Bryna Siegel, Ph.D. Director, Autism Clinic Co-Director, Autism Neurodevelopment Center
47
What Is An ABA Placement? Seattle University School of Law Administrative Law Judge Training October 19, 2011 Bryna Siegel, Ph.D. Director, Autism Clinic Co-Director, Autism Neurodevelopment Center [email protected] Professor, Child & Adolescent Psychiatry University of California, San Francisco
description
What Is An ABA Placement? Seattle University School of Law Administrative Law Judge Training October 19, 2011. Bryna Siegel, Ph.D. Director, Autism Clinic Co-Director, Autism Neurodevelopment Center [email protected] Professor, Child & Adolescent Psychiatry - PowerPoint PPT Presentation
Transcript of Bryna Siegel, Ph.D. Director, Autism Clinic Co-Director, Autism Neurodevelopment Center
What Is An ABA Placement? Seattle University School of Law
Administrative Law Judge Training October 19, 2011
Bryna Siegel, Ph.D.Director, Autism Clinic
Co-Director, Autism Neurodevelopment [email protected]
Professor, Child & Adolescent Psychiatry University of California, San Francisco
Today’s Topics
What has applied behavior analysis contributed to the treatment of autism?
How and when do we use it? Where does ABA ‘fit’ with developmental
considerations for treatment? How do we integrate approaches to ‘cover all
bases’ in defining ‘appropriate placement’?
Themes in ABA Literature on Autism Treatment
Efficacy of behavioral methods (ABA) Individualization (ABA) Intensity (ABA) Natural environment as teaching milieu (PRT) Parents/ home/ outside world’s role in
acquisition & generalization (NET)
A Brief History of ABA and Autism
Pavlov Skinner: Learning in animals worked in humans too
Lovaas at UCLA uses ABA for severe SIBs Lovaas uses ABA to teach ‘positive’ behavior,
not just to extinguish ‘negative’ behavior. Lovaas’s curriculum content neither
developmental or autism-specific, but… Introduces intensity, data-based trials & high
mastery levels; these are validated and reified.
Applied Behavior Analysis (ABA) and the Culture of Autism Treatment
ABA has become most widely-available one-to-one treatment modality for ASDs One-to-one complements heterogeneity of ASDs Potential for highest intensity
ABA has become highly influential in classroom practices too: Mandate for data-driven instructional practices Need for functional behavioral analyses of behavior
incompatible with instruction
What Have We Learned About ABA and ASDs in the Last 20 Years?
ABA can be effective at home and in schools Behavioral principles have been applied with
different emphases: Performing: Discrete trial training (DTT) Requesting: Pivotal response training (PRT) Adapting: Natural environment training (NET)
Remaining Challenges: Motivation especially social motivation Developmental appropriateness of curriculum Generalization of objectives of learning
Selecting the Right Tool for the Job
Concept of the Autism Treatment Toolbox
ABA and the Autism Treatment Toolbox
What does autism treatment need to target? What does ABA target most specifically? What does ABA leave unaddressed? How do you fill an autism treatment ‘toolbox’:
for a particular child, or for a particular age group, or for a particular sub-group of children with ASDs?
What tools does ABA give us?
An Example: ABA for Low Functioning Autism (LFA)?LFA: NV/ minimally verbal, PIQ < 50, verbal lower Non-linear effect of # hrs of tx
More is not necessarily better if LFA Hi intensity (≥ 25 hr./wk)~ low intensity (≤ 20 hr./wk)
Best ABA outcomes: NVVerbal in 1st 3 m. of tx (per Lovaas)= non-
responders Low level of behavior incompatible w/ instruction
Implementation of ABA Methods as a Function of Placement
When should treatment be given in a natural environment? Home? Child care?
Can treatment be delivered in an inclusive setting? Typically developing peers predominate?
Can treatment be delivered in an integrated setting? Designed for typical and atypically developing children
both? Does treatment motivate child to self-initiate?
The Importance of Integrating ABA Methods with Developmental
Considerations
(so it’s not dog training….)
IACAPAP Beijing 2010 [email protected]
What Is the Developmental-Behavioral Approach?
Establish curriculum content based on developmental level/ ‘what comes next’.
Uses behavioral methodology to teach developmentally-based curriculum.
Enhancing motivation by differentially rewarding self-initiative in learning
Why It’s Important to Include a ‘Developmental’ Perspective
The brain matures in a fixed sequence, supporting behavior emerging from increasingly complex and integrated neural capacities.
Behavioral development has a fixed sequence tied to that neural development.
Children may learn at different rates & ways, but the ordered sequence for a solid foundation.
Why is it Important to Include a Behavioral Perspective?
Empirical efficacy of behavioral methods Flexibility for individualization Ability to control intensity Natural environment as teaching milieu
(PRT) Parents/ home/ outside world’s role in
acquisition & generalization (NET)
An Example of Curriculum that is Developmental and Behavioral
Based on where the child is developmentally (e.g. 18 month receptive language—teach the next set of skills—moving from MLU=1 to MLU=2).
Calibrate growth trajectory based on learning history and assessment observations and results; re-calibrate trajectory annually before drafting IEP goals.
Do teach using validated behavioral principles.
Another Example of Curriculum that is Developmental and Behavioral
Purely Behavioral/ Not Developmental: Learning ‘stand-up/ sit down’ before ‘mama and dada.’
Changing the content to be developmental: Teaching ‘horizontally’, not ‘vertically’: 10 barnyard animals versus 10 faces of mommy
Integrating Developmental and Behavioral: Keeping the ABA teaching method and pairing it with a developmental curriculum.
How Have These Considerations Been Reified in National Standards?
National Research Council of Nat. Acad. Of Sciences (2001)
Part C of IDEIA (2004) Div. of Early Childhood/ Council on Exceptional
Children (2005) Nat. Assn. for Ed. of Young Children (2009)
‘Active Ingredients’: Intensity
Candidates include: Use of 1:1 ? # Hours/ Week? # Trials? % Accurate Responses? Level of prompting needed for response?
‘Active Ingredients’: Developmentally-Appropriate Appropriate for Chronological Age? Appropriate for Developmental ‘Age’? Developmentally-sequenced? Comports with developmental ‘morphology’?
(e.g., Language: # of single words before phrases)
‘Active Ingredients’: Addresses Social Deficits
Establishes theory of mind Establishes joint attention Establishes instrumental attention-seeking Establishes expressive attention-sharing Promotes imitative learning
The Role of Diagnostic and Psycho-Educational Assessment in
Formulating a Developmental-Behavioral Plan
The Importance of Convergent Validity in Differential Diagnosis
Structure(Structured)
Criterion Based
Structure(Unstructured)
Play-Based
Setting:(Natural) Home
Setting:School/Clinic
Data Collection:Interview
Data Collection:Observe
Informant: Child
Informant:Parent
AUTISMDIAGNOSIS
Let’s Just Treat What’s Wrong Importance (or Not) of Diagnosis Identifying Learning Processes Identification of What Needs to be
Learned Figuring Out How to Teach so the Child
becomes an Independent Learner
Accounting for Responder Characteristics in an Educational
Plan
What is A ‘Responder Characteristic?’
Specific ‘Autistic Learning Disabilities’ Developmental Level Language Level Maladaptive Behaviors
(Behavioral) Goals Should Be Predicated on Developmental
Trajectory Diagnosis can change Degree of cognitive impairment can change Language competencies can change Changes affect treatment plans Changes affect prognostic expectations Re-examining goals in light of developmental
trajectory
The Autistic Learning Disabilities / Autistic Learning Styles Approach
Siegel B (2010). ‘Reconceptualizing Autistic Spectrum Disorders as Autism-Specific Learning
Disabilities and Learning Styles’in T Millon, Krueger, & Simonsen (Eds) Contemporary Directions in Psychopathology, New York: Guilford
Publications
Autistic Learning Styles Defined:
Autistic learning styles are intact functions automatically being deployed to compensate for impaired systems
By looking for autistic learning styles, we discover what works and can make more use of those intact systems (improving on success)
What’s an Autistic Learning Style?ALD + Intact Abilities = ALS
Defined by Matrix of Ability and Disability:Matrix of Ability and Disability:What the child can’t do (ALD) plus what the child can
do = autistic learning style (ALS)What the Child Does Well Shows Us:How to ‘deconstruct’ ‘symptoms’ into what works &
what doesn’t (e.g., Echolalia)Compensatory strategies that are autism-specific
(e.g., VAC vs ASL) Processing modality ‘substitution’ (e.g., Hearing for blind vs visual memory for ASD)
Matrix of Ability and DisabilityExamples:
Auditory Processing & Visual Memory
Intact Abilities
Impaired Functions
Auditory memory Visual memory
Slowauditoryspeed
Echolalia with low comprehension
Low language comprehension
Insists on routines
Autistic Learning Styles (ALSs)Related to Memory
Verbal Intelligence-Related Good Auditory Memory without ‘Parsing’
(Memorizes songs, videos or books without understanding full meaning)
Performance Intelligence-Related Good Procedural Memory (Prefers Routines)
(Anticipates exact sequence of events leading to desired outcomes)
Autistic Learning Styles (ALSs)Related to Motivation
Verbal Intelligence-Related Better use of language when requesting
than commentingPerformance Intelligence-Related Good visual-motor-spatial ability without
need for semantic supports(Does puzzles backward or upside down, draws from ‘photographic’ memory)
The ALS/ALD Approach: A New Heuristic
ALS = ‘Autistic Learning Styles’ALD = ‘Autistic Learning Disabilities’
The ALS/ ALD heuristic can be used to classify autistic alterations in Perception, Cognition, Information-Processing, Motivation & Expression
Autistic Learning Disabilities:How Social Deficits Affect Learning
Lack of socio-emotional reciprocity=Lack of desire to please othersLow response to social reinforcers Lacks concern re: effect on others
Lack of awareness of others= Motive to please self is foremost Instrumental learning style Lack of social imitation=
Low “incidental” learning via copying others No drive to follow group norms
Why Should
I Care?
Autistic Learning Disabilities:How Non-Verbal Communication
Deficits Affect LearningLow comprehension of facial/ vocal cues: Smiles, frown, more subtle facial affect Tone of voice to mark affective/ semantic meaningIgnores gestures that are the ‘first’ language: Gaze toward topic of conversation Point to initiate joint attention to topicDoes not signal comprehension, intentions feelings
Autistic Learning Disabilities:How Verbal Communication
Deficits Affect LearningReceptive Language Signal : noise problem for verbal ‘signal’ Language processing with poor ‘parsing’ Overly literal/ concrete, limited generalization
Expressive Language Without ‘theory of mind’, no drive to ‘share’ ideas Without instrumental motive, no drive to express Oral-motor apraxia synergistic w/ low expressive
drive
Autistic Learning Disabilities:How Play and Exploration
Deficits Affect LearningLack of imagination in play= No consolidation of experience via play linking action and language No symbolic actions to link to language to abstract thinkingStereotyped and repetitive interests= Averse to novelty/ low curiosity Limited learning through exploration Repetitive interests = mental ‘down time’
‘Active Ingredients’ of ABA Methodology & the ALD/ALS Model
ABA Approaches (DTT/ PRT/ NET)
SOCIAL INTERACTIONSOCIAL INTERACTION Likely Benefits
Low Response to Social Reward
Yes(via paired association)
Infrequent Social Reference or Joint Attention
No(attention directed to stimulus materials)
Low Drive for Peer Affiliation
No (object or teacher models)
Limited Modeling or Imitation
Yes(via forward/ backward chaining)
ABA Approaches (DTT/ PRT/ NET)
COMMUNICATION COMMUNICATION Likely Benefits
Poor Comprehension/ Limited Para-Linguistics
Partial(Rotely- taught/ non-generative)
Slow Auditory Processing Speed, Poor Parsing
Partial(Telegraphic Speech)
Preference for Visual over Auditory Modalities
Yes(Use of Visuals & Procedures)
Theory of Mind/ Perspective-Taking
No(Reliance of Direct Learning)
ABA Approaches (DTT/ PRT/ NET)
ORGANIZING INFORMATIONORGANIZING INFORMATION Primary Benefits
Lack of Representation Capacity (Imagination)
Partial(Rotely- taught/ non-generative)
Preference for Repetition over Novelty
Yes(adult-direction)
Sensory Modulation Difficulties
Yes(de-sensitization)
ABA Approaches in the Context of Group vs Individual Treatments
Approaches
Sunnyvale [email protected]
Approaches to Autism TreatmentOne-to-One Treatments
Adult-Led Child-Led
Discrete Trial Training
Pivotal Response Training/ NET
Incidental Teaching
SCERTS Floor-Time/ DIR Relationship
Development Interaction (RDI)
Hanen
Group-Based
Treatments
Special Education
GeneralEducation
TEACCH Denver Model
Inclusion/ Mainstreaming
RSP/DIS Supports
Autistic Learning Disabilities and the Methods that Address Them
Or When to Use ABA and When to Reach for a Different Tool
Sunnyvale [email protected]
Area of Autistic Learning
Disability
One-to-One Adult-Led (ABA-DTT/ PRT/ NET)
One-to-One Child-
Initiative (Floor-Time/
SCERTS/RDI)
Special Education (TEACCH/
Other Special Day Class)
General Education
(Full or Partial Inclusion)
SOCIAL SOCIAL INTERACTIONINTERACTION Primary Likely Benefits
Low Response to Social Reward
Yes(via paired
association)
Yes(via child choice of content
No(completed
order as reward)
No (response assumed)
Infrequent Social Reference or Joint Attention
No(attention directed to stimulus
materials)
Yes(major focus)
No (attention directed to routine or materials)
Yes(once imitation
present)
Low Drive for Peer Affiliation
No (object or teacher
models)
No (adult as model for affiliation)
No (inclusion w/ comparable
peers)
Yes(IF peers are interesting
models)
Limited Modeling or Imitation
Yes(via forward/
backward chaining)
No (adult as model for affiliation
No (routine as
model)
Yes(IF salient peer
models)
Sunnyvale [email protected]
Area of Autistic Learning
Disability
One-to-One Adult-Led (ABA-DTT/ PRT/ NET)
One-to-One Child-
Initiative (Floor-Time/
SCERTS/RDI)
Special Education (TEACCH/
Other Special Day
Class)
General Education
(Full or Partial
Inclusion)
COMMUNICATION COMMUNICATION Primary Likely Benefits
Poor Comprehension/ Limited Para-Linguistics
Partial(Rotely- taught/ non-generative)
Yes(In context of
social regulation)
Yes(Routine as
Replacement)
No (assumed at age
level)
Slow Auditory Processing Speed, Poor Parsing
Partial(Telegraphic
Speech)
No (May Assume
R > E)
No(Emphasis on
visual)
No (assumed at age
level)
Preference for Visual over Auditory Modalities
Yes(Use of Visuals &
Procedures)
Yes(Pairs words with activity)
Yes(Visually
sequenced environment)
Multi-modal earlier, then
auditory
Theory of Mind/ Perspective-Taking
No(Reliance of Direct
Learning)
Yes(Anticipation/ Prediction of
Other’s Actions)
No(work is
individual)
Yes(via group
participation)
Sunnyvale [email protected]
Area of Autistic Learning
Disability
One-to-One Adult-Led (ABA-DTT/ PRT/ NET)
One-to-One Child-
Initiative (Floor-Time/
SCERTS/RDI)
Special Education (TEACCH/
Other Special Day
Class)
General Education
(Full or Partial
Inclusion)ORGANIZING ORGANIZING
INFORMATIONINFORMATION Primary Likely Benefits
Lack of Representation Capacity (Imagination)
Partial(Rotely- taught/ non-generative)
Yes (innovation as main focus)
No (more emphasis on classification)
Partial (if child imitates & @ devel. level)
Preference for Repetition over Novelty
Yes(adult-direction)
Yes (innovation as main focus)
Yes(time delimited
tasks)
Partial(varied
curriculum if child can follow
it)
Sensory Modulation Difficulties
Yes(de-
sensitization)
Yes(gradual building
of reciprocity)
Yes(controlled
physical environment)
No(environment
design for those w/o difficulty)
In Conclusion ABA is a powerful tool in the autism
treatment toolbox It’s not the only tool Integration of ABA methods with
developmental curriculum is the highest standard for evidence-based treatment
