Designing Effective School-Based Interventions for Children with Autism

John J. Wheeler, Ph.D.Director and Professor

Center of Excellence in ECLD

Introduction

• Given the increase in prevalence of children being identified with autism, now 1 in 68 (CDC, 2015) this session will provide attendees with an understanding of the importance of providing evidence-based practices in addressing the educational and behavioral support needs of children with ASD and their families.

Diagnosis to Intervention

Merging Research to Practice

• We will also examine the gap between researchers and practitioners and the need for portability of interventions within applied settings.

• Finally, the importance of building capacity and infrastructure to address the lifespan needs of these children and families will be discussed.

What to Teach? How to Teach?

What are Evidence-Based Practices?

• Evidence-based practice originated in the field of medicine where scientific literature was used to inform medical practice (Odum, 2005).

EBP Model Applied to Medicine

EBP

Patient Concerns

Clinical Expertise

Research Evidence

Evidence-Based Practices in Autism

• To be considered an evidence-based practice for individuals with ASD, efficacy must be established through peer-reviewed research in scientific journals using:

• Randomized or quasi-experimental design studies. Two high quality experimental or quasi-experimental group design studies, OR

• Single-subject design studies. Three different investigators or research groups must have conducted five high quality single subject design studies, OR

• Combination of evidence. One high quality randomized or quasi-experimental group design study and three high quality single subject design studies conducted by at least three different investigators or research groups (across the group and single subject design studies).

• High quality randomized or quasi-experimental design studies do not have critical design flaws that create confounds to the studies, and design features allow readers/consumers to rule out competing hypotheses for study findings. High quality in single subject design studies is reflected by a) the absence of critical design flaws that create confounds and b) the demonstration of experimental control at least three times in each study.

• The NPDC on ASD has identified 27 practices that meet the above criteria for evidence-based practices for children and youth with autism spectrum disorders. We continue to review the literature for practices that meet our definition and will add as appropriate (NPDC, 2014).

• http://autismpdc.fpg.unc.edu/content/evidence-based-practices

Intervention Approaches

• Comprehensive Treatment Models– Constitute a set of practices designed to have a

broad impact on the core deficits associated with ASD, examples of these include the TEACCH model and the UCLA Young Autism Program as two from a list of ten.

• Focused Intervention Practices– Are intervention methods designed to address a

specific target skill or behavior.

Merging EBP into Practice

• Research findings paired with professional judgment, data-based decision making, family input, and the capacity to implement interventions are all factors to consider (NAC, 2009).

Confounding Variables

• The difficulties we experience in merging EBP with practice can often be as a result of:– Insufficient professional knowledge and

experience– Limited training and supports– On size does not fit all as learners with ASD

represent a very individualized population of learners

Importance of Effective Training

Solutions? Professional Development

• Professional development which includes in-service and pre-service training and on-going professional development in the area of ASD can assist in building the capacity of professionals, schools and systems to meet the educational and behavior support needs of youngsters with ASD.

Building Capacity through Professional Development

General Recommendations

Family Partnerships

• Family partnerships are the key to success for all involved when developing interventions for children with ASD.

• Parents and family know and understand the child far better than we as professionals, our efforts should be aimed at empowering families and in building their capacity to sustain over time.

Family/Professional Partnerships

Benefits of Family Partnerships

• Parents provide us with significant insight about their child and his/her family.

• Parents should be involved to the greatest extent possible in identifying socially relevant goals and have input on the design and delivery of interventions.

• As children age, they should be involved to the greatest extent possible in the development of their IEP and in self-advocacy.

Individualized Interventions

• When designing educational and behavior supports recognize that these should first and always be individualized as no two children are the same.– Attempt to match intervention and treatment

strategies with each child’s strengths, interests, and family goals.

– Environmental structure, instructional strategies, and behavior supports should be tailored to the individual child to maximize probability of success.

Greatest Example: Baseball

Specific Classroom ExampleLearner Profile

What are the strengths that promote learning? What are the challenges that inhibit learning? Is there a skill or performance deficit (or both)? What is the current stage of learning? Successful input modes (teaching formats)? Successful output modes (response formats)? Desired objects / activities / social reinforcers? Are there specific cues, prompts, or materials that

have in the past been used successfully?

Systematic Instruction

Effective Practices

Assess

PlanTeach

Evaluate and Revise

Systematic Instruction

• Key to systematic instruction is:– Planning• Identification of socially valid goals with longitudinal

planning (hopes and dreams),• Designing instructional procedures for teaching and

evaluating student performance,• Methods for collecting data as to how well we

implement the procedure (treatment integrity/fidelity) and how well the child performs (progress).

Applied Example

Applied Example:Daniel 6 years old Diagnosed with autism at age 2 ½ Previously in an activity-based preschool

program that practiced consequence-based classroom management

Transition to a kindergarten program Needed assistance in the area of task

engagement.

Target Behaviors

Target behavior selected: Independent task engagement

Independently locating task materials Completing tasks Putting materials away upon completion Self-monitoring using a photo activity

schedule.

Intervention

Development of intervention: Increased levels of structure & consistency by

using a daily classroom schedule Individualized activity schedule Design & delivery of developmentally-

appropriate tasks incorporating visual cues Environmental modifications including

designated areas for leisure and group activities.

Outcomes

Results: Daniel averaged 29% on task engagement in

baseline. His performance increased to 87% during

intervention. Over the course of follow-up (4 months) his

mean performance was 86% during probe conditions.

AE/Specific Strategies IV

Importance of Structure

Structured Learning Environments

• Children with ASD generally perform better in the presence of predictable classroom structure and routines– These include classroom and individualized

activity schedules,– Careful and planned design and presentation of

tasks with an emphasis on embedded visual cues if and when needed.

Specific Examples/Schedule

Specific Examples/Instructional Cues

Curricular Content

• Curricular content should address both the functional and academic goal areas for the specific child– Communication and social skills,– Core academic content,– And other functional/applied skills as deemed

appropriate by the child’s parents and team members.

Positive Behavior Supports

• PBS represents a pro-active method for addressing the challenging behaviors experienced by some children including those with ASD.

• My personal/professional approach is aimed at prevention so emphasis placed on structure in the environment, within instruction and routines throughout the child’s day.

Keys to Understanding Behavior

PBS and Autism: Some Points to Consider

• Challenging behavior often ensues because of either skill deficits or because of performance issues (motivation)– Determine the function of these behaviors

(sensory needs, social attention, escape/avoidance, access to tangible reinforcement)

– Examine the tasks/events associated with the behavior• Assess the presence/absence of visual clarity and cues?

PBS and Autism: Some Points to Consider

• Examine the consequences which follow the behavior, what are the outcomes?

• Identify a replacement behavior that serves the same function and provides the learner with access– Target form (what it looks like basically) rather than

function (the purpose it serves),– Provide functional and differential reinforcement

systematically over time to shape the desired behavior/skill.

A Quote to Remember

A lack of learning in any particular situation should first be interpreted as a result of inappropriate or insufficient use

of teaching strategy, rather than an inability on the part of the learner.

(Gold, 1980)

Resources

• Wheeler, J.J., & Richey, D.D. (2014). Behavior management: Principles and practices of positive behavior supports. Columbus, OH: Pearson.

• Wheeler, J.J., Mayton, M.R., & Carter, S.L. (2015). Methods for teaching students with Autism Spectrum Disorders: Evidence-based practices. Boston: Pearson.

Thank You !