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Autism and ABA Annie Baghdayan, PhD, BCDA-D, LBA The National Center for Disability Education & Training University of Oklahoma OPC Statewide Conference Definition of Autism • A developmental disability significantly affecting: • Verbal and nonverbal communication • Social interaction • Evident before age 3, that adversely affects a child's educational performance. • Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements • Resistance to environmental change or change in daily routines, and • Unusual responses to sensory experiences (P.L. 101-476, 2004). © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved What is Autism? • Autism Spectrum Disorders (ASD) are a group of related brain-based disorders that are characterized by three distinctive features. • Difficulty with social interactions • Delays/difficulty in verbal and nonverbal communication • Repetitive behaviors or narrow, obsessive interests • American Academy of Pediatrics, 2006 © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved ASD Annie Baghdayan, PhD 1 OPC Statewide Conference DSM-5 • The DSM-5 (available since May 2013) proposed one diagnostic category. It uses the diagnosis of Autism Spectrum Disorder. • This diagnosis will take the place of the 4 previously separate disorders: • Autistic disorder, • Asperger’s disorder, • Childhood disintegrative disorder and • Pervasive developmental disorder not otherwise specified (PDD-NOS) © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Prevalence of Autism • Autism is increasing at a rate of approximately 10-17% per year. • Autism Society of America • In October 2010, 3,062 children ages 3-21 in Oklahoma received special education services under the Autism category. • Reported by State of Oklahoma in accordance with section 618 of IDEA, U.S. Department of Education, Office of Special Education Services • According to CDC 1 in 68 children are identified with ASD (1 in 42 boys and 1 in 189 girls). Annie Baghdayan, PhD 2 OPC Statewide Conference Prevalence of Autism http://www.cdc.gov/ncbddd/autism/data.html Why the increase in autism? • Reasons are not completely clear. • Theories: • Increased awareness of autism • More screening tools and services • Changes in how autism has been defined and diagnosed. • Children with milder symptoms are being diagnosed. • Increased prevalence due to increase in various environmental factors © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Evidence-Based Intervention Strategies • In 2009, 11 “treatments” or practices with an evidence base • Reviewed by National Standard Project from National Autism Center • In 2010, 24 EBPs • National Professional Development Center (NPDC) • Included 10 years, 1997-2007 • In 2014, 27 EBPs • Second review by NPDC • Included 22 years, 1990-2011 • • 29,101 possible studies 456 studies RCT, quasi-experimental, single case design • Strength of evidence for assessment • Based on number, type of studies using each EBP © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Annie Baghdayan, PhD 3 OPC Statewide Conference Evidence – Based Practices (2014) Antecedent-based interventions Cognitive behavioral intervention* Differential reinforcement Pivotal response training Prompting Reinforcement Response interruption/redirection Discrete trial training Scripting* Exercise* Self-management Extinction Social narratives Functional behavior assessment Social skills training Functional communication training Structured play groups* Task analysis Modeling* Naturalistic interventions Parent-implemented intervention Technology-aided intervention/instruction* Time delay Video modeling Peer-mediated instruction/intervention Visual supports Picture Exchange Communication System * Added from 2014 literature review What is Applied Behavior Analysis? • Applied Behavior Analysis - ABA is the use of scientific principles of learning and motivation to teach effectively • The core concept is that the consequences of what we do affect what we learn and what we will do in the future • Positive reinforcement: behaviors that produce a good outcome are more likely to occur in the future • People are motivated by what they get out of what they do • Examples: money, feeling good for helping someone, approval from others, satisfaction of a good book, etc. © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Positive Reinforcement • The ABA approach to autism is to identify what motivates each individual child • Every child is different • Teaching must use what is motivating to the child, not what we think should be motivating to the child • Then we teach the child by teaching new skills in very small steps and rewarding the child with positive reinforcement when they make an effort at learning © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Annie Baghdayan, PhD 4 OPC Statewide Conference Effectiveness of ABA • ABA assumes that if a child is not learning, it is NOT the child’s fault, it is our fault • • • • • We must change the way we are teaching We must continue to try different ways of teaching until we find one that works ABA is the best method for finding what works We do not blame the child if learning does not happen We believe it’s our responsibility to figure out how to teach whatever the child needs to learn © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Why Is ABA Effective For Children with Autism? • Is consistent with general principles of learning: • Task analysis: • Breaks complex material into smaller, more teachable units. Provides numerous structured opportunities for a child to learn a new skill before advancing to the next skill • Stimulus Control: • Highlights relevant stimuli while simultaneously minimizing extraneous stimuli • Prompting and prompt fading procedures • Errors are minimized while correct responses are maximized © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Why Is ABA Effective For Children with Autism? • Is consistent with general principles of learning: • Reinforcement • All students have an individualized motivational system • Generalization • Promotes skills across settings, instructors, and situations • Maintenance • Skills are functional and therefore continually used by students © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Annie Baghdayan, PhD 5 OPC Statewide Conference Discrete Trial Training (DTT) • Breaks down learning opportunities into well-controlled, discrete teacher-student interactions Instruction → Correct Response → Reward OR Instruction → Incorrect Response → Correction © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Discrete Trial Training (DTT) • Provides structure for the learning interaction • Provides a very large number of learning opportunities in a small amount of time • Is proven by hundreds of studies to be an effective teaching procedure • https://www.youtube.com/watch?time_continue=30&v=4qRe6JQLBTM © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Natural Environment Training • Naturalistic behavioral teaching procedures go by many names: • • Incidental Teaching, Pivotal Response Teaching, Basic approach: • • • • • Teach in the natural environment Set up situations where the child will be motivated (e.g., toy out of reach) Wait for child to initiate Prompt the correct behavior Reinforce it © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Annie Baghdayan, PhD 6 OPC Statewide Conference Natural Environment Training • • • • • • • • Much more natural approach than DTT Less structured Looks more like typical interactions Great for teaching play and social skills Great for establishing generalization of skills learned in DTT Some children prefer NET over DTT Proven by dozens of studies to be an effective teaching procedure https://www.youtube.com/watch?v=mnkEZaAHGrA © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Behavioral Interventions • Behavioral interventions teach individuals with ASD functional alternative behaviors to reduce problem behaviors in their environment (Wilczynski, Rue, Hunter, & Christian, 2012). © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Behavioral Interventions • Prompting - an antecedent stimuli added to the environment to elicit a correct response (Ulke-Kurkcuoglu, 2015). • Example: • Verbal cues – clap hands • Modeling – adult claps hands • Physical guidance – adult physically guides child to clap hands © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Annie Baghdayan, PhD 7 OPC Statewide Conference Behavioral Interventions • Chaining- Breaking down complex tasks into sequence of discrete responses (Cooper, Heron, & Heward, 2007). • Examples: • Forward chaining – sequence of steps are taught in their natural order • Child receives reinforcement when step is performed correctly • Total-task chaining – sequence of steps are taught in natural their natural order • Child receives training throughout learning process • Backward chaining - Last step of behavior chain is completed first © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Self-Management • Teaches individuals with ASD to self-regulate their own behaviors to gain greater independence (Lee, Simpson, & Shogren, 2007). • • • • Goal setting - sets own goals Self-monitoring - records occurrence of targeted behavior Self-evaluation - compares one’s performance to targeted goal Self-reinforcement - self-administered or by teacher © Copyright 2016 University of Oklahoma Board of Regents. All Rights Reserved Functional Communication Training (FCT) • Purpose is to decrease maladaptive behaviors by giving learner communicative response that acts as a replacement behavior (Mancil & Boman, 2010). Annie Baghdayan, PhD 8 OPC Statewide Conference FCT Steps • • • • Identify maladaptive behavior Conduct functional assessment to discover function of behavior Determine more appropriate response that serves same function Teach and reinforce more appropriate replacement behavior (Mancil & Boman, 2010). Web Resources Families 1. www.autismspeaks.org -One of the leading autism science and advocacy organizations. Autism Speaks provides a comprehensive resource guide for all states. The site also boasts an impressive list of apps that parents may find useful, including games that focus on communication and social skills. 2. www.autism-society.org -Another great site that includes helpful resources for those with autism, family members, as well as professionals. Autism Society also gives updates on the latest autism news and press releases. 3. www.disabilityscoop.com – Sign up for Disability Scoop’s e-mail news to receive the most current updates on developmental disabilities. Disability Scoop’s experts have been cited by multiple online news sites, including USA Today and People.com. 4. www.autism.healingthresholds.com – Healing Thresholds includes information on many different therapy treatments for children with autism. The site focuses on the top 12 used by parents, but also includes useful information on nearly 100 additional therapies. Book Resources Families • Understanding Autism Spectrum Disorder (ASD) : 36-page booklet that provides answers to questions parents have about autism including: symptoms, diagnosis, treatment strategies, and transitioning to adulthood. • Autism Spectrum Disorders: What Every Parent Needs To Know This awardwinning book is an invaluable resource for parents and caregivers of children who have been diagnosed with an ASD. This book helps parents understand how ASD is defined and diagnosed and provides information on the most current types of behavioral and developmental therapies. Annie Baghdayan, PhD 9 OPC Statewide Conference Web Resources Professionals Autism Internet Modules http://www.autisminternetmodules.org Adapted Learning https://www.adaptedlearning.com/default.aspx Geneva Center http://www.elearning.autism.net/cc/index.php Organization for Autism Research http://www.researchautism.org National Autism Center http://www.nationalautismcenter.org National Inst. of Health, Autism Research Network http://www.autismresearchnetwork.org/AN/ Contact Us Annie Baghdayan, PhD, BCBA-D, LBA [email protected] The National Center for Disability Education & Training http://ncdet.ou.edu/ University of Oklahoma 3200 Marshall Ave. Norman, OK 73072 Annie Baghdayan, PhD 10