bringing aba and biomedical interventions together c enter for a utism and r elated d isorders, inc...
TRANSCRIPT
Bringing ABA and Bringing ABA and Biomedical Interventions Biomedical Interventions
TogetherTogether
Center for Autism and Related Disorders, Inc
Doreen Granpeesheh, Ph.D. B.C.B.A
Today’s PresentationToday’s Presentation
How can Biomedical and ABA interventions work together?
What is ABA
What makes a good ABA program
Breakdown of the CARD program
The CARD Curriculum
The Full Treatment ApproachThe Full Treatment Approach
Autism: Genetic Predisposition Immune Dysfunction Environmental Insult
• Toxic overload, Vaccines, Antibiotics Gastrointestinal Dysfunction
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BIOLOGICAL BASIS
The Full Treatment ApproachThe Full Treatment Approach
Autism: Language Delay Social Delay Restricted and Repetitive Behaviors Maladaptive Behaviors
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BEHAVIORAL MANIFESTATION
The Full Treatment ApproachThe Full Treatment Approach
ABA Increase
Skills Decrease
Maladaptive Behaviors
Generalize to Daily Living
Biological Treatment Eliminate Triggers Stabilize condition Achieve Health Ensure the child’s
Maximum Learning Potential
A healthy child…..A healthy child…..
Eats betterSleeps better
Feels better
CAN LEARN BETTER…..
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April May June July Aug Sept Oct Nov Dec
Months
Ch
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Tantrum
Non-Compliance
Ritual SSB
ABA + Lexapro
ABA + Lexapro + Coromega
+ ProDHA
ABA
ABA and Biomedical together…ABA and Biomedical together…
New Skills AcquiredNew Skills Acquired
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Mar 04 April 04 May 04 June 04 July 04 Aug 04 Sept 04 Oct 04 Nov 04 Dec 04
Months
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ABA + Lexapro
ABA + Lexapro +
Coromega + ProDHA
ABA
Behaviors ReducedBehaviors Reduced
Monthly Behavior Statistics 5/'04 - 6/'05
0
50
100
150
Month
Freq
uenc
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Elopement Fidgeting Leaning Running into Items Grabbing Items Screaming
Chelation and Antifungal
Treatment 10/8/'04
Applied Behavior AnalysisApplied Behavior AnalysisWhat is ABA ?ABA is based on the principles of
Operant Conditioning Theory:
“Human Behavior is affected by events that precede it (antecedents) and events that follow it (consequences)”
Change these events…change Behavior!
What behavior do we want to change?What behavior do we want to change?
Deficits Language Play Social Skills Theory of Mind Executive Functions
Excesses Self Stimulatory Behs Maladaptive Behs
• Tantrums
• Aggression
• Noncompliance
Skill Repertoire Instruction Behavior Management
Behavior Management Skill Repertoire Instruction
Child Tantrums to get what he wants… Teach him to ask for the object
Child screams to escape a task…
Child hits to get your attention…
Child self stimulates…
Teach him to ask for a break
Teach him to call your name
Teach him something more appropriate to do
Challenging behaviors can be replaced by more appropriate ones!
Treatment ModelTreatment ModelApplied
Behavior Analysis
Skill Repertoire Building
Behavior Management
Curriculum Assessment
Teaching Strategy
DTT NETFluency-Based
Instruction
Functional Behavioral Assesment
DescriptiveIndirect Experimental
Function-Based
Treatment
Generalization & Maintenance
Behavior ManagementBehavior Management
ABA: Challenging Behaviors occur for 4 reasons: Escape (I don’t want to go to school) Tangible (Give me back my toy) Attention (Look at me) Self-Stimulatory (internal reinforcer value)
In some instances, you have to look deeper.. Why doesn’t he want to go to school (is he anxious
about failing?) Why does she body rock (is she in pain?)
Challenging Behavior = Communication
What makes a good ABA program?What makes a good ABA program? Provider needs to understand what the child is trying to communicate…and teach him better ways to communicate it. Provider needs to really understand child’s skills and deficitsProvider needs to deliver a program that is individualized to each childProvider needs to constantly modify this program to fit the child’s strengths and weaknesses Visual perceptual difficulty? Auditory comprehension difficulty? Attention and Distractibility? Pre-Requisite skills?
PROVIDER NEEDS TO HAVE A PLAN!!!
The CARD I Treatment ModelThe CARD I Treatment ModelABA Foundation Errorless Teaching Discrete Trial Training Natural Environment Training Fluency Verbal Behavior throughout
instruction
Children from 0-8 yrs
Intensive treatment
Shift from home-based 1:1 learning to school & community based learning opportunities
Biological Intervention
0
10
20
30
40
Year1
Year2
Year3
Year4
Allocation of Hours
Home-based School-based
A 4 year progressionA 4 year progression
Year 1: Child entering at age 2-3 25 hours per week building to 40 hours Emphasis on
• Building a relationship with child • Replacing challenging behaviors with
functional communication Mands (Requests) Tacts (labels)
• Receptive identification (objects, actions, body parts, colors, shapes)
• Receptive instructions• Verbal and Non-verbal Imitation• Identical Matching• Play Skills (toy play)• Adaptive Skills (toilet training)• Fine and Gross Motor• Dietary restrictions/medical compliance
0
10
20
30
40
Year1
Year2
Year3
Year4
Allocation of Hours
Home-based School-based
A 4 year progressionA 4 year progressionYear 2:
Child age 3-4 40 hours (in home with partial transition to school) Emphasis on
• Building Expressive Language Objects, Actions, Attributes, Prepositions, Pronouns Categories, Functions, Occupations, Locations
• Beginning Conversation Intraverbals Reciprocal Statements Asking Questions
• Developing Observational Learning I See Sequences Tell me about/Describe
• Emotion Recognition• Inferring others desires• Play Skills (functional pretend, symbolic, imaginary)• Adaptive Skills (dressing, grooming, feeding)• Fine and Gross Motor• Sharing and Turn taking• Attention (dual and divided)
0
10
20
30
40
Year1
Year2
Year3
Year4
Allocation of Hours
Home-based School-based
A 4 year progressionA 4 year progressionYear 3: Child age 4-5 40 hours (20 hours at home; 20 hours at school) Sample Programs
• Advanced Language Concepts Pragmatic Language Maintaining Conversation (topic initiation, repair,
maintenance)• Meta and Social Cognition
Identifying and Managing own emotions Understanding other’s Perspectives, Knowledge
and Beliefs Inferences
• Executive Function Attention Saliency Flexibility with Routines Inhibition and Self Monitoring Planning
• Social Skills Levels of Friendship Recognizing Social Cues
• Problem Solving• Play Skills (peer play dates)• Adaptive Skills • Fine and Gross Motor
0
10
20
30
40
Year1
Year2
Year3
Year4
Allocation of Hours
Home-based School-based
A 4 year progressionA 4 year progression
Year 4: Child age 5-6 40 hours (10 hours at home; 30
hours in school and fading services)
Emphasis on• Teacher and Parent training• School Skills
Listening and Reading comprehension
Math and Problem Solving
• Advanced Social Skills Detecting Sarcasm Understanding Deception Group Skills
• Continued Self Regulation Self Esteem and
Confidence Task and Social Planning
0
10
20
30
40
Year1
Year2
Year3
Year4
Allocation of Hours
Home-based School-based
The CARD CurriculumThe CARD Curriculum
Language Play AdaptiveMotor SkillsMotor Skills
ExecutiveFunctions
Cognition
School Skills
Social Skills
A Functional ApproachA Functional Approach
Acquiring language is more than learning, “the meaning of words”
Teach the basic functions of language so that the child learns how to “use” language to communicate
Language
The CARD CurriculumThe CARD Curriculum
Jody hands mom the blue crayon
3 crayons present & mom says, “give me blue”
Receptive
Jody matches blue cards3 color cards on tableMatching
Jody says, “blue”Mom asks, “What color is the sky?”
Conversation
(Intraverbal)
Jody says, “blue”
Jody says, “blue paint”
Jody says, “blue”
Child’s Behavior
Mom says, “blue”Imitation
AntecedentFunction
Jody sees a blue carLabeling
(Tact)
Jody is ready to finger paint, but no paint
Requesting(Mand)
Language
Sample Basic Language Program: Colors
Topography of LanguageTopography of Language
Phonology: the sound of language
Morphology: the structure of language
Semantics: the meaning of language
Syntax: the arrangement of language
Pragmatics: Social Language
Language
The CARD CurriculumThe CARD Curriculum
Emphasis on ensuring spontaneity in Emphasis on ensuring spontaneity in language uselanguage use
Emphasis on teaching language that is Emphasis on teaching language that is functional in everyday situationsfunctional in everyday situations
Emphasis on generalizationEmphasis on generalization
Make sure the child understands that language is useful for communication!
Language
Overall Goals in Teaching LanguageOverall Goals in Teaching Language
The CARD CurriculumThe CARD Curriculum Play
Features of a Comprehensive Play Skills ProgramFeatures of a Comprehensive Play Skills Program
Modeled after the development of play skills in Modeled after the development of play skills in typically developing childrentypically developing children
Breaks down each type of play into its own Breaks down each type of play into its own systematic and comprehensive programsystematic and comprehensive program
Sequential formatSequential format
Programs may be used individually, concurrently, Programs may be used individually, concurrently, or cumulativelyor cumulatively
The CARD CurriculumThe CARD CurriculumPlay
Target AreasTarget Areas
Independent Play Tracking
Social EmotionalDevelopmentthrough Play
Independent Toy Play
Interactive Play
PretendPlay
Constructive Play
Independent Vocal PlayReciprocal Vocal Play
Exploratory Play
Sensorimotor PlayTask Completion (Peg Boards, Puzzles)
Social GamesNursery Rhymes
Songs with ObjectsBoard Games
Locomotor PlayPeer Play
Functional Pretend PlaySymbolic PlayImaginary Play
Sociodramatic Play
Block ImitationStructure Building
Sand ConstructionsClay Constructions
Arts and Crafts
The CARD CurriculumThe CARD Curriculum AdaptiveSkills
Personal SkillsBathing
Dressing/UndressingFastening/Unfastening
FeedingGrooming
Toilet TrainingUtensil Use
Domestic SkillsTelephone Skills
LaundrySetting/Clearing TableRepairing Broken Items
Preparing FoodMaking Bed
Using Basic Tools
Safety AwarenessStrangers
Household chemicalsGerms
Environmental
The CARD CurriculumThe CARD CurriculumMotor SkillsVisual
MotorBinocularity
Accomodative SkillsVisual Processing
Fine MotorColoring Cutting
Drawing Finger skillsHand Skills
Pre-Handwriting
Gross MotorProne Position Running Sitting Squatting Stairs StandingSupine Position Skills Walking Rolling Throwing Balance Beam Catching Hopping Jumping Kicking
The CARD CurriculumThe CARD Curriculum School Skills
MathNumber Concepts
Rote CountingReading Numerals
Numeral ComprehensionOrdinal Position
Numerals in SequenceAddition
SubtractionAdvanced Counting
MoneyTime
Language Arts 1Reading
Visual Discrimination of SymbolsReciting AlphabetUppercase LettersLowercase LettersWord Recognition
Reading OrallyReading Comprehension
Book TopographyStory Comprehension
Story SummarizingText Comprehension
Language Arts 2Manuscript Writing
Printing SymbolsPersonal Data
Lowercase LettersUppercase Letters
Letters in SequenceLetters Dictated
Simple SentencesQuality of Printing
Physical EducationScience
HistorySocial Studies
NonAcademicSkills
The CARD CurriculumThe CARD Curriculum
Cognition: Cognition: Meta-cognition: Identifying your own …Meta-cognition: Identifying your own … Social Cognition: Inferring others’…Social Cognition: Inferring others’…
EmotionsThoughts
Knowledge
Desires
Beliefs
Intentions
Cognition
Classic Test of Social CognitionClassic Test of Social Cognition
““Sally-Anne” or False-Belief TaskSally-Anne” or False-Belief Task
Where will Sally look for her Where will Sally look for her ball? ball?
Where does she think her ball Where does she think her ball is?is?
Cognition
““Typical” Meta and SocialTypical” Meta and SocialCognitive DevelopmentCognitive Development
First few months:First few months: Sense of SelfSense of Self
9 months: 9 months: Joint Attention / Social ReferencingJoint Attention / Social Referencing
15 months:15 months: PretencePretence
18 months: 18 months: Desire / IntentionDesire / Intention
2 years: 2 years: EmotionEmotion
3 years:3 years: KnowingKnowing // ThinkingThinking
44 years: years: Belief / False-BeliefBelief / False-Belief
5 years: 5 years: Intention – Accident vs. PurposeIntention – Accident vs. Purpose
Cognition
The CARD CurriculumThe CARD Curriculum
10 Target Areas
SensesEmotions
Desires
SensoryPerspectives
Knowing
PreferencesThinking
Beliefs
Intentions
Deception
Cognition
The CARD CurriculumThe CARD CurriculumSocial Skills
Absurdities
GroupRelated
Skills
Social Rules
Social Context
Self Esteem
Social Interaction
Social Language
Social Skills
Social InteractionApologizing
AssertivenessComplimentsCooperatingNegotiating
Gaining AttentionGreetings and
IntroductionsLevels of Friendship
Relationships/Manners
Requesting Cessation
Sharing/Turn Taking
Self EsteemDealing with Conflict
WishesPositive Self
StatementsWinning Losing
Social ContextCommunity Social
BehaviorImitation
Responding to Social Cues
What’s Missing Inferences
Social RulesCompliance
Recognizing RulesFollowing Rules
Questioning Rules
Group Related SkillsChoral Activities
Group DiscussionPeer Pressure
AbsurditiesFigures of SpeechHumor and Jokes
Tricks and Deception
Social LanguageSocial Vocalization
Topic SelectionTopic Initiation
Topic MaintenanceTopic Breakdown and Repair
Topic TransitioningJoining a ConversationEnding a Conversation
Prosody
The CARD CurriculumThe CARD Curriculum
Process that underlies goal directed behavior
Goal Directed Behavior Involves…
Visualizing situation
Identifying desired objective
Determining plan to meet objective
Monitoring progress to goal
Inhibiting distractions
Executive FunctionsWhat is Executive Function?
The CARD CurriculumThe CARD Curriculum
Executive Function
TaskPlanning
Inhibition
Flexibility
Meta-CognitivePlanning
Attention
Memory
Basic Concepts
EF
Social Planning
Basic EF ConceptsEye contact
PointingJoint Attention
FlexibilityGenerating Alternatives
Problem SolvingRelaxation Training
AttentionCognitive Set ShiftingSustained AttentionDivided Attention
Alternating AttentionSaliency
MemoryWorking
Visual-spacialAuditory
Associative
InhibitionWaiting
Generating AlternativesIdentifying social cues
Meta-CognitiveSelf-EvaluationSelf-Monitoring
Of AttentionOf Reinforcement
Emotion Regulation
Task PlanningOrganizing Materials
PrioritizationTime management
Goal DirectionTask Initiation
Social PlanningPlanning
in social contexts
Other CARD ProgramsOther CARD Programs
CARD II: Age 8-Adult Consultation and training for schools Training for parents and caregivers Vocational Skills Training
Feeding and Pill Swallowing Program
Behavior Management Consultations
Visual Program for non-vocal children
Treatment of Challenging Behavior
Functional Communication
Daily Living Skills
Vocational
Accessing General Ed Curriculum
Social Communication
Social Skills
CARD II: Ages 8-Adult
WPPSI: Pre- & Post-ABA Early Intervention
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20 22 27 29 29 30 30 31 31 31 32 34 38
Average Therapy Hours Per Week
Intel
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uotie
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Pre-Test
Post-Test
And…what is our success rate?
SummarySummaryFind an experienced physician who will help you find the triggers and stabilize the health of your child.Find a good ABA program that will help you assess your child’s strengths and weaknesses and give you a plan of action.Don’t give up HOPE! You were given a child with Autism because you are an exceptional person who can handle this exceptional situation!