Identifying Effective Practices

Sorting Through the Claims of

Evidence Based Practices

LASARD Project

October, 2011

Autism Spectrum Disorders

Characterized by:

Difficulty with communication

Difficulty with social interaction

Repetitive behaviors/restricted interests

Educational programming should address core

characteristics

(American Psychiatric Association [DSM-IV-TR], 2000)

LAQI Key Areas

Communication

Social Interaction Behavior

Curriculum & Instruction

Environment Inclusive Practices

Collaboration

Transition

http://www.hdc.lsuhsc.edu/

Evidence-Based Practices

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Evidence-based Practice is defined as:

“Educational Practices that have

been demonstrated effective

based on quality research.”

Odom, Brantlinger, Gersten, Horner, Thompson, and Harris (2005) as cited in

Test et al., (2009)

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Core Components

1. Individualized supports and services for students and

families

2. Systematic instruction

3. Comprehensible and/or structured environments

4. Specialized curriculum content

5. A functional approach to problem behaviors

6. Family involvement

Iovannone, Dunlap, Huger, & Kincaid (2003)

Evidence-Based Practices

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Systematic Instruction includes:

Carefully planning for instruction by identifying valid

educational goals,

Carefully outlining instructional procedures for teaching,

Implementing the instructional procedures,

Evaluating the effectiveness of the teaching procedures,

Adjusting instruction based on data

Iovannone, Dunlap, Huger, & Kincaid (2003)

Evidence-Based Practices

Successful Outcomes

Effective treatments that are:

Systematically and objectively verified

Replicated

Tailored to needs of student and team

Family

School

Implemented with fidelity

Simpson (2005)

Determining Evidence-Based Practices

•National Initiatives

•Research synthesis

Terminology in identification of Evidence-based Practices

US DOE NPDC-ASD NAC Other criteria (Simpson, 2008)

Meets evidence standards

Evidence-based practices

Established Scientifically based practices

Meets evidence standard with reservations

Emerging Promising practices

Does not meet evidence based standards

Unestablished Practices with limited supporting information

Ineffective/ Harmful

Not recommended

US DOE What Works Clearinghouse

What Works Clearinghouse, 2008, p. 13

US DOE What Works Clearinghouse

What Works Clearinghouse, 2008, p. 73

Council for Exceptional Children Division for Research

Published in Exceptional Children, Vol. 71 (2), Winter 2005 Overview by Odom, Brantlinger, Gersten, Horner, Thompson,

& Harris

Evaluating quality of evidence from:

Correlational research (Thompson, Diamond, McWilliam, Snyder, & Snyder)

Single subject design (Horner, Carr, Halle, McGee, Odom, & Wolery)

Group experimental and quasi-experimental (Gersten, Fuchs, Compton, Coyne, Greenwood, & Innocenti)

Qualitative studies (Brantlinger, Jimenez, Klingner, Pugach, & Richardson)

National Professional Development Center on Autism Spectrum Disorder

autismpdc.fpg.unc.edu

Definition of EBP

LSU-HSC Human Development Center

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To be considered an evidence-based practice (EBP) by The National

Professional Development Center on 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 studies,

single-subject design studies. Three different researchers 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.

National Professional Development Center on Autism Spectrum Disorders, 2010

Evidence Based Practices

Computer-aided instruction

Differential reinforcement

Discrete trial training

Extinction

Functional behavior assessment

Functional communication training

Naturalistic interventions

Parent-implemented intervention

Peer-mediated instruction/intervention

Picture Exchange Communication System ™

Pivotal response training

Prompting

Reinforcement

Response interruption/redirection

Self-management

Social narratives

Social skills training groups

Speech generating devices

Stimulus control

Structured work systems

Task analysis

Time delay

Video modeling

Visual supports

National Professional Development Center on Autism Spectrum Disorders

National Autism Center

www.nationalautismcenter.org

National Autism Center Ratings

Strength of evidence based on Scientific Merit Rating

Scale:

Research design

Measurement of the dependent variable

Measurement of independent variable

Treatment fidelity

Participant ascertainment

Generalization

NAC, 2009

National Autism Center: Established Treatments

Antecedent Package

Behavioral Package

Comprehensive

Behavioral Treatment for

Young Children

Joint Attention

Intervention

Modeling

Naturalistic Teaching

Strategies

Peer Training Package

Pivotal Response

Treatment

Schedules

Self-management

Story-based Intervention

Package

Retrieved from: http://autismpdc.fpg.unc.edu/content/national-standards-project

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Scientifically-based Practices Applied behavior analysis (ABA)

Pivotal response training (PRT)

Discrete trial training (DTT)

Promising Practices PECS

Incidental Teaching

Structured Teaching (TEACCH) Visual Supports

SCERTS

Social Stories

Video Modeling

Peer Support Strategies

Assistive Technology

Simpson (2005)

Evidence-Based Practices

Selected Evidence-Based Practices

Inclusion here does not indicate specific

endorsement of these practices over

others

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Systematic application of behavioral principles to

change behavior.

Behavior, both adaptive and maladaptive, is learned.

Learning occurs as a result of the consequences of the

behavior.

Behavior refers to a student’s response and can be academic

skills/knowledge or social/emotional responses.

Alberto & Troutman (2009)

Applied Behavior Analysis (ABA)

Discrete Trial

Incidental Teaching

Peer Mediated Strategies

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Lowrey, 2008

Response Prompting Strategies

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Based on the principles of ABA

Prompting strategies provide a systematic delivery system that increases the likelihood the student will respond correctly

Includes verbal, gestural, model, physical, & visual prompts

Systems include: Least-to-Most Prompting Systems

Most-to-Least Prompting Systems

Graduated Guidance Prompting Systems

Constant & Progressive Time Delay Systems

Naturalistic Prompting Procedures Alberto & Troutman, 2009

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Based on principles of ABA

The discrete trial method has four distinct parts:

1. the trainer's presentation,

2. the child's response,

3. the consequence

4. a short pause between the consequence and the next

instruction (between interval trials).

Discrete Trial Training

Lovaas, O. I. (1981)

NPDC on ASD Checklist

http://autismpdc.fpg.unc.edu/content/discrete-trial-training-0

WWC on DTT

http://ies.ed.gov/ncee/wwc/reports/ece_cd/lovaas_model/index.asp

Functional Communication Training (FCT)

LASARD

Communication based intervention

Reduces or eliminates problematic behavior by

teaching the student a specific form of

communication matched to the function of the

problematic behavior

Communicative form will replace problematic

behavior because it is more efficient and effective

Carr, Levin, McConnachie, Carlson, Kemp, & Smith (1994)

Steps for Implementation: FCT

12/2/2011 LASARD

1. Complete a functional behavior assessment of the challenging behavior.

2. Identify a replacement behavior as a substitute for the challenging behavior

3. Manipulate the environment to elicit the challenging behavior to provide opportunities to practice replacement behavior and plan opportunities for generalization

4. Prompt student to use replacement behavior

5. Do not reinforce challenging behavior and provide immediate reinforcement for use of replacement behavior

6. Shape the response

7. Fade the use of prompts

8. Increase the time between the replacement behavior and the reinforcement

Data collection throughout!

Adapted from Franzone (2009)

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Based on principles of ABA

Individuals exchange a picture of a desired item for

that desired item

Later phases teach individuals to discriminate

pictures, put together simple sentences, comment,

answer direct questions

Frost & Bondy, 2002

Picture Exchange Communication System (PECS)

PECS Phase II Video

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Treatment and Education of Autistic and Communication related handicapped CHildren

Uses Systematic Instruction Principles

Based on the principles of Structured Teaching: Principle 1: Physical Structure

Principle 2: Scheduling

Principle 3: Work System

Principle 4: Routine

Principle 5: Visual Structure

Not behavior modification (like ABA), but more reliant on environmental stabilizers

www.teacch.com

TEACCH

TEACCH

Pictures retrieved from: http://www.preschoolfun.com/pages/teacch%202008.htm

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Visual schedules Allows students to:

Make sense of environment

Predict scheduled events

Comprehend expectations

Anticipate changes throughout

the day Heflin & Simpson, 1998

Choice boards Assists students to:

Know what choices are available

Participate in the decision making process Hodgdon, 1995

Visual Supports

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Carol Gray Describes a situation, skill, or concept in terms of relevant social cues,

perspectives, and common responses in a specifically defined style and

format.

Goal is to share accurate social information in manner that is easily

understood by its audience.

Goal should never be to change the individual’s behavior, rather

that the individual’s improved understanding of events and expectations

may lead to more effective responses.

Social Stories ™

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Billy’s Snack Book

When I am at school, we take a break called snack time. At snack time all of the kids usually go outside. I usually go outside too! There are lots of kids outside at snack time. Some of the kids are standing. Some of the kids are sitting, but they are talking to each other. The kids like to talk to each other at snack time. I will try to talk to the other kids too!

There are many things I can talk to the other kids about:

I can ask them what kinds of things they like to do after school.

I can tell them what kinds of things I like to do after school.

I can talk about what Disney movies I like.

I can ask about what Disney movies they watched.

I can ask them if they have pets.

The kids will like me if I talk to them. They will want to be my friend!

Scattone, D., Tingstrom, D., & Wilczynski, S. (2006)

Sample Social Story

NAC Evidence Level - Established

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Video modeling interventions involve a child watching videotapes of positive examples of adults, peers, or him- or herself engaging in a behavior that is being taught.

Can refer to interventions that use the self as model (video self-modeling) and interventions that use another as model (e.g., peer or adult).

May be created for a wide array of skills (e.g., social, communication, functional) and in a variety of settings (e.g., home, school, community).

Delano, M. (2007).

Video Modeling

Hahnville video modeling

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Peer-mediated interventions are effective in increasing social interactions between typical peers and students with ASD and related disabilities.

May include Peer training

Peer tutoring

Peer networking

PALS (systematic)

Owen-DeSchryver, J., Carr, E., Cale, S., & Blakeley-Smith, A. (2008).

Peer Support Strategies

http://kc.vanderbilt.edu/pals/

NPDC on ASD Checklist

http://autismpdc.fpg.unc.edu/content/peer-mediated-instruction-and-intervention

PMI- Systematic planning for implementation

Students

Activity Target skills Teaching/ Prompting

Peers to be included

Jill Lunch Initiate and maintain appropriate conversations with peers

Picture supports

2 Females

Corey Lunch Utilize typical interpersonal skills during a conversation with peers (space, facing speaker, appropriate volume)

Scripts 2 Male

Reese Lunch Maintain age-appropriate conversations with peers

Scripts with instruction for redirection

1 Female, 1 Male

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AT – Used to support or enhance the functional

capabilities of individuals with disabilities

May include computer-assisted instruction, mobility devices,

high and low tech adaptations, and AAC

AAC – Supporting existing speech or developing

independent use of a non-speech symbol system

May include sign language, PECS, voice output devices

• National Research Council (2001)

Augmentative/Alternative Communication (AAC) Assistive Technology (AT)

What evidence-based practice to use?

One size does not fit all!

Consider:

The student’s needs

The student’s learning style, temperament, and interests

Your program strengths/needs

Supports already in place

History of what has and has not worked

Your professional knowledge

Adapted from Odom, S. & Cox, A. (2009)

Data Based Decision Making

Let data be your guide to practices that are effective

for each student.

Baseline

Intervention

Maintenance

Alberto & Troutman, 2009

Summary

Identify and use evidence-based practices

Identify an area of individual student need

Consider the research base of practices that address that

need by consulting national resources and professional

journals

Match the practice to the needs of each individual student

Make decisions on efficacy from data