1. MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER Deficits in social attachments and behavior Deficits in verbal and nonverbal communication Presence of perseverative, stereotyped, repetitive, behaviors

2. Social Interaction Differences  Kids with autism smile!  Social interaction may be desired but difficult  Poor reciprocity in social interaction  Relationship with care providers may be most strongly developed  Peer relationships difficult

3. Autistic Types Interactive but odd Passive Aloof Dr. Lorna Wing Unknown

4. Communication Differences  Delayed/Different Communication  Speech without communication vs. communication without speech  Echolalia  Poor gesture use  Instrumental hand leading  Playlalia and lack of symbolic play

5. Stereotyped Behavior  Perseverative Interests or play  Motor stereotopies in preschool and beyond  Insistence on sameness/routine  Need for “prediction” and “control”  Preoccupation with parts of objects

6. What is not addressed in the DSM-IV  Sensory Processing  Temperament  Motor Planning  Imitation  Anxiety and Avoidance  Adaptive Skills  Impact of intellectual functioning

7. OTHER FEATURES OF AUTISM Incidence is cited at rate of between 1 in 2500 to 1 in 500 births. 4:1 boys to girls ratio Lifespan disorder No known etiology although known to be organic in nature. Commonly accompanied by mental retardation Heterogeneous disorder

8. Treatment Although current push towards identifying biological bases of the disorder, no treatment implications are on the horizon. The form of treatment with the greatest empirical validation is treatment based upon a behavioral model.

9. Behavioral Model Treatment based on the systematic application of the principles of learning Consitently empirically demonstrated to be effective in improving the behavior of children with autism Developed via the methodology of applied behavior analysis Initial demonstrations were the first to show these children could learn in a systematic manner

10. Components of Discrete Trial Training Instruction > Response > Consequence Presenting Instructions and Questions: Child attending Easily discriminable Short and consistent Child responds or fails to respond Child responds or fails to respond Consequences: Consequences: Types of consequences Types of consequences Manner of presenting consequences Manner of presenting consequences

11. Results of Early Behavioral Intervention Initial demonstrations involved highly structured discrete trial format Initial demonstrations involved highly structured discrete trial format Proved to be very effective in establishing a wide range of behaviors in these children Proved to be very effective in establishing a wide range of behaviors in these children Provided basis for all behavioral treatments to follow Provided basis for all behavioral treatments to follow Can lead to substantial improvement in many children with autism Can lead to substantial improvement in many children with autism

12. Problem Areas Generalization Generalization Stimulus Stimulus Response Response Lack of spontaneity Lack of spontaneity Robotic responding Robotic responding Prompt dependency Prompt dependency Slow progress Slow progress Time consuming Time consuming Difficult to implement Difficult to implement Children and treatment provider may not like Children and treatment provider may not like

13. Naturalistic Strategies Developed in response to needed improvements Developed in response to needed improvements Arose from a number of different laboratories Arose from a number of different laboratories Called “incidental teaching,” “pivotal response Called “incidental teaching,” “pivotal response training,” “milieu treatment,” etc. training,” “milieu treatment,” etc. All share many of the same components All share many of the same components

14. Components of Pivotal Response Training Motivation Child Choice Reinforce Attempts Direct Reinforcement Intersperse Maintenance Tasks Frequent Task Variation Turn Taking Responsivity Tasks Involve Simultaneous Multiple Cues Tasks Involve Simultaneous Multiple Cues

16. Results of Naturalistic Treatment Strategies Greater generalization More positive affect More positive home interactions More enjoyable for both children and treatment provider

17. Parental Affect Subject Means Subject Negative/Neutral Affect   Positive Affect Overall Rating

18. Parent-Child Interaction Measures Individual Target Behavior Pivotal Response Training Interaction Scales Positive Neutral Negative Parent Training Conditions

19. Developing Individualized Treatments Important child variables Important parent and family variables Important cultural variables Important treatment/behavior interactions

20. Factors that Influence Treatment Efficacy

21. ADMI JOTO ALKO JECI ROTO THBL NOFO DABO KYMA KASU CHDE AIAC CANE CHLI JOCO KYBR PACH ROBE SASI STWI ELTU DYRE JODO JOTA BESM BOBA DAGL JASA JBBA YOTK ZATA ANCR PRT DATA SET

22. ADMI JOTO ALKO JECI ROTO THBL NOFO DABO KYMA KASU CHDE AIAC CANE CHLI JOCO KYBR PACH ROBE SASI STWI ELTU DYRE JODO JOTA BESM BOBA DAGL JASA JBBA YOTK ZATA ANCR BEST RESPONDERS

23. ADMI JOTO ALKO JECI ROTO THBL NOFO DABO KYMA KASU CHDE AIAC CANE CHLI JOCO KYBR PACH ROBE SASI STWI ELTU DYRE JODO JOTA BESM BOBA DAGL JASA JBBA YOTK ZATA ANCR NON RESPONDERS

24. Profile Behaviors Toy Play Approach Behavior Avoidance Behavior Verbal Self-Stimulatory Behavior Nonverbal Self-Stimulatory Behavior

25. Best Responders Profile Mean Percent Interval Occurrence

26. Non Responders Profile Mean Percent Interval Occurrence

27. Language Data - Responders Mean Percent Interval Occurrence

28. Responders Toy Play Social Skills Mean Percent Interval Occurrence

29. Language Data Non-Responders Mean Percent Interval Occurrence

30. Non-Responders Toy Play Social Skills

31. Parental Stress  Parents experience significant stress in areas related to child with autism –Long-term care –Limits on family opportunity –Koegel, Schreibman, Loos, Dirlich- Wilhelm, Dunlap, Robbins & Plienis (1992)

32. Parental Stress Con’t  Different types of training have a differential effect on stress of parents –Naturalistic strategies reduce stress more than highly structured techniques  Parental stress is correlated with progress of child in family-oriented programs  Parents under high degree of “parent domain” stress (PSI) may not benefit from parent training.

33. Parent Support  Parents enrolled in parent training programs report that social support would be likely to reduce stress. –Gallagher, Beckman & Cross, 1983 –Moes, Koegel, Schreibman & Loos, 1993

34. Parent Support/Information Group  Purpose: –Does participation in a parent group reduce stress in parents of children recently diagnosed with Autistic Spectrum Disorders? –Do parents enrolled in a parent group learn the training techniques better than parents not enrolled in a parent group?

38. Individualizing Placement Type  Which children will benefit most from early inclusion programming?

39. Peer Social Avoidance Attempts

40. Language Use

41. Conclusions  Autism is a complex disorder  One treatment methodology, placement type or parent program will not be optimally effective for all children or families.  Continued individualization of intervention necessary.