by school district) Once a year, hold a team meeting of ALL service providers Purpose: To foster communication and collaboration (NOT joint planning or eval)

Project DATA’s Transition Planning & Support Transitions are especially difficult for children with ASDs Work with school district, preschool, and family to ensure adequate planning for smooth transition to school Teach new skills Transfer visual support Visit new school and meet teacher

Conclusion Project DATA is just one example of an effective early intervention program Over 50% of students move on to inclusive kindergartens Remember that there is no one “right” way to educate a child with an ASD A program’s success is measured by the child’s progress

First Signs www.firstsigns.org Organization founded by parents Excellent info on early diagnosis and intervention