What are they, and what does that mean? By Keith Hersh M.S. BCBA

•Word of Mouth •Books •Journal Articles •Peer Reviewed Journal Articles

•No Research •Case Study •Citing  Other’s  Research •Group Design •Single Subject Design

•Prediction •Control •Research must include changing something and measuring the outcome. •Best measurement is repeated measurement over time •Less reliable research uses pre and post test surveys.

•There  is  no  “best”  type  of  research. •Different tools for different jobs. •As a parent, what can I do to figure out if I am looking at good or bad research?

•Is it peer reviewed? •Did it measure behavior or use surveys? •How many subjects? •Is there replication? •Have external agencies reviewed the literature? •The National Research Council, The Surgeon General, The American Academy of Pediatrics, The National Autism Center, The NPDCASD

•11 Established Treatments – thoroughly researched and have sufficient evidence for us to confidently state that they are effective. •22 Emerging Treatments – some evidence of effectiveness, but not enough for us to be confident that they are truly effective. •Unestablished – No evidence at this time. •Ineffective/Harmful – Research shows the treatment is not effective, and may even be harmful.

•Antecedent Package •Behavioral Package •Comprehensive Behavioral Treatment for Young Children •Joint Attention •Modeling •Naturalistic Teaching Strategies •Peer Training Packing

•Pivotal Response Training •Schedules •Self-Management •Story-Based Interventions

•Effective With: •Communication skills •Social skills •Play Skills •Problem Behaviors •Sensory and emotional regulation

•Example: •Data are taken that show when Bob gets a small lunch at 12:00 p.m., he is much more likely to hit people during his work skills program at 3:00 p.m. •Norman will ruminate (bring up partially digested food) if he drinks liquids during his meal. Norman does not ruminate if he drinks 30-40 minutes after a meal.

•Effective With: •Academic Skills •Communication Skills •Personal Responsibility •Problem Behavior •Self-Stimulatory Behavior

•Examples •In the last example, Bob was more aggressive when he was hungry. In a behavioral package, staff teach Bob to say “I’m  Hungry”  to  get  a  snack  and  “Break”  to  take a break, instead of aggression. •John has problems with finishing his work in school. His behavioral package says, if you finish your work, you go to recess, if you don’t  finish  your  work,  you  stay  back  until  the work is finished.

•Effective With: •Children 0-9 with Autism •Settings that can have high teacher to student ratio •Experts in ABA strategies •Communication Skills •Motor Skills •Problem Behaviors •General Symptoms Associated with ASD

•Example: •John attends an ABA center for 30 hours per week •The program is run by a Board Certified Behavior Analyst •John has 2 other therapists that work directly with him at the center •John’s  parents  attend  bi-weekly team meetings, and implement the behavior plan at home •Focuses on deficits and excesses

•Works With: •Ages 0-5 with Autism •Children  who  don’t  share  attention  with  another focused on an object or activity. •Increasing eye gaze at same object •Increasing pointing to same object •Increasing talking about a same object

•Example: •Teaching student to look at the same object and interact with it or talk about it. Student is not allowed to go play alone or next to another student without sharing an item. Many times starts with sharing an object, taking turns, then both having an object, and imitating each other, or doing the same activity. (parachute, throwing a ball, commenting)

•Works With: •Ages 3-18 with Autism •Communication Skills •Higher Cognitive Skills •Play Skills •Problem Behaviors •Multiple Step Tasks

•Examples: •An 16 year old student is taught to wash his clothes. The therapist shows a video of doing the laundry. The therapist shows each segment of the video, before the student can complete that step. Feedback is given each time the student performs a step. •A student is learning to leave the computer when the timer goes off. Two other peers are at the computer table. When the timer goes off, the other two peers go back to their seat.

•Works With: •Shown Effective for ages 0-9 with Autism •Communication Skills •Interpersonal Skills •Play Skills •Usually requires learning in structured setting first then more natural setting.

•Examples: •Every day before snack and lunch all students in the classroom must wash their hands. A task analysis is designed to monitor progress and independence every time hands are washed. The student sees other students wash their hands before, and hears other students being praised for the steps. Prompting is slowly faded for the last successful step in the chain.

•Examples: •Dee enjoys playing with princesses. As part of her program, she is learning to label colors. After she can identify colors on cards at the table, the teacher then gets 5 princesses with different color gowns. The student requests each the colors of the gowns, and gets to play with the princess for correctly identifying that color.

•Works With: •Ages 3-14 with Autism •Communication Skills •Play Skills •Sharing •Social Interactions •Asking for help

•Examples: •Nathan is in a Physical Education class with typical peers. He seems to enjoy praise and interaction with his peers, but often struggles to participate in games such as soccer or basketball. Peers are taught to prompt (physically and verbally) and to reinforce (verbal and tangible) participation in the games. •Notes: Keep ages/skill levels similar. Contingencies for peers. Siblings are great!

•Works With: •Ages 3-9 with Autism •Communication Skills •Interpersonal Skills •Play Skills

•Examples: Note that PRT is very similar to ABA. It can be very difficult to determine exactly what constitutes PRT. •Teaching by varying materials to avoid boredom, using natural reinforcers and making sure they are available for attempts to communicate, teaching in the natural environment. •PRT heavily focuses on using existing motivation and naturally occurring situations to teach and reinforce behavior.

•Works With: •EVERYONE!!!!! •Transitions (sometimes) •Predicting what comes next •Independent living

•Examples: •A picture of each classroom activity is placed on a Velcro board. Each time an event is completed, the picture symbol is removed  and  placed  in  a  “finished”  box  or  side of the board. •A day planner is used to document all outings or variances from the normal schedule. (Lucas and his daily schedule).

•Works With: •Ages 3-18 with Autism •Academic skills •Interpersonal skills •Self-regulation •Teaching awareness of learners behavior •Recording your own data

•Examples: •Student is first taught rules from a list. Student  is  taught  to  label  when  other’s  follow the rules in video and role play. Student is asked to evaluate their own behavior. •Travis  and  the  “Changing  my  behavior  plan”

•AKA Social Stories •Works With: •Ages 6-14 with Autism •Favorable  with  Asperger’s  and  students  with  more developed language skills •Choice and play skills •Self-regulation (predicting consequences) •Social behavior •Understanding emotions

•Examples: •Not just a story! •Must be specific about actual behaviors •Identifies social consequences for behavior •A learner is staring at girls in the classroom excessively and classmates are reporting being uncomfortable. A story outlines only looking at someone briefly and looking away. The story focuses on social consequences for staring.

•A student does not engage in choice making or engaging with materials. The teacher designs stories about how to use materials and combines the story with modeling and reinforcement. •An adolescent takes 8 pills a day. The family designs a story about when to take pills, and sets a wrist watch to have 3 alarms to remind the student. Social stories with pictures of the watch and pill containers are used to teach the student to take pills independently.

•There are many interventions that have been shown to be effective to change behavior of individuals with autism. •These interventions are based on principles of behavior. •Professional BCBA expertise •Data collection is mandatory •Family input is crucial to success

•The  National  Autism  Center,  “Evidence-Based  practice  and  Autism  in  the  Schools.”    2009. •Wait  there’s  more!!!!! •The National Professional Development Center on Autism Spectrum Disorders, “Evidence  Based  Practices.”     •“ABA  Resources”  at  www.i-aba.com