Discernment. Symptoms are a bit different before 2 years. Autism Spectrum Disorder. Pamela R. Rollins, Ed.D. UTD/Callier Center TARRC Conference, 2018

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1 Autism Spectrum Disorder PAMELA ROLLINS, MS ED.D, CCC SLP ASSOCIATE PROFESSOR CALLIER CENTER FOR COMMUNICATION DISORDERS A neurodevelopmental disorder that emerges before 3 years of age Spectrum Refers to the diversity of symptoms, skills and intellectual disability Two Core Features Restricted, repetitive patterns of behavior, interests, or activities Persistent deficits in social communication and interaction 2 Restricted Repertoire of Activities & Interests may not be present before 2 years. Disruption in social interaction & communication is present by 18 mos. Symptoms are a bit different before 2 years Jeremy Veenstra-VanderWeele & Randy D Blakely 2011 Discernment Social Communication Nonsocial Language COGNITIVE DEVELOPMENT IN THE FIRST TWO YEARS OF LIFE Tomasello et al., mos. + PURSUING GOALS 6 10 mos mos. 1

2 Pursuing Goals is not social Typical Children 2 mos. + PURSUING GOALS 6 10 mos mos. Children with ASD Pursing goals in the absence to social cognition Sharing Emotion (2 months on) ASD PURSUING GOALS 6 10 mos. XX Social smile Face to face (dyadic) interaction Mutual gazing Social responsiveness Responds to vocalization & facial expressions (Protoconversations) Reciprocal exchanges of emotions Pursuing Goals 6 10 months Child is goal directed Selective attention to goal Persist until goal is met Happy when goal is met Understand other s goals Monitors adults actions Predict what comes next so can take turns in a routine Sharing Attention & Intention months Shared Goal Mutual knowledge that they are doing something together Often demonstrated by a 3 point gaze shift 2

3 Intentional communication Pursuing Goals Behavioral Regulations (9 10 mos) Requesting, Protesting LABELING Processes for Word/Language Learning PURSUING GOALS Perceptual Information Social Cues Sharing attention and intention Directing Attention (10 24 mos) Showing, Pointing Commenting ISOLATED WORDS & PHRASES LANGUAGE Ninio & Snow, 1996; Rollins et al., 1998; Rollins, 2016, 2017 Hollich, Hirsh Pasek et al., 2000; Rollins, 2003 Ramification for Intervention Before the emergence of Sharing Intention Linguistically based intervention practices bombard the child with language, focus on requesting & labeling work on increasing utterance length Do not provide the social environment necessary for social communication to develop. Social Approach to Intervention ATTENTION & Rollins, 2016 Enactive Mind Theory Children with ASD show a decline in eye contact between 2 6 mos It emphasizes the way that the human mind organize is by interacting with the environment A person s perceptions and experiences are a crucial part of social learning 17 Jones and Klin

4 Naturalistic Developmental Behavioral Model Early Autism Intervention V1.1 DEVELOPED BY RENEE HOFFMAN & MICHELLE CAMPBELL Manualized intervention protocol to coach parents Meets the service delivery model of TX IDEA Part C programs Innovative protocol for working on social eye gaze/mutual gazing Thirty nine percent of the population in Texas is Hispanic Provide culturally sensitive intervention Two bilingual clinicians assess and provide therapy in Spanish. Spanish Language Fliers, parent interviews, consent forms Written and audio versions of program manual Pathways RCT 110 toddler with ASD Age range months (M=28.4, SD = 5) Overall Demographics Ethnicity Overall Demographics Chip Eligibility 22% 45% 54% 46% 24% 9% 4

5 Referral Source Mullen Scale of Early Learning (M=56, SD = 10.5) 27% 9% 64% Pathways RCT (1) Is Pathways an effective ECI model? (2) Is protocol for implicit eye gaze an important ingredient to intervention success? Pathways Intervention Weekly visits (90 min) to the child s home Units (1) Learning environment (2) Face to face, interactions & social sensory routines, (3) Social eye gaze/communication (4) Animation, (5) Imitations, Videos were time linked & Coded Digital recordings of dyadic interactions Two streams of video ipad, Wide angle Social Eye Contact Verbal vocal reciprocity Communicative intention Spy glasses, child s face 5

6 Participant Characteristics at Start of Intervention Group 1 (n = 14) Group 2 (n = 10) Group 3 (n = 10) M (SD) M (SD) M (SD) Age 30.0 (5.0) 29.9 (4.9) 29.0 (3.8) ADOS (4.1) 16.8 (3.6) 17.2 (3.2) 7 children (M = 1.87 hours/week). 3 children (M = 20.8hours/week). NVIQ 61.9 (11.7) 66.9 (14.3) 56.0 (11.4) Group by time interaction on Social skills Social eye contact Vineland Social Scores Vocal verbal reciprocity Estimated Marginal Means Estimated Marginal Means Group 1 Group 2 Group 3 F (2, 31) = 7.34, p <.002, partial η2 =.321 F (2, 31) = 3.48, p <.043, partial η2 =.183 Group 1 Group 2 Group 3 Estimated Marginal Means Children with words at 1 Communication Diversity Communication Rate Key findings (1) Pathways is an effective ECI model. (2) Pathways innovative protocol for social eye gaze is the key factor in social progress. Group 1 Group 2 Group 3 (3) Pathways innovative protocol for social eye gaze may be pivotal for the development of social skills and, when acquired, has a cascading effect on communication skills 6

7 Parental Stress & Parenting Behaviors Parental Stress (n = 61) F (2, 58) = 3.24 p =.046, partial η 2 =.10 Jones, A., Rollins, PR. (2018). Parental Stress & Parent Responsivity (n=26) Parent Responsivity & Vocal Verbal Reciprocity (n=26) R 2 =.26 R 2 =.42 F (2, 23) = 8.325, p =.002, r =.65, R 2 =.42 John, Jones, & Rollins, 2018 F (1, 24) = 8.222, p =.008, r =.505, R 2 =.255 Jhaveri, & Rollins, 2018 Acknowledgements Social Approach to Intervention ATTENTION & Funding sources: The Texas State Legislation (administered by the Texas Higher Education Coordinating Board) Students for their assistance with coding videos in the social communication lab. Renee Hoffman and Michelle Campbell of Pathways The children and families who participated in the study The interventionists for their important contribution to this project: Cristina Rangel, M.S, CCC SLP Galite Hyams, M.A., CCC SLP Megan Nauta, M.S., CCC SLP Sara Brantley, B.S. 7