a spectrum disorder developmental 11/9/2009 Sensory Issues Anxiety Behaviour Social diagnosis is reliable by 24 months

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1 Autism Spectrum Disorders (ASD) Behaviour difficulty with change intense interests repetitive and sticky Anxiety What are ASDs? Social Communication low social interest friendships for level not reciprocal weak sharing eye contact weak nonverbal no/delayed speech 2-way conversation not reciprocal weak nonverbal weak play You can download this handout from under Workshops Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 2 Sensory Issues ASD a spectrum disorder from very delayed to above average abilities from mild to moderate to severe symptoms of ASD developmental abilities & symptoms may improve with good programming Early Signs of ASD ASD Diagnosis diagnosis is reliable by 24 months symptoms often seen by 12 months prognosis is best with early intensive intervention the younger, the better! Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 3 Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 4 1

2 Red Flags immediate evaluation if no babbling by 12 months no gesturing by 12 months no single words by 16 months no 2-word phrases by 24 months (not just echolalic) any loss of any language or social skills at any age (30%) Filipek et al, Amer. Acad. Neurology, Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 5 First Signs of Autism: Behaviour At 12 months of age, may see unusual eye contact visual tracking disengagement of visual attention orienting to name Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 6 imitation social smiling reactivity, social interest & affect sensory behaviors Zwaigenbaum, Bryson, Rogers, Roberts, Brian & Szatmari, 2005 Why? Early Diagnosis of Autism early intervention better prognosis so parents know connect to autism community support for families Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 7 Ontario Parents Experiences A. Spadafora, M.A., parents of 80 children with PDDs median birth year of 2000 ( ) average age of diagnosis ~ 51 months (early intervention best before 42 months) age at first concern ~ 19 months (1 48 mo.); approx. 34 months before diagnosis! Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 8 2

3 Early Identification What we are doing already is NOT good enough for EARLY identification & intervention! Families: Research Shows Social Support helps parents of children with autism helps siblings of children with autism AND helps children with autism make more progress Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 9 Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 10 Intervention Autism Spectrum Disorders (ASD) Children with ASD learn differently. They need different supports to help them learn & maintain behavioural control. Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 12 3

4 Intervention Components earliest age (as soon as autism is suspected) active engagement in intensive, 5 full- days, min. 25 hrs/wk, full-year, 1 on 1 teach social, communication, cognitive development, & play skills systematic, individualized generalization parent involvement National Research Council, Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 13 Evidence-Based Interventions National Standards Report, established treatments produce beneficial outcomes, known to be effective 22 emerging treatments some evidence 5 unestablished treatments no sound evidence of effectiveness, can not rule out harm Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p Established Treatments Antecedent Package Behavioral Package Comprehensive Behavioral Treatment for Young Children (ABA) Joint Attention Intervention Naturalistic Teaching Strategies Peer Training Package Pivotal Response Treatment Schedules Story-based Intervention Package Modeling Self-management Applied Behaviour Analysis also called Intensive Behaviour Intervention (IBI) a systematic method of; selecting teaching goals breaking tasks into small steps repetition of teaching positive reinforcement keeping precise track of progress teaching children to apply skills in all settings has the strongest research support Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p Marcia Gragg, PhD, CPsych, Nov

5 The Summit Centre for Preschool Children with Autism affiliated with U of W! Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 17 The Summit Centre a registered charitable organization U of W lends Dr. Gragg as Summit Clinical Director under a Consultancy Agreement Our Mandate 1. Early Intensive Intervention 2. Research 3. Public Awareness & Training Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 18 Evidence-based The media covers many ASD fads, often costly, that can waste families time & money Summit Centre; bases treatment on research; Applied Behaviour Analysis (ABA) values & participates in research to create knowledge & change services disseminates research-based decision making to families, service providers avoids unfounded treatments, dispels rumours Summit Centre: 1. What We Are Now Board Retreat, Nov. 9, Summit Centre: Our Services 2007 Unity 1997 STEPS Research Child with ASD 2009 Early Signs Clinic Training Students Family Support Public Education Summit Centre: 1. What We Are Now Board Retreat, Nov. 9,

6 STEPS treatment program Specialized Teaching, Education, Partnership & Support for children with ASD up to 6 yrs, under 4 yrs. to start up to 31.5 hours/week of 1-on-1 Applied Behaviour Analysis (ABA) treatment in centre and at home, 50 weeks a year individualized written programs for cooperative behaviour, communication, social skills, daily living skills, preacademic skills Marcia Gragg, PhD, CPsych, Nov. 9, Established Treatments Antecedent Package Behavioral Package Comprehensive Behavioral Treatment for Young Children (ABA) Joint Attention Intervention Naturalistic Teaching Strategies Peer Training Package Pivotal Response Treatment Schedules Modeling Self-management Story-based Intervention Package Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 22 Applied Behaviour Analysis Line Shaping (file #4) (2:55) Shaping behaviour (making a straight line) Also shaping verbal responses (saying purple marker ) with verbal prompting Stimulus generalization (using different writing utensils, from chalk on blackboard to marker on paper, with different colours) Fading (physical prompting such as hand over hand, verbal prompting to do it like this ) Positive Reinforcement (praise, Doritos) Marcia Gragg, PhD, CPsych, Nov. 9, Naturalistic Teaching Circle Time (file #20) (0:56) AVSEQ20.DAT Prompting (such as gesture to look and pay attention) Also prompting physically and verbally, for him to raise his hand (shaping the topography of hand-raising) Shaping verbal behaviour (saying blue ) Praise and Positive Reinforcement Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 24 6

7 UNITY: 3 Month Intensive ABA Parent Training at The Summit Centre for Preschool Children with Autism Unity Parent Training based on the model of the HOPE Center provides high-quality intensive ABA training to selected parents of children with ASD parents with high motivation, learning, support parents attend in pairs with their children for 3 months, 180 hours training 1-on-1 and 1-on-2 Senior staff trainers trains 6 parents per year Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 25 Summit Centre: 1. What We Are Now Board Retreat, Nov. 9, Unity 12 parents interviewed training was busy & stressful quickly believed children were more capable after 1 month, parents felt more competent, confident, in control & empowered knowledge of ABA & ASD increased throughout social support from family, friends, & staff was generally helpful & relieved stress follow-up, all believed changes in children & themselves were worth the effort ABA training fundamentally changed the way that they interacted with their children. Early Signs Project Partnership with Talk 2 Me, St. Mary s Family Learning Centre, U of Windsor, Unity for Autism Foundation Since Jan. 2009, provides for month olds; promotion of Early Signs info to M.D.s, others training in screening for SLPs early identification by SLPs parent/child group early intervention diagnostic assessment clinic for ASD referrals & research Summit Centre: 1. What We Are Now Board Retreat, Nov. 9, Summit Centre: 1. What We Are Now Board Retreat, Nov. 9,

8 Family friendly Parents with children just diagnosed or suspected with ASD are frightened of the implications, desperate for early intervention. Summit Centre; welcoming!!! supportive sees Parents as partners includes extended family & other supports Summit Centre: 1. What We Are Now Board Retreat, Nov. 9, family tours monthly Family Support parent and sibling support groups monthly free childcare for children w ASD annual Family Barbecue & Holiday Potluck many parent & extended family members volunteer mutual support parent buddy system for Unity training educate parents on benefits of Social Support Summit Centre: 1. What We Are Now Board Retreat, Nov. 9, Training Students ~ 40 practicum students per year high schools, St. Clair, Lambton, Seneca, Algonquin, Mohawk & St. Lawrence colleges, University of Windsor Psychology, Nursing, Music Therapy, Autism Behaviour Science, Educational Assistant Want to Learn More? Methods of Behavioural Change Theories and methods of behavioural change Self-Change Project OR Mini-practicum Project to observe behavioural interventions in the community Summit Centre: 1. What We Are Now Board Retreat, Nov. 9, Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 32 8

9 Practicum in Developmental Psychology Winter 2005 class Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p 33 Practicum in Developmental Psychology Supervised practicum in learning-based behaviour change strategies. Students practice behavioural assessment and systematic remediation of clinical problems through application of operant techniques in community placements. Practicum placement for 8 hours per week Class for 80 min. per week Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 34 Put in incredible time and energy! Practicum in Developmental Psychology Winter 2009 class donated over 1100 volunteer hours Marcia Gragg, PhD, CPsych, Sept 15/09 p. 35 St. Clair College Autism and Behavioural Science post-graduate certificate program 1 year program, post B.A. programs/postsec/autism/ Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 36 9

10 Community Resources for ASD click on Local Autism Services Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p. 37 Even the smallest footsteps can cross great distances. Marcia Gragg, PhD, CPsych, Nov. 9, 2009 p