Intervention, Support and Context

Question 1

interventions

Answer 1

potential therapies (need to approach with caution and check for scientific evidence)

Question 2

early educational programs

Answer 2

• communication support (Picture exchange communication system [PECS])
• behavioural interventions (Applied behavioural analysis [ABA])
• general development/educational strategies (elements from elsewhere)

Question 3

Picture exchange communication system (PECS)

Answer 3

• a unique augmentative (large one of its kind) intervention for individuals with ASD and related developmental disorders
• moderate to severe learning difficulties
• children of school age struggling to develop spoken language
• pictures used to start communication with child
• also helps with challenging behaviour as the child can communicate and is less frustrated
• building up through 6 phases

Question 4

PECS 6 phases

Answer 4

Phase 1 - how to communicate (exchange pictures for items)
Phase 2 - distance of persistence (using single pictures in different places
Phase 3 - picture discrimination (select 2 or more pictures of their favourite things from communication book)
Phase 4 - sentence structure (learn to construct simple sentences on detachable strip - expanding using adjectives)
Phase 5 - answering questions (‘what do you want?’)
Phase 6 - commenting (in response to questions, learning to make up new sentences)

Question 5

applied behavioural analysis (ABA)

Answer 5

• Lovaas (1987)
• began around autism but can be applied to other disorders
• very rigid structure (intense)
• begin before 3 years
• 40h per week for 2 years
• one-to-one discrete trials (same thing every time)
• often applied in a less rigid way

e.g. Early Start Denver Model (ESDM)

Question 6

Early Start Denver Model (ESDM)

Answer 6

• early as 12 months as not too far behind peers
• 20h per week (aiming to teach every 10s)
• uses eye contact, sound effects and vocal imitation
• ‘treatment appropriate’ - trying to ‘normalise’ child (training autism out of child)

\+ reduces challenging behaviour 
\+ can be positive for parents 
\+ can improve adaptive behaviour 
\+ can facilitate communication 
- false hope
- financial 
-outcome may not be positive
- training someone to be neurotypical

Question 7

Makrygianni and Reed (2010)

Answer 7

• review of behavioural programs
• improve several developmental aspects
• predictors of improvement: program intensity, duration, prenatal training, age and adaptive behaviour at intake

Question 8

Family support

Answer 8

• important to consider what family members are worried about and what they value or disvalue about their childs behaviour, language and education
• Cridland et al (2014) - family systems
• bi-directional influence on family (affects each other)
• affects daily routines, self care, mobility, communication and stress
• research could influence clinical support services

Question 9

Guite et al (2004)

Answer 9

support different family members (multiple people within the family)

Question 10

Cridland et al (2014)

Answer 10

• boundaries (border between family system and environment, external boundary between family and other systems)
• permeability - degree of difficulty or ease that information and system members have at crossing this boundary
• boundary ambiguity - confusion about roles and responsibilities experienced by family members resulting from poorly regulated boundaries
• resilience - ability to cope with challenging life circumstances (physical, psychological, emotional, social resilience)
• traumatic growth - extension of resilience (coping involves positive change as a result of changing life circumstances (e.g. increases life appreciation, family solidarity - positive change due to change in circumstance)

Question 11

permeability

Answer 11

• open systems can be weak resulting in confusion about family roles, identities and goals
• closed systems can be rigid and restrict information flowing limiting physical, psychological and social growth

Question 12

positive impact of autism on family

Answer 12

• improved communication skills
• higher level of empathy and patience
• increased compassion
• refocus of energy
• improved self-concept and self-confidence

Question 13

context

Answer 13

• variability
• use of standardised measures
• sample size

no static end state of the developmental trajectory

Question 14

variability

Answer 14

universality of deficit
- some individuals may not experience same difficulty

inter-individual variability
- one child could share features with another, but may be variation within that child thats unique

intra-individual variability
- going to have differences within an individual depending on sleep, mood, hormones, environment …

Question 15

sample size

Answer 15

the larger the better (practical consideration, e.g. funding)

what effect size is expected

expected drop out rate

participant fatigue

whats the research question

Question 16

use of standardised measures

Answer 16

used and developed on a large group of neurtypical participants

can compare the results against atypical P’s