innovations in autism treatment from nj: the garden academy model

Innovations in Autism Treatment From NJ: The Garden Academy Model

David W. Sidener, Ph.D., BCBA-D

Garden Academy:Science-based education, with a heart

• Executive Director (DWS) with clinical background▫ Master’s – Temple; PhD – WMU▫ Clinical experience – Bancroft, CIFA, KKI, PCDI

• Clinical Director-Danielle Gureghian, PhD, BCBA-D▫ Master’s - UMBC; PhD – University of Kansas

• Staff Trainers – Kim Sancho, BCBA; Bridget Spanarkel, BCBA; Lindsey Gallagher, BCBA; Allison Neaman, M.Ed; Lauren Sinning, BCaBA.

• Consultants – Tina Sidener, PhD, BCBA-D; Hannah Kaplan, BCBA; Jill D’Ambrosia, BCBA

1. Overview• Parent-initiated, from need for services• Approved by NJ DOE, May 2009• Currently 29 students w/ intensive staffing• 5 staff trainers • Serve students 2 ½ - 15 (eventually to 21)• Must have autism diagnosis• Entire program/curriculum - ABA• Graduated 2 students to regular ed in home

district

2. Evolving Curriculum: Influences I

• Princeton Child Development Institute (PCDI)▫ Activity Schedules▫ Emphasis on token systems▫ Professionalism▫ Commitment to whatever it takes to help kids

Evolving Curriculum: Influences II

• Lovaas’ curriculum▫ Emphasis on program sequences, identifying

prerequisites, next steps and maintenance.▫ Examples –

Go/Went/Did/Got program sequence I see/It is/I have sequence Reciprocal conversation sequence

We see a lot of “I used to do Lovaas, now we do VB” kinds of comments on listservs and these often conclude with something like, “and now my child is doing so much better, or learned to talk, etc”. However, I urge you to not throw the baby out with the bathwater. There are some real gems in Lovaas’ curriculum and program methods. Now, there are some things that we do differently from Lovaas programs but science is cumulative – we do what works, then if we’re lucky, we add to it.

Example Program Sequences

• The following are sequences based in the curriculum developed by Lovaas (1981, 2002) and represent possible ways in which curriculum units may be linked together.

Evolving Curriculum: Influences III

• VB MAPP▫ A solid behavioral assessment instrument, easily

linked to curriculum and teaching targets.▫ We’ve been using it seriously for about 2 years but

will make more use of it in coming years.

Evolving Curriculum: Influences IV• Current behavior-analytic research

▫ Analog Functional Analyses Individualized conditions and methods, as needed

▫ Treatment Assessment Often conducted in brief sessions rather than across

the whole day. Some recent examples: Noise Assessment,

Transition Assessment▫ Essential Skills Curriculum

In-house instrument that identifies major program areas, often overlooked areas and is linked to the NJ core curriculum areas.

Essential Skills Curriculum I

1. Matching Skills2. Imitation Skills3. Function-identified behavior

1. Essential manding skills2. MO-based problem behavior replacements

4. Observational learning1. Do children “learn” by observing others’

consequences? Little behavior-analytic research.

Essential Skills Curriculum II

5. Ability to respond to multiple dimensions of stimuli

1. Color v. label; say v. do; ask v. answer2. Go get the small red block at the window.

5. Joint (stimulus) control and verbal mediation1. Ability to respond to own verbal behavior

5. Key Self-Help skills – Eating, Sleeping, Toileting, Dressing

Essential Skills Curriculum III

8. Responding under appropriate reinforcement:1. Play as automatically reinforced (students

enjoy/select play activities)2. Social behavior under the control of social

stimuli1. Eye contact2. Social initiation3. Responding to praise, smiles and approval

Essential Skills Curriculum IV

9. Remembering1. Respond after a delay (DMTS)2. Remote reporting

1. What did you do today at school?1. You might use a gradually increasing delay to teach a

child to “remember” earlier events. What you are probably teaching the child to do is to construct intraverbal chains and to respond to her own verbal behavior.

3. Parent Training Model• Weekly parent training sessions.• Typically 3 per month at home, 1 per month at

school.• Recently began using Parent Child Interaction

Therapy (PCIT)▫ Emphasis on identifying parent-directed

interactions (PDI) vs. child-directed interactions (CDI).

▫ Model helps to identify and structure these types of interactions and to develop effective consequences.

Why Parent Training?

• Our goal is to have the biggest impact that we can have on our kids’ education and good behavior!

• We can have a bigger impact by partnering with parents and supporting what they do at home and in the community.

• Parents’ good teaching may be informed by practices used and evaluated at Garden Academy.

Why Else?

• Kids spend 2 ½ times as much time awake at home compared to hours in school. Even if children get 20 hours of additional home therapy there are still a lot more hours at home than at school. Parents must be their child’s best teacher!

The Garden Academy PT Model

• Garden Academy seeks to provide a comprehensive, research based program for children with autism that includes the family as an integral component.

• As a partner in their child’s success, it is expected that parents participate in an ongoing monthly Parent Training Program that is offered by Garden Academy.

Parent Training Goals• Ensure generalization of skills learned at school to the home

and community setting.• To provide family members with training in procedures based

in applied behavior analysis to increase skills and decrease problem behavior.

• To provide support to family members in community activities and integration.

• To assist family members in identifying appropriate objectives to be addressed in the home and community.

• To assist family members in developing, implementing, and evaluating skill acquisition and behavior reduction procedures.

Parent Training Model• In order to facilitate the best collaboration the

typical frequency of training visits is as follows:▫ 4 Parent Training sessions per month -

3 to take place at home and 1 to take place at school (May be some exceptions or individual arrangements)

Parent training may also take place in the community.

Goals for parent training will continue to be developed via collaboration between parents and GA staff.

The Training Session

• Meeting goals and individual session agendas are developed collaboratively.

• Written agendas are used in order to help with addressing all identified concerns and training items.

• A typical session lasts for 60-90 minutes.• More or less time may be required depending on

the nature of the visit.

4. Function-Based Treatment

• Analog Functional Analyses▫ Conducted at least 19 analog functional analyses

at Garden Academy since 2007. Some of these have taken up to 3 months to conduct.

▫ Mostly for forms of self-injury, also property destruction, screaming and other disruptive behavior

▫ Have customized conditions as well as research designs.

• Baseline

Demand condition from FA served as baseline.

5. Teaching Verbal Operants

• A Verbal Behavior account is about asking the question, “Why is he (or why should he be) talking, or saying that particular thing, right now?”▫ It is an analysis of the events leading up to the

verbal behavior and the events following it, a functional analysis.

• One example - Mand Training

6. Data-Based, Annual Staff Performance Evaluation• Built data-based, staff evaluation, Performance Matrix,

based on Daniels and Daniels (2004)• Assesses observable components of effective teaching.• Sections include:1. Classroom observation2. Documentation3. Professionalism4. Relationship development5. Teaching social competence6. Teaching new skills/Quality components7. Decreasing problem behavior8. Maintaining the physical environment

Other Key Elements of GA Program

7. Feeding interventions – see graph8. BCBA training and supervision

1. We provide in employee’s second year, after successful passing of annual performance evaluation

7. Collaborate with Caldwell University ABA training programs

1. Graduate student observations2. Conduct Master’s Theses at Garden Academy3. Doctoral level staff sit on thesis committees

9. Collaboration with Caldwell

• More than 30 current and former staff affiliated with CU as Grad students or faculty.

• At least 22 (out of 36) current staff have or working on graduate degrees in ABA or SPED.

• GA staff on thesis committees and conducted more than 10 Master’s thesis projects at GA.

• Collaborate on various clinical issues.• Collaborate on research and grants.

10. Future Directions

• Outreach Programs▫ After school, home programs for our students▫ Consult to local school districts re: students they

keep in district. NJ public school districts have opened hundreds of

autism programs and classrooms in the last 10 years. They don’t always have the best tools to serve these

students.▫ Feeding clinic

• Prevocational, Vocational and Adult programs

Conclusion• There is a growing need for science-based, ABA

services for school-age children and adults.• Our clients and students need and benefit from

high quality applied behavior-analytic services.• As practitioners we will be best able to

contribute if we ▫ train ourselves in and embrace as much of our

science as possible, and▫ collaborate with existing funding and regulatory

systems.

Thank you!