Language and Cognition Development Clinic

Size: px

Start display at page:

Download "Language and Cognition Development Clinic"

Brittany Bell
5 years ago
Views:

1 The Autism Research and Treatment Center (SIU): Promoting the Emergence of Complex Language and Social Skills DANA PALILIUNAS, MS, BCBA, DR. MARK R. DIXON, BCBA -D WILLIAM B. ROOT, MS, BCBA, DR. RUTH ANNE REHFELDT, BCBA-D Language and Cognition Development Clinic DANA PALILIUNAS, MARK R. DIXON Declaration Related to Conflicts of Interest I declare that neither I, nor my immediate family, have a financial interest or other relationship with any manufacturer/s of a commercial product/s or service/s which may be discussed at the conference. 1

2 Need for Autism Treatment As many of you are aware, according to the CDC, About 1 in 68 children has been identified with autism spectrum disorder (ASD) ASD is reported to occur in all racial, ethnic, and socioeconomic groups The total costs per year for children with ASD in the United States were estimated to be between $11.5 billion - $60.9 billion In addition to medical costs, intensive behavioral interventions for children with ASD cost $40,000 to $60,000 per child per year. Growing need for accessible, effective, and efficient treatments Established Treatments NAC National Standard s Project, Phase 2 (2015): For children, adolescents, and young adults under 22 years of age: 14 Established Interventions 18 Emerging Interventions 13 Unestablished Interventions For adults ages 22 and older: 1 Established Intervention 1 Emerging Intervention 4 Unestablished Interventions Established Interventions: Behavioral Interventions Cognitive Behavioral Intervention Package Comprehensive Behavioral Treatment for Young Children Language Training (Production) Modeling Natural Teaching Strategies Parent Training Peer Training Package Pivotal Response Training Schedules Scripting Self-management Social Skills Package Story-based Intervention Behavior Analytic Treatments for ASD Discrete Trial Training Natural Environment Teaching Verbal Behavior Behavior Therapy Pivotal Response Training Natural Language Paradigm Among others 2

Advances in Behavior Analysis: Relational Frame Theory (RFT) Psychological account of human language Focus: How we learn language through interactions with the environment The behavior of relating

3 Advances in Behavior Analysis: Relational Frame Theory (RFT) Psychological account of human language Focus: How we learn language through interactions with the environment The behavior of relating stimuli together along various dimensions Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition (Hayes, Barnes-Holmes, & Roche, 2001) RFT: How People Relate Coordination -Sameness -Identity Matching -Patterning Comparison -Superlatives -Monetary Values -Ordering Events in Time Opposition -Directions -Feelings Adjectives -Weather Distinction -Picture Discrimination -What Doesn t Belong? -Ordering from a Menu Hierarchy -Stacking and Nesting -Biomes and Habitats -Family Relations Deictic -Perspective Taking -Here, There, Elsewhere -Past and Future Derived Relational Responding (DRR) Learning through relations between stimuli without needing to be directly taught Generative and efficient Not every response needs to be directly taught Fosters meaningful interaction with the environment Directly Trained Derived Sun S-U-N 3

Implications for ASD HOW CAN WE APPLY THIS UNDERSTANDING OF LANGUAGE DEVELOPMENT TO THE

PEAK Relational Training System Evaluation and curriculum guide for teaching basic and

accounts of verbal behavior to develop directly trained skills and generalization of responses

relate stimuli together and derive novel responses 4 Modules 4 Full Assessments 2

Basic foundational learning abilities Generalization: Develop basic and complex skills across

4 Implications for ASD HOW CAN WE APPLY THIS UNDERSTANDING OF LANGUAGE DEVELOPMENT TO THE TREATMENT OF CHILDREN WITH AUTISM? PEAK Relational Training System Evaluation and curriculum guide for teaching basic and advanced language skills from a contemporary behavior analytic approach Uses traditional accounts of verbal behavior to develop directly trained skills and generalization of responses in novel situations Adds contemporary accounts of verbal behavior to develop the ability to relate stimuli together and derive novel responses 4 Modules 4 Full Assessments 2 Pre-Assessments of Relational Ability 184 Programs per Module PEAK Modules Direct Training: Basic foundational learning abilities Generalization: Develop basic and complex skills across stimuli, contexts, and people Equivalence: Teach concept formation and develop multisensory learning Transformation: Develop the ability to relate stimuli together in varied and complex ways 4

5 Number of Clients Relationship between Language and IQ Direct Training Generalization r =.759 p <.01 Dixon, Whiting, Rowsey, Belisle (2014) Relationship Between DRR and IQ Equivalence Transformation IQ 100 IQ r = R 2 = p < r = R 2 = p < PEAK E PA Total Score PEAK T PA Total Score Introduction to the LCD Clinic On-Campus ABA Clinic and Research Facility at SIUC Dr. Mark R. Dixon Officially opened in January 2016 Free therapy for children with or without formal diagnoses 30 Goal: Take what we know about language and apply it in 20 treatment 10 Focus on development and training of language skills using PEAK System LCD Clinic Growth Jan-16 Jun-16 Jan-17 Jun-17 Jan-18 5

6 Assessment: Evaluate language and cognitive skills in order to determine the most appropriate intervention Research: Faculty and student therapists to develop research projects, both single-subject and group design, in order to evaluate treatment procedures. LCD Clinic Model Treatment: 1:1 intensive ABA therapy 4 hours per week using evidence-based procedures to to improve language and cognitive skills Staff Development: Undergraduate and Graduate level therapists develop skills with behavior analytic training and regular supervision and feedback PEAK Relational Training System Skills Video Preliminary Outcome Data PEAK Direct Training Assessment Scores PEAK Direct Training Score Intake 6 months PEAK Direct Training Score Intake 6 months 1 year 6

7 Continuum of Services Our Goal: Provide a continuum of services to clients in our community Often ABA practices focus on the development of language skills for younger populations Once clients have developed these complex language skills, they may experience a different set of challenges those that involve language processes Club 57 WILLIAM B. ROOT, RUTH ANNE REHFELDT Now What? Once we have complex language and cognition. New relations and experiences interact in new ways I am Wil Wil is a student Wil is a BCBA Wil is not a good BCBA or Student because X, Y, and Z Wil is sad, happy, frustrated 7

8 The Need 30 % of individuals with ASD also have an anxiety disorder. Social phobia, separation anxiety, and panic disorder 26 % of those with autism have had depression Compared to just 10 % of adults who didn't have autism. Almost 2 % of adults with ASD have tried to kill themselves Compared to less than 0.5% of the other adults. Adolescents and Young Adults Depression rates around 7 to 12 %, as high as 30 % in high functioning ASD. 1 in 4 young people with autism were completely isolated References: Matson, J. L., & Williams, L. W. (2014) Wagner, M., Newman, L., Cameto, R., Garza, N., & Levine, P. (2005). Common Interventions for Psychological Events -Counseling Psychological Events as Inner Causes Alter the Inner Cause for Psychological Distress Ignore it Medicate it Get ride of it FIX IT Common Interventions for Psychological Events -Counseling However, youth with ASD report significant difficulties accessing healthcare services, particularly comprehensive health services Part of the reason for this difficulty stems from service providers feeling ill equipped to work with individuals with ASD, particularly individuals with comorbid mental health issues Challenges accessing services can often precipitate crises for individuals with ASD, leading families to be distrustful of healthcare services and service providers. 8

An Alternative Way of Understanding Psychological Events Radical Behaviorism Psychological events under

learn to interact with psychological events How we learn Natural Selection Learning history of the

group How We Learn- Direct Contingencies Lean to AVOID the Cave How We Learn Verbal Contingencies/Rules

9 An Alternative Way of Understanding Psychological Events Radical Behaviorism Psychological events under external sources of control Public and Private events as behavior Instead of fixing, transform how we learn to interact with psychological events How we learn Natural Selection Learning history of the species Operant Selection Learning history of the individual Cultural Selection Learning history of the group How We Learn- Direct Contingencies Lean to AVOID the Cave How We Learn Verbal Contingencies/Rules Cave = Lion = Get Hurt O.K. I will AVOID the cave Direct and Verbal Contingencies: Both are evolutionarily adaptive 9

Where Rules Become Unworkable Rule I am Different I have Autism I Can t Have a Job Go to College Have a Family AVOID Those behaviors Those Contexts Rule I am Different I have Autism TRANSFORM I Can

10 Where Rules Become Unworkable Rule I am Different I have Autism I Can t Have a Job Go to College Have a Family AVOID Those behaviors Those Contexts Rule I am Different I have Autism TRANSFORM I Can Find Meaningful Employment Continue to Learn and Grow Create Meaningful, Long Lasting Relationships ENGAGE Those behaviors Those Contexts Psychological Events as Operant Behavior Through consequences in the lifetime of the individual, we learn to engage and avoid certain behaviors and contexts Experiential Avoidance The attempt to alter the form, frequency, or situational sensitivity of private events even when doing so causes behavioral harm, (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Experiential avoidance is thus due to the natural effects of human language a pattern that is then amplified by the culture into a general focus on feeling good and avoiding pain, (Hayes et al., 2006). Psychological Flexibility The ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. (Hayes et al., 2006) Acceptance and Commitment Therapy (ACT) Developed within a coherent theoretical and philosophical framework Functional Contextualism Unit of Analysis: Workability Empirically based psychological intervention to increase psychological flexibility. ACT illuminates the ways that language entangles clients into futile attempts to wage war against their own inner lives. Through metaphor, paradox, and experiential exercises clients learn how to make healthy contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients gain the skills to recontextualize and accept these private events, develop greater clarity about personal values, and commit to needed behavior change. Reference: Dr. Steve Hayes, 10

The Goal of ACT Promote Valued Living Present Moment Awareness Be Here Now Acceptance Open UP Defusion Watch Your Thinking Self-as-Context Pure Awareness Committed Action Do What It Takes Values Know

11 The Goal of ACT Promote Valued Living Present Moment Awareness Be Here Now Acceptance Open UP Defusion Watch Your Thinking Self-as-Context Pure Awareness Committed Action Do What It Takes Values Know What Maters Reference: Harris (2008) How To Teach New Ways to Interact With Psychological Events Alter the Context Concretely Through Experience Symbolically Through Language Experientially Direct Contingencies + Verbal Contingencies Experiential Metaphor Metaphoric language transfers functions from one experiential field to another (Torneke, 2010) you link a network of connections with another network.. Which swiftly opens up new possibilities both internal ( thinking in a different way ) and external ( acting differently than usual ) (Torneke, 2010). The use of metaphor + Experiential Activity The move away from talk therapy Beneficial For learners who have difficulty with abstract and metaphor Make the metaphor an experience Now, they can interact with it 11

12 Video Autism Research and Treatment Center Southern Illinois University-Carbondale Club 57 Dr. Ruth Anne Rehfeldt High Functioning adults with autism spectrum disorder IQ above 80 We are now in our 3 rd month of operation Opened in January, 2017 Currently 35 adolescents and adults From as far South as Cairo Illinois, and as far North as DuQuoin Illinois Small groups: 3-4 individuals Preliminary Data Altering How The Client Talks About Experiences Typically Avoided Typical Dependent Measure for clinical outcome is Likert-type ratings on questionnaires Can we alter believability and how comfortable the client is with painful thoughts by observing changes in ratings to the questionnaires? AAQ-II Compare thought distraction with defusion Thought Distraction: Don t think about that, it isn t that big of a deal Defusion: Repeat the word to defuse the believability 12

Video Preliminary Data Altering How The Client Talks About Experiences Typically Avoided Can we take the same questionnaire, and now alter the way the client talks about the experience Ask

13 Video Preliminary Data Altering How The Client Talks About Experiences Typically Avoided Can we take the same questionnaire, and now alter the way the client talks about the experience Ask them questions from the AAQ-II Observe pre/post changes in verbal behavior related to the questions Pre: Ask questions from the AAQ-II Post: Ask the same questions from the AAQ-II Video 13

ACT: A New Approach To Psychological Events Instead of fixing, or reducing the problem Teach new ways to interact with the

Further Research and Resources Social Isolation Negative Self-Talk Statements Lack of Services Genetic Barriers Environmental

pharmacological and medical determinates (Genetic Code) Environmental determinates of psychological events Understanding

14 ACT: A New Approach To Psychological Events Instead of fixing, or reducing the problem Teach new ways to interact with the event What if we can JUST BE with ALL of life Instead of avoiding or struggling to fix, interact in a new way The Need For Further Research and Resources Social Isolation Negative Self-Talk Statements Lack of Services Genetic Barriers Environmental Barriers Genetic Code vs Zip Code Physiological determinates of psychological events Understanding and planning for pharmacological and medical determinates (Genetic Code) Environmental determinates of psychological events Understanding direct and verbal contingencies as environmental determinates (Zip Code) Genetic Code WITH Zip Code An effective treatment plan includes both 14

ACT for PARENTS with a Child with Autism. Presented by Stephanie A. Sokolosky, EdD, BCBA-D, LBA, LSSP, LPA

ACT for PARENTS with a Child with Autism Presented by Stephanie A. Sokolosky, EdD, BCBA-D, LBA, LSSP, LPA 1 Objectives Overview of ACT Training/Therapy Exploring ACT training for parents with a child/family