ps 572 prompt presentation lit rev
TRANSCRIPT
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Overview Article summary
Search terms and parameters
Critique
Guidelines for evidence-based practice
References
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Journal article summary Teaching young nonverbal children
with autism useful speech: A pilot
study of the Denver Model andPROMPT Interventions
Rogers, S., Hayden, D., Hepburn, S.,Charlifue-Smith, R., Hall, T., & Hayes, A.
(2006)
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Introduction Children with autism have significant
deficits in speech and language
production Language proficiency as an indicator for
predicting outcomes
Many interventions focus on
language acquisition
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Two approaches have been usedhistorically:
1. Discrete trial teaching
Didactic, adult-directed instruction deliveredfrom a pre-set curriculum often taught in
massed trials (Rogers et al., 2006) After initial discrete trials, more complex language
skills are taught through associative learning
Motivation is provided through external rewards
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2. Naturalistic teaching methods (I.e.,natural language teaching, incidentalteaching, or pivotal response training)
Child-initiated behavior in a natural interactivecontext (Rogers et al., 2006)
Incorporates modeling, shaping, and naturalreinforcers
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Differences between DTT
and naturalisticapproaches
Adult-directed v. child-directed
Individualization of each learning
opportunity
Type of reinforcement
Role of child as initiator
Degree of generalization promotion
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Both are behavioral approaches
Language impairment for children withautism is a developmental disorder
Developmental interventions (Prizant) focuson:
Social engagement
Imitation skills
Means-ends concepts Understanding language
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The Denver Model A developmental approach to language
acquisition Specific developmental curriculum
Individualized
Based on discrete trials, naturalistic teachingmethods, and dyadic exchanges
Teaching based on attention to bothteaching techniques and interpersonal
relationships (Rogers et al., 2006) Can be implemented in inclusive
classrooms, individual therapies, or 1:1
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The Denver Model (cont.) Only 1 aspect of model implemented
in current study (the communication
curriculum) Frequency: 1x/week, 50-min. session;daily home review by parents
Why?: typical of area programs
Description of session: naturalistic
social-affective teaching interactions(sensory social routines) alternatedwith didactic instruction
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Structure of sessions: Highly motivating social games and activities
Naturalistic teaching High frequency of social interactions
Imitation of actions (objects, body parts, oral-facialmovements, speech sounds)
Massed trials and naturalistic teaching
Receptive understanding (simple instructions)
Naturalistic teaching
Object associations Matching (objects-pictures, pictures-objects)
Verbal approximations Naturalistic teaching
Modeling, shaping, and reinforcement Put in a notebook with goals and objectives,
lesson plans, and data
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PROMPT Therapy PROMPT = Prompts for Restructuring Oral
Muscular Phonetic Targets
Based on neuromotor principles of speechproduction (Chumpelik (Hayden), 1984)
Use of touch can:
Develop, rebalance, or re-establish speech motorcontrol
Provide a foundation for integrating sensory
modalities in developing concepts and expressivelanguage
Enhance social-emotional interaction and trustbetween clinician and client (Rogers et al., 2006)
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Elements of PROMPT Use of tactile-kinesthetic information as a
critical modality for recognizing,developing, re-balancing, and integrating
cognitive, linguistic, and motor behavior Determining a Communication Focus or an
aspect of development in which to embedand focus communication intervention
Developing goals and embeddingobjectives that embody the CommunicationFocus whil working on motor/language,cognitive, and social function
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Elements of PROMPT
(cont.) Analyzing the global and speech motor sub-systems to
determine three priority areas that need immediatedevelopment or rebalancing and create an initial,functional lexicon (core vocabulary)
Deciding on the purpose of prompting and what typesof prompts should be used to support and developmotor control for speech and language and/orinteraction and cognitive development
Concrete understanding of how chosen goals and
objectives will directly affect motor resourcing and,therefore, materials, activity choices
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Elements of PROMPT
(cont.) Insuring that a high degree of motor-sound
practice (using prompts for accuracy of production)and generalization of these into novel syllables and
words within naturalistic activities are used withineach session
The inclusion of reciprocal interaction or choice-making, in all activities, in almost every turn.
Presentation of the same or similar activities over
time to provide a structure in which increasedmotor-language complexity and cognitive learningof events and sequences may be practiced.(Rogers et al., 2006)
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PROMPT in use Initially, use play-based activities,
wait for child to initiate, and require
a sound production Then, use vocal modeling and manual
manipulation (of jaw, lips, or otherspeech mechanisms) while child
vocalizes Fade tactile prompts to visual prompts
(of hands moving)
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The Denver Model v.
PROMPT Similarities
Developmentally-based
Focus on sharedattention and socialinteractions
Use naturalisticteaching methods
Match activities todevelopmentallevels
Initially, adult-structured
Differences
Organization ofevaluation data
How goals andobjectives are chosen
Organization of motorsystems towards tasks
Use of imitation v.tactual-kinesthetic
prompts
How tasks are taught
How programs aremodified
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Present study Purpose
Develop the methods and tests of both
models for developing speech in non-verbal pre-schoolers with autism
Gather empirical support for bothapproaches
See if typical frequency of speechsessions with daily parent review wouldbe sufficient in producing speech
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Participants
10 children (aged 20-65 months)
Recruited through clinic specializing intreatment of ASD & parent-groups
Criteria for participation:
Diagnosis of autism Spontaneous functional use of less than 5 words
per day
From parent reports and clinical observations
Developmental quotient of >30
No co-morbid conditions
NOTE: All participants received varyinglevels of outside therapies
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Setting
2-room suite w/ one-way mirror
University of Colorado Autism andDevelopmental Disabilities ResearchLaboratory
All sessions videotaped
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Design
ABA design (replicated 9 times) Pre- and post-treatment tests
Diagnostic, developmental, and speech-languageassessments
10-min. speech samples in baseline, treatment,
and maintenance phases
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Procedure Pre-treatment assessments Autism Diagnostic Observation Scale (ADOS) Social Communication Questionnaire (SCQ)
Mullen Scales of Early Learning
Vineland Adaptive Behavior Scales
MacArthur Communicative Development Inventory(CDI)
Previous intervention history (through parentinterview)
Type of treatment, staff:student ratio, hours in therapy
Background information
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Baseline Baseline speech probes (x3)
15-min.
Examiner put out a new toy every 5 min. andencouraged child to play with it
Play partner instructed not to initiate anyactivities
Made statements regarding childs play
Examiner asked for 1 request and 1 episode
of joint attention
Scored # of words and # of phrases emitted
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Treatment Children randomly assigned to
Denver Model or PROMPT
Received 1 hr./ week therapy (12weeks)
Denver Model: parents present duringsession
Taught to implement one new skill in each of4 areas and had them practice
Asked to implement procedures for 45 min.per day
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PROMPT
Parents observed sessions via video
Parents asked to practice new words orapproximations
Not required to manually prompt any responses
Asked to implement procedures for 30 min. perday
Family decided how to incorporate practice intodaily routines
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Procedure (cont.) Speech samples
Each session was videotaped; a 10-min. samplewas randomly selected from each session
Data collection
# of novel words or approximations
# of novel phrases
Function of communication (I.e., joint attention,
social interaction) Spontaneous v. prompted
Summarized in graphs at end of the study
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Post-treatment
3 weeks after completion
Same assessments as in pre-treatments
Three month follow-up
Used to score childs functional use ofspeech
Identical to speech probes in baseline
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Treatment integrity 2 independent speech therapists trained up
to fidelity on both interventions
Likert scales developed for both
Developers of scales viewed videotapes regularly,visited quarterly, and supervised (by phone)monthly
Scored at 85% or better for 25% ofsessions
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Results
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Results (cont.) 8 of 10 participants engaged in functional
use of at least 5 novel words
Generalization probes showed less use Reasons? Not enough sessions (12)
Sessions not targeted for generalization andmaintenance
Generalization sessions looked at too many novelfeatures
Children not spontaneous enough
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Results (cont.) Overall gains
Significant gains = score of 2 or 3 on ADOS inpre-treatment, score of 0 on post-treatment
Significant gains observed in both interventions
Denver Model: more in imitation skills
PROMPT: more in functional play skills
Generalization
9 of 10 participants used novel words at homeafter treatment
Based on parent report
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Discussion Purpose was preliminary tests of
interventions
Experimenters urge more research More replication and extensions
8 participants generated some newspeech, 4 generated novel phrases,2 used phrases in generalizedmanners (novel statements in novelsettings)
Positive parent feedback
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Limitations Children already in a developmental period
where language is observed to accelerate
Gains observed were still consideredlimited compared to typical children
Better gains observed for participants withhigher levels of parent involvement
Parents provided extra practice opportunities
than what was specified Implementation monitored by parent report
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Limitations (cont.) Direct comparison of 2 interventions wasimpossible Too many similarities
Participants differed from one another (age,mental ages, expressive language capabilities)
Many components to each treatment
Limited generalization and maintenance data
Children were receiving outside therapies
concurrently No IOA
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Future research Obtain similar participants
Control for effects of treatment
Component analysis of eachtreatment
Control for more extraneousvariables
I.e., outside therapies
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Search parameters
JABA
PsycINFO
Google
First, attempted PROMPT Therapy 0 in JABA; mixed results in PsycINFO, 8060 on
Google
Link for www.promptinstitute.com
Tab for research; provides a research summary
No articles mentioned were peer-reviewed Out of 6 articles mentioned 2 unpublished research, 2 conference proceedings, 2 manuals
authored by Hayden
Other links to research were all presentations givenby Hayden or colleagues
1 study available (Rogers et al.)
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PROMPT: Introduction to Technique: AManual (2006)
References section
Chumpelik--3 articles (2 unpublished, 1theoretical)
Hayden--11 articles (0 research studies)
Guides, manuals, assessments, etc.
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Rogers et al. study (Hayden co-
authors)References section
Looked at all research containingPROMPT
5 references (all Chumpelik or Hayden) All unpublished, theoretical, or conference
proceedings
Google search for entire titles of all
possible research studiesNone available
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ASAT online Research Summary: One small study indicatesthat an oral-motor therapy, PROMPT, may beefficacious in establishing early language skills innonverbal children with autism (Rogers et al., 2006).There have been no other peer-reviewed scientific
studies on Oral-Motor Training or Therapy forindividuals with autism spectrum disorders. (2008)
Recommendations: Researchers may wish toconduct studies with strong scientific designs toevaluate Oral-Motor Therapies. Professionals shouldpresent Oral-Motor Therapies as under-researched
and encourage families who are considering theseinterventions to evaluate them carefully. (2008)
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Does PROMPT have enough
evidence to support its use? Gina Greens gold standards for evidencebased practice At least 3 between group designs demonstrating
efficacyNO
At least 3 single case designs demonstratingefficacyNO
At least 3 investigators needed for corroborationNO
Documentation of: How participants were obtainedYES
Continuous measurement of DVNO
Calibrated data collectionNO
Inter-observer agreementNO
Procedural integrityYES (25% of sessions)
Operationally defined baseline conditionYES
Treatment effectsNO
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Conclusions?
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References Rogers, S., Hayden, D., Hepburn, S., Charlifue-Smith, R., Hall,
T., & Hayes, A. (2006). Teaching young nonverbal children withautism useful speech: A pilot study of the Denver Model andPROMPT interventions. Journal of Autism and DevelopmentalDisorders, 36, 1007-1024.
Hayden, D. (2006). PROMPT: Introduction to Technique: AManual. Santa Fe, NM: The Prompt Institute.
Association for Science in Autism Treatment (2008). RetrievedJune 11, 2008, fromhttp://www.asatonline.org/resources/treatments/oral.htm
The Prompt Institute (2008). Retrieved June 11, 2008 fromhttp://www.promptinstitute.com
Green, G. (2008). Evaluating Evidence about Treatments forAutism. Presentation for Applied Behavior Analysis InternationalConference, San Diego, CA.