1. EARLY INTERVENTION PROGRAM FOR CHILDREN WITH AUTISM Jaruwan Kittisopit, M.D.

4. The Walden Program Research based Early Childhood Program Established 1985 Emory Autism Center, Department of Psychiatry and Behavioral Science, Emory Medical School, Atlanta, Georgia, USA Systematic replication of the Toddler Center Model for typical children’s day care by O’Brien, Porterfield, Herbert-Jackson, Risley 1979.

5. The Walden Program Hallmarks Naturalistic ABA approach “Incidental Teaching concepts”

6. Behavioral approach : Applied Behavior Analysis, ABA Traditional ABA Discrete-trial procedure ( Lovaas 1981) Comprehensive or Naturalistic ABA Incidental Teaching (McGee et.al.,1983,1999) Pivotal Response Training ( Koegel,1999) Peer-mediated strategies ( Strain and Kohler,1998)

8. Program Mean Age at entry (range) in months Hours per weeks Usual Setting a Concepts Orientatio n b Primary Teaching Procedure Children’s unit 40 (13-57) 27.5 School (s)t-BDiscrete trial Denver community Based approach 46 (24-60) 20 School(I),home, community DPlayschool curriculum Developmental Intervention model 36 (22-48) 10-25 Home, clinicDFloor time therapy Douglass 47 (32-74) 30-40 School (S, I), home t-BDiscrete trial, naturalistic LEAP 43 (30 - 64) 25 School (I),homec-BPeer-mediated intervention naturalistic Pivotal Response Training 36 (24-47) varies School(I),home, community, clinic c-BPivotal response training TEACCH 36 (24 up) 25 School (s), clinicMStructured teaching UCLA Young Autism Project 32 (30-46) 20-40 Homet-BDiscrete trial Walden 30 (18-36) 36 School(I), homec-BIncidental teaching a (S) Segregated classroom; (I) Inclusive classroom b (t-B) Traditional Behavioral approach; (c-B) Comprehensive Behavioral approach; (M) Mixed approach Lord C, McGee JP, eds. National Research Council (2001). Educating Children with Autism. Committee on Educational Intervention for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, D.C.: National Academy Press, 2001.

9. The Incidental Teaching Definition: A systematic protocol of instruction that is delivered in the context of natural stimulus conditions of everyday environments Origin: Teaching complex language in the disadvantaged, typical children ABA concept Peer Incidental Teaching & Inclusion setting Hart & Risley 1968,1974, 1975,1982 McGee GG, Almeida MC, Sulzer-Azaroof B, Feldman RS. Promoting reciprocal interactions via peer incidental teaching. J Appl Behav Anal 1992; 25:117-26.

10. The Incidental Teaching Procedure Environmental is arranged Child initiates Teacher prompts : Use least to most prompts Child responds Teacher immediately provide Access to the desired item/activity ( Contingent Reinforcer) Praise and Confirm the correct response Child enjoys the desired item : Keep interaction enjoyable Teacher keeps looking for child initiation, or Create the next Teachable Moment

11. Incidental teaching Discrete Trial Child friendly session Natural setting Child initiated Correlation of the response and the reinforcer ( internal reinforcer) Slower to master the skill Overcome generalization and initiation problem Highly structured session Distract free setting Teacher directed No correlation btw the response and the reinforcer (external reinforcer) Faster to master the skill Less generalization and initiation

13. The Walden Program Hallmarks Naturalistic ABA approach “Incidental Teaching concepts” Positive Behavioral Interventions and Supports Promote Social and Language development “Verbal-only-program” Early inclusion Active family collaboration Family training 2 hr/ 2 wk for Home based-program 10 hr/wk

14. The Walden Program Hallmarks Environmental arrangement : Cubby, Toy shelves, Hobby boxes, Name tags, Seats, Gates, Physical zones Toy rotation system & Teaching theme Reinforcer assessment system

15. The Walden Program Hallmarks Overlapping activities schedules Designated teaching zones & Goal & Individual goal Free play – Play skill, Vocabulary Snack – Communication Outdoor – Peer interaction Table – Peer interaction & Academic readiness

16. The Walden Program Structure Combined Center and Home-based Program ( 25-30 hr plus 10 hr/ wk) Classrooms : Toddler, Preschool, Pre- Kindergarten 5 d/ wk, Full day, 8:30-15:30, all year Teacher : Child 1:3 1:4 1:5 CWA : TYP 1:2 (total 12-15) Staff

17. Individual Educational Plan, IEP

18. Sequences of Social Goals across the Walden treatment continuum Toddler Preschool Pre-K Social Responsiveness Play Skills Tolerance of Peer Proximity Focus on Peers Synchrony of Play Response to Peer interaction Conversation with peers Peer Negotiation Attraction of Peer bids Initiation of Interactions Sustained Interactions Community Participation

19. Sequences of Communication Goals across the Walden treatment continuum Toddler Preschool Pre-K Initial Verbalizations Verbal Requests Vocabulary Pragmatics of Conversation Amount of talking Complexity of Language Correct of Syntax Elaborated Vocabulary Vocabulary and Corrections

20. Sequences of Behavioral Goals across the Walden treatment continuum Toddler Preschool Pre-K Engagement Independent Daily Living Decreased Behavior Problems Conventional School Behaviors Academic Readiness

22. The Walden Program Structure Ongoing Objective Assessment Entry-Exit VDO Daily probes 1:1 records Biweekly review of individual case Program Evaluation Teachers Classrooms

24. Outcomes of The Walden Graduates McGee GG, Morrier MJ, Daly T. Walden Early Childhood Program. In: Handleman JS, Harris SL. eds. Preschool Education Programs for Children with Autism 2nd ed. Austin: Pro-ed, 2001:157-90. N = 34 ( 10 @ Neuro Dx) EntryExit Age, yr3.6 ( 2.0- 5.6) 6.0 ( 4.11- 7.4) % Peer Interaction 311 (1 -27 ) ( 17/34 in TYP range 6-39) % Verbal cases 0 80% NV- 4/34  ¾ NeuroDx % of Verbalizatio n 616 Regular School 26/33