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Research Panel: know our data
and get involved!
Diane Cullinane, MD
Josh Feder, MD
Connie Lillas, PhD, MFT, RN
Lois Black, PhD
Devin Casenheiser, PhD
Jim Stieben, PhD
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Support Parent Choice Today!www.dirfloortimecoc.com
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The Roots
Greenspan, S.I. and Wieder, S. (1997) Developmental patternsand outcomes in infants and children with disorders in relating andcommunicating: A chart review of 200 cases of children withautistic spectrum diagnoses. Journal of Developmental andLearning Disorders 1:87-141
Greenspan, S.I. and Wieder, S. (2005) Can Children with AutismMaster the Core Deficits and Become Empathetic, Creative andReflective? A Ten to Fifteen Year Follow-up of a Subgroup ofChildren with Autism Spectrum Disorders (ASD) Who Received aComprehensive Developmental, Individual-Difference,Relationship-Based (DIR) Approach. The Journal ofDevelopmental and Learning Disorders 9.
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Specifically DIR/FT
Solomon, R., Necheles, J., Ferch, C., &Bruckman, D. (2008). Pilot study of aparent training program for young children
with autism: the P.L.A.Y. Project HomeConsultation Program. Autism, 11(3), 205-224.
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Relationship Focused Intervention
Mahoney, G. & Perales, F. (2003). Using relationship-focused intervention to enhance the social-emotionalfunctioning of young children with autism spectrumdisorders. Topics in Early Childhood Special
Education, 23, 74-86.
Mahoney, G., and Perales, F. (2005) Relationship-focused early intervention with children with pervasivedevelopmental disorders and other disabilities: acomparative study. Journal of Developmental &Behavioral Pediatrics26: 77-85.
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Parent mediated Intervention
Kasari, Gulsrud, Wong, Kwon, & Locke.Randomized Controlled Caregiver MediatedJoint Engagement Intervention for Toddlers
with Autism. J. Autism Dev Disord (2010)
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The Scotts
Salt, Shemilt et. al. The Scottish Centre forAutism preschool treatment programme. IIThe results of a controlled treatment
outcome study. (2002) SAGE publicationsof The National Autistics Society. Vol 6(1)33-46.
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A Hybrid
Dawson, G., Rogers, S., Munson, J., Smith, M.,Winter, J., Greenson, J., Donaldson, A. &Varley, J. (2009). Randomized controlled
trial of an intervention for toddlers withautism. The Early Start Denver Model.Pediatrics. Online verson e17-e23.
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Reviews
Odom, Boyd, Hall, & Hume. Evaluation ofComprehensive Treatment Models forIndividuals with Autism Spectrum Disorders.
J Autism Dev Disord (2009) Ospina, M. et al. Behavioural and
Developmental Interventions for Autism
Spectrum Disorder: A Clinical SystematicReview. (2008)
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The best is yet to come!
Drs. Devin Casenhiser, Jim Steiben, Stuart Shanker andeveryone at York / MEHRI
The York Study!
Dr. Rick Solomon
The Play Project
Dr. Josh Feder The Bridge Project
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Getting Started in Research
Josh Feder, MD
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But Im a clinician
Why are you HERE?
Learn more
Make friends
Step gradually
Help out
Persist, and maybe perseverate
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Learn about Evidence Based Practice
Evidence Based Medicine Sackett 1995
Best Available Research combined withClinical Judgment and Experience
For the Purpose of Informed Consent
Parent Choice!
More from Connie later
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Understand the Challenges of Doing Research
Subjective experience (affect) is at the center
Heterogeneity: all the people are so different
More than one treatment at a time
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Overcoming Challenges
Efficiency studies (vs. Efficacy Studies)
FEAS, SEGC
Reflective Community Consensus Process
BRIDGE going post-denominational (thanksStanley)
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Tuning Into Each Other
Customizing Project ImPACT
to address our key community values and reach younger children for
the SoCal BRIDGE Collaborative
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BRIDGE
Community collaboration
Parents, clinicians, researchers, agencies,funders
Vetting ideas
Learning from each other
Coming to consensus
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Taking Project ImPACT..
Parent driven
Mixed developmental/ behavioral
Language focused
Specific goals
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ImPACT
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And make it ours
Warm it up
Broaden the vision
Give it our context
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BRIDGE Enhancements
Engagement
Communication
Sensori-motor
Reflective process
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Warmed up
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Project ImPACT
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And Make it Ours
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The Evidence Based Movement: 19th
Century Science versus Complexity:
Welcome to the 21st Century
Connie Lillas, PhD, MFT, RN
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California Quake Crisis
Legislators do not understand the issues
DIR not on EI & DMH list of approvedtherapies
Need for push back nationally
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Pushing Backthe Problem
Reductionist, narrow research paradigms
Outdated research models
Children are complex
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Pushing Back - Solutions
Advocacy from Parent to Professional
Know and educate colleagues about thedifference between Evidence Based Practice and
Evidence Based Treatments Educate about research paradigm matches
versus mismatches
Support research that is practice-based evidence
Promote professional and parental critical thinkingand informed choice
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Insist on Clarity:E-B-Treatments do NOT equal E-B-Practice
Evidence-Based Practice is:
A decision making processthat holds the tensionbetween:
The best available clinical research (EBTs)
Professional wisdom based in sound theory and practice
Cultural and family values (with informed choice) Buysee and Wesley, 2006
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Insist on Match Between ResearchApproach & Clinical Population
Problems with Gold Standard Research:
Often simple, subclinical cases are involved inresearch settings
Designed for single diagnosis, not matching co-occurring diagnoses
Lacks flexibility to account for individualdifferences
Lacks flexibility for following a therapeutic alliance,shifts in behaviors, and cultural sensitivities
In Lillas and Turnbull, 2009, from Weisz & Gray, 2008
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21st Century Vision for Paradigm Shift in
Research
a critical question for the field is what
approach to empirical testing will give us thestrongest treatments that are most robust inactual clinical practice
(Weisz & Gray, 2008, p. 62)
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Get Involved!
Practice-Based Evidence
Push-back with complex clinical cases that drivescientists search for new knowledge
Attend conferences and join organizations withchild development researchers (map)
Take complex models and frameworks into
clinical research settings Search and find cutting-edge dynamic systems
research paradigms that can hold complexity
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The Importance of Affect:Research in Support of DIR Intervention
Lois M. Black, Ph.D.
Faculty DIR Institute
Clinical Psychologist/Pediatric NeuropsychologistResearch Professor
Oregon Health & Science University
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Black, et al., IMFAR 2009: Understanding the Effects of Enhancing Vocal
Prosody on Childrens Comprehension and Retention of Story Narratives
Participants: N=79Ages 4-8, overall IQ > 70.ASD group N=37
TD group N=42
3 Prosodic Modes: Disconnected
Recorded words in random order,concatenated words together intosentences
Imposed synthetic pitch contour
on sentences Minimal grammatical prosody; no
pragmatic or affective prosody stress correct syllable word
meaning intelligible descending or ascending
contours -- questions andstatements
Standard intact grammatical, minimal
pragmatic, affective prosody
Enhanced exaggerated grammatical,
pragmatic, affective prosody
NARRATIVES:Affectively-rich, interpersonalstories.Factual + Social CognitiveInformation
Immediate and delayed questionsGoal: What are the effects ofenhancing vocal prosody affect inones voice -- on comprehensionand retention of information?
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Findings, contd:
No such beneficial effect of prosodic mode was seen in the TD
group. (Essentially no differences across disconnected, standardand enhanced conditions.)
TD performed better than ASD children in all prosodic modes.
Trends were found for the interaction to be more pronounced for thesocial cognitive questions.
Conclusions:
Enhanced prosody specifically targeted to highlight the multiple
levels of information in complex verbal communication helpscomprehension and retention of information in children with ASD,in particular, social cognitive information.
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Critical Elements for DIR Intervention
Research
Pre-treatment measures Heterogeneity/How we know who our
children are Post-treatment/Outcome measures What are we striving to achieve for
our children
Treatment manual
Fidelity measures
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What we need most
Treatment manual
Fidelity measures
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The Final Frontier: Research onDIR on both Clinical and
Functional Imaging Outcomes
Devin Casenheiser, PhD
Jim Stieben, PhD
Stuart Shanker, D. Phil. Oxon
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The York MEHRI Study
2 hours per week FT coaching
Study population & controls\
Clinical measurement of effects
Functional Imaging
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Findings:
Clinical improvement
Brain looks better!
Publication status
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Implications
Profound evidence
Comparison w/ other imaging studies
Next steps (studies, advocacy)
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