Evidenced Based Interventions Interventions for children with FASDs and their families:

Transcription

1 Evidenced Based Interventions Interventions for children with FASDs and their families: An overview of five innovative research projects Barbara Bentley, PsyD, MS Ed A common theme reported by families has been that clinicians and professionals have been reluctant to diagnose their children because there were no known effective treatments. Now interventions specifically targeted towards difficulties associated with FASDs have been found to be effective. CDC supported research In 2001, in response to the Healthy Children Act of 2000, the Centers for Disease Control and Prevention (CDC) provided federal funding to develop systematic, specific, and scientifically evaluated interventions appropriate for children with FASDs and their families. Awards were made to five grantees to develop interventions. All five interventions specifically addressed the neurodevelopmental needs of children with FASDs. Intervention Sites/Projects Project Bruin Buddies- UCLA Georgia-sociocognitive Habilitation using the MILE Program- Marcus Institute (KK at Emory) Neurocognitive habilitation for children with FASD- Children s Research Triangle PCIT: an EBT to reduce behavior problems among children with FASD- U of OK HSC Families Moving Forward: a behavioral consultation intervention- U of W 1

2 To help protect your privacy, PowerPoint has blocked automatic download of this picture. 3/10/2012 Characteristic UCLA Marcus Institute White, Non Hispanic (%) African American (%) Child Sex Male (%) Child Age (M, SD) Child IQ (K- Bit) Living w Bio- Mother (%) Children s R Triangle U of Oklahoma U of W (1.56) (14.83) 6.38 (2.00) (13.4) 8.73 (1.55) (16.11) 4.70 (1.4) (11.20) 8.06 (2.07) 94.3 (12.50) NA DX of FAS (%) Key Points about the Projects Children identified as needing services had FASD s-low percentage had FAS Interventions included very targeted skill sets All were relatively short term (14-16 weeks/sessions) minute sessions All were interventions that could be provided in community based systems Themes for Successful Treatment Important lessons emerged from these five interventions that may explain success: children with milder issues need help, parent education/training should be included, children need to learn specific skills and need support to generalize skills, targeted goals should be integrated into existing systems of treatment. 1. Project Bruin Buddies: a social skills training program to improve peer friendships Parent assisted children s friendship training Based on Frankel and Myatt s Children s Friendship Training (2003) Procedure included parents as facilitators of their children s social skills. Parent education about FASD and how to facilitate skills was included. 2

3 1. Methods year, 96 completed with measurable social skill deficits(1 SD below mean on VABS), IQ over 70 2-group longitudinal design CFG or Delayed Treatment Control, cohorts (7-8 per group) Intervention: 12, 90-minutes sessions/parents concurrent sessions-education on FASD and training to facilitate play and social skills Measures: Test of Social Skills Knowledge, Social Skills Rating System Parent Form, Test of Parent knowledge of FASD, Satisfaction 1. Outcomes No differences in groups at baseline CFT-statistically significant improvement in their knowledge of social behavior, parent s report increased social knowledge, skills, and decreased behavior problems Gains were maintained at 3-month f/u and social skills were actually improved >85% of parents reported the intervention was appropriate, 92.5 reported info was helpful 2. Georgia-sociocognitive habilitation using math interactive learning experience (MILE) All children received a psycho-ed evaluation, IEP planning and ed consultation, and assessment of readiness to learn Intervention Group also received: Workshops for parents: FASD information particularly on ed needs and special education, behavioral regulation management MILE Intervention: Plan, do, review method (Perry Preschool), active learning, 6 weeks tutoring 2. Methods year consented, 56 completed post testing, no ID or sig MH problems Compared outcomes of intervention group (Math) and psycho-ed assessment and consultation only Measures: Satisfaction, FASD knowledge, Behavior (CBCL), Test of Early Mathematical Ability-2, Bracken, Bayley items 3

4 2. Outcomes >90% satisfaction for both groups Prediction of math gains for both groups, but better gains in intervention group. Confirmed. 58.6% in math group gained > SD on any of the 4 outcomes measures used, only 23.1% of control did so. Positive outcomes after relatively short intervention 3. Neurocognitive Habilitation for children with FASD (Children s Research Triangle) Used the Alert Program (Williams & Schellenberger, 1996) Car engine metaphor to help develop state regulation and modulation Targeted executive functioning sets: memory, cause and effect reasoning, sequencing, planning, and problem solving 3. Measures and Procedures 78 total children ages 6-11, 2 cohorts developed Intervention group received a full evaluation and participated in a course of 12 weekly sessions (75 minutes) of group intervention using the Alert Program while their parents concurrently participated in a parent education group. Control children received evaluation and community treatment (OT, SLP), no parent training 3. Outcomes BRIEF and RATC were administered during the post intervention period Significant improvement in EF in treatment group on BRIEF, no subtest score diff. Premise of focus on self regulation to improve EF found to be valid Treatment group also showed better resolution skills on the RATC-suggesting improved sequencing and cause and effect learning 4

5 4. PCIT: application of an EBP to reduce behavioral problems in children with FASD PCIT, which included parent education and direct coaching includes direct work with the child and parent versus Parent Support and Management (PSM) program (Barkley, 1997), which was parent only training (Control group) PCIT had to be adapted to accommodate the learning and behavioral issues of children with To help protect your privacy, PowerPoint has blocked automatic download of this picture. FASD 4. Methods and Procedures 58 children ages 3-7, 46 entered treatment Groups received 14 weeks of the assigned intervention (PCIT or PSM) Only 46% of families completed the entire 14 week treatment program (there were no stat sig differences in drop-out vs completion group) Outcomes included: PSI, Eyberg Child Behavior Inventory (ECBI), CBCL 4. Outcomes Improvements found in both groups for PS and child behavior, but no differences in effect PSM reported 100% positive feelings, and 80% would rec to a friend, PCIT group: 100% felt problems had improved, only 70% of PSM reported improved problems Study supported that both models are viable interventions for caregivers of children with FASD PSM may be a more cost-effective intervention 5. Families Moving Forward: Behavioral Consultation Intervention (U of W) FMF model was designed to modify specific parenting attitudes and parenting responses toward their child s problem behaviors. Developed a parent friendly positive behavior support approach to dealing with challenging child behaviors. Based on social learning theory, congruent with evolving literature for children with DD. 5

6 52 children aged Methods FMF intervention provided supportive behavioral consultation lasting 9-11 months with at least 16 every-other week sessions with a MH provider Control group received standard of care community resources Outcomes: Parenting sense of competence (PSOC), PSI, ECBI, Multidimensional Assessment of Parental Satisfaction (MAPS) 5. Outcomes FMF reported more self care behaviors (72% vs 44%). No group diff in child-related PS. FMF reported family needs being met more often and significantly higher provider satisfaction. FMF had decrease of child behavior problems (66.88 at base to post). Projects UCLA: Bruin Buddies Marcus Institute: MILE Program Children's R Triangle: Alert Program U of O: PCIT U of W: Families Moving Forward Ages Included 6-12 year 3-10 year 6-11 year 3-7 year 5-11 year Summary Target for Intervention Social Skills Math Skills Executive Functioning Disruptive Behaviors Parenting Attitudes Positive Features Strong long term outcomes Only 6 week TX, includes EF approach Model can be done with PP and modified Parent coaching model Can address individual needs Negative Features Family involvement essential Math is main target, No ID or MH Not for younger children Expensive model for outcome Longer TX model Lessons Learned All 5 tested approaches were used specifically for children with FASD and their families Important Elements to Intervention: Parent education or training All studies showed improved parent knowledge of FASD and how the knowledge is applicable to parenting Explicit instruction on working with a child with FASD was essential 6

7 Awareness of wide range of difficulties The models acknowledged and accommodated for the cognitive, social, behavioral difficulties resulting from prenatal exposure Individualized and targeted interventions specific to the deficits of children with FASD can be implemented within a framework of current community services. Significant Benefit to Families Scientifically validated and efficacious interventions for children with FASD exist. The common theme previously reported by families regarding the reluctance to diagnose because there are no known effective treatments no longer appears valid. New directions for families and community providers. 7