dir summer inst research panel (2.3 redacted for posting on circle stretch 041911)

8/7/2019 Dir Summer Inst Research Panel (2.3 Redacted for Posting on Circle Stretch 041911)

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Research Panel: know our data

and get involved!

Diane Cullinane, MD

Josh Feder, MD

Connie Lillas, PhD, MFT, RN

Lois Black, PhD

Devin Casenheiser, PhD

Jim Stieben, PhD


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Support Parent Choice Today!www.dirfloortimecoc.com


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The Roots

Greenspan, S.I. and Wieder, S. (1997) Developmental patternsand outcomes in infants and children with disorders in relating andcommunicating: A chart review of 200 cases of children withautistic spectrum diagnoses. Journal of Developmental andLearning Disorders 1:87-141

Greenspan, S.I. and Wieder, S. (2005) Can Children with AutismMaster the Core Deficits and Become Empathetic, Creative andReflective? A Ten to Fifteen Year Follow-up of a Subgroup ofChildren with Autism Spectrum Disorders (ASD) Who Received aComprehensive Developmental, Individual-Difference,Relationship-Based (DIR) Approach. The Journal ofDevelopmental and Learning Disorders 9.


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Specifically DIR/FT

Solomon, R., Necheles, J., Ferch, C., &Bruckman, D. (2008). Pilot study of aparent training program for young children

with autism: the P.L.A.Y. Project HomeConsultation Program. Autism, 11(3), 205-224.


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Relationship Focused Intervention

Mahoney, G. & Perales, F. (2003). Using relationship-focused intervention to enhance the social-emotionalfunctioning of young children with autism spectrumdisorders. Topics in Early Childhood Special

Education, 23, 74-86.

Mahoney, G., and Perales, F. (2005) Relationship-focused early intervention with children with pervasivedevelopmental disorders and other disabilities: acomparative study. Journal of Developmental &Behavioral Pediatrics26: 77-85.


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Parent mediated Intervention

Kasari, Gulsrud, Wong, Kwon, & Locke.Randomized Controlled Caregiver MediatedJoint Engagement Intervention for Toddlers

with Autism. J. Autism Dev Disord (2010)


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The Scotts

Salt, Shemilt et. al. The Scottish Centre forAutism preschool treatment programme. IIThe results of a controlled treatment

outcome study. (2002) SAGE publicationsof The National Autistics Society. Vol 6(1)33-46.


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A Hybrid

Dawson, G., Rogers, S., Munson, J., Smith, M.,Winter, J., Greenson, J., Donaldson, A. &Varley, J. (2009). Randomized controlled

trial of an intervention for toddlers withautism. The Early Start Denver Model.Pediatrics. Online verson e17-e23.


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Reviews

Odom, Boyd, Hall, & Hume. Evaluation ofComprehensive Treatment Models forIndividuals with Autism Spectrum Disorders.

J Autism Dev Disord (2009) Ospina, M. et al. Behavioural and

Developmental Interventions for Autism

Spectrum Disorder: A Clinical SystematicReview. (2008)


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The best is yet to come!

Drs. Devin Casenhiser, Jim Steiben, Stuart Shanker andeveryone at York / MEHRI

The York Study!

Dr. Rick Solomon

The Play Project

Dr. Josh Feder The Bridge Project


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Getting Started in Research

Josh Feder, MD


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But Im a clinician

Why are you HERE?

Learn more

Make friends

Step gradually

Help out

Persist, and maybe perseverate


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Learn about Evidence Based Practice

Evidence Based Medicine Sackett 1995

Best Available Research combined withClinical Judgment and Experience

For the Purpose of Informed Consent

Parent Choice!

More from Connie later


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Understand the Challenges of Doing Research

Subjective experience (affect) is at the center

Heterogeneity: all the people are so different

More than one treatment at a time


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Overcoming Challenges

Efficiency studies (vs. Efficacy Studies)

FEAS, SEGC

Reflective Community Consensus Process

BRIDGE going post-denominational (thanksStanley)


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Tuning Into Each Other

Customizing Project ImPACT

to address our key community values and reach younger children for

the SoCal BRIDGE Collaborative


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BRIDGE

Community collaboration

Parents, clinicians, researchers, agencies,funders

Vetting ideas

Learning from each other

Coming to consensus


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Taking Project ImPACT..

Parent driven

Mixed developmental/ behavioral

Language focused

Specific goals


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ImPACT


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And make it ours

Warm it up

Broaden the vision

Give it our context


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BRIDGE Enhancements

Engagement

Communication

Sensori-motor

Reflective process


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Warmed up


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Project ImPACT


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And Make it Ours


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The Evidence Based Movement: 19th

Century Science versus Complexity:

Welcome to the 21st Century

Connie Lillas, PhD, MFT, RN


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California Quake Crisis

Legislators do not understand the issues

DIR not on EI & DMH list of approvedtherapies

Need for push back nationally


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Pushing Backthe Problem

Reductionist, narrow research paradigms

Outdated research models

Children are complex


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Pushing Back - Solutions

Advocacy from Parent to Professional

Know and educate colleagues about thedifference between Evidence Based Practice and

Evidence Based Treatments Educate about research paradigm matches

versus mismatches

Support research that is practice-based evidence

Promote professional and parental critical thinkingand informed choice


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Insist on Clarity:E-B-Treatments do NOT equal E-B-Practice

Evidence-Based Practice is:

A decision making processthat holds the tensionbetween:

The best available clinical research (EBTs)

Professional wisdom based in sound theory and practice

Cultural and family values (with informed choice) Buysee and Wesley, 2006


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Insist on Match Between ResearchApproach & Clinical Population

Problems with Gold Standard Research:

Often simple, subclinical cases are involved inresearch settings

Designed for single diagnosis, not matching co-occurring diagnoses

Lacks flexibility to account for individualdifferences

Lacks flexibility for following a therapeutic alliance,shifts in behaviors, and cultural sensitivities

In Lillas and Turnbull, 2009, from Weisz & Gray, 2008


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21st Century Vision for Paradigm Shift in

Research

a critical question for the field is what

approach to empirical testing will give us thestrongest treatments that are most robust inactual clinical practice

(Weisz & Gray, 2008, p. 62)


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Get Involved!

Practice-Based Evidence

Push-back with complex clinical cases that drivescientists search for new knowledge

Attend conferences and join organizations withchild development researchers (map)

Take complex models and frameworks into

clinical research settings Search and find cutting-edge dynamic systems

research paradigms that can hold complexity


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The Importance of Affect:Research in Support of DIR Intervention

Lois M. Black, Ph.D.

Faculty DIR Institute

Clinical Psychologist/Pediatric NeuropsychologistResearch Professor

Oregon Health & Science University


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Black, et al., IMFAR 2009: Understanding the Effects of Enhancing Vocal

Prosody on Childrens Comprehension and Retention of Story Narratives

Participants: N=79Ages 4-8, overall IQ > 70.ASD group N=37

TD group N=42

3 Prosodic Modes: Disconnected

Recorded words in random order,concatenated words together intosentences

Imposed synthetic pitch contour

on sentences Minimal grammatical prosody; no

pragmatic or affective prosody stress correct syllable word

meaning intelligible descending or ascending

contours -- questions andstatements

Standard intact grammatical, minimal

pragmatic, affective prosody

Enhanced exaggerated grammatical,

pragmatic, affective prosody

NARRATIVES:Affectively-rich, interpersonalstories.Factual + Social CognitiveInformation

Immediate and delayed questionsGoal: What are the effects ofenhancing vocal prosody affect inones voice -- on comprehensionand retention of information?


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Findings, contd:

No such beneficial effect of prosodic mode was seen in the TD

group. (Essentially no differences across disconnected, standardand enhanced conditions.)

TD performed better than ASD children in all prosodic modes.

Trends were found for the interaction to be more pronounced for thesocial cognitive questions.

Conclusions:

Enhanced prosody specifically targeted to highlight the multiple

levels of information in complex verbal communication helpscomprehension and retention of information in children with ASD,in particular, social cognitive information.


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Critical Elements for DIR Intervention

Research

Pre-treatment measures Heterogeneity/How we know who our

children are Post-treatment/Outcome measures What are we striving to achieve for

our children

Treatment manual

Fidelity measures


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What we need most

Treatment manual

Fidelity measures


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The Final Frontier: Research onDIR on both Clinical and

Functional Imaging Outcomes

Devin Casenheiser, PhD

Jim Stieben, PhD

Stuart Shanker, D. Phil. Oxon


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The York MEHRI Study

2 hours per week FT coaching

Study population & controls\

Clinical measurement of effects

Functional Imaging


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Findings:

Clinical improvement

Brain looks better!

Publication status


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Implications

Profound evidence

Comparison w/ other imaging studies

Next steps (studies, advocacy)


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dir summer inst research panel (2.3 redacted for posting on circle stretch 041911)

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