the center for community inclusion and disability studies at the university of maine with autism now...

8/6/2019 The Center for Community Inclusion and Disability Studies at the University of Maine with Autism NOW April 19, 2011

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Social development maternal imitation

Active participation in intensive instructional programming for a minimum of a fullschool day, 5 days (at least 25 hours) a week.

IT MAY HELP TO LOOK AT SOME OF THE THINGS THAT YOUNG CHILDREN WITH

AUTISM STRUGGLE

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Learn things not just in one environment, with one teacher, and in response to a

specific prompt. Need to learn to use of skills spontaneously. Need to learn the

social context of skills.

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All these things seem to be related. Not surprising. Development is a complex

process.

Relationship between imitation of actions and play skills.

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Joint attention can be taught.

Whalen & Schreibman (2004) Following baseline, all five children weresuccessfully taught to respond to joint attention initiations

from the experimenter and four of the children were taught

to initiate protodeclarative pointing and coordinated joint

attention.

WhalenL Following

participation in the intervention, positive collateral changes

were observed in social initiations, positive affect, imitation,

play, and spontaneous speech.

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ABA. Reinforce the behavior. Most joint attention teaching takes place at a table rather than

in naturalistic settings. Tend to focus on skills rather than engagement (Kasari, 2010))

Kasari (2010) Whalen and Schreibman (2003) demonstratedthat an interventionist could teach joint attention skills ofpointing and gaze shifting to five preschool children withautism. However, the generalization of the skills to interactionswith an untrained adult (the mother) was limited totwo of the five children demonstrating joint attention in thiscontext. Other studies note similar effects of the jointattention training with some success in the acquisition ofspecific targeted joint attention skills but less success ingeneralization of these skills to mothers or teachers (Joneset al. 2006; Martins and Harris 2006).

Possibly because skills are taught in overly structured, contrived settign. Whalen andSchreibman (2003) demonstratedthat an interventionist could teach joint attention skills ofpointing and gaze shifting to five preschool children withautism. However, the generalization of the skills to interactionswith an untrained adult (the mother) was limited totwo of the five children demonstrating joint attention in thiscontext. Other studies note similar effects of the jointattention training with some success in the acquisition ofspecific targeted joint attention skills but less success ingeneralization of these skills to mothers or teachers (Jones

et al. 2006; Martins and Harris 2006).

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3 to 4 years of age.

During this session the targeted skill was still shaped using techniques of systematic prompting and

reinforcement, but on the floor, the experimenter used naturally occurring opportunities, similar tomilieu teaching (Warren & Kaiser, 1986; Koegel, Koegel, & Carter, 1999). Principles applied on thefloor included following the childs lead and interest in activities, talking about what the child wasdoing, repeating back what the child said, expanding on what child said, giving corrective feedback,sitting close to the child andmaking eye-contact, and making environmental adjustments to engage the child. The floor session waschild-driven rather than adult-directed, and environmental manipulations were strategically used tofacilitate the childs social and communicative attempts. Based on other research findings (Lewy &Dawson, 1992; Ninio & Bruner, 1978; Tomasello & Farrar,1986), two other strategies were also applied. One strategy was to imitate the childs actions on toys,and a second strategy was to use the childs activity interests to develop play routines.

Children in the joint attention group initiated more shows and greater improvement in responding tojoint attention, and children in the play group showed greater

diversity of play (types) and more sophistication ofplay (play levels).

2006 - Both joint attention and symbolic play groups showed improvements in joint attention andplay compared to control. Those with lower expressive scores to start made more significant gains inJA group. JA seems especially important for those with low initia expressive scores.

In the current study, we focused our intervention on the development of play routines in whichthe adult could follow in on the childs interests, maintain and then expand upon their play activities.These expansions encouraged longer topics in which children had more opportunities tocommunicate. Finally, because we found that children with the least amount of language benefittedthe most from the joint engagement intervention (Kasari et al. 2008) we focused our efforts ontoddlers whowere expected to have minimal language abilities

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Motor imitation and language gestural imitation and expressive language; Motor

imitation at age 2 and language abilities at 4.

Imitation and play skills. Research suggests ability to imitate both functional and

symbolic actions is related to the development of play skills.

Imitation and joint attention even when controlling for developmental age or IQ.

In fact, researchers who taught imitation skills to children saw an increase in joint

attention.

In a more direct analysis of the relationship,Ingersoll and Schreibman (2006)

demonstrated that teaching object imitation skills to young children with autism

increased coordinated joint attention. Interestingly, Whalen, Schreibman, and

Ingersoll (2006) found that training joint attention initiations (coordinated joint

attention, showing, and pointing) in young children with autism resulted in

increases in object imitation. These findings suggest that in autism, imitation and

joint attention behaviors are related and increases in one positively affect the

other. It may be that joint attention and imitation, particularly with objects, both

involve triadic engagement and that either one can support the use of the other.

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Although this method is successful for teaching verbal and nonverbal imitation in a

controlled setting (Baer, Peterson, & Sherman, 1967; Lovaas, Berberich, Perloff, &Schaeffer, 1966; Metz, 1965), it has been criticized for several reasons. First, the

adult-directed nature of the instruction and tight stimulus control can compromise

the spontaneous use of skills (Carr, 1981). Second, the highly structured teaching

environment (Lovaas, 1977) and use of artificial reinforcers (Koegel, O'Dell, &

Koegel, 1987) can prevent generalization to the natural environment (eg, Spradlin &

Siegel, 1982). Third, imitation is taught in isolation, rather than in the context of co-

occurring social communicative behaviors, making it unrepresentative of natural

adult-child interactions, and potentially limiting its use by parents and other family

members (Schreibman, Kaneko, & Koegel, 1991). Only learning function isimitation itself.

Lewey *& Dawson (1992) contingent imitation led to

s

Some research suggests that most children are motivated by social rewards of

Teaching social functions of imitation in context may be important.

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Kasari (2008) found that pre-schoolers with ASD made similar progress in joint

attention regardless of whether they received direct instruction in symbolic play or in

joint attention.

Social communication development predicted by early ability to play especially

symbolic play.

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Natural contexts Things like imitation and joint attention involve the use of skills

but those skills only have meaning in social contexts. Learning to point in response to

a specific prompt is very different from using a point socially. Similarly, imitation forthe sake of imitation is not that valuable a skill. If it is incorporated into play with

peers, however, it becomes a tool that can be used to help the child develop socially.

See Social Function of Imitation

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Confusion because much of the group research looking at overall outcomes fro groups ofstudents getting a specific kind of ABA is EIBI Lovaas, discrete trial. Evolved a great dealsince then. Also tons of research showing that children with ASD can learn specific behaviors

using ABA methods

Corsello: Contemporary behavioral: These methodologies have commonalities, includingteaching within natural contexts (during play, snack, work,within the classroom, at home), the use of natural reinforcers (reinforcing children forrequesting by giving them what they areasking for), and systematic trials that are initiated by the child (the child makes the initialattempt). Contemporary behavioral approaches have resulted in good outcomes for teachinglanguage content,

Naturalistic - A variety of strategies that closely resemble typical interactions and occur innatural settings, routines and activities. Odum, ColleteKlingenberg, Rogers, &Hatton,(2010

Corsello (2005) One common feature of developmentalinterventions is that they are childdirected.In developmental interventions, theenvironment is organized to encourage orfacilitate communicative and social interactions.The child initiates and the adult responds.

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Value of Lovaas study: Kids can learn and improve.

Also tons of research showing that children with ASD can learn specific behaviorsusing ABA methods

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Smith et al. (2000 and 2001) found significant improvements only for those with PDD-NOS

Reichow and Wolery (2009) Without comparisons

between EIBI and empirically validated treatmentprograms, it is not possible to determine if EIBI is more orless effective than other treatment options.

Reichow and Wolery only 2 of thirteen studies they reviewed used true experimentaldesigns.

Meta-analysis revealed that IQ was the only area that had a strong effect size. Also

The analyses of effect sizes suggest children with autismreceiving EIBI made large gains on multiple domains ofbehavior, and made better progress than children withautism who receive less intense behavioral intervention or

other treatments. Although the results appear to suggest most individualsmade progress across all domains, this conclusionis not permitted by the data. Individual data typically werenot presented, therefore, it is unclear if individuals makingchange in one domain (e.g., IQ) also made gains in another(e.g., adaptive behavior). Also, the outcomes were measurednarrowly; thus, functioning across relevant domainswas not measured in depth or breadth. Further, for themean change effect sizes, no controls existed for maturation.Thus, while the effect sizes were often large, theycannot be attributed to EIBI exclusively.

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From ICAN: Teachers arrange the environment by placing preferred toys and

activities of each student within sight, but not within reach, to encourage the student

to initiate teaching sessions based on preplanned learning objectives. Once the childshows an interest in the materials by gesturing or requesting an item or activity, the

teacher prompts an elaboration on the initiation. The child subsequently obtains the

desired item upon generating the elaboration. For example, a student may say,

barn, to request a toy barn, followed by the teachers question, what color barn?

When the student says, red barn, she is allowed to play with the barn for a couple

of minutes. A nonverbal student might work on the skill of asking for help using a

gesture. For example, the teacher could place the childs favorite toy, a dump truck, in

a plastic container that the child could not open. Once the child attempts to open the

box, the teacher physically prompt him to hand the box to her for help.

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Show significant reductions in autistic symptoms after two years of intervention while

comparison children not participating in LEAP do not;2. Make marked developmental progress on intellectual and language measures,

while comparison children not participating in LEAP do not;

3. Are far more socially engaged and appropriate; and

4. Maintain gains (through college age) with no signs of developmental regression (cf.,

Hoyson et al., 1984; Kohler & Strain, 1997; Sainato, Goldstein, & Strain, 1992; Strain,

1987, 2001, Strain & Hoyson, 2000).

Each autistic child has an individually designed educational plan, which includes the

mainstream curriculum, as well as specific objectives, behaviours and social

interactions.The mainstream curriculum is supplemented with learning activities and

instructional strategies specifically designed to facilitate the development of

functional skills, independent play and work skills, social interaction skills, language

skills and adaptive behaviour.

WALDEN program also uses ABA in inclusive classrooms.

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For the last five years Dr. Strain and his colleagues (particularly Ted Bovey) have

conducted what is the largest randomized trial of early intervention in the autism

field. It is also the first early intervention randomized trial of a school-based modeland the first randomized evaluation of inclusive services for young children with

autism.For this study, a clustered randomized design was employed in which 28

inclusive preschool classrooms from across the US were randomly assigned to receive

two years of training and coaching to fidelity in the LEAP preschool model and 28

inclusive classes were assigned to receive intervention manuals only. In total, 177

intervention classroom children and 117 comparison classroom children participated.

Children were similar on all measures at start. After 2 years, experimental class

children were found to have made significantly greater improvement than their

comparison cohorts on measures of cognitive, language, social, problem behavior

and autism symptoms. This is the first RCT to show significant behavioral

improvement across all the defining characteristics of autism. Behavior at entry did

not predict outcome, nor did family SES. The fidelity with which teachers

implemented LEAP strategies did predict outcomes. Finally, social validity

measurement showed that procedures and outcomes were favorably viewed by

intervention class teachers.

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From ASAT: Studies have indicated that PRT may improve academic performance,

increase language and play skills, and reduce disruptive behavior in individuals with

autism.

Roll car. Roll ball. Throw ball.

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The SCERTS Model is a comprehensive, multidisciplinary, educational approach for individualswith ASD and related disabilities. SCERTS provides a scope and sequence of developmentallygrounded goals and objectives, as well as a framework and specific guidance for selecting

evidence-based strategies or elements of practice to meet these goals and objectives. Theresult is a comprehensive program for supporting children and their families that focuses onmeaningful, authentic progress within everyday routines at school, home, and in thecommunity.

Wetherby: 40 school study of its use in the classroom. RCT. Schools assigned to SCERTS orbusiness as usual. K-2

Wetherby and Lord: The major research objective is to directly compare two different parentinterventions: a parentimplementedintervention (PII) offered in 3 weekly sessions for 9 months using the SCERTS

model to teach parents how to embed transactional supports to target social communicationandemotional regulation within everyday activities for 25 hours a week; and an information,education and support group (IES) offered twice monthly for 9 months to teach parents howtosupport their childs communication, language, and play development and learning and tonetwork with other parents. Each site will recruit 20 children with ASD who are under 18monthsof age from three sources: 1) referrals for suspected ASD; 2) screening of high-riskpopulations,including younger siblings of children with ASD and children referred to early intervention

programs; and 3) ASD screening of children recruited by the FIRST WORDS Project from ageneral pediatric sample. Families will be randomly assigned to either PII or IES as the firstcondition beginning at 18 months of age and will receive the other condition beginning at 27months of age, totalling 18 months of intervention. The effectiveness of PII and IES will beexamined with growth trajectories of social communication and autism symptoms and groupoutcomes on verbal and nonverbal developmental level and adaptive behavior. The findings 24


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The Greenspan model is described as a relationship-based model, in which the goal

is to help the child develop interpersonal

connections that will lead to the mastery of cognitive and developmental skills,

including (1) attention and focus, (2) engaging and relating, (3) nonverbal gesturing,

(4) affect cuing, (5) complex problem solving, (6) symbolic communication, and (7)

abstract and logical thinking. The program is based on following the childs lead and

looking for

opportunities to close the circle of communication or respond in a way that leads to

expanding a skill or interaction.

Floortime is a specific technique to both follow the childs natural emotional

interests (lead) and at the same time challenge the child towards greater and

greater mastery of the social, emotional and intellectual capacities.

Self-regulation and interest in the world2. Intimacy or Engagement3. Two-way

Communication4. Complex Communication5. Emotional Ideas6. Emotional and

Logical Thinking

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Autistic individuals often have difficulty with receptive and expressive language,

sequential memory, and handling changes in their environment. The TEACCH method

provides the individual with structure and organization. This method relies on five

basic principles; a brief description of each is provided below.

A schedule or planner is set up which indicates what the person is supposed to do

and when it is supposed to happen. The person's entire day, week, and possibly

month, are clearly shown to the person through words, photographs, drawings, or

whatever medium is easiest for the person to comprehend.

The work system tells the person what is expected of him/her during an activity, how

much is supposed to be accomplished, and what happens after the activity is

completed. The goal is to teach the person to work independently. The work system

is also organized in such a way that the person has little or no difficulty figuring out

what to do. For example, the activity or task should be performed from top to bottom

and from left to right.

Routine that involves checking schedule or planner. System can be used throughout

lifetime.

Little emphasis on fading unlike ABA

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Remember the slide with all the arrows. We saw lots of things that seem to interact andaffect long term developmental outcomes joint attention, imitation, social engagement. Isthere anything that might underly all these things? Is there a way to pull it all together?

Similarity in interventions. Both groups included intervention that emphasized self-inititatedcommunication, child choice, motivating learning materils and activities, joint actioinroutines, natural reinforcers and play-based learning activities. Curriculum used by both alsohad joint attention and imitation goals. So both groups had curricula that focused on these.The intervention group had a supplementary curriculum.

Fifty toddlers with ASD, ages 21 to 33 months, were randomized to one of two six-monthinterventions: Interpersonal Synchrony or Non-Interpersonal Synchrony. The interventionsprovided identical intensity (10 hours per week in classroom), student-to-teacher ratio,schedule, home-based parent training (1.5 hours per month), parent education (38 hours),

and instructional strategies, except the Interpersonal Synchrony condition provided asupplementary curriculum targeting socially engaged imitation, joint attention, and affectsharing; measures of these were primary outcomes.

Instructional strategies for both conditions represented a continuum of adult-imposedstructure ranging from discrete trial teaching (Lovaas, 1987) to pivotal response training(Koegel et al., 1989) to routines-based interactions. Low-tech augmentative communicationsystems were used as needed. Visual cues (Carr, Binkoff, Kologinsky, & Eddy, 1978) andvisually based organizational strategies (Lord, Bristol, & Schopler, 1993) were provided.

While the AEPS included goals for joint attention and imitation, the IS group received manymore orchestrated opportunities to respond to and initiate joint attention, imitate othersduring social interaction, and share positive affect, with interventionists enticing andmodeling social targets, prompting as needed. More discrete breakdown of social targets waspresented within the IS than the AEPS curriculum. The IS physical learning environmentpresented frequent ecologically valid opportunities for initiating and responding to jointattention to proximal and distal objects, people, and events (e.g., placing thematically 28


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The IPG model was created by Pamela Wolfberg, Ph.D. out of deep concern for the manychildren who are missing out on peer play experiences as a vital part of childhood. The IPGmodel is grounded in current theory, research and practice pertinent to addressing core

challenges in autism that impact on both social and representational aspects of play. Whileinfluenced by the work ofVygotsky, this mullti-dimensional model encompassesdevelopmental and ecological features that are framed within sociocultural theory.Embedded in the model are practical tools and techniques for observing, interpreting, andbuilding on children's play interests and social communicative abilities, and for designingenvironments conducive to social and imaginative play.In practical terms, an IPG bringstogether children with autism (novice players) in mutually engaging play experiences withmore capable peer play partners (expert players) while guided by a qualified adult facilitator(play guide). Each IPG is individualized as a part of a childs comprehensive educational andtherapy program. Play sessions are tailored to the unique interests, developmental capacitiesand sociocultural experiences of novice and expert players. Guided by sensitive assessments,

the IPG intervention (guided participation) provides a system of support for maximizing eachchilds developmental potential and intrinsic motivation to play, socialize and formmeaningful relationships with other children. Equal emphasis is placed on guidingneurotypicals to be more accepting, responsive and inclusive of children who may presentdiffering ways of playing, communicating and relating with others. Further, novice and expertplayers are encouraged to mediate their own play activities with minimal adult guidance.

Equal emphasis is placed on guiding neurotypicals to be more accepting, responsive andinclusive of children who may present differing ways of playing, communicating and relatingwith others. Further, novice and expert players are encouraged to mediate their own playactivities with minimal adult guidance.

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Researchers cannot just

address a simple question about whether a treatment is

effective; they must specify clearly for whom and in what

context.40

For whom? What age, what level of skill, communication? What family

characterstics

To change a specific behavior? To teach a skill that will lead to a cascade of skill

acquisition? Pivotal skills. Joint attention, play, imitation.

In a highly controlled, structured setting with a university-trained graduate student?

In a regular classroom? At home?

Smith, Groen, & Wynn (2000), for example, in one of the only randomized clinical

trials of a comprehensive program, found that students with full syndrome autism,

as a group, made no significant progress in an EIBI program. An analysis of their

reported data reveals that only the group with PDD-NOS made significant progress.

reveals that only the group with PDD-NOS made significant progress. Individually,

only one student with autism in the study made significant progress. As Rogers and

Vismara point out, the group with autism actually had a 10-point average loss onstandard language scores.

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It is one thing to say an intervention works or that there is research saying that it

works.

It is quite another to say that A is more effective than B. On top of we cannot say

that something that works for one child will work for another.

This research simply has not been done. Anyone who says it has either does not

know the literature or is misrepresenting it.

tic reviews of psychosocial interventions for autism:

an umbrella review

JENNIFER KREBS SEIDA MPH1 | MARIA B OSPINA MSC1 | MOHAMMAD KARKHANEHMD1 |

LISA HARTLING MSC1 | VERONICA SMITH PHD2 | BRENDA CLARK MD3

Developmental Medicine and Child Neurology

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