DAVID MARK COUILLARD, THE FLORIDA BAR, INITIAL BRIEF OF DAVID MARK
V. Mark Durand University of South Florida St. … · V. Mark Durand University of South Florida...
39
V. Mark Durand University of South Florida St. Petersburg
Transcript of V. Mark Durand University of South Florida St. … · V. Mark Durand University of South Florida...
V. Mark Durand University of South Florida St. Petersburg
Two major characteristics of autism spectrum disorder are expressed in DSM-5
◦ Impairments in social communication and social interaction
◦ Restricted, repetitive patterns of behavior, interests, or activities
Three aspects;
◦ Problems with social reciprocity (a failure to engage in back and forth social interactions),
◦ Nonverbal communication and,
◦ Initiating and maintaining social relationships
Set clear expectations and boundaries. Be
consistent. Develop structure. Practice and
provide repetition to build understanding and
skills.
TEACCH Program and the “culture of autism”
Can you have too much structure and
predictability?
Mesibov, G. B., Shea, V., & Schopler, E. (2004). The TEACCH approach to autism spectrum disorders. New York: Springer.
http://www.autismspeaks.org/docs/family_services_docs/sk/Appendix.pdf
Reward what you want to see utilizing positive
reinforcement strategies. Use the student’s
interests to engage and motivate him.
Pivotal Response Training
DIR/Floortime (Developmental, Individual
Difference, Relationship-based)
Denver Early Start
Ingersoll, B. R. (2010). Teaching Social Communication. Journal of Positive Behavior Interventions, 12(1), 33-43
Settings Approaches
Teaching episodes
Materials and activities
Target skills
Child initiated Child initiated Specific social
communication skills (e.g., two word phrases, pointing, pretend play schemes)
Adapted from: Ingersoll, B. R. (2010). Teaching social communication. Journal of Positive Behavior Interventions, 12(1), 33-43.
Settings Approaches
Elicitation strategies
Prompt strategies
Environmental arrangement (i.e., in-sight, out-of-reach, controlling access)
Varied according to child’s initiation (i.e., physical guidance, modeling, explicit instruction)
Adapted from: Ingersoll, B. R. (2010). Teaching social communication. Journal of Positive Behavior Interventions, 12(1), 33-43.
Settings Approaches
Reinforcement properties
Reinforcement contingencies
Natural
Loose shaping, reinforce attempts toward target
Adapted from: Ingersoll, B. R. (2010). Teaching social communication. Journal of Positive Behavior Interventions, 12(1), 33-43.
“Normalizing” brain functioning1 2
Plasticity
1 Dawson, G., Jones, E. J. H., Merkle, K., Venema, K., Lowy, R., Faja, S., . . . Webb, S. J. (2012). Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 51(11), 1150-1159. 2 Voos, A., Pelphrey, K., Tirrell, J., Bolling, D., Wyk, B., Kaiser, M., . . . Ventola, P. (2013). Neural mechanisms of improvements in social motivation after pivotal response treatment: Two case studies. Journal of Autism and Developmental Disorders, 43(1), 1-10.
Significant variability in implementation of evidence-based practices1
Even with training and supports
1Mandell, D. S., Stahmer, A. C., Shin, S., Xie, M., Reisinger, E., & Marcus, S. C. (in press). The role of treatment fidelity on outcomes during a randomized field trial of an autism intervention. Autism.
Prospective longitudinal study with parents
Not severity of disability
Not severity of behavior problem
Best Predictor?
Parental pessimism
Similar findings with teachers
Common themes ◦ I cannot control this child
◦ People are judging me
◦ This child cannot behave better
◦ These situations are always a problem
◦ Things will never get better
◦ If others did it my way…
◦ It’s my fault
Optimistic Parenting 1
Optimistic Teaching 2
1 Durand, V. M., Hieneman, M., Clarke, S., Wang, M., & Rinaldi, M. (2013). Positive family intervention for severe challenging behavior I: A multi-site randomized clinical trial. Journal of Positive Behavior Interventions, 15(3). 2 Steed, E.A., & Durand, V.M. (2013). Optimistic teaching: Improving the capacity for teachers to reduce young children's challenging behavior. School Mental Health, 5(1), 15-24.
Provide Parent/Teacher Training
General Support
Can we make pessimistic them more optimistic?
Integrating cognitive-behavioral intervention with behavioral training
Situation What happened?
(success or difficulty)
Beliefs What did you think and
feel?
Consequences What happened as a
result? (actions)
When my son sat down
for dinner, he started
whining and crying.
(difficulty)
I thought “We will never
have a normal dinner”
and felt defeated, thinking
that meals will always be
a problem.
I gave him cookies so he
would stop crying.
Identify the consequences or results of the negative (and positive) thinking (e.g., When you were thinking _____, how did that affect what you did? What were the results of your actions – both immediate and long-term?)
Parenting/teaching “in the moment”
Strategy to help with pessimistic beliefs
Distracting oneself from the pessimistic thoughts
Replace the pessimistic ideas with positive thoughts or affirmations (e.g.., “This is a difficult situation and I am handling it well. I am a committed, loving parent. If I can follow through with my plan, things will get better.”)
Both treatments produced significant improvements in child behavior
Optimistic parenting – more improvements
Optimistic parenting - Parents report overall improvements on QoL
BPT families tend to use avoidance strategies to improve child behavior
OP families tend to use more active strategies
OP families report more community involvement with their children and less anxiety
Teachers received either Optimistic Teaching or traditional behavioral coaching.
Teachers in the Optimistic Teaching condition implemented significantly more skills related to teaching children social skills.
Teachers in the Optimistic Teaching condition reported significantly fewer children with serious social emotional difficulties post-intervention.
Teachers in the Optimistic Teaching condition involved families in their children’s social emotional development when compared to teachers who were exposed to traditional behavioral coaching alone.
Durand, V.M. & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Facilitator’s guide. New York: Oxford University Press.
Durand, V.M. & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Workbook. New York: Oxford University Press.
Durand, V.M. (2011). Optimistic parenting: Help and hope for you and your challenging child. Baltimore, MD: Paul H. Brookes.
Durand, V.M. (in press). Autism spectrum disorder: A
clinical guide for general practitioners. Washington,
D.C.: American Psychological Association.
Available December, 2013
