Online Briefs & Learning Modules for Evidence-Based Treatment Strategies

The National Professional Development Center on Autism Spectrum Disorders holds an impressive wealth of information and resources for evidence-based practices for children with autism. We wanted to share their website as a resource to both parents and providers, since evidence-based strategies are so important in devising a home or school-based program for students with ASD. Specifically, we found the online learning and training modules by the NPDC on ASD to be extremely useful and – even better – accessible to anyone online.

For the following evidence-based practices (EBP), the NPDC on ASD has developed briefs with the following components:

  • Overview of the practice
  • Step-by-step instructions for implementation
  • Checklist to document the degree of implementation
  • References that support the efficacy of the practice

Each brief package comes in downloadable PDF formats for easy saving and printing. Some practices also come with downloadable data collection sheets and supplemental materials for teachers to use.

EBP Briefs 1

Additional resources provided by the NPDC on ASD include Learning Modules to accommodate children in early intervention (birth to 3 years).  The 10 Learning Modules touch upon:

  1. Discrete Trial Training (DTT)
  2. Functional Communication Training (FCT)
  3. Naturalistic Intervention
  4. Parent-Implemented Intervention
  5. Picture Exchange Communication System (PECS)
  6. Pivotal Response Training (PRT)
  7. Prompting
  8. Reinforcement
  9. Structured Work Systems
  10. Time Delay

Each module includes a pre-assessment, objectives, an overview of the evidence-based practice, detailed information about the use of the EBP, step-by-step instructions for implementing the practice, case studies, a summary, a post-assessment, frequently asked questions, and references at the end.

EBP Briefs 2

For more information on the NPDC, visit their website at www.autismpdc.fpg.unc.edu

Pick of the Week: NEW! Executive Function Curriculum Books

How can you help kids with autism be flexible, get organized, and work toward goals – not just in school but in everyday life? It’s all about executive function. This week, we’re offering 15% off* our newest books on teaching executive function: Unstuck & On Target: An Executive Function Curriculum and Solving Executive Function Challenges. Just use our promo code EXECFXN at check out to redeem these savings!

Unstuck_and_On_TargetThese practical resources for parents, teachers, and therapists help high-functioning students with autism improve on these critical skills.

Unstuck & On Target! is a robust classroom-based curriculum book that will help educators and service providers teach these executive function skills to high-functioning students with autism through ready-to-use lessons that promote cognitive and behavioral flexibility. This curriculum gives clear instructions, materials lists, modifications for each lesson, and intervention tips to reinforce lessons throughout the school day. Topics touched upon include flexibility vocabulary, coping strategies, setting goals, and flexibility in friendship, all introduced and reinforced with evidence-based lessons. Lessons will target specific skills, free up the instructor’s time, fit easily into any curriculum, ensure generalization to strengthen home-school connection, and best of all, make learning fun and engaging for students in the classroom.

Unstuck & On Target! also comes with an accompanying CD-ROM that contains printable game cards, student worksheets, and other materials for each lesson. The curriculum is targeted for students with cognitive ability and language skills ages 8-11.

Solving_Executive_Function_ChallengesSolving Executive Function Challenges is a strategy guide that offers teachers and caretakers various ways to teach EF skills, including setting and achieving goals and being flexible, as well as ideas for accommodations and actions to address common problems (e.g. keeping positive, avoiding overload, coping, etc.).

To be used with or without the robust curriculum Unstuck and On Target!, this strategy guide aims to show how to embed executive function instruction in everyday scenarios with specific examples, samples IEP goals, and scripts and worksheets that break down tasks into manageable chunks. This guide is appropriate for learners in grades K–8.

Don’t forget – you can save 15%* this week only on these new executive function books by applying promo code EXECFXN at check out!

*Offer is valid until 11:59pm EDT on October 7th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Guest Article: “Promoting Socialization in Children with Autism Through Play” by Julie Russell

We’re so pleased to bring you this guest post by Julie Russell, Educational Director at the Brooklyn Autism Center (BAC). BAC is a not-for-profit ABA school serving children aged 5–21. Here, Julie describes specific, simple strategies for promoting socialization in children on the spectrum.

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Promoting Socialization in Children with Autism Through Play
by Julie Russell, Brooklyn Autism Center

Socialization – defined as a continuing process where an individual acquires a personal identity and learns the norms, values, behavior, and appropriate skills – is a vital part of life. It is also a particularly difficult skill for individuals with autism. Children with autism often struggle with initiating conversation, requesting information, making contextual comments, and listening and responding to others. These difficulties can interfere with the development of friendships for children on the spectrum.

The best way to improve socialization in children with autism is to emphasize play. There are several strategies to teach play skills to children on the spectrum that can help them improve socialization and develop friendships.

One method of teaching socialization is to condition the typically-developing peer as a reinforcer by pairing the peer with items and activities that are reinforcing for the child with Autism. The peer can give the child with Autism a preferred edible or join in on a preferred activity for the child with autism. If Ben’s (the child with autism) favorite edible is Twizzlers and his preferred activity is completing a puzzle, Adam (his typically developing peer) can offer Ben a Twizzler and join in on completing the puzzle. The typically developing peer is then associated with both the preferred edible and the preferred activity, making Adam a reinforcer for Ben.

This method is a great way to make the peer more desirable for the child with autism. The items or activities used for conditioning should only consist of items/activities that the child with autism already enjoys. When trying to introduce a new item or activity to the child with autism, peers should not be included right away. Trying to teach how to play with the item and the peer simultaneously can be confusing and over-stimulating for the child with autism. The child with autism should first be taught how to play appropriately with the age-appropriate activity during individual instruction, and then the peer can be included in the activity once mastery of the activity has been demonstrated.

Another way to promote socialization is to engage the child with autism in cooperative games, or any activity that requires interaction where each child has a role that is needed in order to complete the activity. This way, the motivation to engage with the typically developing peer will be higher. When teaching the child with autism how to play cooperative games, such as board games, you can include teaching skills that target turn taking and sharing. Children with autism (or any child) may have difficulties with giving up preferred items/activities, so these may be challenging skills to teach. In order to teach these skills with success, begin by having the child with autism share and take turns with non-preferred items/activities, then gradually fade in more highly preferred items to take turns and share.

Evidence-based practices such as social stories, peer modeling, and video modeling are also excellent methods to promote socialization in children with autism. Reading social stories and watching “expert” peers interact will allow children with autism to view and understand appropriate behavior before interacting with a new peer or practicing skills such as turn-taking, requesting information, and listening and responding to others.

All of the above methods of promoting socialization are used in Brooklyn Autism Center’s after school program BAC Friends, which pairs our students with typically developing peers from neighboring elementary and middle schools. We also provide additional opportunities for our students to practice peer socialization (along with academic work) during our reverse inclusion program with Hannah Senesh Community Day School. These methods combined with enthusiastic peers have helped our students improve their socialization skills and develop meaningful friendships.

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WRITTEN BY JULIE RUSSELL, MS, BCBA

Julie holds an M.S. in Applied Behavior Analysis from Simmons College in Boston, Massachusetts and received her BCBA in 2009. She has over 10 years of experience working with children with autism and related developmental differences in centers, schools, school districts and home-based programs. Julie received her supervision hours for board certification in behavior analysis by Dr. Nathan Blenkush, Ph.D., BCBA from JRC in Boston, Massachusetts. She was a Clinical Supervisor at ACES (Center for Applied Behavior Analysis) in San Diego California and Clinical Supervisor at the ELIJA School in Levittown, NY before joining the Brooklyn Autism Center as Educational Director.

Pick of the Week: “Classifying with Seasons” Fun Deck – Teach time concepts with match-up games and more

Classifying with SeasonsWinter, Spring, Summer, or Fall… What happens in each season and what do you need for it? With the changing season and cooler days, we thought it was the perfect time to share our newly added Classifying with Seasons Fun Deck as our Pick this week. The Classifying with Seasons Fun Deck contains 13 illustrated cards for each season, depicting holidays, activities, clothing, and weather that might occur. This week, take 15% off* your set of Classifying with Seasons by entering our code CLASSIFY at check out!

Use the Classifying with Seasons Fun Deck to teach time concepts, categorizing, and more. These cards come in a sturdy tin, and make great match-up games, as well as conversation and story starters.

Fall Examples

This week only, don’t forget to save 15%* on your deck of the Classifying with Seasons cards by entering promo code CLASSIFY at check out!

*Offer is valid until 11:59pm EDT on September 30th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Tip of the Week: Altering the Teaching Environment to Address Problem Behaviors

A few years ago, I went in to observe an ABA therapist I was supervising. She was working with a ten-year-old girl with Aspergers. One of her goals was to increase eye contact during conversation, but her student wasn’t making much progress in this area. She had consulted the research and was considering a new behavior intervention plan, and wanted my input before doing so.

junior school classroom at the German School in Ham, by 3S Architects. Image shot 2006. Exact date unknown.The first thing I noticed when I walked in to observe was that she did her entire session at a long wooden table, sitting side-by-side with her student. After watching for about ten minutes, I asked if we could change the seating arrangement. We moved her student to the end of the table, then had the therapist sit next to her, but on the perpendicular side. This way, eye contact was much easier as they were able to face each other. The student’s eye contact improved instantly with a small environmental change. (Of course, once we made the environmental change, we worked together to address other changes that could be made to encourage eye contact.)

Environmental changes can be a quick and simple solution to some problem behaviors. Here are some questions to consider in order to alter the environment effectively:

  • Is it possible that a change in furnishings could change the behavior? For example, moving a child’s locker closer to the classroom door may decrease tardiness, putting a child’s desk in the furthest corner from the door may decrease opportunities for elopement, or giving your child a shorter chair that allows them to put their feet on the ground may decrease the amount of times they kick their sibling from across the table. You may also want to consider partitions that allow for personal space, clearly-marked spaces for organizing materials, proximity to students and distractions (such as windows or the hallway).
  • Can you add something to the environment to change the behavior? For example, your student may be able to focus better on independent work if you provide noise-cancelling headphones, line up correctly if a square for him/her to stand is taped to the floor, or your child may be more efficient with completing chores if they’re allowed to listen to their favorite music while doing so.  I’ve also seen some cases in which the teacher wears a microphone that wirelessly links to a student’s headphones, increasing that student’s ability to attend to the teacher’s instruction.
  • Will decreasing access to materials impact the behavior? For example, removing visuals such as posters and student work may increase your student’s ability to attend or locking materials in a closet when not in use may decrease your student’s ability to destroy or damage materials.
  • Will increasing access to materials impact the behavior? For example, making a box of pre-sharpened pencils may decrease the behavior of getting up frequently to sharpen pencils. (I recently visited a classroom in which the teacher put pre-sharpened pencils in a straw dispenser on her desk, and each week one student was assigned the job of sharpening pencils at the end of the day).

Whenever you do make changes to the environment, you may want to consider if the changes require fading. For example, if I make a square on the floor out of tape to teach my student where to stand in the line, I will want to fade that out of over time to increase their independence.

A final consideration is that whatever impact you expect the environmental change to have should be clearly defined and measured. Take data to ensure that the intervention is working so you can make adjustments as necessary.

For more detailed information on modifying environments, there is a great article from the Council for Exceptional Children by Caroline A. Guardino and Elizabeth Fullerton entitled “Changing Behaviors by Changing the Classroom Environment.” Click here for the article.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, she has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

States Begin to Include ABA Coverage

It looks like progress is being made on getting treatments such as ABA covered by insurance. Disability Scoop is reporting that states are finally starting to include coverage of treatments like Applied Behavior Analysis for children with autism under Medicaid. This means that states must cover services consistent with the categories defined by Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). This includes Applied Behavior Analysis, speech and occupational therapies, and other personal care services.

Read the full article here.

Has anyone in CA, NV, and CT had success with getting services like ABA covered?

 

 

 

Simplifying the Science: Parent-Conducted Toilet Training for Kids with Autism

For many of the families I work with, toilet training their child with autism becomes a long, painful process. I typically recommend the Rapid Toilet Training (RTT) protocol developed by Azrin & Foxx (1971) but many parents struggle to maintain implementation without the presence of a behavior therapist or toilet training specialist. And while Azrin & Foxx’s results have been replicated in other studies, RTT has primarily been used in educational and outpatient settings, and the amount of time it has taken to complete toilet training has been longer than in the initial study.

This is why I was especially excited to come across the study by Kroeger & Sorensen (2010) about “A parent training model for toilet training children with autism,” which is based on Azrin & Foxx’s initial study with some key modifications. This study focuses on parent-conducted toilet training in the home and was completed with two children with autism.

As mentioned in previous blog posts, the best interventions usually are multi-pronged approaches. This is no different. While there are multiple steps involved, it’s important to recognize that one of these children was fully toilet trained in 4 days, and the other in 11 days. Both children maintained toilet training skills when researchers checked in at 2 weeks, 6 months, and 3 years. Setting aside a few days or a couple of weeks to complete this intensive protocol may be intimidating at first, but achieving similar results as the two children in the study has a huge impact on the life of your child and the entire family.

Prior to starting the intervention, they received medical consent and clearance from the children’s attending developmental pediatricians. They then performed a preference assessment (the RAISD) to determine reinforcers. The study then states that “The families were asked to restrict the children’s access to these reinforcers for a minimum of 3 days prior to implementing the intensive training treatment protocol.”

The intensive toilet training program had 5 components:

Increased fluids: In consultation with a pediatrician, the study states that “parents were instructed to increase the children’s access to fluids for 3 days prior to implementing the training.” This increase in fluid intake continued until 6:00 PM on the first day of training.

Toilet scheduled sitting: Since the protocol was completed in the privacy of the children’s homes, the children were able to remain undressed from the waist down while being toilet trained. The children were continuously seated on the toilet, then able to leave the toilet for voiding in the toilet, or for brief “stretching” breaks. As they achieved higher frequency of appropriate voiding in the toilet, the amount of time spent on the toilet decreased and the amount of time escaping the toilet increased. (The schedule for fading out time seated on the toilet is detailed in Table 1 of the study.) Also, while seated on the toilet, the child was able to play with preferred items, but not the most preferred items.

Reinforcement for continent voids: According to the study, “If the child successfully voided while on a scheduled sit, they were provided immediate reinforcement (primary edible reinforcement and planned escape to a preferred activity). If the child self-initiated a void while on a break, he was provided immediate reinforcement and a new break time was begun after the self-initiated break.”

Redirection for accidents: When accidents occur, a neutral verbal redirection was provided, such as “We go pee on the toilet” and then the child was physically redirected back to the toilet. Once they were on the toilet, a scheduled sit was begun.

Chair scheduled sitting: Once the child began to experience success with voiding on the toilet, a chair was placed next to the toilet. During scheduled sits, the child would sit on the chair. If he began to void on the chair, the study states that he “was provided with the least intrusive, minimal, physical prompt. When he independently moved from the chair to the toilet to void three consecutive times, the chair was systematically moved away from the toilet in 2-feet increments.”

The study goes into further detail on each of these five components, as well as how to generalize the skill and how parents were trained in the protocol. The study made modifications to the Azrin & Foxx study to make it easier to apply in the home setting for parents, and it removed any form of punishment.

While this is a comprehensive toilet training program that requires a high level of time and attention from the parents, it is set up to help parents achieve results in a relatively short period of time.

The study states, “Parents of incontinent children with developmental disabilities report higher personal stress and distress likely related to the toileting problems presented by their children than parents of toilet trained children with developmental disabilities. It could be deduced then that continence training not only increases associated hygiene factors and access to activities and placements, but also increases the quality of life for the parents by reducing stress and subsequently for other family members such as siblings as corollary recipients of the distress” (Macias et al., 2006).

The potential to improve the quality of life for both your child with autism and your entire family is worth the challenge of implementing this protocol.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Pilot Study Finds that Parent-led Early Intervention Can Reduce Autism Symptoms in Babies

Autism symptoms can display in babies as young as 6 months old. A new pilot study at the UC Davis MIND Institute found that parents could reduce symptoms of autism in babies under 12 months by using intervention treatments in the home as detailed in the Early Denver Start Model.

As reported in a recent Huffington Post article, the study involved parents and their babies between 7 and 15 months of age in a 12 week-long treatment conducted by parents in home-like environments. The treatment was based on the Early Denver Start Model and revolved around parent-child interactions, such as bathing, feeding, playing, and reading. Four comparison groups were also included: Those who were at a higher risk for autism because of an affected sibling; those who were at low risk; those who had developed autism by age 3; and those with early symptoms who received treatment at a later age.

At the start of the study, all babies displayed early signs of autism, such as low interest in interactions and repetitive behaviors, which increased by around 9 months. However, by 18 to 36 months of age, the children in the treatment group produced lower autism severity scores than the comparison groups who did not go through the treatment.

The Huffington Post article “Pilot Intervention Eliminates Autism Symptoms In Babies” highlights the importance of early intervention in autism treatment. While this research is highly preliminary, the findings show that therapy and early intervention are key factors in treating infants and children with early signs of autism, and possibly in reducing them altogether. This study offers hope for parents and professionals in helping their children succeed with more tools and resources for the earliest stages of autism.

Read more about the pilot study on Huffington Post here.

ASD Brains Show Decrease in Neuronal Autophagy, Underlying Oversensitivity and Deficits in Social Interaction

SOURCE: New York Times article by Pam Belluck

A recent study led by David Sulzer at Columbia University Medical Center showed that in children and adolescents with autism, brain tissue within the temporal lobe exhibit a decrease in neuronal autophagy (the brain’s process of clearing out old and degraded cells), which underlies oversensitivity and deficits in social interaction.

NY Times: Guomei Tang, PhD and Mark S. Sonders, PhD/Columbia University Medical Center

In early development, synapses—connections that allow neurons to communicate with each other—allows for infants to develop with as much external stimuli and information as possible. However, in childhood and adolescence, these synapses are gradually “pruned” so that the brain can develop more specific and advanced functions by not being overloaded with stimuli. As one can imagine, brains of children with autism fail to “prune” these synapses, causing them to be constantly overloaded with stimuli. In this study, young children with and without autism show roughly the same number of synapses, suggesting a “pruning” problem in autism, rather a problem with overproduction. Dr. Sulzer’s team also found biomarkers in the brains of children and adolescents diagnosed with autism, which suggested malfunctions in the process of autophagy (the neural degradation of old cells and damaged cell organelles). Without autophagy, the synaptic pruning process can’t occur.

These findings give us some insight into how autism develops from childhood onward, and help explain symptoms like oversensitivity and deficits in social interactions. Whether autism is a problem of brains with too little connectivity or too much of it has been of debate in recent years in the field of autism research. Ralph-Axel Müller, at San Diego State University, found in his studies that there was too much connectivity within brains of individuals with autism. “Impairments that we see in autism seem to be partly due to different parts of the brain talking too much to each other,” he reported to the NY Times. “You need to lose connections in order to develop a fine-tuned system of brain networks, because if all parts of the brain talk to all parts of the brain, all you get is noise.1

Eric Klann, a professor at New York University, also acknowledged an autophagy decrease in ASD brains. “The pruning problem seems to happen later in development than one might think,” Dr. Klann informed the Times. “It suggests that if you could intervene in that process that it could be beneficial for social behavior.”1 With further research into how this decrease in autophagy—and thus the synaptic pruning process in brains of children with autism—can be addressed earlier in a child’s development, there is hope that symptoms of autism may be preventable in the future.

1 “Study Finds That Brains With Autism Fail to Trim Synapses as They Develop.” New York Times. 21 Aug. 2014. Web. <http://www.nytimes.com/2014/08/22/health/brains-of-autistic-children-have-too-many-synapses-study-suggests.html>.

Simplifying the Science: Are You Giving Your Student Enough Freedom?

One of my favorite research papers was published in the Journal of Applied Behavior Analysis in 1990 by Diane J. Bannerman, Jan B. Sheldon, James A. Sherman, and Alan E. Harchik. The title is Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap. It’s an in-depth look at the level of control practitioners can exert over the individuals they serve, and the implications of that control.

It’s important to consider the ethical implications of requiring the individuals we work with to complete specified exercises at scheduled times, eat a healthy diet for all meals, and limit TV. I have seen situations in which the practitioner is holding the individual with developmental disabilities to a higher standard than they hold themselves! Most of you reading this can probably quickly rattle off the name of the last TV show you “binge-watched” or the delicious ice cream you enjoyed too much of.

So how do we teach making appropriate choices to individuals with developmental disabilities without denying the personal freedoms we all value?

One quote from the paper states, “Not only do people strive for freedom in a broad sense they also enjoy making simple choices, such as whether to engage in unproductive, though harmless, activities, like watching sitcoms on television, eating too many doughnuts, taking time off from work, or taking a nap before dinner.” In an effort to teach our learners independent skills, we often neglect to teach meaningful decision-making that reflects the types of decisions neurotypical adults make every day. Since the paper was originally published, there has been more work done on promoting decision-making skills for learners with developmental disabilities, but the issues described in the paper are still relevant today.

Here are a few key considerations described:

  • We need to consider client preference when creating daily schedules, goals, and access to preferred activities.
  • A client’s refusal to participate in an activity may not be a failure to teach appropriately but an expression of preference.
  • It is important for practitioners to teach choice-making. The paper states, “Many people require teaching to help them discover their own preferences and learn to make responsible choices.” We should consider this as an essential step towards promoting independence in our clients.
  • Inflexible schedules for clients can sometimes be obstacles to opportunities for choice-making.

The paper goes on to cite multiple research articles and laws for both sides of the argument about the right to choice for those with developmental disabilities. You can read the full text here.  Overall, I consider this article to be essential reading for anyone working with clients with disabilities. It provides a lot of information to support its final conclusion that “all people have the right to eat too many doughnuts and take a nap” and we have the responsibility to teach clients how to exercise such freedoms.

WRITTEN BY SAM BLANCO, msed, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.