Saturday, October 16, 2010
Saturday, October 9, 2010
Assessment: Targeting the treatment towards the real issues, not just the child.
When a child presents with Autism, or almost any developmental disability or social emotional issue, the tendency is often to immediately provide intervention to the child.
First, you must have a good standard assessment for diagnosis and treatment. So many developmental disabilities and mental illnesses today have well researched prescriptive treatment that it is often a huge waste of time and money when the wrong intervention is used for the child; however, just because you have the completed the right assessments for diagnosis, does not mean you have completed all the needed assessment for treatment.
In any situation where the issue/behavior is a significant issue, you must also complete a Functional Analysis of Behavior. Often, the most important intervention is not targeted directly at the child; but at the environment and setting events.
The following information is as applicable to the home as it is to the classroom.
http://www.challengingbehavior.org/do/pyramid_model.htm
http://www.challengingbehavior.org/do/resources/documents/yc_article_7_2003.pdf
For additional information see postings on this website on Functional Analyses of Behavior and Setting Events.
First, you must have a good standard assessment for diagnosis and treatment. So many developmental disabilities and mental illnesses today have well researched prescriptive treatment that it is often a huge waste of time and money when the wrong intervention is used for the child; however, just because you have the completed the right assessments for diagnosis, does not mean you have completed all the needed assessment for treatment.
In any situation where the issue/behavior is a significant issue, you must also complete a Functional Analysis of Behavior. Often, the most important intervention is not targeted directly at the child; but at the environment and setting events.
The following information is as applicable to the home as it is to the classroom.
http://www.challengingbehavior.org/do/pyramid_model.htm
http://www.challengingbehavior.org/do/resources/documents/yc_article_7_2003.pdf
For additional information see postings on this website on Functional Analyses of Behavior and Setting Events.
Thursday, October 7, 2010
Current best practice treatment for Autism by age and diagnosis.
The National Autism Center’s
National Standards Project
Findings and Conclusions
2009
Overview and Summary
Outcomes:
Established Treatments
(Note from Pete: This represents an expansion of established treatments as well as an expansion of age groups. It does not change the well researched fact that earlier intervention is best; however, it ads effective treatment recommendations for an expanded age range. While we can still say best practice, best results, are early, there appears to be emerging evidence that significant progress can also be made later. We still don’t have any solid research showing significant or anywhere near significant outcomes for lower functioning children with Autism.)
“The following interventions are Established Treatments:
· Antecedent Package
· Behavioral Package
· Comprehensive Behavioral Treatment for Young Children
· Joint Attention Intervention
· Modeling
· Naturalistic Teaching Strategies
· Peer Training Package
· Pivotal Response Treatment
· Schedules
· Self-management
· Story-based Intervention Package”
“Treatment Targets
Established Treatments have demonstrated favorable outcomes for many treatment targets…
· Antecedent Package, Behavioral Package, and Comprehensive Behavioral Treatment for Young Children have demonstrated favorable outcomes with more than half of the skills that are often targeted to be increased…
· Behavioral Package has demonstrated favorable outcomes with three-quarters of the behaviors that are often targeted to decrease…
· Other Established Treatments have demonstrated favorable outcomes with a smaller range of treatment targets. In many cases, this provides a rich opportunity to extend research findings.
Age Groups
Established Treatments have demonstrated favorable outcomes with many age groups.
· Behavioral Package has demonstrated favorable outcomes with all age groups.
· Antecedent Package, Comprehensive Behavioral Treatment for Young Children, Modeling, and Self-management have demonstrated favorable outcomes with two-thirds of all age groups.
· Naturalistic Teaching Strategies have demonstrated favorable outcomes with one-half of all age groups.
· Only one Established Treatment has been associated with favorable outcomes for the early adult age group. Further investigation is necessary for this age group.
· Other Established Treatments have demonstrated favorable outcomes with a small range of age groups…”
(Pete’s note: We really have enough information now to allow for prescriptive treatment according to diagnosis and age group. This is a carry over from the 2005 study; but adds and further confirms these findings. One would almost wonder why we would pay for anything that doesn’t fit the model, with a few rare; but still prescribed exceptions.)
“Diagnostic Groups
Established Treatments have demonstrated favorable outcomes with many diagnostic groups.
· Behavioral Package, Comprehensive Behavioral Treatment for Young Children, Joint Attention Intervention, Modeling, Naturalistic Teaching Strategies, and Peer Training Package have demonstrated favorable outcomes with most diagnostic groups.
· A few Established Treatments (i.e. Modeling and Story-based Intervention Package) have been associated with favorable outcomes for Asperger’s Syndrome…
· Other Established Treatments have demonstrated favorable outcomes with a smaller range of diagnostic groups. In many cases, this provides a rich opportunity to extend research findings.”
(Pete’s note regarding the table of information: While this information is fairly current and comprehensive, it does not include the research that came out this year regarding DENVER or the current research regarding P.L.A.Y.)
Unfortunately I am unable to insert a table into this blog; however, in order to see the table showing treatment by diagnosis and age, and to see the entire report, go to: http://www.nationalautismcenter.org/pdf/NAC%20Findings%20&%20Conclusions.pdf
(Pete’s note: That concludes the primary summary.
The following includes a basic summary of the packages. The reference under Antecedent Packages includes the incredibly important setting events, which places a significant component of primary intervention in the home. P.L.A.Y. has a lot of Joint Attention and NTS.)
“Established Treatments with definitions and examples:
· Antecedent Package … These interventions involve the modification of situational events that typically precede the occurrence of a target behavior. These alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. Treatments falling into this category reflect research representing the fields of applied behavior analysis ( ABA ), behavioral psychology, and positive behavior supports…
· Behavioral Package … These interventions are designed to reduce problem behavior and teach functional alternative behaviors or skills through the application of basic principles of behavior change. Treatments falling into this category reflect research representing the fields of applied behavior analysis, behavioral psychology, and positive behavior supports…
· Comprehensive Behavioral Treatment for Young Children … This treatment reflects research from comprehensive treatment programs that involve a combination of applied behavior analytic procedures (e.g., discrete trial, incidental teaching, etc.) which are delivered to young children (generally under the age of 8). These treatments may be delivered in a variety of settings (e.g., home, self-contained classroom, inclusive classroom, community) and involve a low student-to-teacher ratio (e.g., 1:1). All of the studies falling into this category met the strict criteria of: {a} targeting the defining symptoms of ASD , {b} having treatment manuals, {c} providing treatment with a high degree of intensity, and {d} measuring the overall effectiveness of the program…
· Joint Attention … These interventions involve building foundational skills involved in regulating the behaviors of others. Joint attention often involves teaching a child to respond to the nonverbal social bids of others or to initiate joint attention interactions.
· Modeling … These interventions rely on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with ASD . Modeling can include simple and complex behaviors. This intervention is often combined with other strategies such as prompting and reinforcement.
· Naturalistic Teaching Strategies … These interventions involve using primarily child-directed interactions to teach functional skills in the natural environment. These interventions often involve providing a stimulating environment, modeling how to play, encouraging conversation, providing choices and direct/natural reinfocers, and rewarding reasonable attempts.
· Peer Training Package … These interventions involve teaching children without disabilities strategies for facilitating play and social interactions with children on the autism spectrum. Peers may often include classmates or siblings. When both initiation training and peer training were components of treatment in a study, the study was coded as ‘peer training package.” These interventions may include components of other treatment packages (e.g., self-management for peers, prompting, reinforcement, etc.).
· Pivotal Response Treatment … This treatment is also referred to as PRT , Pivotal Response Teaching, and Pivotal Response Training, PRT focuses on targeting “pivotal” behavioral areas – such areas as motivation to engage in social communication, self-initiation, self-management, and responsiveness to multiple cues, with the development of these areas having the goal of very widespread and fluently integrated collateral improvements. Key aspects of PRT intervention delivery also focus on parent involvement in the intervention delivery, and on intervention in the natural environment such as homes and schools with the goal of producing naturalized behavioral improvements.
· Schedules … These interventions involve the presentation of a task list that communicates a series of activities or steps required to complete a specific activity. Schedules are often supplemented by other interventions such as reinforcement.
· Self-management … These interventions involve promoting independence by teaching inficiduals with ASD to regulate their behavior by recording the occurrences/non-occurrence fo the target behavior, and securing reinforcement for doing so. Initial skills development may involve other strategies and may include the task of setting one’s own goals. In addition, reinforcement is a component of this intervention with the individual with ASD independently seeking and/or delivering reinforcers.
· Story-based Intervention Package … Treatments that involve a written description of the situations under which specific behaviors are expected to occur. Stories may be supplemented with additional components (e.g., prompting, reinforcement, discussion, etc.).
National Standards Project
Findings and Conclusions
2009
Overview and Summary
Outcomes:
Established Treatments
(Note from Pete: This represents an expansion of established treatments as well as an expansion of age groups. It does not change the well researched fact that earlier intervention is best; however, it ads effective treatment recommendations for an expanded age range. While we can still say best practice, best results, are early, there appears to be emerging evidence that significant progress can also be made later. We still don’t have any solid research showing significant or anywhere near significant outcomes for lower functioning children with Autism.)
“The following interventions are Established Treatments:
· Antecedent Package
· Behavioral Package
· Comprehensive Behavioral Treatment for Young Children
· Joint Attention Intervention
· Modeling
· Naturalistic Teaching Strategies
· Peer Training Package
· Pivotal Response Treatment
· Schedules
· Self-management
· Story-based Intervention Package”
“Treatment Targets
Established Treatments have demonstrated favorable outcomes for many treatment targets…
· Antecedent Package, Behavioral Package, and Comprehensive Behavioral Treatment for Young Children have demonstrated favorable outcomes with more than half of the skills that are often targeted to be increased…
· Behavioral Package has demonstrated favorable outcomes with three-quarters of the behaviors that are often targeted to decrease…
· Other Established Treatments have demonstrated favorable outcomes with a smaller range of treatment targets. In many cases, this provides a rich opportunity to extend research findings.
Age Groups
Established Treatments have demonstrated favorable outcomes with many age groups.
· Behavioral Package has demonstrated favorable outcomes with all age groups.
· Antecedent Package, Comprehensive Behavioral Treatment for Young Children, Modeling, and Self-management have demonstrated favorable outcomes with two-thirds of all age groups.
· Naturalistic Teaching Strategies have demonstrated favorable outcomes with one-half of all age groups.
· Only one Established Treatment has been associated with favorable outcomes for the early adult age group. Further investigation is necessary for this age group.
· Other Established Treatments have demonstrated favorable outcomes with a small range of age groups…”
(Pete’s note: We really have enough information now to allow for prescriptive treatment according to diagnosis and age group. This is a carry over from the 2005 study; but adds and further confirms these findings. One would almost wonder why we would pay for anything that doesn’t fit the model, with a few rare; but still prescribed exceptions.)
“Diagnostic Groups
Established Treatments have demonstrated favorable outcomes with many diagnostic groups.
· Behavioral Package, Comprehensive Behavioral Treatment for Young Children, Joint Attention Intervention, Modeling, Naturalistic Teaching Strategies, and Peer Training Package have demonstrated favorable outcomes with most diagnostic groups.
· A few Established Treatments (i.e. Modeling and Story-based Intervention Package) have been associated with favorable outcomes for Asperger’s Syndrome…
· Other Established Treatments have demonstrated favorable outcomes with a smaller range of diagnostic groups. In many cases, this provides a rich opportunity to extend research findings.”
(Pete’s note regarding the table of information: While this information is fairly current and comprehensive, it does not include the research that came out this year regarding DENVER or the current research regarding P.L.A.Y.)
Unfortunately I am unable to insert a table into this blog; however, in order to see the table showing treatment by diagnosis and age, and to see the entire report, go to: http://www.nationalautismcenter.org/pdf/NAC%20Findings%20&%20Conclusions.pdf
(Pete’s note: That concludes the primary summary.
The following includes a basic summary of the packages. The reference under Antecedent Packages includes the incredibly important setting events, which places a significant component of primary intervention in the home. P.L.A.Y. has a lot of Joint Attention and NTS.)
“Established Treatments with definitions and examples:
· Antecedent Package … These interventions involve the modification of situational events that typically precede the occurrence of a target behavior. These alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. Treatments falling into this category reflect research representing the fields of applied behavior analysis ( ABA ), behavioral psychology, and positive behavior supports…
· Behavioral Package … These interventions are designed to reduce problem behavior and teach functional alternative behaviors or skills through the application of basic principles of behavior change. Treatments falling into this category reflect research representing the fields of applied behavior analysis, behavioral psychology, and positive behavior supports…
· Comprehensive Behavioral Treatment for Young Children … This treatment reflects research from comprehensive treatment programs that involve a combination of applied behavior analytic procedures (e.g., discrete trial, incidental teaching, etc.) which are delivered to young children (generally under the age of 8). These treatments may be delivered in a variety of settings (e.g., home, self-contained classroom, inclusive classroom, community) and involve a low student-to-teacher ratio (e.g., 1:1). All of the studies falling into this category met the strict criteria of: {a} targeting the defining symptoms of ASD , {b} having treatment manuals, {c} providing treatment with a high degree of intensity, and {d} measuring the overall effectiveness of the program…
· Joint Attention … These interventions involve building foundational skills involved in regulating the behaviors of others. Joint attention often involves teaching a child to respond to the nonverbal social bids of others or to initiate joint attention interactions.
· Modeling … These interventions rely on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with ASD . Modeling can include simple and complex behaviors. This intervention is often combined with other strategies such as prompting and reinforcement.
· Naturalistic Teaching Strategies … These interventions involve using primarily child-directed interactions to teach functional skills in the natural environment. These interventions often involve providing a stimulating environment, modeling how to play, encouraging conversation, providing choices and direct/natural reinfocers, and rewarding reasonable attempts.
· Peer Training Package … These interventions involve teaching children without disabilities strategies for facilitating play and social interactions with children on the autism spectrum. Peers may often include classmates or siblings. When both initiation training and peer training were components of treatment in a study, the study was coded as ‘peer training package.” These interventions may include components of other treatment packages (e.g., self-management for peers, prompting, reinforcement, etc.).
· Pivotal Response Treatment … This treatment is also referred to as PRT , Pivotal Response Teaching, and Pivotal Response Training, PRT focuses on targeting “pivotal” behavioral areas – such areas as motivation to engage in social communication, self-initiation, self-management, and responsiveness to multiple cues, with the development of these areas having the goal of very widespread and fluently integrated collateral improvements. Key aspects of PRT intervention delivery also focus on parent involvement in the intervention delivery, and on intervention in the natural environment such as homes and schools with the goal of producing naturalized behavioral improvements.
· Schedules … These interventions involve the presentation of a task list that communicates a series of activities or steps required to complete a specific activity. Schedules are often supplemented by other interventions such as reinforcement.
· Self-management … These interventions involve promoting independence by teaching inficiduals with ASD to regulate their behavior by recording the occurrences/non-occurrence fo the target behavior, and securing reinforcement for doing so. Initial skills development may involve other strategies and may include the task of setting one’s own goals. In addition, reinforcement is a component of this intervention with the individual with ASD independently seeking and/or delivering reinforcers.
· Story-based Intervention Package … Treatments that involve a written description of the situations under which specific behaviors are expected to occur. Stories may be supplemented with additional components (e.g., prompting, reinforcement, discussion, etc.).
Tuesday, October 5, 2010
More progress for less money. Best practice, affordable therapy/intervention for Mental Health or Developmental Disabilities. Economic Best Practice for Government Agencies and Schools: Coaching
Many states are considering making significant cuts to the amount of money they spend on therapy/intervention for children and teens with developmental disabilities or mental health diagnoses.
There is a cost effective way to help children and families; however, it requires parental responsibility. Some have argued that some families can’t be active participants in their children’s therapy. That argument is bogus and has been proven false by research. Almost ANY family can actively participate in their child’s therapy/intervention.
For children with Autism, one solution is P.L.A.Y. therapy. http://www.playproject.org/media/pdfs/PilotStudy_PLAYProject.pdf
The cost per child is approximately $2,500.00 per year as of 2008. Another option is Coaching.
P.L.A.Y. is a form of coaching; however, there are many forms of coaching in therapy and intervention.
While most of the research revolves around early childhood, there is supportive literature for this practice with older children, teens, and even adults. In fact, if you go to the bottom of: http://responsiblepracticalparenting.blogspot.com/ and use the Google Parenting and Google Scholar search engines, using key words such as: coaching, intervention, early, childhood, teens, therapy, you will find a wealth of information and research.
If you are currently spending $25,000.00 to $100,000.00 per year per child and getting poor results, consider coaching through one of the established research based models. Typically for $10,000.00 per year per child or less, you can actually get better results.
As mentioned, there are other ways of doing coaching; but the bottom line is, it is significantly more effective and significantly less expensive.
Full family centered involvement with contextualized routine based interventions in the environments natural to the child and family is the most effective way to significantly improve behaviors in the home and other natural environments and make significant progress based on the natural routines of the child and family.
If your state, school, or government entity is considering significant cut-backs in services, encourage those who make these decisions to consider a coaching model.
If we do not do something effective, the unintended consequences are going to be even more expensive.
Supplemental Materials:
http://www.coachinginearlychildhood.org/nleconcepts.php
http://www2.ku.edu/~kskits/ta/Packets/UsingPrimaryService/References.pdf
http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf
http://www.fippcase.org/
See: http://bestoutcomes.blogspot.com/ & http://currentautismresearchhopeforautism.blogspot.com/ for additional information.
There is a cost effective way to help children and families; however, it requires parental responsibility. Some have argued that some families can’t be active participants in their children’s therapy. That argument is bogus and has been proven false by research. Almost ANY family can actively participate in their child’s therapy/intervention.
For children with Autism, one solution is P.L.A.Y. therapy. http://www.playproject.org/media/pdfs/PilotStudy_PLAYProject.pdf
The cost per child is approximately $2,500.00 per year as of 2008. Another option is Coaching.
P.L.A.Y. is a form of coaching; however, there are many forms of coaching in therapy and intervention.
While most of the research revolves around early childhood, there is supportive literature for this practice with older children, teens, and even adults. In fact, if you go to the bottom of: http://responsiblepracticalparenting.blogspot.com/ and use the Google Parenting and Google Scholar search engines, using key words such as: coaching, intervention, early, childhood, teens, therapy, you will find a wealth of information and research.
If you are currently spending $25,000.00 to $100,000.00 per year per child and getting poor results, consider coaching through one of the established research based models. Typically for $10,000.00 per year per child or less, you can actually get better results.
As mentioned, there are other ways of doing coaching; but the bottom line is, it is significantly more effective and significantly less expensive.
Full family centered involvement with contextualized routine based interventions in the environments natural to the child and family is the most effective way to significantly improve behaviors in the home and other natural environments and make significant progress based on the natural routines of the child and family.
If your state, school, or government entity is considering significant cut-backs in services, encourage those who make these decisions to consider a coaching model.
If we do not do something effective, the unintended consequences are going to be even more expensive.
Supplemental Materials:
http://www.coachinginearlychildhood.org/nleconcepts.php
http://www2.ku.edu/~kskits/ta/Packets/UsingPrimaryService/References.pdf
http://www.fippcase.org/caseinpoint/caseinpoint_vol4_no1.pdf
http://www.fippcase.org/
See: http://bestoutcomes.blogspot.com/ & http://currentautismresearchhopeforautism.blogspot.com/ for additional information.
Friday, July 9, 2010
Enhancing the well-being of children ... - Google Books
Enhancing the well-being of children ... - Google Books: "Enhancing the well-being of children and families through effective"
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