ABA 553: Assessing Autism Interventions Presentation #1 BCBA Pervasive Developmental Disorders Science Presentation #1 BCBA Pervasive Developmental Disorders Science

Behavior Analyst Certification Board (BACB) Board Certified Behavior Analyst (BCBA) or eligible Master’s degree course work in behavior analysis supervised experience in behavior analysis Supervised training by a doctoral level professional specifically in teaching children with autism Board Certified Behavior Analyst (BCBA) or eligible Master’s degree course work in behavior analysis supervised experience in behavior analysis Supervised training by a doctoral level professional specifically in teaching children with autism

What is a Pervasive Developmental Disorder (PDD)? Pervasive developmental disorders are characterized by severe and pervasive impairment in several areas of development: Reciprocal social interaction skills Communication skills Presence of stereotyped behavior, interests, and activities Pervasive developmental disorders are characterized by severe and pervasive impairment in several areas of development: Reciprocal social interaction skills Communication skills Presence of stereotyped behavior, interests, and activities

These disorders are usually evident in the first years of life and are often associated with some degree of mental retardation. These disorders may be observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system). These disorders are usually evident in the first years of life and are often associated with some degree of mental retardation. These disorders may be observed with a diverse group of other general medical conditions (e.g., chromosomal abnormalities, congenital infections, structural abnormalities of the central nervous system). What is a Pervasive Developmental Disorder (PDD)?

Specific Pervasive Developmental Disorders Autistic Disorder (299.00) Rett’s Disorder (299.80) Childhood Disintegrative Disorder (299.10) Asperger’s Disorder (299.80) Pervasive Developmental Disorder Not Otherwise Specified (299.80) Autistic Disorder (299.00) Rett’s Disorder (299.80) Childhood Disintegrative Disorder (299.10) Asperger’s Disorder (299.80) Pervasive Developmental Disorder Not Otherwise Specified (299.80)

How Common are Pervasive Developmental Disorders? Autism Spectrum Disorders : 1/88 eight-year- olds (as of 2008 data – CDC Report) 4+:1 Male-to-Female Ratio Increase in prevalence may be due to Increases in requests for service Changes in diagnostic criteria An actual increase in prevalence Autism Spectrum Disorders : 1/88 eight-year- olds (as of 2008 data – CDC Report) 4+:1 Male-to-Female Ratio Increase in prevalence may be due to Increases in requests for service Changes in diagnostic criteria An actual increase in prevalence

Possible Etiologies Brain and Nervous System defects that occur during initial brain development abnormalities in the brain structures that make up the limbic system. Inside the limbic system, an area emotional behavior. One study of high-functioning children with autism found that the amygdala was indeed impaired but that another area of the brain, the hippocampus, was not. In a study of younger children, researchers observed low levels of activity in the parietal areas and the corpus callosum. high levels of the neurotransmitter serotonin have been found in a number of people with autism. Brain and Nervous System defects that occur during initial brain development abnormalities in the brain structures that make up the limbic system. Inside the limbic system, an area emotional behavior. One study of high-functioning children with autism found that the amygdala was indeed impaired but that another area of the brain, the hippocampus, was not. In a study of younger children, researchers observed low levels of activity in the parietal areas and the corpus callosum. high levels of the neurotransmitter serotonin have been found in a number of people with autism.

Possible Etiologies Each of these differences has been seen in some but not all the people with autism who were tested. What could this mean? Perhaps the term autism actually covers several different disorders, each caused by a different problem in the brain. Or perhaps the various brain differences are themselves caused by a single underlying disorder that scientists have not yet identified. Discovering the physical basis of autism should someday allow us to better identify, treat, and possibly prevent it. Each of these differences has been seen in some but not all the people with autism who were tested. What could this mean? Perhaps the term autism actually covers several different disorders, each caused by a different problem in the brain. Or perhaps the various brain differences are themselves caused by a single underlying disorder that scientists have not yet identified. Discovering the physical basis of autism should someday allow us to better identify, treat, and possibly prevent it.

Possible Etiologies Genetic Prenatal/Perinatal complications Maternal Rubella 10% risk of Autism Environmental Psychogenic “refrigerator mother” Immunizations m m Genetic Prenatal/Perinatal complications Maternal Rubella 10% risk of Autism Environmental Psychogenic “refrigerator mother” Immunizations m m

Current Research Areas Intervention technologies to improve characteristics Etiology Nervous system changes associated with autism Intervention technologies to improve characteristics Etiology Nervous system changes associated with autism

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 and stereotyped patterns of behavior, interests and activities 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 and stereotyped patterns of behavior, interests and activities Adapted from: Diagnostic and Statistical Manual, 4th Ed., APA, 1994

I. Qualitative Impairment in Social Interaction Marked impairment in the use of non- verbal behaviors such as eye contact, facial expression or gestures to regulate social interaction Failure to develop appropriate peer relationships Lack of spontaneous seeking to share enjoyment or interests Lack of social/emotional reciprocity Marked impairment in the use of non- verbal behaviors such as eye contact, facial expression or gestures to regulate social interaction Failure to develop appropriate peer relationships Lack of spontaneous seeking to share enjoyment or interests Lack of social/emotional reciprocity

II. Qualitative Impairments in Communication Delay in, or total lack of, the development of spoken language In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation Stereotypic and repetitive use of language Lack of varied, spontaneous pretend or social play Delay in, or total lack of, the development of spoken language In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation Stereotypic and repetitive use of language Lack of varied, spontaneous pretend or social play

III.Restrictive Repetitive and Stereotyped Patterns of Behavior or Interests Preoccupation with one or more stereotyped and restricted pattern of interest that is either abnormal in intensity or focus Inflexible adherence to non-functional routines Stereotyped and repetitive motor mannerisms Persistent preoccupation with parts of objects Preoccupation with one or more stereotyped and restricted pattern of interest that is either abnormal in intensity or focus Inflexible adherence to non-functional routines Stereotyped and repetitive motor mannerisms Persistent preoccupation with parts of objects

Autistic Disorder (299.00) B. Delays or abnormal functioning in at least one of the following areas: social interaction, social communication, or symbolic or imaginative play, with onset prior to the age of three. C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder. B. Delays or abnormal functioning in at least one of the following areas: social interaction, social communication, or symbolic or imaginative play, with onset prior to the age of three. C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

Diagnostic Criteria for : Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) This category should be used when there is severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills or when stereotyped behaviors are present but the criteria are not met for a specific PDD Adapted from: Diagnostic and Statistical Manual, 4th Ed., APA, 1994

Learning Characteristics of Children with Autism Stimulus overselectivity Difficulty responding to natural contingencies Difficulty generalizing skills May rely on rote memory May memorize information rather than “comprehend” it May demonstrate proficient performance on tasks demanding visual spatial judgment and pattern recognition Splinter skills Stimulus overselectivity Difficulty responding to natural contingencies Difficulty generalizing skills May rely on rote memory May memorize information rather than “comprehend” it May demonstrate proficient performance on tasks demanding visual spatial judgment and pattern recognition Splinter skills

Learning Characteristics of Children with Autism Difficulty in all dimensions of language including expressive/receptive language and: Phonology - Rules determining how sounds can be sequenced Morphology - Rules for meaning of sounds (e.g., un, pro, con) Syntax - Rules for a language’s grammar Semantics - Rules for meaning of words Pragmatics - Rules for communication especially difficult for a child with autism Difficulty in all dimensions of language including expressive/receptive language and: Phonology - Rules determining how sounds can be sequenced Morphology - Rules for meaning of sounds (e.g., un, pro, con) Syntax - Rules for a language’s grammar Semantics - Rules for meaning of words Pragmatics - Rules for communication especially difficult for a child with autism

Why does Autism Need Such a Specialized Treatment? Because its is 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) Because its is 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)

Why does Autism Need Such a Specialized Treatment? 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 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

Why does Autism Need Such a Specialized Treatment? Attention deficits Lack of eye contact, availability of learning, unaware of danger Emotional impairments Non-contextual emotions, lack of self-concept Social impairments Eye contact, gestures, facial expression, greetings, awareness of other children, friendships, Play skills deficits Imaginative, pre-occupations with objects/activities, general content knowledge Attention deficits Lack of eye contact, availability of learning, unaware of danger Emotional impairments Non-contextual emotions, lack of self-concept Social impairments Eye contact, gestures, facial expression, greetings, awareness of other children, friendships, Play skills deficits Imaginative, pre-occupations with objects/activities, general content knowledge

Why does Autism Need Such a Specialized Treatment? Sleep disturbances Going to sleep late, getting up early, getting up during the night Toileting impairments Lack of awareness of accidents Eating disabilities Texture, appearance, gustatory Sleep disturbances Going to sleep late, getting up early, getting up during the night Toileting impairments Lack of awareness of accidents Eating disabilities Texture, appearance, gustatory

How do we help? It All Begins with Knowledge! Knowledge lets us know how things work Information about “how things work” is only useful if it is accurate “My brother’s cousin’s landscaper’s uncle told me that this plant derivative cures acne!” Unfortunately lots of knowledge sources can have inaccuracies and biases So how do we know which knowledge is accurate? Knowledge lets us know how things work Information about “how things work” is only useful if it is accurate “My brother’s cousin’s landscaper’s uncle told me that this plant derivative cures acne!” Unfortunately lots of knowledge sources can have inaccuracies and biases So how do we know which knowledge is accurate?

Ah Ha! Science! Science is nothing more than a certain way to gather knowledge strives to minimize bias and maximize accuracy Uses objective, systematic, and direct observation of phenomena being studied Likely to be method to gather most accurate source of knowledge for how things work in the world Science is nothing more than a certain way to gather knowledge strives to minimize bias and maximize accuracy Uses objective, systematic, and direct observation of phenomena being studied Likely to be method to gather most accurate source of knowledge for how things work in the world

What Does Science Look At? Test tubes and lab coats? Specifically, how does the environment we live in affect what we do, think and feel? Various things affect me and what I do affects others I’m a teacher and I’m most interested in knowing how what I’m doing is affecting a child’s learning Specifically, what is going to be the most effective educational strategy for each particular child? Test tubes and lab coats? Specifically, how does the environment we live in affect what we do, think and feel? Various things affect me and what I do affects others I’m a teacher and I’m most interested in knowing how what I’m doing is affecting a child’s learning Specifically, what is going to be the most effective educational strategy for each particular child?

How Can We Use Science to Study What & How a Child Learns? We have a scientific discipline that has been developing for SEVENTY years It’s called…. Applied Behavior Analysis We have a scientific discipline that has been developing for SEVENTY years It’s called…. Applied Behavior Analysis

What is Applied Behavior Analysis? (Cooper, Heron, Heward, 1987) Applied behavior analysis is the science in which procedures derived from the principles of learning are systematically applied to improve socially significant behavior and to demonstrate experimentally that the procedures employed were responsible for the improvement in behavior Why? Applied behavior analysis is the science in which procedures derived from the principles of learning are systematically applied to improve socially significant behavior and to demonstrate experimentally that the procedures employed were responsible for the improvement in behavior Why?

Scientifically Validated Treatment: Applied Behavior Analysis (ABA) (a/k/a Behavior Management; Intensive Behavioral Intervention [IBI]) “The use of non-validated treatment approaches for children with autism may be ineffective and possibly harmful to your child and may take time away from treatments that have shown to be effective.” (Green, 1996; New York State Department of Health, 1999) “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.” U.S. Surgeon General, David Satcher, M.D., Ph.D. “The use of non-validated treatment approaches for children with autism may be ineffective and possibly harmful to your child and may take time away from treatments that have shown to be effective.” (Green, 1996; New York State Department of Health, 1999) “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.” U.S. Surgeon General, David Satcher, M.D., Ph.D.