Collabarative Program For AutismCollabarative Program For AutismIn University of Northern ColoradoIn University of Northern Colorado

Wiranpat Rattanasatien ,MDWiranpat Rattanasatien ,MD

Yuwaprasart Child & AdolescentYuwaprasart Child & Adolescent

Psychiatric Hospital, PMHPsychiatric Hospital, PMH

Iceberg of AutismIceberg of AutismCultural of autismCultural of autism

Social relatednessSocial relatedness

Joint attention&reciprocityJoint attention&reciprocity

CommunicationCommunicationExpressive deficit :intent,meanExpressive deficit :intent,mean

Receptive deficit :meaning,processingReceptive deficit :meaning,processing

Sensory processing integration Sensory processing integration and modulation of inputsand modulation of inputs

Difficulties with change limited Difficulties with change limited interest repetitive behavioral rigidityinterest repetitive behavioral rigidity

Cognitive style problems with organization&Cognitive style problems with organization&sequencing&planing attention&relevance sequencing&planing attention&relevance

abstraction&generalization abstraction&generalization

The Colorado Working with Children with The Colorado Working with Children with Autism Spectrum Disorder for Teachers, Autism Spectrum Disorder for Teachers,

Service Provider and ParentsService Provider and ParentsDeveloped by Colorado Task Force June 2000Developed by Colorado Task Force June 2000

• The child’s and the parent’s culture(s) be recognized The child’s and the parent’s culture(s) be recognized and respectedand respected

• Services and supports for the child be individualizedServices and supports for the child be individualized

• Services and supports be based on experience and Services and supports be based on experience and research that meet recognized scientific and research that meet recognized scientific and academic standards (i.e. academic peer review)academic standards (i.e. academic peer review)

• Each child be taught with a curriculum that is age-Each child be taught with a curriculum that is age-appropriate ,individually appropriate and culturally appropriate ,individually appropriate and culturally appropriateappropriate

Diagnostic and Statistical Manual of Mental Diagnostic and Statistical Manual of Mental

Disorder IV Citeria for Autistic DisorderDisorder IV Citeria for Autistic Disorder • A) A total of six (or more) items from (1),(2), and (3), A) A total of six (or more) items from (1),(2), and (3),

with at least two from (1) and one each from (2) and with at least two from (1) and one each from (2) and (3):(3):

• qualitative impairment in social interaction, as qualitative impairment in social interaction, as manifestated by at least two of the following :manifestated by at least two of the following :

» marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze ,facial expression ,body postures ,and gestures to regulate social interaction

» failure to develop peer relationships appropriate to developmental level

» a lack of spontaneous seeking to share enjoyment,interests ,or achivements with other people (e.g. by a lack of showing .bringing . or pointing out items of interest)

» lack of social or emotional reciprocity

– qualitative impairments in communication as qualitative impairments in communication as manifested by at least one of the following :manifested by at least one of the following :

» delay in . or total lack of ,the devepment of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

» in individuals with adequate speech . marked impairment in the ability to initiate or sustain a conversation with others

» stereotyped and repetative use of language or idiosyncratic language

-lack of varied . spontaneous make-believe play -lack of varied . spontaneous make-believe play or social imitative play appropriate to the or social imitative play appropriate to the developmental leveldevelopmental level

– restricted repetative and stereotyped restricted repetative and stereotyped patterns of behaviour ,interests and patterns of behaviour ,interests and activities , as manifested by at least one activities , as manifested by at least one of the following :of the following :

» encompassing preoccupation with one or more encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is stereotyped and restricted patterns of interest that is abnormal either in intensity or focusabnormal either in intensity or focus

» apparently inflexible adherence to specific ,nonfunctional apparently inflexible adherence to specific ,nonfunctional routine or ritualsroutine or rituals

» stereotyped and repetative motor manerisms (e.g.,hand stereotyped and repetative motor manerisms (e.g.,hand or finger flapping or twisting , or complex whole-body or finger flapping or twisting , or complex whole-body movements)movements)

» persistent preoccupation with parts of objects.persistent preoccupation with parts of objects.

• B)B) Delayed or abnormal functioning in at least Delayed or abnormal functioning in at least one of the following areas ,with onset prior to age one of the following areas ,with onset prior to age 3 years (1)social interaction ,(2)language as used 3 years (1)social interaction ,(2)language as used in social communication ,or(3)symbolic or in social communication ,or(3)symbolic or imaginative play.imaginative play.

AssessmentAssessment

The Autism Diagnostic Observation The Autism Diagnostic Observation Schedule-Generic (ADOS-G)Schedule-Generic (ADOS-G)

Autistic Diagnosis Interview. (ADI-R)Autistic Diagnosis Interview. (ADI-R)

Vineland Adaptive Behavior ScalesVineland Adaptive Behavior Scales

Mullen’s communication ScalesMullen’s communication Scales

Planning StrategiesPlanning Strategies • Use child profiles that look at strengths ,interests and Use child profiles that look at strengths ,interests and

needsneeds• Incorporate family input in the IEP/IFSP processIncorporate family input in the IEP/IFSP process• Determine the child’s motivational interests and Determine the child’s motivational interests and

needsneeds• Establish clear goalsEstablish clear goals• Design meaningful curriculumDesign meaningful curriculum• Practice authentic assessmentPractice authentic assessment• Employ formal and informal Employ formal and informal assessmentsassessments• Use choice of learning stylesUse choice of learning styles• Develop the IEP/IFSP goals and Develop the IEP/IFSP goals and objectivesobjectives• Write transitional plansWrite transitional plans• Employ strategies for evaluationEmploy strategies for evaluationof IEP goals and objectivesof IEP goals and objectives• Understand issues related toUnderstand issues related to identificationidentification

Data Collection for Analysis ,Data Collection for Analysis , and Program Changes and Program Changes

• Design student progress measurement Design student progress measurement systemssystems

• Conduct assessment and evaluationConduct assessment and evaluation• Use data-based decision-makingUse data-based decision-making

Environmental and Classroom ArrangementEnvironmental and Classroom Arrangement

• Employ visual strategiesEmploy visual strategies• Use techniques of structured teachingUse techniques of structured teaching• Use consistency in designing the learning Use consistency in designing the learning

environmentenvironment• Monitor and modify environmental stimuli Monitor and modify environmental stimuli

Collaborative Systems EducationCollaborative Systems Education

Proactive home-school communication Proactive home-school communication Collaborative working relationships with all Collaborative working relationships with all

providers : Active family participationproviders : Active family participation Establishing prioritized goals with familiesEstablishing prioritized goals with families Identifying family strengths ,capacities and Identifying family strengths ,capacities and

stylesstyles Utilizing strategies Flexibility and openness Utilizing strategies Flexibility and openness

to new ideasto new ideas Proactive medical supportProactive medical support

Generic Instructional StrategiesGeneric Instructional Strategies

• Sensory Integration Strategies Sensory Integration Strategies • One-on-one teachingOne-on-one teaching• Information and skills to address needsInformation and skills to address needs• Functional skills embeded within routines Functional skills embeded within routines

Curricular adaptation and modificationCurricular adaptation and modification• Normal developmentNormal development• Build on strengthsBuild on strengths• Positive behavioral approaches for difficult Positive behavioral approaches for difficult

behaviourbehaviour• Differential Instruction to meet individual needsDifferential Instruction to meet individual needs• Intentional teaching to increase flexibility and Intentional teaching to increase flexibility and

independence for learnersindependence for learners• Blend best practices with behavioral intervention Blend best practices with behavioral intervention

and standardand standard

Employ strategies for evaluation of IEP goals and objectivesEmploy strategies for evaluation of IEP goals and objectiveso Rating scalesRating scaleso Observations based on frequency ,duration or amplitude of behaviorsObservations based on frequency ,duration or amplitude of behaviorso Observations based on correct responding . error and adult promptsObservations based on correct responding . error and adult promptso Observations based on level of independent performanceObservations based on level of independent performanceo Interviews with key informants (families .teachers ,peers)Interviews with key informants (families .teachers ,peers)

Understand issues related to identificationUnderstand issues related to identification Discrete trial training : using antecedent ,behavior , and Discrete trial training : using antecedent ,behavior , and

consequence formatconsequence format Task AnalysisTask Analysis Errorless learning with structure tasks for student success and Errorless learning with structure tasks for student success and

reinforce successive approximations toward the target behavior reinforce successive approximations toward the target behavior (shaping)(shaping)

Cooperative groupsCooperative groups Social skills trainingSocial skills training Positive behavioral support plansPositive behavioral support plans Assistive technology and augmentative Assistive technology and augmentative communicationcommunication Future/individualized planingFuture/individualized planing Applied behavior analysisApplied behavior analysis Facilitated playFacilitated play

Intervention Approaches to Intervention Approaches to Autism Spectrum DisorderAutism Spectrum Disorder

• Activity Based InterventionActivity Based Intervention• Challenging behaviors using a functional Challenging behaviors using a functional

assessment approach byassessment approach by– Attempting to understand the intent of the Attempting to understand the intent of the

unconventional behaviorsunconventional behaviors– Subsequent replacement of more conventional Subsequent replacement of more conventional

means of interactionmeans of interaction– The adaptation of the extrinsic or environmental The adaptation of the extrinsic or environmental

variable to lead to more successful interactionvariable to lead to more successful interaction

Baby SignsBaby Signs

• Teach babies to use simple, easy-to-do Teach babies to use simple, easy-to-do gestures for communicating with their gestures for communicating with their parents and caregivers. These gestures or parents and caregivers. These gestures or “signs” represent an item or concept, like “signs” represent an item or concept, like “cat,” “eat,” or “all gone.” “cat,” “eat,” or “all gone.”

• Using signs gives babies a way to “talk” Using signs gives babies a way to “talk” with their parents, before they can talk. with their parents, before they can talk.

• Babies and toddlers often use signs as a Babies and toddlers often use signs as a natural part of the communication process. natural part of the communication process.

Head Start and Early Head StartHead Start and Early Head Start

Comprehensive child development Comprehensive child development programs that serve children from birth to programs that serve children from birth to age 5, pregnant women, and their age 5, pregnant women, and their families. families.

They are child-focused programs and have They are child-focused programs and have the overall goal of increasing the school the overall goal of increasing the school readiness of young children in low-income readiness of young children in low-income families. families.

Even Start Even Start

A Part A preschool program using A Part A preschool program using an Even Start model must an Even Start model must integrate early childhood integrate early childhood education, adult literacy or adult education, adult literacy or adult basic education, and parenting basic education, and parenting education into a unified family education into a unified family literacy program. literacy program.

Denver Model of Intensive Therapy forDenver Model of Intensive Therapy for Yong Children with Autism Yong Children with Autism

The main goals of treatment areThe main goals of treatment are• Bringing the child into coordinated ,interactive social relations for Bringing the child into coordinated ,interactive social relations for

most of his/her waking hours ,and social experience can occurmost of his/her waking hours ,and social experience can occur• Intensive teaching to “fill in” the learning deficits that have Intensive teaching to “fill in” the learning deficits that have

resulted from the child’s past lack of access to the social world resulted from the child’s past lack of access to the social world due to the effects of autismdue to the effects of autism

The main tools areThe main tools are• Teaching imitationTeaching imitation• Developing awareness of social interventions and reciprocityDeveloping awareness of social interventions and reciprocity• Teaching the power of communicationTeaching the power of communication• Teaching a symbolic communication systemTeaching a symbolic communication system• Making the social world as understandable as the world objects : Making the social world as understandable as the world objects :

social milieusocial milieu

Beliefs at the Core of the Beliefs at the Core of the Denver ModelDenver Model

• Families should be at the helm of their Families should be at the helm of their children’s treatment.children’s treatment.

• Each child with autism and family is unique.Each child with autism and family is unique.• Children with autism can be very successful Children with autism can be very successful

learners.learners.• Autism is at its core , a social disorder.Autism is at its core , a social disorder.• Children are members of families and Children are members of families and

communities.communities.• Children autism have Children autism have

minds ,opinions ,preferences ,choices ,feelinminds ,opinions ,preferences ,choices ,feelingg.

• Autism is a complex disorder affecting Autism is a complex disorder affecting virtually all areas of functioning.virtually all areas of functioning.

• Children with autism are capable of Children with autism are capable of becoming becoming intentional ,effective ,symbolic intentional ,effective ,symbolic communicatorscommunicators

• Systemic instruction is a powerful tool Systemic instruction is a powerful tool for young children with autism.for young children with autism.

• Play is one of the young child’s most Play is one of the young child’s most powerful cognitive and social learning powerful cognitive and social learning toolstools

• Successful intervention needs more Successful intervention needs more than 20 hours per weekthan 20 hours per week

The Inclusive ,Community-Based ModelThe Inclusive ,Community-Based Model

• Teaching within family routines.Teaching within family routines.• Teaching within inclusive preschool Teaching within inclusive preschool

settings.settings.• Intensive 1:1 TeachingIntensive 1:1 Teaching

Main aspects of the Main aspects of the Intervention ApproachIntervention Approach

• Design and Implementation of the Intervention Plan.

• Emphasis on Relationships ,Share Control ,and Positive Emotion.

Content AreasContent Areas• CommunicationCommunication

– Teaching the child to use nonverbal Teaching the child to use nonverbal communicative gestures.communicative gestures.

– Teaching motor imitation.Teaching motor imitation.– Teaching the meaning and Teaching the meaning and

important of communication.important of communication.– Teaching symbolic representation.Teaching symbolic representation.

• Play Play – social ,physical ,constructive ,symbsocial ,physical ,constructive ,symb

olic, and independent.olic, and independent.– Age-appropriate play skills Age-appropriate play skills – Individual teaching and directly Individual teaching and directly

guided in inclusive preschool guided in inclusive preschool experiences.experiences.

• Sensory-based activitiesSensory-based activities : : attention ,arousal and affect.attention ,arousal and affect.– Through sensory-social dyadic routines.Through sensory-social dyadic routines.– Through planned group sensory activities.Through planned group sensory activities.

• Personal independence and Personal independence and participation in family routines.participation in family routines.

• Social skills.Social skills.• Motor Motor

skillsskills :development ,sequencing ,planni :development ,sequencing ,planningng

• Behavioral ManagementBehavioral Management.

Typical Daily Schedules of Intervention Typical Daily Schedules of Intervention

7:30-8:30amHome dressing and mealtime programs.

9:00-12:00Inclusive preschool intervention.

12:00-1:30Mealtime programs ,hygiene programs.

1:30-4:30 1:1 structured teaching programs.

4:30-5:30 Play indoors and outdoors.5:30-7:00 Chores ,mealtime program

,communication programs.8:00-Bedtime Book routines

• Role of families :Role of families :– Families are at the helm of their Families are at the helm of their

child’s treatment.child’s treatment.– Parents are the primary teachersParents are the primary teachers– Home visits are scheduled as Home visits are scheduled as

needed.needed.

Transition OutcomesTransition Outcomes

• Workplace competenciesWorkplace competencies• Knowledge of community resources and Knowledge of community resources and

referral proceduresreferral procedures• Vocational assessment strategiesVocational assessment strategies• Community-based learning experiencesCommunity-based learning experiences