Transcript Slides - Conference.ie

Video training materials for
parents on behavioral principles:
A project in development
LYNN BRENNAN, ED.D., BCBA-D
CONSULTANT TO THE UNIVERSITY OF
CONNECTICUT PARENT TRAINING PROJECT
CONFERENCE:
AUTISM SPECTRUM DISORDER:
FROM CLINICAL PRACTICE TO EDUCATIONAL
PROVISION
CENTRE FOR AUTISM AND DEVELOPMENTAL
DISORDERS
NATIONAL UNIVERSITY OF IRELAND, GALWAY
GALWAY IRELAND
JANUARY 13, 2012
Parent Mediated Intervention
 Various approaches – some behavioral and others developmental, social-
communication, eclectic
 Goals vary - Some target very specific and discrete behaviors/skills (i.e.
imitation, compliance, joint engagement, etc.) others have a broader focus.
A few examples:
 Ingersoll & Dvortcsak, 2006 (Combination of Developmental [Indirect]
and Naturalistic Behavioral [Direct] Tx Models)
 Ingersoll & Gergans, 2006 (Reciprocal Imitation Training - RIT)
 Bahadourian & Greer, 2005 (CABAS Model PT)
 Johnson et al., 2007; Aman et al., 2009 (Multi-site Randomized
Controlled Trial; Meds Alone vs. Meds + PT)
 Vismara, Colombi & Rogers, 2009 (Early Start Denver Model)
 Kasari et al., 2010 (Joint engagement)
 Smith, Groen & Wynn, 2000 (EIBI vs Parent Training)
 Green, J., et al., 2010 (PACT) (Parental Synchrony, Child Initiation,
Shared Attention Time) & Alred, Green & Adams, 2004
Commercially Available
ABA Video Based Parent Training Programs
 Examples:
 Simple Steps Autism - Mickey Keenan Ph.D.,
BCBA-D*, Karola Dillenburger Ph.D., BCBA-D, *
Stephen Gallagher, Ph.D., BCBA-D*, Neil
Martin Ph.D., Ph.D., BCBA-D
*University of Ulster
 Rethink Autism - Daniel A. Etra, Eran Rosenthal,
Jamie Pagliaro, Bridget A. Taylor, Psy.D., BCBA-D,
Robyn Catagnus, Ed.D., BCBA-D
 Maximum Potential Kids - Coby Lund Ph.D.,
BCBA, and Janet Lund, Ph.D., BCBA
University of Connecticut Parent Training Project
 Teaching Skills To Toddlers: A Program for
Caregivers
 Three year project funded by the U.S. National
Institute of Health (NIH)
 Principal Investigator is Deborah Fein, Ph.D.
University of Connecticut Board of Trustees
Distinguished Professor of Psychology and
Pediatrics
Project Aims
 Design and produce an effective, primarily video
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based, parent training program
Training in basic behavioral principles
Application of these principles to some common
problems of young children with ASD
The DVD package will be offered free of charge.
Designed to be accessible to individuals with a wide
range of education or literacy levels.
Project Aims - Continued
 The DVD's are NOT designed as a substitute for
professionally delivered Intensive Early Behavioral
Education (EIBI).
 Primary prevention strategy to reduce the likelihood
and/or severity of the problem behaviors that are so
often concomitant with ASD
 Give parents a set of tools that enable them to:
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Promote social engagement
Teach fundamental communication skills and other
foundational learning skills
Manage interfering behavior
Target Consumers
 Caregivers with developmental concerns with or
without an ASD diagnosis.
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Caregivers waiting for early intervention to start
Caregivers wanting to supplement sparse early intervention
Behavior therapists who want to provide supplemental
teaching materials to caregivers
Caregivers who have little or no access to early intervention
 American consumers will primarily be in the first
three groups
International Outreach
 Project also under development for use in developing
countries where little or no intervention is available
 Physicians and researchers from Albania,
Bangladesh, Mexico, India, Japan and Turkey have
expressed interest in collaborating on development
of international versions of the training materials
Pilot Project with the Albanian Children’s
Foundation (ACF)
 Vodafone Project: Year-long therapist training
program with the ACF and Autism Speaks.
 Limited parent training was provided as a part of the
Vodafone project.
 New Autism Speaks grant will include the
development and testing of an Albanian version of
the DVD training program in conjunction with ACF.
MOTHER’S RATINGS
2010-2011 TRAINING WORKSHOPS
 Adapted from Treatment Evaluation Inventory – Short Form
(TEI-SF) 5-Point Likert Scale
 As a result of this year’s training program, I believe that I
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have a better understanding of my child’s learning
challenges. 5
After a year of participation in this training project, I
believe that I am more skilled at helping my child. 4.2
I find this treatment to be an effective way of teaching
important skills. 5
I would be willing to use these procedures to change my
child’s problem behavior. 5
I like the procedures used in this treatment. 4.8
MOTHER’S RATINGS
2010-2011 TRAINING WORKSHOPS
Continued…
 I believe this treatment to offer an effective means of
helping with problem behavior. 4.2
 I believe the treatment is likely to result in permanent
improvement. 4
 I believe it would be acceptable to use this treatment with
individuals who cannot choose treatments for
themselves. 4
 Overall, I have a positive reaction to this treatment. 5
 I attended the workshops on feeding problems, toilet
training and/or incidental teaching methods in the home
environment, and I found the information useful and
helpful. 4.8
Parents’ Comments
 Periodic clinic meetings seen as very helpful
 Eager to continue participating in their children’s
intervention
 Desire for more focus on generalization of skills from
therapy environment to home
 Desire for more focus on problem behavior at home
and in community
 More on the Albanian Pilot Project later…
DVD Format
 Experts will describe basic evidence-based principles
and techniques using simple, non-technical language
 Input from in-country experts to ensure that material is
culturally sensitive
 For example, in some versions, the diagnostic label of
autism or ASD will not be used in an effort to increase
acceptability of the DVD’s.
 Concepts will be packaged in short, easy-to-digest
modules or tool-kits
 Instruction will be accompanied by illustrative video
clips, which are currently being filmed and culled.
DVD Format Continued
 Caregivers can move at their own pace
 Modules can be viewed individually and reviewed
 Caregivers will be encouraged to discuss the concepts
and practice the techniques with other adults before
trying them with their children.
 Major concern is the minimal amount (in some cases
absence) of expert feedback at regular intervals
 Will need to provide self-assessment strategies and
possibly oral quizzes after each module
 May provide homework and quizzes for parents in formal
studies
Content
 The instruction will be based on principles of Applied
Behavior Analysis (ABA), with specific application to:
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Social Reciprocity
Functional Communication
Receptive and Expressive Language
Cognitive Skills
Play Skills
Activities of Daily Living (i.e., feeding, toilet training, etc.)
A Basic Understanding of Functional Behavior Assessment
 Structured and naturalistic behavioral teaching strategies will
be presented.
 Adaptations for children under the age of three will be
specifically addressed.
 Typical developmental milestones will also be reviewed.
Scope and Sequence of the DVD Program
Part One
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Section 1 – Introduction
Section 2 – Normal Milestones
Section 3 - Some Basic Principles of Teaching
Section 4 – Teaching Social Interaction to Very Young
Children
Section 5 – Using Visual Supports to Jump Start
Communication
Section 6 – Teaching Daily Living Skills
Section 7 - Some basic ideas about preventing and
handling problem behavior.
Section 8 - Play
Scope and Sequence of the DVD Program
Part Two
 Section 1 - Getting started with more intensive teaching
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sessions with child over 2 years of age.
Section 2 - Let’s Review - A review of some important
lessons from Part 1
Section 3 - More about Reinforcement
Section 4 - More about Shaping and Chaining
Section 5 – More about Naturalistic Teaching Methods
Section 6 - More about Structured Teaching Methods
Section 7 – Teaching more Advanced Language and
Communication Skills
Shaping Eye Contact During Mealtime
• Timing is everything!
• Wait for eye contact before delivering bites.
• Prompt by holding the food up near your eyes.
Pick-up Games of Peek-a-boo After Lunch!
• Condition YOURSELF as a reinforcing agent…
• YOU can be more fun than ANY toy!
• Make eye contact fun ~ The element of surprise!
Bubble Fun in the Bathtub
• Teaching “Nose & All Gone” in the Natural Environment
• Repetition – Creating routines
•Fill in the blanks
•Make small changes to the routines
At Playtime, Select Toys that Enable you to
Embed Yourself into the Play
• Working on eye contact with a set of tops that the child
cannot operate on her own.
• Note the use of simple language
Toys with multiple pieces can easily be used to
promote eye contact.
Access to the balls is contingent upon
eye contact.
What to do when the child is over-focused on a
toy that is not conducive to joint engagement.
• If the child has selected a toy that is not conducive to joint engagement it
may be preferable to select a different toy.
•BEFORE removing a toy that is drawing attention away from you, present
the replacement.
• Remove pieces BEFORE you give the child the toy.
• Embed yourself in the play by controlling access to the pieces which can
function as natural reinforcers.
Shaping a Request Point
Series of prompted to independent request points.
Shaping Imitation
Notice the progression from a fully prompted response to
a partially prompted response, followed by an
independent response which can now be shaped for
accuracy.
The Albanian Pilot Project
 Current plan is for 3 groups of 15 families each,
matched for age & family income
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Professionally Delivered Center-Based Intervention Alone
Parent Training DVD with Minimal Home Support
Combined Treatment
Project Evaluation: Pre- and post-intervention
 Early Intervention Parenting Self-Efficacy Scale
(Guimond et al, 2008).
 Modified version of the Treatment Evaluation
Inventory – Short Form (TEI-SF) (Kelley et al.,
1989)
 Home Situations Questionnaire (HSQ) – PDD
Version (Chowdhury et al., 2010)
 Selected sections from the ABLLS-R (Partington,
2006)
Project Evaluation Continued
 Treatment Fidelity will be rated blind to group from
a video-taped teaching session, using relevant items
from the Performance Evaluation Form (PEF)
(adapted from Leaf & McEachin, 1999) to assess key
instructional skills including:
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Ensuring child is attending prior to speaking
Use of clear instructional commands using language
appropriate to child’s skill level
Use of prompts and prompt fading procedures
Delivery of contingent consequences
“Film at 11:00”
Remember…This is a project in development.
Please stay tuned…
As they say on the 6:00 news…
“Film at 11!”
Thank you!