GCAP Final Project Letter of Intent. Intervening with Autism: Linking Theory to Practice: Margaret R Davidson

Transcription

1 Letter of Intent 1 Running Head: LETTER OF INTENT GCAP Final Project Letter of Intent Intervening with Autism: Linking Theory to Practice: A Training Manual for Behavioural Therapy Programs with Autism Spectrum Children Margaret R Davidson Athabasca University Graduate Centre for Applied Psychology

2 Letter of Intent 2 Problem Statement In partial fulfillment of my Masters degree in Counselling Psychology, I intend to create a training manual for behavioural therapists working with children on the autism spectrum. The prevalence of autism is increasing (Baird et al., 2006; Newschaffer, Falb, & Gurney, 2005), and with this increase there is a growing demand for treatment services. As new therapists enter the field, there is a need for cost effective and accessible training in working with autism spectrum children (National Research Council (NRC), 2001; Scheuermann, Webber, Boutot, & Goodwin, 2003). It is my intention to create a manual which will introduce new therapists to working with children with autism. This manual will contain a brief overview of some of the more common intervention models and will explain how these models fit with the theory. It will review autism spectrum disorders; the common behaviour patterns seen, some of the theories about intervention, and practical tips about how to implement the interventions. This manual is intended as a brief introduction, and will include references to other works if the reader wishes to learn more about a particular topic. Project Rationale There are many theories underlying autism treatment. In order for these theories to work to the advantage of the client, the front line therapist must have an understanding of the theories. If the therapist is unaware of the theories he or she can not be reasonably expected to implement programs that coincide with the theories. No matter what the therapy model, the knowledge and skills of the individual delivering the therapy are critical.

3 Letter of Intent 3 A great many books have been written about autism; so many that a person new to the field may not know where to start. There is a need for a manual that brings together information on autism treatments and the theories behind these treatments in manner that is easy to understand and that helps therapists to use treatments effectively. This manual is intended to be an introductory training guide for individuals beginning their careers working with autism spectrum individuals. This manual will be used by two agencies providing specialized services to children with autism. Currently new staff members receive training that includes an experienced staff member modeling interventions and giving performance feedback, but new staff members do not receive formal training on theory. This manual will be distributed to new staff. It is intended as a stand alone training resource that staff can work through on their own. This makes the manual cost effective as it can be implemented at low cost to the agency. Review of the Literature Diagnosis with autism spectrum disorder is based on three areas of deficit; qualitative impairments in social interaction, qualitative impairments in communication, and restricted, repetitive, and stereotyped patterns of behavior, interest, and activities (American Psychiatric Association, 2000). The combination of these deficits results in a number of practical problems, including that fact that children with autism have difficulty with attending, do not spontaneously imitate, and are not socially motivated (Siegel, 2003). Treatment needs to address these difficulties. New York State Department of Health Early Intervention Program (1999b) reviewed 232 group studies and 68 single-subject design studies of interventions for

4 Letter of Intent 4 children with autism, and concluded that intensive behavioural intervention programs were the only interventions supported by the literature. New York State Department of Health Early Intervention Program (1999a) recommended that treatment providers consider the best available scientific research when implementing treatment programs. Much of the evidence for behavioural treatments originated with Lovaas s (1987) study of intensive behavioural interventions for autism. Lovaas studied three groups of children. The experimental group received 40 hours per week of intensive behavioural intervention from trained therapists, one control group received 10 hours per week of less intensive intervention from trained therapists, and a second control group received 10 hours per week of treatment from another agency (Lovaas). Lovass reported that 47% of the experimental group achieved normal academic functioning in a regular grade one class, as compared to 2% of the control group. As well, the children in the experimental group gained on average 30 IQ points over those in the first control group (Lovaas). A study by Sallows and Graupner (2005) replicated these results, finding that 48% of 23 children studied achieved average IQ scores and were succeeding in regular first or second grade classes, demonstrated generally average academic abilities, spoke fluently, and had peers with whom they played regularly (p. 433). Another replication study by Cohen, Amerine-Dickens, and Smith (2006) found that 10 of 21 children (47.6%) in an early intensive behavioural therapy program achieved average range scores on test measures, and were in regular classrooms either independently or with a part time aid. These studies used highly trained therapy staff. Staff at the Lovaas program received training in learning theory and applied behavioural analysis, followed by a nine month internship (Lovaas, 2003). In many intensive behavioural intervention programs,

5 Letter of Intent 5 staff are trained in workshops followed by periodic supervision (Shea, 2004). Training workshops typically are one to three days, with supervision every one to three months (Lovaas; Siegel, 2003). Lovaas expressed concern that therapists who had received only workshop training would not achieve as positive of outcomes as would better trained staff. Smith, Parker, Taubman, and Lovass (1992) conducted a study of workshop training for staff working in a group home with autistic clients. The study consisted of an experimental group who participated in a week long training workshop, featuring lectures on the principles of behavioural therapy and hands on practice (Smith et al.). The comparison group worked at the same group homes but did not participate in training (Smith et al.). Smith et al. found that the skills of the experimental group improved significantly over those of the comparison group; however, the percent correct use of behavioural procedures by the experimental group was still only % following training. In addition, the experimental group did not show significantly better theoretical knowledge as compared to the group who received no training (Smith et al.). These results substantiate Lovaas s (2003) concerns regarding the sufficiency of workshopbased training. Behavioural interventions can be either directive or naturalistic (New York State Department of Health Early Intervention Program, 1999a). Directive programs are those in which the therapist controls the interaction, for example discrete trial training, and naturalistic programs are those in which the intervention setting is similar to the child s usual environment (New York State Department of Health Early Intervention Program). Delprato (2001) conducted a critical review of 10 controlled studies comparing

6 Letter of Intent 6 normalized interventions with discrete trial interventions. Delprato concluded that normalized interventions were more effective than discrete trial interventions, although he noted that normalized and discrete trial interventions may be complementary, not antagonistic. Discrete trial interventions may be more effective in acquisition whereas normalized interventions may be more effective in application and generalization of skills (Delprato). Normalized teaching is even harder to implement than is discrete trial training. When properly conducted, normalized teaching does not give the appearance to the casual observer of anything special occurring. Yet, more expert analysis reveals systematic applications of behavioral principles, such as those pertaining to stimulus control, consequation, and motivation (Delprato, p. 315). If staff are to apply behavioural principles, they first need an understanding of those principles. Maurice, Green, and Luce (1996) suggested that therapists who are unaware of the research regarding why behaviour patterns such as stimming or disruptive behaviour occur may inadvertently make the problem worse. It is important that therapy staff have a solid understanding of the theories underlying behavioural therapy. Smith et al. (1992) suggested that a lack of theoretical knowledge prevented staff from generalizing skills from a workshop to the workplace. Siegel (2003) noted that a lack of theoretical knowledge can lead therapy programs to drift, and result in poor quality programs. What training most often lacks is opportunities for the tutors to read about autism, behavioural analysis, or development As a result, most one-to-one tutors in ABA/DTT programs are more like technicians than teachers in certain respects

7 Letter of Intent 7 knowing what to do, but not always knowing why an activity is done in a particular manner (Siegel, p. 328). NRC (2001) stated that staff training remains one of the weakest elements of effective programming for children with autistic spectrum disorders and their families (p. 225). The need for training is especially important as most home programs rely on relatively inexperienced staff (NRC). Scheuermann et al. (2003) found that staff shortages have resulted in untrained staff being hired. Scheuermann et al. (2003) stated that working effectively with individuals with autism required knowledge of specialized techniques. They further found that many teachers and paraprofessionals did not have these skills. In many areas, autism specific training is not available (Scheuermann et al.; Simpson, 2004). Leblanc, Ricciardi, and Luiselli (2005) stated that training needs to be practical and time efficient or it is unlikely that human services agencies will implement it. NRC (2001) suggested that staff training could be improved by the development of print training manuals, as well as video and audio training materials. Moore et al. (2002) found that training involving written instructions followed by modeling improved the accuracy of staff in implementing behaviour analysis methods. Methods and Procedures This project will begin with a comprehensive literature review on the topic of autism treatment. The first step will be to search the online databases available through Athabasca University. The databases targeted will include PsycINFO, Psychology and Behavioral Sciences Collection, and other databases. Search terms will include autism treatment, applied behavioural analysis, intensive behavioural intervention, floor time,

8 Letter of Intent 8 verbal behaviour, and other terms that arise during the search. The reference lists of prominent articles will be reviewed and a search conducted for the key articles cited. Other search terms will include the names of researchers prominent in the autism field including Lovaas, Smith, Koegel, Harris, and others. The library catalogue will also be searched using similar search terms. There are numerous prominent books on the subject of autism treatment; these books will be obtained. An internet search will be conducted, focusing on web pages maintained by recognized organizations in the autism community. Web pages will be carefully reviewed to ensure that they are credible sources. During the literature review relevant information about the major behaviourally orientated therapies being used in the treatment of autism spectrum disorder will be gathered. Once the information has been gathered a training manual will be written. The main objective of this manual will be to relate theory to practice in the area of autism treatments. The manual will clearly explain the basic theories and the basic therapy models, and how they are connected. The manual is intended as a stand alone resource that staff can work though on their own and in their own time. As well, staff will be able to refer back to the manual on an ongoing basis. In order to make the manual a relevant learning experience it will be small enough not to be intimidating but contain enough information to be useful. The manual will be divided into chapters with each chapter having a clear learning goal at the beginning and a review test at the end. Theories will be illustrated with examples and case studies in order to help the reader relate the theory to practical use. Straight forward language will be used in order to make the manual readable. The manual will address the theoretical basis of treatment and the specific

9 Letter of Intent 9 therapy techniques that arise from the theory. The manual will also address how intervention techniques can be integrated together. Implications of the Project There is a need for an accessible and user friendly training material for individuals entering the autism therapy field. Reliable training for front line therapists will improve the consistency of the interventions delivered to the clients. Currently many therapists enter the field with little or no training or experience. This manual will be used by two agencies that currently have no formal training in the theories underlying behavioural therapy. The manual will be distributed to new staff at these agencies. It will provide the staff with an overview of autism, how it is diagnosed, the theories behind some of the common intervention programs, and practical tips on working with clients. This manual will supplement the staff training that these agencies are currently doing and help to ensure that therapists have the skills needed to adequately help their clients. This project will consist of the development of a user friendly, yet comprehensive, interactive training manual. I believe that this project is manageable within a one year time frame. The project does not involve human subject research and therefore the risks are negligible.

10 Letter of Intent 10 References American Psychiatric Association. (2000). Diagnostic and statistical manual of metal disorders (DSM-IV-TR) (4 th ed. Text revision). Arlington, VA: American Psychiatric Association. Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The special needs and autism project (SNAP) [Electronic version]. The Lancet, 368(9531), Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting [Electronic version]. Developmental and Behavioral Pediatrics, 27(2), S145-S155. Delprato, D. J. (2001). Comparisons of discrete-trial and normalized behavioral language intervention for young children with autism [Electronic version]. Journal of Autism and Developmental Disorders, 31(3), Harris, S. L., & Delmolino, L. (2002). Applied behavior analysis: Its application in the treatment of autism and related disorders in young children [Electronic version]. Infants and Young Children, 14(3), Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children [Electronic version]. Journal of Consulting and Clinical Psychology, 55(1), 3-9. Lovaas, O. I., (2003). Teaching individuals with developmental delays: Basic intervention techniques. Austin, TX: PRO-ED, Inc.

11 Letter of Intent 11 Leblanc, M., Ricciardi, J., & Luiselli, J. (2005). Improving discrete trial instruction by paraprofessional staff through an abbreviated performance feedback intervention. Education & Treatment of Children, 28(1), Retrieved February 17, 2009, from Professional Development Collection database. Maurice, C., Green, G., & Luce, S. C. (1996). Behavioral intervention for young children with Autism: A manual for parents and professionals. Austin, TX: Pro-Ed. Inc. Moore, J. W., Edwards, R. P., Sterling-Turner, H. E., Riley, J., DuBard, M., & McGeorge, A. (2002). Teacher acquisition of functional analysis methodology. Journal of Applied Behavior Analysis, 35(1), Retrieved March 31, 2009, from PubMed Central database. National Research Council. (2001). Educating children with autism [Electronic version]. Washington, DC: National Academy Press. New York State Department of Health Early Intervention Program. (1999a). Intervention methods for young children with autism. In Clinical practice guideline report of the recommendations: Autism/pervasive developmental disorders (chap. 4). Retrieved Dec 1, 2006, from sm/ch4_pt1.htm New York State Department of Health Early Intervention Program. (1999b). Summary of evidence. In Clinical practice guidelines report of the recommendations: Autism/pervasive developmental disorders (Appendix C). Retrieved Oct 13, 2006, from

12 Letter of Intent 12 sm/app_c.htm#appendix_c Newschaffer, C. J., Falb, M. D., & Gurney, J. G. (2005). National autism prevalence trends from United States special education data [Electronic version]. Pediatrics, 115(3), Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors [Electronic version]. American Journal on Mental Retardation, 110(6), Scheuermann, B., Webber, J., Boutot, E. A., & Goodwin, M. (2003). Problems with personnel preparation in autism spectrum disorders. Focus on Autism & Other Developmental Disabilities, 18(3), Retrieved March 29, 2009 from Academic Search Complete database. Shea, V. (2004). A perspective on the research literature related to early intensive behavioral intervention (Lovaas) for young children with autism [Electronic version]. Autism, 8(4), Simpson, R. L. (2004). Finding effective intervention and personnel preparation practices for students with autism spectrum disorders. Exceptional Children, 70(2), Retrieved March 29, 2009 from Academic Search Complete database. Smith, T., Parker, T., Taubman, M., & Lovaas, O. I. (1992). Transfer of staff training from workshops to group homes: A failure to generalize across settings [Electronic version]. Research in Developmental Disabilities, 13, Siegel, B. (2003). Helping children with autism learn: Treatment approaches for parents and professionals. New York: Oxford University Press.