Evidence-Based Communication Approaches for Children With Autism Andy Bondy, Ph.D. Pyramid Educational Consultants, Inc. Cambridge Center for Behavioral Studies West Coast Conference on Autism Santa Barbara, CA April 20, 2012 What does ‘evidence-based’ mean? The National Professional Development Center on Autism Spectrum Disorders A multi-university center to promote the use of evidence-based practice for children and adolescents with ASD Definition of Evidence-Based Practice: • To be considered an evidence-based practice for individuals with ASD, efficacy must be established through peer-reviewed research in scientific journals using: • Randomized or quasi-experimental design studies. Copyright, 2012 by Pyramid Educational Consultants, Inc. 2 What does ‘evidence-based’ mean? The National Professional Development Center on Autism Spectrum Disorders: • Two high quality experimental or quasi-experimental group design studies, single-subject design studies. • Three different investigators or research groups must have conducted five high quality single subject design studies, or combination of evidence. – One high quality randomized or quasi-experimental group design study and three high quality single subject design studies conducted by at least three different investigators or research groups (across the group and single subject design studies). Copyright, 2012 by Pyramid Educational Consultants, Inc. 3 List of EBP for NPDC • Antecedent-Based Interventions (ABI) • Pivotal Response Training • Computer-Aided Instruction • Prompting • Differential Reinforcement • Reinforcement • Discrete Trial Training • Response • Extinction Interruption/Redirection • Functional Behavior Assessment • Self-Management • Functional Communication Training • Social Narratives • Naturalistic Intervention • Social Skills Groups • Parent-Implemented Intervention • Speech Generating • Peer-Mediated Instruction and Devices/VOCA Intervention • Structured Work Systems • Picture Exchange Communication • Task Analysis System (PECS) • Time Delay • Video Modeling • Visual Supports Copyright, 2012 by Pyramid Educational Consultants, Inc. 4 National Standards Project 11 “Established” Treatments: treatments that produce beneficial outcomes and are known to be effective for individuals on the autism spectrum. The overwhelming majority of these interventions were developed in the behavioral literature (e.g., applied behavior analysis, behavioral psychology, and positive behavior support). 22 “Emerging” Treatments: treatments that have some evidence of effectiveness, but not enough for us to be confident that they are truly effective. 5 “Unestablished” Treatments: treatments for which there is no sound evidence of effectiveness. There is no way to rule out the possibility these treatments are ineffective or harmful. Copyright, 2012 by Pyramid Educational Consultants, Inc. 5 NSP Established Treatments: 1. Antecedent Package 2. Behavioral Package 3. Comprehensive Behavioral Treatment for Young Children 4. Joint Attention Intervention 5. Modeling 6. Naturalistic Teaching Strategies 7. Peer Training Package 8. Pivotal Response Treatment 9. Schedules 10.Self-management 11.Story-based Intervention Package Copyright, 2012 by Pyramid Educational Consultants, Inc. 6 NSP Emerging level of evidence: 1. Augmentative and Alternative Communication Device {14 studies} 2. Cognitive Behavioral Intervention Package {3 studies} 3. Developmental Relationship-based Treatment {7 studies} 4. Exercise {4 studies} 5. Exposure Package {4 studies} 6. Imitation-based Interaction {6 studies} 7. Initiation Training {7 studies} 8. Language Training (Production) {13 studies} 9. Language Training (Production & Understanding) {7 studies} 10. Massage/Touch Therapy {2 studies} 11. Multi-component Package {10 studies} Copyright, 2012 by Pyramid Educational Consultants, Inc. 7 NSP Emerging level of evidence: 12. Music Therapy {6 studies} 13. Peer-mediated Instructional Arrangement {11 studies} 14. Picture Exchange Communication System {13 studies} 15. Reductive Package {33 studies} 16. Scripting {6 studies} 17. Sign Instruction {11 studies} 18. Social Communication Intervention {5 studies} 19. Social Skills Package {16 studies} 20. Structured Teaching {4 studies} 21. Technology-based Treatment {19 studies} 22. Theory of Mind Training {4 studies} Copyright, 2012 by Pyramid Educational Consultants, Inc. 8 Does everyone agree on what is EVP? Keenan & Dillenburger (2010). When all you have is a hammer . RCTs and hegemony in science. Research in Autism Spectrum Disorders Abstract: Over the past 40 years Applied Behaviour Analysis (ABA) has utilised inductive, natural science methods to investigate techniques for the analysis and augmentation of socially significant behaviours. Unfortunately, many individuals with ASD in the UK cannot avail of these techniques because of an obdurate reliance on randomised controlled trials (RCTs) as the single most respectable measure of effectiveness of interventions. In this paper we focus on how the debate about RCTs is played out in the ‘autism wars’. Copyright, 2012 by Pyramid Educational Consultants, Inc. 9 How does the world view ‘communication’ and its assessment? Ask a speech-language pathologist! Someone like Lori Frost, M.S., CCC/SLP Copyright, 2012 by Pyramid Educational Consultants, Inc. 10 Milestones 0-12 Months 0-2 months Three-day olds infants recognize mom over other voices. Attracted to and prefer to look at faces. Make eye contact with parents 2-4 months Differentiated response to tone of voice Smile and laugh in response to speech 4-8 months Begin using vocal play to respond to or initiate interaction (“proto- conversations”) 6-12 months Use vocalization to gain attention or objects (protodeclaratives and protoimperatives) Use “vocables” – reliable productions that are not real words Joint Attention: •Follow parents' gaze or gesture to attend to an object •Direct parents' attention by looking at objects Copyright, 2012 by Pyramid Educational Consultants, Inc. 11 What are typical language assessment instruments? Here are several commonly used assessment protocols familiar to SLPs Copyright, 2012 by Pyramid Educational Consultants, Inc. 12 Autism Diagnostic Observation Scale- ADOS Communication Frequency of Vocalization directed to others Stereotyped/Idiosyncratic Use of Words or Phrases Use of Other's Body to Communicate Pointing Gestures Reciprocal Social Interaction Unusual Eye Contact Facial Expressions Directed to Others Shared Enjoyment in Interaction Showing Spontaneous Initiation of Joint Attention Response to Joint Attention Quality of Social Overtures Copyright, 2012 by Pyramid Educational Consultants, Inc. 13 Overall Language Assessment Tool Ages What it tests Communication and Symbolic 0,6 -6,0 Frequency, Means, & range of Behavior Scales communicative intents, many of the subtle nuances specific to children with ASD Evaluating Acquired Skills in 0;3-8;0 Semantics, syntax, morphology, and Communication (EASIC) pragmatics McArthur Communication 0-16 Comprehension, word production and Development Inventory - Infant months aspects of symbolic and communicative Scale gesture McArthur Communication Up to 30 Word production and the early phases of Development Inventory - Toddler months grammar. Scale Communication Matrix 0-24 Expressive communication skills of children months who have severe or multiple disabilities, Rossetti Infant-Toddler 0-3 years Interaction-attachment, pragmatics, Language Scale gesture, play, language comprehension and language expression. Copyright, 2012 by Pyramid Educational Consultants, Inc. 14 Pragmatic Language Assessment Tool Ages What it tests Communication and Symbolic 0.6 -6.0 Many of the subtle nuances specific to Behavior Scales-Developmental children with ASD Profile Language Use Inventory 18-47 Gestures, words and sentences. months …Directing attention, sharing something of interest, teasing, adapting communication to listener Social Responsiveness Scale 4-18 …Social awareness, social information processing, capacity for reciprocal social communication Child Behavior Checklist 4-18 Competencies and behavioral/emotional problems Test of Pragmatic Language 5-13;11 Use of pragmatic language to socially achieve goals Copyright, 2012 by Pyramid Educational Consultants, Inc. 15 What does ABA mean? “The process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree and to demonstrate that the interventions employed are responsible for the improvement in behavior.” (Baer, Wolf and Risley, 1968; Sulzer- Azaroff & Mayer, 1991) Copyright, 2012 by Pyramid Educational Consultants, Inc. 16 Another description of ABA “ABA is not something we ‘do’ to students, it’s a description of how the world works. It is the science of how the world affects the person, how the person affects the world, how the person affects other people, and how the person’s behavior affects the person’s ‘other’ behavior. Much like biology describes the biological world, Behavior Analysis describes the world of behavior. If we have a notion of how these relationships work, it can help us design environments that are conducive to learning. This, in part, is what ABA is.” (Castrogiovanni, 2009) Copyright, 2012 by Pyramid Educational Consultants, Inc. 17 Why do we behave? A Contingency Analysis • We study ‘Behavior under what conditions’ • Three Primary Functional relationships – Gain some type of R+ • Concrete, activity, social, internal – Avoidance/Escape • Demand,