What comes to mind when you hear the word. Autism: The Antidote to the 25 Hours of Professional-Delivered Service.

Transcription

1 5/3/17 Autism: The Antidote to the 25 Hours of Professional-Delivered Service Robin McWilliam, Ph.D., & Kimberly Resua, M.T. National Early Childhood Inclusion Institute Chapel Hill, NC May 2017 Objectives Participants will gain knowledge of how to serve young children with autism spectrum disorder (ASD) through the use of evidence-based practices Participants will develop an understanding of caregivermediated intervention for young children with ASD. What comes to mind when you hear the word 1

2 Common Perceptions of Autism Unemotional Unaffectionate Resistant to change Savant Hand-flapping Rocking Nonverbal In their own world BUT, as the famous quotation says Autism Spectrum Disorder (ASD) 1 in 68 children in the United States has ASD DSM-5 Impairment in social communication and social interaction Presence of restricted, repetitive behaviors (American Psychiatric Association, 2013; Centers for Disease Control, 2016) 2

3 Recommendations for ASD Services The National Research Council (2001) recommends that children with ASD engage in developmentally appropriate, planned services for at least 25 hours per week. Recommendations for ASD Services The National Research Council (2001) recommends that children with ASD engage in developmentally appropriate, planned services for at least 25 hours per week. What Is Developmentally Appropriate for Young Children? or 3

4 Services for Young Children Children birth to age 3 receive early intervention services (Part C, IDEA). Best practice in early intervention includes Children s natural environment Learning opportunities through everyday experiences Family-centered practice (DEC, 2014; Workgroup on Principles and Practices in Natural Environments, 2008) Services for Young Children How do 25 hours per week of services fit into the lives of children and families? A Simple Concept: Learning Opportunities 4

5 Routines-Based Intervention Routines are where life happens Life doesn t happen in therapy or early intervention sessions (even home visits) Routines-based intervention makes assessment and intervention contextual, instead of decontextualized (McWilliam, 2010) Routines-Based Interview In-depth interview of the family s daily events and activities Results in family s choosing their goals (McWilliam, 2010) Support-Based Visits As the interventionist Do not work with the child Do not teach the caregivers Instead Work with the adults Consult collaboratively with the caregivers (McWilliam, 2010) 5

6 5/3/17 Caregiver-Implemented Intervention Broadened perspective of family-centered practices in early intervention with an emphasis on caregiver-implemented intervention (Friedman, Woods, & Salisbury, 2012) What Do You Notice? Clinician-Implemented Intervention Caregiver-Implemented Intervention Caregiver-Implemented Intervention In caregiver-implemented intervention, professionals support caregivers to facilitate their children s learning within everyday activities. Caregivers are in the driver s seat, making it possible for caregivers to implement the recommended 25 hours per week. 6

7 Caregiver Coaching Caregiver coaching: the process by which professionals support caregivers to facilitate their children s learning, through actively involved practices that build caregiver competence and generalization of skills. Caregiver Coaching Caregiver coaching: the process by which professionals support caregivers to facilitate their children s learning, through actively involved practices that build caregiver competence and generalization of skills. What Does the Research Tell Us? 7

8 A Review of the Literature We reviewed 10 studies of caregiver-mediated intervention models for infants and toddlers with and at risk for ASD We defined and examined 5 coaching components to see how each study addressed these elements. Coaching Components 1) Caregiver implementation 2) Building on caregivers competence 3) Guided practice 4) Collaborative/joint problem solving 5) Reflection Study Details Total of 10 studies Each of a different intervention model 9 RCTs, 1 single-subject design RCT most common method ( gold standard ) 4 RCTs < 50 participants 5 RCTs > 50 participants High quality of research 8

9 Coaching Components Baranek et al., 2015 X No Information No Information No Information X Carter et al., 2011 X No Information No Information No Information No Information Dawson et al., 2010 Caregiver & Therapist No Information No Information No Information No Information Green et al., 2015 X No Information No Information No Information No Information Kasari et al., 2010 X No Information X No Information No Information Kasari et al., 2014 X No Information X No Information No Information Rogers et al., 2012 X No Information X No Information X Rogers et al., 2014 X No Information X No Information X Schertz et al., 2013 X X No Information No Information X Wetherby et al., 2014 X X X X X Key: 1) Caregiver Implementation, 2) Building on Caregivers Competence, 3) Guided Practice, 4) Collaborative/Joint Problem Solving, 5) Reflection Next Steps: Where Do We Go? Impact of Working This Way Adults are empowered Know what to do throughout the day Child receives intervention in every routine Child receives intervention in context where skills are needed Generalization (Stokes & Baer, 1972) 9

10 Why We Work This Way All the intervention occurs between visits 25+ hours Building families capacity Promoting children s functioning, engagement, and participation References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Baranek, G. T., Watson, L. R., Turner-Brown, L., Field, S. H., Crais, E. R., Wakeford, L.,... Reznick, J. S. (2015). Preliminary efficacy of adapted responsive teaching for infants at risk of autism spectrum disorder in a community sample. Autism Research and Treatment, Carter, A. S., Messinger, D. S., Stone, W. L., Celimli, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen s More Than Words in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52, Centers for Disease Control and Prevention. (2016). Autism spectrum disorder: Data & statistics. Retrieved from Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J.,... Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125, e17-e23. Division for Early Childhood. (2014). DEC recommended practices in early intervention/early childhood special education. Retrieved from Friedman, M., Woods, J., & Salisbury, C. (2012). Caregiver coaching strategies for early intervention providers: Moving toward operational definitions. Infants & Young Children, 25, Green, J., Charman, T., Pickles, A., Wan, M. W., Elsabbagh, M., Slonims, V.,... Gliga, T. (2015). Parent-mediated intervention versus no intervention for infants at high risk of autism: A parallel, single-blind, randomised trial. The Lancet Psychiatry, 2, Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40, Kasari, C., Siller, M., Huynh, L. N., Shih, W., Swanson, M., Hellemann, G. S., & Sugar, C. A. (2014). Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behavior & Development, 37, McWilliam, R. A. (2010). Routines-based early intervention: Supporting young children with special needs and their families. Baltimore, MD: Paul H. Brookes. National Research Council. (2001). Educating Children with Autism. Washington, DC: National Academy Press. Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A.,... Dawson, G. (2012). Effects of a brief Early Start Denver Model (ESDM) based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 51, Rogers, S. J., Vismara, L. A., Wagner, A. L., McCormick, C., Young, G., & Ozonoff, S. (2014). Autism treatment in the first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Developmental Disorders, 44, Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of Joint Attention Mediated Learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28, doi: /j.ecresq Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-implemented social intervention for toddlers with autism: An RCT. Pediatrics, 134, Workgroup on Principles and Practices in Natural Environments. (2008). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from 10