Transcript Outcomes of Autism Early Intervention Over 3 Years

Two Year Outcomes of Autism
Early Intervention in BC
January, 2005
Pat Mirenda, Ph.D., Project Director
Veronica Smith, Anat Zaidman-Zait, Paula Kavanagh,
and Karen Bopp, Research Assistants
Bruno Zumbo, Ph.D., Statistical Consultant
The University of British Columbia
What is Early Intensive
Behavioral Intervention in BC?
Early intensive behavioral intervention
(EIBI) was implemented in May, 2001
There are three EIBI sites:
– Delta Association for Child Development
– Queen Alexandra Centre for Children (Victoria)
– Thompson Okanagan Autism Project (TOAP)
(child development centres in Penticton,
Kelowna, Vernon, Kamloops)
©Pat Mirenda, Ph.D., 2005
What Services Do EIBI
Programs Provide?
EIBI consists of
– Year-round, at least 20 hours/week of 1:1 intervention
– Highly structured teaching, based on applied behavior
analysis (ABA) principles
– Integrated therapies (SLP, OT, etc.)
– Component of integration with typical peers
– Positive behavioural support for problem behaviour
– Family involvement in training and intervention
Each EIBI sites is funded to provide services to a
minimum of 25 children and families at any time
©Pat Mirenda, Ph.D., 2005
What is Interim Early Intensive
Intervention in BC?
The Interim Early Intensive Intervention (IEII) funding
model (also known as Individualized Funding) was
implemented in June, 2002 for all BC children with
autism spectrum disorders, ages 0-6
Families receive up to $20,000 per year to purchase
services for their children from a list of “Qualified Service
Providers”
– Behaviour consultants and interventionists
– Speech-language pathologists
– Occupational and physiotherapists
©Pat Mirenda, Ph.D., 2005
The Evaluation Project
The evaluation project was initiated at the
very beginning of the EIBI and IEII programs.
So, the results only apply to the children and
families who were initially involved in these
programs, which have developed
considerably since the evaluation was
completed
Results may be different if the evaluation was
conducted today
©Pat Mirenda, Ph.D., 2005
Overview of the Evaluation
The evaluation project was approved by UBC’s
Behavioral Ethics Review Board
All EIBI and IEII families were invited but not
required to participate in the project
– 50% of EIBI children/families who gave consent in
each site were selected at random for the
evaluation. The total number of EIBI families in the
project was 39.
– All IEII families who consented to participate and
whose children were eligible to receive at least one
year of IEII funding were also included. The total
number of EIBI families in the project was 31.
©Pat Mirenda, Ph.D., 2005
Evaluators
Evaluators assessed each family and child at the
EIBI site office or at home
Multidisciplinary team of evaluators
– Psychologist (same person each time)
– Speech-language pathologist (SLP) (same person
each time)
– Family interviewer (different evaluators each time)
Psychologist, SLP each spent several hours with
each child, often on separate days
Family interviewers spent several hours with family
member(s)
Children and families were assessed before
intervention started (T1), 6 months later (T2), 1 yr
later (T3), and 2 yrs later (T4)
©Pat Mirenda, Ph.D., 2005
Participants by Region
BC Region
EIBI Participants
IEII Participants
Kootenays
0
1
Okanagan
9
0
Thompson/Caribou
4
0
Upper Fraser
0
0
South Fraser
13
6
Simon Fraser
0
6
Coastal North Shore
0
0
Vancouver/Richmond
0
12
North
0
3
Upper Island
2
2
Victoria
11
1
TOTAL
39
31
©Pat Mirenda, Ph.D., 2005
Who Were the Children?
•Variable
•EIBI (N = 39)
•IEII (N = 31)
•Age at T1
•46 mo (range = 21-68 mo)
•55 mo (range = 28-72 mo)
•Gender
•33 boys (85%), 6 girls
•25 boys (81%), 6 girls
•T1 diagnosis •29 autism (74%), 10
PDDNOS
•27 autism (87%), 4
PDDNOS
•Ethnicity
•74% Euro-Canadian, 21%
Asian-Can, 5% other
•26% Euro-Canadian, 42%
Asian-Can, 32% other
•Primary
language at
home
•97% English, 3% other;
13% spoke more than 1
language at home
•58% English, 16% Chinese,
26% other; 61% spoke more
than 1 language at home
©Pat Mirenda, Ph.D., 2005
Children (Con’t)
Before intervention started
– 61% of EIBI children and 97% of IEII children were
in preschool or day care
– Most children both groups had received small
amounts of intervention from infant development
consultants, speech-language pathologists,
occupational therapists, or other professionals
– Four EIBI and three IEII children had received ABA
therapy; three received more than 900 hours,
while the others received fewer hours
©Pat Mirenda, Ph.D., 2005
Who Were the Families?
•Variable
•EIBI
•IEII
•Marital
status
•29 two-parent
•26 two-parent
families (74%), little families (84%), little
change over 2 yrs
change over 2 yrs
•Average
family
education
•Professional
diploma/some
University
•Some University
•Average
family
occupation
•Semi-skilled
worker/skilled
manual worker
•Semi-skilled
worker/skilled
manual worker
©Pat Mirenda, Ph.D., 2005
Treatment Provided
 Pat Mirenda, Ph.D., 2005
Treatment Services Received
As part of their intervention, all EIBI and
almost all IEII children received
– At least some structured ABA teaching or behavior
support services
– Either direct or consultative speech-language and
occupational therapy
Some EIBI and IEII children received various
recreation therapies
All but two children attended day care,
preschool, or school as well
©Pat Mirenda, Ph.D., 2005
Average Hours of Treatment
Over 2 Years
IEII
EIBI
Estimated Number of
Hours/Week
40
35
27.0
27.8
30
25
20
16.3
10.3
15
10
5
0
Without Preschool/School
Including Preschool/School
©Pat Mirenda, Ph.D., 2005
Was There a Relationship Between Child
Progress and Hours of Treatment?
Using statistical tests, we found no
significant relationship between child
progress on any measure and either
– Total hours of treatment without school or
– Total hours of treatment including school
This means that factors other than hours
of treatment were better predictors of
child outcomes
©Pat Mirenda, Ph.D., 2005
Outcomes over
2 Years (T1-T4)
T1 average age = 4:2
T4 average age = 6:1
 Pat Mirenda, Ph.D., 2005
Understanding the Results….
Sometimes, test scores can change just because a child
has “good day” or a “bad day” when he/she is tested -but the difference is not really meaningful or important -it could have occurred “by chance”
We used a number of statistical tests to determine
whether children made more progress over 2 years they
would have made just by chance
We use the term “significant” in this presentation to
indicate that there is a 5% or less likelihood that a
change occurred by chance, and code this in green
We use the term “not significant” to indicate that the
result could have occurred by chance, and code this
in red
©Pat Mirenda, Ph.D., 2005
Understanding the Results….
First, growth curve analyses were done
– To determine whether the rate of change over 2
yrs of treatment was greater than expected by
chance (i.e., “significantly different”) and
– To obtain estimates of the children’s rate of
progress on various measures prior to intervention
Then, the data were analyzed to examine
specific predictors of progress over 2 yrs
©Pat Mirenda, Ph.D., 2005
Were There Differences In Progress
Between the EIBI and IEII Groups?
There no significant differences between
the two service delivery groups on any
measure
– On average, the EIBI and IEII children made
similar progress over 2 years
– So, we combined the two groups into one
group of 70 children to answer the rest of the
questions
©Pat Mirenda, Ph.D., 2005
Were There Differences in Progress Between
Children with Autism and PDD-NOS?
There were no significant differences
between the two diagnostic groups on
any measure
– Children with autism and children with
PDD-NOS (pervasive developmental
disorder-not otherwise specified) made
similar progress
– So, we analyzed the results across both
children with autism and those with PDDNOS to answer the rest of the questions
©Pat Mirenda, Ph.D., 2005
Was More Progress Made by Children Who
Were Younger at T1?
There were no significant differences
between children who started treatment younger
and those who started when they were older on
any measure
– Children who started when they were older made as
much progress as children who started when they
were younger
– But remember: At T1, EIBI children were 46 months
old, on average (range = 21-68 mo) and IEII children
were 55 months old, on average (range = 28-72 mo),
at T1 -- that is, no children were older than age 6 at
T1
©Pat Mirenda, Ph.D., 2005
Were There Differences for Children Who
Were “Testable” vs. “Untestable”?
“Untestability” was determined on a test-by-test basis,
using different criteria for each measure
Children were considered to be untestable if they met the
criterion established for each test at both T1 and T2
Significant differences were found between testable and
untestable children on several measures
– In other words, children who could not achieve at least a minimum
test score on these tests both before they began treatment as well
as 6 months later made less progress over 2 years, compared to
children who could be tested successfully
So, the results for testable and untestable children will be
presented separately in the slides that follow
©Pat Mirenda, Ph.D., 2005
Reading the Graphs
We used growth curve analysis to find out
whether the children’s scores on various
tests changed significantly over the 2 yrs
We charted the results using graphs that
140
look like this:
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
What Do the Graphs Mean?
Each grey line is one
child
These are the child’s
test score
These are when the
child was tested
– 0 = before intervention
(T1)
– 6 months later (T2)
– 12 months later (T3)
– 24 months later (T4)
140
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
What Do the Graphs Mean?
The red line is the 140
average test score 120
across all 70
100
children
80
So, in this graph, the
60
average score
40
increased from 60 to
20
just over 80
0
between T1 and 2
years later
0
6
12
24
©Pat Mirenda, Ph.D., 2005
Test Results
The next slides present the test results
over 2 years for all 70 children
©Pat Mirenda, Ph.D., 2005
Autism “Severity” and
Symptoms: CARS and ABC
CARS: Childhood Autism Rating Scale
– Administered by psychologist
– Based on observation of child and family
interview
– Provides descriptions of symptoms and
“severity” rating
ABC: Autism Behavior Checklist
– Administered by family interviewer
– Based on parent report of behaviors
©Pat Mirenda, Ph.D., 2005
CARS
On the CARS, low 60
scores = less
severe autism
Average score at
40
baseline: 35.9
Average score at
2 yrs: 34.2
This is not a
20
meaningful
decrease in
autism severity, as
0
observed by the
psychologist
0
6
12
24
©Pat Mirenda, Ph.D., 2005
ABC
On the ABC, low 140
scores = fewer
120
autistic behaviors
Average score at 100
baseline: 61
80
Average score at 2 60
yrs: 41
40
This is a significant
decrease in autistic 20
behaviors, as
0
reported by parents
0
6
12
24
©Pat Mirenda, Ph.D., 2005
Temperament and Atypical
Behavior Scale (TABS)
Administered by family interviewer, based on
parent report
Provides subscale scores related to four clusters
of atypical behaviors
– Detached: behaviors related to being “in his/her own
world”
– Hypersensitive: easily frustrated, tantrums,
aggressive, impulsive
– Underreactive: socially unresponsive
– Dysregulated: sleep problems, difficult to comfort
©Pat Mirenda, Ph.D., 2005
TABS Standard Scores
On the TABS, high scores
= fewer unusual behaviors
On average, the children’s
lowest scores were on the Typical
“detached” subscale and
remained “atypical” after 2 At risk
years of intervention
Scores for the other
subscales improved
Atypical
somewhat, but the
children were still in the
TABS “at risk” category
60
50
40
20
Detached
Hypersensitive
Underreactive
10
Dysregulated
30
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
IQ: Testable Children
These are standard
scores, not raw scores
Typical children’s
standard scores tend
to be stable over time
Testable children
– Started with a
mean score of 60
– Ended with a mean
score of 83.7 at T4
(+23.7 pts)
– This is significant
140
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
IQ: Untestable Children
Untestable children
140
– Started with a
120
mean score of
45.8
100
– Ended with a
80
mean score of
60
49.7 at T4 (+3.9
pts)
40
– This is significant, 20
even though it is a
0
small increase
0
6
12
24
©Pat Mirenda, Ph.D., 2005
One More Lesson!
To read the next set of
graphs, you need to know
what this dotted red line
means
This is a statistical
estimate of what the
average child’s test score
would have been without
intervention
In general, the bigger the
gap between the solid and
the dotted red lines, the
greater the impact of the
intervention
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
Adaptive Behavior: VABS
VABS: Vineland Adaptive Behavior
Scales
– Administered by psychologist
– Based on parent interview
– Provides total score and subscale scores
in four areas:
•
•
•
•
Communication
Daily living skills
Socialization
Motor skills
©Pat Mirenda, Ph.D., 2005
VABS: Communication
Typical children (ages 08) gain approx. 1.15 raw
score points per month
(ppm) on this subscale
EIBI and IEII children
gained, on average
– .7 ppm prior to
intervention
– 1.07 ppm during
intervention
This is a significant gain
of +7 months more than
would have occurred
without intervention
31% of the change was
due to treatment; 69%
was due to maturation
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
VABS: Socialization
Typical children (ages 08) gain approximately 1.0 120
raw score ppm on this
100
subscale
EIBI and IEII children
gained, on average
80
– .72 ppm prior to
intervention
60
– .74 ppm during
intervention
40
This is not a significant
gain compared to what
20
would have occurred
without intervention
0
4% of the change was
due to treatment; 96%
was due to maturation
0
6
12
24
©Pat Mirenda, Ph.D., 2005
VABS: Motor Skills
Typical children (ages 0-6)
gain approximately 1.0 raw
120
score ppm
EIBI and IEII children
100
gained, on average
80
– .87 ppm prior to
intervention
60
– .74 ppm during
intervention
40
This is not a significant gain
20
compared to what would
have occurred without
0
intervention; in fact, it is a
slight decrease in gain
0
6
12
24
©Pat Mirenda, Ph.D., 2005
VABS: Daily Living Skills
Typical children (ages 08) gain approximately
140
1.35 raw score ppm
120
EIBI and IEII children
gained, on average
100
– .7 ppm prior to
intervention
80
– 1.15 ppm during
60
intervention
This is a significant gain
40
of +6 months more than
20
would have occurred
without intervention
0
46% of the change was
due to treatment; 54%
was due to maturation
0
6
12
24
©Pat Mirenda, Ph.D., 2005
Preschool Lifestyle Inventory
The PLI measures the number of
different leisure and personal
management activities done by the child
across nine areas in the past 30 days,
by parent report
Also measures the amount of support
required by the child in activities (1 = no
support; independent, 4 = substantial
support), by parent report
©Pat Mirenda, Ph.D., 2005
Results: Leisure Activities
Children were engaged in significantly more
– Play activities (e.g., puzzles, drawing, lego, play-dough,
doll play, looking at books, board games)
– Exercise activities (e.g., riding a tricycle, going on
swings/slides, skating, throwing a ball)
– Media activities (e.g., using a computer, watching
TV/videos
– Community activities (e.g., going to the park, movies,
swimming, church, parties)
– Other leisure activities identified by the parent
©Pat Mirenda, Ph.D., 2005
Results: Daily Living Skills
Children were also engaged in significantly more
– Food-related activities (e.g., using spoon/fork,
ordering food in restaurant, making a snack)
– Space and belongings activities (e.g., putting away
toys, setting the table, pet care)
– Personal hygiene and community activities (e.g.,
toileting, dressing, using a schedule)
©Pat Mirenda, Ph.D., 2005
Results: Support
Over 2 years, children required
significantly less support for personal
hygiene and community activities (e.g.,
toileting, dressing, washing hands,
brushing teeth)
©Pat Mirenda, Ph.D., 2005
Social Network Analysis
Form (SNAF)
Measures the number of socially
important people in the child’s life within
the past 30 days, by parent report
– Family members
– Preschool/daycare/school contacts
– Friends
– Neighbours
– Paid staff
– Other
©Pat Mirenda, Ph.D., 2005
Social Network Results
Significant increases were found in the
number of children’s
– Preschool/school peers
– Friends
– Paid staff
No significant differences were found in
other areas (e.g., number of family
members, neighbours, etc.)
©Pat Mirenda, Ph.D., 2005
Receptive Language Tests
PLS-AC: Preschool Language Scale-3
– Administered by speech-language
pathologist (SLP)
– Provides receptive language subscale
score (global language comprehension)
PPVT: Peabody Picture Vocabulary
Test (IIIA and IIIB)
– Administered by SLP
– Measures single word vocabulary
comprehension
©Pat Mirenda, Ph.D., 2005
PLS-AC: Testable Children
Typical children (ages 08) gain approximately 0.6
raw score ppm
Testable children gained,
on average
– 0.4 ppm prior to
intervention
– .75 ppm during
intervention
This is a significant gain
of +12 months more than
would have occurred
without intervention
39% of the change was
due to treatment; 61%
was due to maturation
60
50
40
30
20
10
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
What Does This Mean?
For these children, skills gained as a result of the
change in rate of progress include the ability to
understand
–
–
–
–
–
Advanced spatial concepts (e.g., under, in back of)
Advanced descriptors (e.g., long ,short)
Time concepts (e.g., day versus night)
Advanced quantities (e.g., “Which one has five…?”)
Complex directions (e.g., “Give me the small red ball in
the box”)
– Passive voice (e.g.,”The boy was chased by the dog”)
©Pat Mirenda, Ph.D., 2005
PLS-AC: Untestable Children
Typical children (ages 08) gain approx. 0.6 raw
score ppm
Untestable children
gained, on average
– 0.2 ppm prior to
intervention
– 0.5 ppm during
intervention
This is a significant gain of
+12 months more than
would have occurred
without intervention
67% of the change was
due to treatment; 33%
was due to maturation
60
50
40
30
20
10
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
What Does This Mean?
For these children, skills gained as a result of
the change in rate of progress include the ability
to identify
–
–
–
–
–
–
–
Pictures
Body parts (e.g., hair, mouth, eye, nose, etc.)
Action words (e.g., eat, sleep, drink, play, wash)
Basic spatial concepts (e.g., in, off, out of)
Pronouns (e.g., me, my, him)
Early quantity concepts (e.g., some, the rest of)
Functional object use (e.g., scissors are used for
cutting paper)
– Basic descriptors (e.g., big, little, wet)
©Pat Mirenda, Ph.D., 2005
PPVT: Testable Children
Typical children (ages 0-8)
gain approx. 1.1 raw score
ppm
Testable children gained,
on average
– 0.4 ppm prior to
intervention
– 1.6 ppm during
intervention
This is a significant gain of
+27 months more than
would have occurred
without intervention
77% of the change was due
to treatment; 23% was due
to maturation
140
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
PPVT: Untestable Children
Typical children gain
approximately 1.1 raw score
ppm
Untestable children gained,
on average
– 0 ppm prior to
intervention
– .4 ppm during
intervention
This is a significant gain of
+20 months more than would
have occurred without
intervention
Unable to estimate the
amount of change due to
treatment because of very
low T1 scores
140
120
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
Expressive Language Tests
PLS-EC: Preschool Language Scale
– Administered by SLP
– Measures global expressive language
EOWPVT: Expressive One-Word Picture
Vocabulary Test
– Administered by SLP
– Measures single word vocabulary output
MacArthur Words & Gestures, Words &
Sentences
– Administered by family interviewers
– Measures parent report of # of words child understand
©Pat Mirenda, Ph.D., 2005
and says, from a list of 680 words
PLS-EC
Typical children gain
approx. 0.6 raw score
ppm
Both testable and
untestable children
gained, on average
– 0.3 ppm prior to
intervention
– 0.5 ppm during
intervention
This is a significant gain
of +6 months more than
would have occurred
without intervention
39% of the change was
due to treatment; 61%
was due to maturation
60
50
40
30
20
10
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
What Does This Mean?
For the “average” child, skills gained as a
result of the change in rate of progress
include the ability to
– Use possessives (e.g., The boy’s cat)
– Tell how an object is used in a short sentence
(e.g., “I use a spoon to eat”)
– Answer questions logically (e.g., “What do you
do when you’re sleepy?” “I go to bed”)
– Use pronouns such as I, she, we, they
©Pat Mirenda, Ph.D., 2005
EOWPVT: Testable Children
Typical children gain
approximately 1.0 raw 100
score ppm
Testable children gained, 80
on average
– 0.4 ppm prior to
60
intervention
– 1.4 ppm during
40
intervention
This is a significant gain
of +25 months more than 20
would have occurred
without intervention
0
71% of the change was
due to treatment; 29%
was due to maturation
0
6
12
24
©Pat Mirenda, Ph.D., 2005
EOWPVT: Untestable Children
Typical children gain
approx. 1.0 raw score
ppm
Untestable children
gained, on average
– 0 ppm prior to
intervention
– .2 ppm during
intervention
This is a significant gain
of +15 months more than
would have occurred
without intervention
Unable to estimate the
amount of change due to
treatment because of
very low T1 scores
100
80
60
40
20
0
0
6
12
24
©Pat Mirenda, Ph.D., 2005
MCDI: Words Said
35
34.3
1-49 words
650 words or more
30
Percent of children
Approximately
one-third (34.3%)
of the children
could say only 149 words on the
MCDI at T1,
compared to only
12% at T4
Only 4.3% of the
children could
say 650 words or
more on the
MCDI at T1,
compared to
almost one-third
(32.7%) at T4
25
22.2
20
20
15.8
15
12
10.3
10
5
32.7
4.3
0
1st Qtr
6 mo (T2)
12 mo (T3)
24 mo (T4)
©Pat Mirenda, Ph.D., 2005
The
children’s
average
number of
words on
the MCDI
increased
from 164 at
T1 to 424 at
T4 -- a
260%
increase
Average number of words said
MCDI: Words Said
450
424
400
332
350
300
257
250
200
164
150
100
50
0
T1
6 mo (T2)
12 mo (T3)
24 mo (T4)
©Pat Mirenda, Ph.D., 2005
What Predicted Change?
We used statistical tests to determine
whether any T1 variables or measures
were good predictors of how much
change would occur in individual
children over the 2 years
In other words, was it possible to predict
before intervention which children would
benefit the most and, if so -- how?
©Pat Mirenda, Ph.D., 2005
Predictors
None of the following were good predictors of change over 2 years:
– Type of service (EIBI vs. IEII)
– Diagnosis (autism vs. PDD-NOS)
– Age at baseline
– Total hours of treatment, either with or without school/
preschool/daycare
Combinations of the following were good predictors of child change
on some measures, over 2 years:
– “Testability” at T1 and T2 but not at T1 alone
– T1 CARS scores (less severe autism predicted more progress)
– T1 IQ scores (higher IQ scores predicted more progress)
– T1 number of words said on the MCDI (more words predicted
more progress)
There may be other (and better) predictors as well that were not
examined in this analysis
©Pat Mirenda, Ph.D., 2005
Parenting Stress: PSI-SF
PSI: Parenting Stress Inventory-Short Form
–
–
Administered by family interviewer
Based on parent report
Provides total parenting stress score and
subscale scores in four areas
©Pat Mirenda, Ph.D., 2005
Parenting Stress: PSI-SF
PSI: Parenting Stress Inventory-Short Form
– Administered by family interviewer
– Based on parent report
– Measures total parenting stress -- that is, stress
related to parenting (in this case) the child with
autism, not stress caused by other factors (e.g.,
marital problems, family illness, financial
difficulties, etc.)
– Scores of 90 or above are considered problematic
(see blue line on next slide)
©Pat Mirenda, Ph.D., 2005
PSI-SF
Average score at
baseline: 96.6
– 90 or more: 64% of
families
Average score at 2 yrs:
82.6
– 90 or more: 34% of
families
This is a significant
decrease but is still
worrisome for the 34%
of families with scores
above 90
160
140
120
100
80
60
40
0
6
12
24
©Pat Mirenda, Ph.D., 2005
What Child Factors Predicted PSI
Scores?
We used statistical tests to determine if specific child
factors were associated with (i.e., predicted) changes in
PSI scores over the 2 years
– We examined all of the test results (IQ, expressive and
receptive language, daily living skills, problem behavior, etc.)
The only significant predictors were changes in problem
behavior scores on the TABS and changes in autistic
behavior scores on the ABC -- together, these
accounted for 77% of the PSI score change
This suggests that reduced problem behavior is the
factor most related to reduced parenting stress and
should be a high priority for direct intervention from the
outset of treatment
©Pat Mirenda, Ph.D., 2005
Parent Perceptions and
Satisfaction
 Pat Mirenda, Ph.D., 2005
Parent Satisfaction: PSQ
PSQ: Parent Satisfaction Questionnaire
– Adapted from an instrument used in Lovaas (ABA)
research sites
– Administered by the family interviewer
– Measures parents’ perceptions of child change in
several areas and satisfaction with the EIBI or IEII
programs as whole
Completed at each evaluation point; here, we
summarize only the results at 32 mo (T5) for
EIBI families and 24 mo (T4) for IEII families
©Pat Mirenda, Ph.D., 2005
Parent Perceptions of Child
Change
Parents were asked if they noticed
improvements in their child’s
– Language and communication skills
– Social skills
– Play and leisure skills
– Aggression and tantrums
– Self-stimulatory and ritualistic behaviour
– Self-help skills
©Pat Mirenda, Ph.D., 2005
Parent Perceptions of Child
Change
Parents rated the amount of change in each
area from 1-7:
–
–
–
–
–
–
–
1 = this is no longer a problem for my child
2 = significantly improved
3 = slightly improved
4 = no change
5 = slightly worse
6 = significantly worse
7 = much worse
©Pat Mirenda, Ph.D., 2005
Parent Perceptions of Child
Change
1 = no longer a problem; 4 = no change; 7 = much worse
7
EIBI T5
IEII T4
6
5
4
3
2
2.1
2.3
2.3
2.6
2.5
2.1
2.4 2.6
2.1
2.4
2.1
2.3
1
0
Lang/ Com
Soci al
Play
Aggr ess/
Tantrum
Sel f-Stim/
Ritual s
Sel f-Hel p
©Pat Mirenda, Ph.D., 2005
Parent Satisfaction
Parents were also asked to rate their
satisfaction in a number of areas
In general, the rating scale was
– 1 = very negative
– 2 or 3 = somewhat or slightly negative
– 4 = neutral or “just right”
– 5 or 6 = somewhat or mostly positive
– 7 = very positive
©Pat Mirenda, Ph.D., 2005
How Do You Feel About…
…the treatment methods used with your child?
1 = very dissatisfied; 7 = very satisfied
7
6
6.3 6.2 6.4 6.4
6.1 5.9 6
5
T2
T3
T4
T5
4
3
2
1
0
EIBI
IEII
©Pat Mirenda, Ph.D., 2005
How Do You Feel About…
…the therapists working with your child?
1 = very dissatisfied; 7 = very satisfied
7
6.7 6.5 6.6 6.7
6.5 6.5 6.3
6
5
T2
T3
T4
T5
4
3
2
1
0
EIBI
IEII
©Pat Mirenda, Ph.D., 2005
How Do You Feel About…
…the workload for you and your child?
1 = much too little; 4 = JUST RIGHT; 7 = much too much
7
6
5.1
5
4
4 4.1
4.4 4.4
4.4
4.2 4.3
4.2
4.1 4
3.9
4.4
4.4
T2
T3
T4
T5
3
2
1
0
EIBI Child
EIBI Parent
IEII Child
IEII Parent
©Pat Mirenda, Ph.D., 2005
How Has Treatment
Affected…
…your stress and that of your child?
7
1 = greatly decreased; 4 = no effect; 7 = greatly increased
6
5
4.6
4
3.4
3
3.8 3.7
2.8
3.4
3.1
2.8
T2
T3
T4
T5
3.3 3.2
2.5 2.4 2.6
2.3
2
1
0
EIBI Child
EIBI Parent
IEII Child
IEII Parent
©Pat Mirenda, Ph.D., 2005
How Has Treatment
Affected…
…your family, overall?
1 = very negative; 7 = very positive
7
6.4
6.3
6.5
6.8
6.3
6.5
6
6.1
5
T2
T3
T4
T5
4
3
2
1
0
EIBI
IEII
©Pat Mirenda, Ph.D., 2005
Quality Compared to Other
Services Received
1 = much worse; 7 = much better
7
6
6
6.3 6.5
5.7
5.8 5.9
5.4
5
T2
T3
T4
T5
4
3
2
1
0
EIBI
IEII
©Pat Mirenda, Ph.D., 2005
How Has Treatment
Affected…
…your confidence and hopefulness for your child’s future?
1 = greatly decreased; 7 = greatly increased
7
6.2
6
5.3
5.5 5.6
6.1
6.3
6.5
5.9
6.2
5.8 5.7
5.6
6 5.9
5
4
T2
T3
T4
T5
3
2
1
0
EIBI
Confidence
EIBI Hope
IEII
Confidence
IEII Hope
©Pat Mirenda, Ph.D., 2005
Recommend to Others?
1 = absolutely not; 7 = absolutely yes
7
6.6 6.6
6.8 6.8
6.7
6.9 6.9
6.5
6.3
6.5
6.7
6.3
6.6 6.7
6
5
4
T2
T3
T4
T5
3
2
1
0
EIBI
Recommend to
Other Families?
EIBI Enroll
Again?
IEII
Recommend to
Other Families?
IEII Enroll
Again?
©Pat Mirenda, Ph.D., 2005
Overall Ratings
1 = absolutely not; very negative; 7 = absolutely yes; very positive
7
6.7
6.5
6.8 6.9
6.5 6.3
6.6
6.9
6.8 6.8 6.8
6.4
6.6
6.3
6
5
4
T2
T3
T4
T5
3
2
1
0
EIBI Worth EIBI Overall IEII Worth
Time &
Rating
Time &
Effort?
Effort?
IEII Overall
Rating
©Pat Mirenda, Ph.D., 2005
Parent Benefits
1 = greatly decreased; 7 = greatly increased
7
6.6
6.3
6
5.7 5.8 5.8
5.7
6
6.2
6.2 6.3 6.2
6.3 6.3
6.1
5
4
T2
T3
T4
T5
3
2
1
0
EIBI Attitude
EIBI
Improv ed Knowledge
Increased
IEII Attitude
IEII
Improv ed
Knowledge
Increased
©Pat Mirenda, Ph.D., 2005
Parent Benefits
1 = greatly decreased; 7 = greatly increased
7
6
5
5.7
5.9
6.1
6.5
6.4
5.5
5.8
5
6.1 6.2 6
5.35.3
4.9
4
T2
T3
T4
T5
3
2
1
0
EIBI Skills
EIBI
Improv ed Re sources
More
Available
IEII Skills
IEII
Improv ed Re sources
More
Available
©Pat Mirenda, Ph.D., 2005
Summary
Over 2 years, children receiving EIBI and
IEII made more progress per month than
they are likely to have made without
treatment, on almost every measure
On average, both EIBI and IEII parents
saw significant improvements over 2-3
yrs in their children, and were very
satisfied with the services they received
©Pat Mirenda, Ph.D., 2005
Many Thanks to…
Psychologists
–
–
–
–
–
–
–
–
Ron Buen
Kathryn Cass
Julie Conry
Linda Eaves
Peggy Koopman
Karl Mueller
Tara Tunstall
Edith van de
Watering
Speech-language
pathologists
–
–
–
–
–
–
–
–
–
–
Barbara Cotter
Marta Eveson
Betsy Niely
Mary McKenna
Shannon Muir
Liz Payne
Lisa Prokopowitz
Pat Savinkoff
Veronica Smith
Rhoda Zacker
©Pat Mirenda, Ph.D., 2005
Many Thanks to…
Family interviewers
–
–
–
–
–
–
–
–
–
–
–
–
–
Kirsten Turoldo
Lynn Edwards
Brenda Fossett
Kim Hurd
Margaret Gauthier
Jane Kelty
Liana Maione
Karen Ott vandeKamp
Laurie Reid
Tawnya Schulz
Robyn Teske
Sandra Waddle
Krista Zambolin
Additional UBC research
assistants
– Karen Ott VandeKamp
– Kim Hurd
– Robyn Teske
Project assistant Jackie
Brown
And, most of all, all the
families and children
who participated!
©Pat Mirenda, Ph.D., 2005
The End
 Pat Mirenda, Ph.D., 2005