The promise of targeted interventions for children with dup15q. Connie Kasari, PhD UCLA

Transcription

1 The promise of targeted interventions for children with dup15q Connie Kasari, PhD UCLA

2 Child Skills Introduction Start End JASPER Evidence

3 Introduction Start 1 End

4 Introduction / Defining Features of ASD ASD interventions Informative for dup15q?

5 Targets for Interventions Core Impairments---ASD Social communication Social communication Engagement Language

6 Joint Attention! Symbolic Play Engagement! Regulation JASPER Early Start Denver! Model ESDM Pivotal Response Training! PRT Floortime DIR Developmental Individual! difference Relationship-based RDI Relationship! Development Intervention Early Achievements Proj! ImPACT PEERS Secret Agent Society Discrete Trial! Training DTT Verbal Behavior Intervention VB SCERT! Social Communication Emotion Regulation Transaction Supports Unstuck and On Target Focused Playtime Intervention Adapted Responsive Intervention Joint Attention Symbolic Play Engagement Regulation JASP! Early Start Denver Model ESDM Pivotal Response! Training PRT Floortime Developmental Individual! difference Relationship-based DIR Relationship! Development Intervention RDI Early Achi! Project ImPACT PEERS Secret Agent! Society Discrete Trial Trainin! DTT Verbal Behavior

7 Introduction / JASPER Joint Attention, Symbolic Play, Engagement, & Regulation JASPER

8 Introduction / JASPER NDBI Naturalistic Developmental Behavioral Intervention (Workgroup, 2014) Targeted Modular Short-term

9 Introduction / JASPER Focus communicative gestures play skills spoken & augmented language engagement

10 Introduction / JASPER Focus Children s spontaneous initiations of skills

11 Introduction / JASPER Components min. sessions. 2-5 times per week. Typically 1:1. Occurs in small spaces. Depends on child s age & needs 8-12 weeks Play-based Home Center Classroom

12 Introduction / JASPER Examples Combination play; minimally verbal; toddler Presymbolic/symbolic play; more language; school-age

13 Evidence Parent Mediated Interventions JASPER Group Education Entry Exit Follow up (Kasari, Lawton, Shih, Barker et al, Pediatrics, 2014

14 Evidence Minimally verbal 5 to 8 year olds Socially communicative utterances JAE+EMT+AAC JAE+EMT Total Socially Communicative Utterances Week Kasari, Kaiser, Goods, Neitfeld, Mathy, Landa, Murphy, Almirall, JAACAP, 2014

15 Evidence

16 Introduction / Core Deficits Question is whether children with dup15q (with or without ASD) will respond to an ASD specific intervention?

17 Introduction / Core Deficits dup15q Early Core Difficulties Engagement Attention Motor/ Seizures Communicative gestures & language

18 Click to edit Master title Introduction / Core Deficits style 37 months 38 months

19 Introduction / Language Development Access to communication Play as context for learning Difference from ASD in social motivation, and object manipulation

20 Pilot Children N= months

21 Intervention u 8 weeks u 16 sessions u Pre and post assessments

22 JASPER Goals 1) Increase children s initiations & maintenance of a joint engaged state 2) Improve play skills 3) Improve communication and language skills

23 Engagement

24 JASPER Child Skills / Engagement States Coordinated joint Supported joint Person / Object engaged Onlooking Unengaged Adamson et al., 2009

25 JASPER Child Skills / Engagement States Unengaged Onlooking Person engaged Object engaged Supported joint Coordinated joint

26 Play

27 JASPER Child Skills / Play Goal: Increase frequency, diversity, & complexity of spontaneous play

28 JASPER Child Skills / Play Levels Play level Functional Symbolic Simple Combination Pre-symbolic

29 JASPER Child Skills / Play Categories Simple Combination Pre-symbolic Symbolic Presentation General Physical Conventional Lifter & Bloom, 1989

30 JASPER Child Skills / Play Categories Simple Combination Pre-symbolic Symbolic Pretend self Child as agent Single scheme sequence Lifter & Bloom, 1989

31 Communicative Gestures & Language

32 JASPER Child Skills / Communicative Gestures requesting ri-kwest-ing v. communicate a want or need; direct the behavior of others. reaching, pointing, giving.

33 JASPER Child Skills Requesting Reach Point Give

34 JASPER Child Skills / Communicative Gestures joint attention joint uh-ten-shuhn n. share and/or maintain social interaction. pointing, giving, showing, coordinated joint look.

35 JASPER Child Skills Joint Attention Point Give Show Coordinated Joint Look

36 JASPER Evidence / dup15q 30 Social Communication Frequency Independent Assessment Frequency of gestures Time 1 Time 2

37 JASPER Evidence / dup15q 90 Talk---all utterances within session 80 Frequency utterances Time 1 Time 2

38 Increasing language Language modeling critical Talk less, give space Simple language (nouns, verbs) Contingency with ipad

39

40 Where do we go from here? u Clear that 16 sessions is not enoughj u Social communication modules (like JASPER) are important as part of a larger program u Children need more motor support, more use of technology

41 THANK YOU TO ALL THE FAMILIES AND TO THE DUP15Q ALLIANCE