INTENSIVE BEHAVIOR ANALYTIC AND ECLECTIC INTERVENTIONS FOR CHILDREN WITH AUTISM: DATA FOR DECISION MAKERS

Transcription

1 INTENSIVE BEHAVIOR ANALYTIC AND ECLECTIC INTERVENTIONS FOR CHILDREN WITH AUTISM: DATA FOR DECISION MAKERS Jane Howard, Ph.D., Board Certified Behavior Analyst, Psychologist April 8, 2016 Conferința Internațională ABA București

2 TOPICS Goal of early intervention for children with autism Eclectic and Intensive ABA models for treatment of autism Description Outcomes Why ineffective models persist Tasks ahead

3 GOALS OF EARLY INTERVENTION HIGH Cognitive & Social Development ZONE OF MODIFIABILITY Typical Development Trajectory Developmentally Delayed Trajectory LOW Birth Kindergarten High School Adulthood

4 EXPRESSIVE LANGUAGE TRAJECTORIES Developmental Equivalent (Months) Catching Up is hard to do Chronological Age (Months) typical predicted from baseline 2 months/ month 1 month per month

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6 How are Treatments Chosen? Past practice Scientific evidence Market forces Chosen treatment Economic factors Political factors Cultural factors Other factors 6

7 How are Treatments Chosen? Different factors may lead to different treatment recommendations Scientific evidence Economic factors Past practice Market forces EIBT Brief behavioral intervention Eclectic approach Medications 7

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10 PARTICIPANT CHARACTERISTICS Howard, Sparkman, Cohen, Green & Stanislaw (2005) IBT (29) AP (16) GP (16) Gender 25 male 4 female 13 male 3 female 16 male 0 female Dx 24 Autism 5 PDDNOS 12 Autism 4 PDDNOS 9 Autism 7 PDDNOS Age at Intake (months) Age at Final Assessment (months) Philosophy ABA Eclectic Eclectic Mother s level of education (years)

11 PROGRAM CHARACTERISTICS Howard, Sparkman, Cohen, Green & Stanislaw (2005) ABA (IBT) Autism (AP) Generic (GP) Hours per week Learning Opp/Hour unknown unknown Staffing Ratio 1:1 1:1 or 1:2 1:6 Speech Tx Consult Model YES YES Occupational Tx NO YES YES

12 SOME BEHAVIORAL CUSPS Attending to people and environmental events Generalized imitation Generalized instruction following Initiate complex speech Motivated to please others Comparison to others

13 NUMBER OF ANNUAL GOALS AND OBJECTIVES IBT Generic (G Autism (AP 56 0 language cognitive social other

14 COGNITIVE FUNCTIONING HOWARD ET AL (2014)

15 OUTCOMES IN NORMAL RANGE

16 OUTCOMES IN NORMAL RANGE

17 OUTCOMES IN NORMAL RANGE

18 OUTCOMES IN NORMAL RANGE

19 OUTCOMES IN NORMAL RANGES

20 OUTCOMES IN NORMAL RANGE

21 PROBABILITY RATIO IN NORMAL RANGE 5 x 6 x 5 x 2 x cognitive receptive expressive adaptive IBT

22 Composite adaptive score Cognitive score

23 Eclectic Treatment Baseline Final assessment 110 Composite adaptive score Cognitive score

24 ABA Treatment Baseline Final assessment 110 Composite adaptive score Cognitive score

25 All Scores for IBT Children 7.4% 85.7% 35.4% 41.1% 92.6% 14.3% 58.9% 64.6% Baseline Year 1 Score is 85 or higher Score is below 85

26 All Scores for IBT Children 7.4% 85.7% 35.4% 41.1% 73.6% 28.6% 47.7% 92.6% 14.3% 26.4% 58.9% 52.3% 64.6% 71.4% Baseline Year 1 Year 2 Score is 85 or higher Score is below 85

27 All Scores for IBT Children 7.4% 92.6% 85.7% 14.3% 35.4% 41.1% 58.9% 73.6% 28.6% 26.4% 47.7% 52.3% 85.1% 14.9% 26.0% 50.4% 49.6% 64.6% 71.4% 74.0% Baseline Year 1 Year 2 Year 3 Score is 85 or higher Score is below 85

28 All Scores for IBT Children 7.4% 92.6% 85.7% 14.3% 35.4% 41.1% 58.9% 73.6% 28.6% 26.4% 47.7% 52.3% 85.1% 14.9% 26.0% 50.4% 49.6% 64.6% 71.4% 74.0% Baseline Year 1 Year 2 Year 3 Score is 85 or higher Score is below 85

29 COMPARISON OF TRANSITIONAL PROBABILITIES IBT CHILDREN AP & GP CHILDREN

30 WHY ECLECTIC MODELS DON T WORK Individual component treatments not effective Component treatments work against each other Too little of (effective) treatment components AP children had 10 hours per week of ABA and used PECS communication systems

31 WHY ECLECTIC MODELS USED Parents and some professionals don t know the model does not work Professionals recommend eclectic approach Too few professionals not trained or skillful in providing intensive ABA Misconceptions about ABA Comprehensive ABA not quick fix Autism is complex and therefore must require a lot of different types of treatment and professionals Eclecticism seems inclusive

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33 FUTURE FOCUS Make treatment outcome measures valuable Communicate the financial and human cost of ineffectively treating Autism Use measures that decision makers value Communicate expected outcomes from high quality, ABA Help regulate and self-correct quality issues Unpack treatment package Determine why some do not benefit as much from ABA and what we need to do differently

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