1
Q
What is ASD?
A
- Etiology remains unknown to date
- A neurobiological disorder of development; thought to be present at birth
- Most likely the result of multiple etiological factors
- Not the result of bad parenting
- Comorbidity with other conditions (e.g., Down syndrome, fragile-X syndrome, other) can occur.
-Strong genetic influences
-higher incidence in siblings
-social-affective symptoms in other family members - Structural brain abnormalities have been found
- This area of research is mushrooming & changing rapidly with too many areas implicated to attribute ASD to a single structural abnormality
- Abnormal EEGs in 33-50%
2
Q
Is ASD more prevalent in males or females?
A
Males 3:1
*Research is changing, might be due to lack of testing in females.
3
Q
Who diagnoses ASD?
A
- Physicians, Psychiatrists, Psychologists, and Educational Psychologists
- Generally an SLP is part of team that may provide diagnosis.
- Team approach to diagnosis, with individuals who are trained in autism diagnosis, is the best.
4
Q
What is the DSM-5?
Diagnostic and Statistical Manual
A
The DSM-5 criteria for autism spectrum disorders include assessment of symptom severity related to the individual’s degree of impairment.
”the symptoms of these disorders (ASD) represent a continuum
from mild to severe, rather than being distinct disorders.”
5
Q
What DSM-5 criteria are required to diagnose ASD?
A
- Difficulties in social communication and social interaction across contexts
- Difficulties in behavior
- Difficulties must be noted in early childhood
- Symptoms together limit and impair everyday functioning
6
Q
What deficits do those with ASD usually have in social communication and interactions?
A
- Deficits in social/emotional reciprocity
- Deficits in nonverbal communicative behaviors
- Deficits in developing & maintaining relationships
7
Q
What are some behaviors that those with ASD usually have?
A
- Stereotyped or repetitive speech, motor movements, or use of objects
- Excessive adherence to specific, nonfunctional routines or rituals (difficulty with change)
- Highly restricted, fixated interests that are abnormal in intensity or focus (Hyperfixations)
- Hyper or hypo-reactivity to sensory input
8
Q
What is ADOS-2?
Autism Diagnostic Observation Schedule
A
- One of the largest evidence base and highest classification accuracy (≥.80)
- A semi-structured assessment of communication, social interaction, and play (or imaginative use of materials).
Three levels.
9
Q
In the ADOS-2, what are the levels of severity and what do they assess?
A
- Level 3: Requiring very substantial support
- Level 2: Requiring substantial support
- Level 1: Requiring Support
Social Communication and restricted repetitive behaviors
9
Q
What are the four moduels of the ADOS-2
A
- Module 1: for children with little or no phrase speech. …
- Module 2: for children who do use phrase speech, but do not speak fluently. …
- Module 3: for younger children who are verbally fluent. …
- Module 4: for adolescents and adults who are verbally fluent.
10
Q
What is ADI-R?
A
- One fo the largest evidence base and highest classification accuracy (≥.80)
- ADI-R = Two hour structured interview with caregivers
11
Q
What are some red flags for ASD in infancy and toddlerhood?
A
- Does not play pretend
- Does not look at what you are pointing to
- Does not use words to express needs and desires by 18 Mo.
- Does not use index finger to point out something of intrest
- Does not point at something to ask what it is
- Does not seek out/initiate social interactions
12
Q
What are some strengths to those with ASD?
A
+ Relative strengths in visuo-spatial processing (e.g., puzzles, etc.)
+ Relative strengths in verbal short term memory
MAY encounter, not true for all
13
Q
When thinking of services to children with ASD…
A
- Early intervention is best
- Programs should be individually designed and carefully planned.
- In order to meet the diverse needs of children with autism, each child’s individual program should draw upon a variety of program models
14
Q
What is the Early Start Denver Model?
A
- An ASD Play-based therapy program
- Symbolic and interpersonal communication are encouraged (symbolic com. = sign, PECS)
- Coordinated interactive social relations are established (sensory social routines= baby bumble bee, pull pull pull pop)
- Intensive teaching fills in the learning deficits (specific forms or areas are taught and repeated until mastery).
- Social skills and experiences are supported.
15
Q
What is LEAP?
(Learning Experiences and Alternate Program for Preschoolers and their Parents)
A
- An educational model that integrates children with ASD into preschool classrooms with their typically developing peers
- Systematic teaching results in daily social and communicative engagement of peers
- Behaviors are analyzed and communicative based strategies are taught that replace behaviors
- Skills are taught one on one and then are generalized (with peers, parents, others)
16
Q
What is TEACCH?
(Treatment and Education of Autistic and Communications Handicapped Children)
A
- A program that helps people with autism spectrum disorder (ASD) learn and develop skills along with independece.
- Emphasizes individual assessment to understand exact level of functioning for planning purposes
- Structured teaching provides an organizational structure to the physical environment
- Work baskets, schedules, clear and explicit expectations and use of visual materials are all part of the process.
17
Q
What are picture schedules?
A
- Visual tools that represents a sequence of activities or tasks using pictures. These schedules help individuals with ASD understand and anticipate daily routines, transitions, or steps in a task.
18
Q
What is PECS?
(Picture Exchange Communication System)
A
- A communication system designed to help individuals express their needs and desires using pictures.
- Based on a behavioral approach- very systematic
- Unique and simple augmentative communication system that teaches initiation imitation, and communicative intent.
- Teaches student to use a picture to request a desired object. Student exchanges picture with teacher/parent- who immediately honors their request. Generalized to peers.
- Can be used to communicate in sentences.
Can be used with many populations
19
Q
What are some ways to help a student with ASD in the classroom?
A
- Low stimulation
- Walls are not busy with art work
- Task oriented
- Goal of independence
- Gradually faded cueing
- Reinforcers as necessary
- Using a shape/color work basket like a work station.
20
Q
Who can PECS be used with?
A
- Down syndrome
- Fragile X syndrome
- Cerebral Palsy
- Autism
- Apraxia of Speech
21
Q
What is Developmental, Individual-Difference, Relationship-Based? (DIR)
A
- Natural language or milieu approaches (Goldstein, 2002)
- Capitalizes on social interaction in a nurturing environment to foster communication
- Considers child’s developmental level (e.g., following the child’s lead)
- Play and Prompt -> Natural Reinforcement
- Floor Time strategy refers to activities in which the adult opens and closes circles of communication with the child
22
Q
What are Milieu Approaches?
A
- Therapeutic strategies that use the environment and social context as integral parts of the treatment process.
23
Q
How are ASD interventions rated??
A
- Established
- Emerging
- Un-established
- Harmful
24
1: Antecedent Package
Antecedent – **BEFORE**
Events or things (environmental stimuli or modifications)
Actions of people (prompts) that precede behavior.
**Prompting:** A prompt(cues, support, or hints) is is help given to a child which assists the child in performing (demonstrating) a skill.
* Prompting forms include:
* Verbal assistance
* Modeling & Gestures
* Physical assistance
**Verbal Prompt (Assistance):** An adult helps the child complete the targeted skill by telling them what to do or how to do it
**Model Prompt:** An adult demonstrates or shows the child
the correct sequence or action of the skill by completing
the action or skill themselves when they have the child’s attention.
**Gestural Prompt:** An adult provides a visual cue for the child to complete a skill (pointing).
**Physical Assistance:** An adult helps the child complete the actions of the skill by touching and
physically guiding the child to complete the target skill
**Full Physical Assistance:** An adult helps the child complete the actions of a skill by physically guiding the child through the ENTIRE sequence of the skill
**Partial Physical Assistance:** An adult helps the child complete the actions of a skill by physically guiding the child through part of the sequence of the skill
**Time Delay:** A prompting strategy where the instructor starts by immediately providing the child with the prompt necessary to complete the behavior right after he gives the discriminative stimulus. After the child responds correctly with this level of prompting, the instructor systematically **increases the amount of time between the discriminative stimulus and the prompt**, giving the child more time to respond independently, until the child responds independently without a prompt
25
2: Behavioral Intervention Package
**Discrete Trial Training (DTT):** distinct, repetitive responses following a specific stimulus that result in reinforcement.
* A discrete trial is a single cycle of instruction that may be repeated several times until a skill is mastered
A discrete trial consists of 5 main parts:
1. **An initial instruction** – ex. “Touch your nose.”
2. A **prompt or cue** given by the provider to help the child respond correctly – ex. Provider points to child’s nose.
3. A **response given by the child** – ex. Child touches their nose.
4. An **appropriate consequence**, such as correct responses receiving a reward designed to motivate the child to respond correctly again in the future – ex. “Nice job touching your nose,” teacher gives child a sticker.
5. A pause between consecutive trials – waiting 1 – 5 seconds before beginning the next trial.
**Positive Behavior Interventions and Supports (PBIS):**
A values-based AND empirically-valid approach for **resolving problem behaviors and helping people lead enhanced lifestyles** by simultaneously impacting the targeted behaviors and teaching the child new **replacement skills** to use.
1. Establishing a Team
2. Conducting Functional Assessment
3. Developing the Intervention Plan (Reducing targeted behaviors + Teaching new (replacement) behaviors)
4. Implementation
5. Evaluations
26
3: Joint Attention
* Parent and child engaging in mutual interest or showing attention to the same object, Activity or Experience
* **Example:** Child looking at an item, shifting gaze to a person and then returning gaze to the item.
27
4: Modeling
* Adult or peer provides demonstration of the target behavior
* Usually combined with prompting and reinforcement
28
5: Naturalistic Teaching
Naturalistic Teaching Strategies:
- Present learning opportunities in the child’s **natural environment**
- Utilize **child selected materials/activities**
- Utilize the child’s **natural motivation and reinforcers**
- Used in teaching a variety of socially relevant behaviors
- Expand on individuals use of language
- Incorporate use of commenting about child’s behavior
- Focus on **TEACHABLE MOMENTS**
Incidental Teaching - Steps
1. Set up the environment
2. Approach - Look/Pause
3. Provide a talk up
4. Withhold access
5. Use general prompt “What do you want?”
6. Use specific prompt
7. Repeat prompt
8. Back up to easier prompt
9. Provide immediate access
10.Provide behavior specific praise
29
6: Peer Training Package
Necessitates the presence of **typical peers**
* **Instruction on social skills provided to typical peers**
* Addition focus on key components of social interactions **(4 turns in a social interaction + Reciprocity)**
* Thoughtful Planning of Social situations **(Use of social toys and materials)**
30
7: Pivotal Response Treatment
PRT is based on the idea of **teaching FUNDAMENTAL behaviors** that lead to generalized gains across a variety of domains.
Key features of PRT include:
* **Multiple Cues**
* **Motivation and,**
* **Self-management**
1. Responsivity to Multiple Cues
* Using a variety of materials for discrimination learning
* Teaches generalization
2. Motivation
* Child choice
* Interspersing maintenance tasks
* Direct / natural reinforcers
* Shared control
3. Self-Management: Allows for changes and shifts in activities directed by the child
31
8: Visual Schedule & Supports
Activity Schedules
-**Transitioning From One Activity to Another**
* Having a schedule with pictures of the activities for the day often helps children with ASD understand what is happening each day.
* Changes in the daily schedule should be represented visually
* You can use schedules to help a child navigate the entire daily schedule, or to navigate certain times of the day
-Daily Schedule
-**Free Choice Schedule**
-**Play Scripts** and **Sequence Scripts**
* Children with ASD often have difficulty sequencing different activities
* They struggle with knowing how to start, and what to do once they finish one step of the
sequence
* Play scripts provide children with step-by-step pictures demonstrating what to do with the toys
* Just like play scripts, sequence strips also provides children with step-by-step pictures to
complete a project/activity
-First-Then Sequences
* Sequencing of a less preferred activity followed by a more preferred activity
* More preferred activity serves as a reinforcer for completing the less preferred activity
* Premack Principal or Grand Ma’s Rule.
* Giving them a visual that demonstrates the relationship between the completion of a task and access to a preferred activity can often be helpful (i.e. first you sit at circle, then you get to see Mom)
-First-Then Visuals
-Teaching Children to Use Visual Supports
* **Pair visual supports with language at child’s level of understand**
* Steps to using visual support
1. Introduce the visual in the **context** they will be using it. Show them the visual, pointing to each picture while labeling the pictures and the relationships between the pictures
2. Prompt the child to **point/take off symbols** as appropriate
3. Prompt the child to **start the behavior** targeted by the picture.
4. Reinforce the child for **completing the behavior**
5. **Systematically fade prompting** as child becomes more independent with the visual
32
9: Augmentative and Alternative Communication (AAC)
* Encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language.
* Any AAC system needs to be readily available to the child in all environments
* Willing Partners
* It is important to consider who the communication partners for the child will be.
* Communication partners must have exposure to the AAC system and understand
* Communication is a social behavior
Grad School Stuff
flashcards
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