Terri Duncan, MSLP, R.SLP.

Transcription

1 Charlene Chamberlain, PhD, R.SLP Terri Duncan, MSLP, R.SLP

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3 Evidence-Based Practice Evidence-based practice in psychology (EBPP) is the integration of the best available research, with clinical expertise, in the context of patient (family) characteristics, culture, and preferences (APA, 2005).

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5 Heterogeneity of the ASD population Changing diagnostic criteria Huge number of sub-topics Procedural fidelity in treatment packages Active Ingredients in treatment Measuring change

6 2003 Wetherby & Woods pilot study observing parent-implemented coaching 2006 Wetherby & Woods preliminary data with 2 yr olds with ASD, and a 3 yr old comparison group Wetherby et al., Randomized Control Trial (RCT) of the model with 82 toddlers randomly assigned to the individual treatment condition or a group treatment condition

7 A word about the web Peer reviewed journals (general vs. specific) General: Pediatrics Canadian Journal of Psychiatry Topics in Early Childhood Journal of Child Psychology and Psychiatry Journal of the American Academy of Child and Adolescent Psychiatry Etc... Specific: Autism Journal of Autism and Developmental Disorders (JADD) Research in Autism Spectrum Disorder Autism Research Journal of Sleep Research

8 Halifax research centre: m ( Edmonton research centre: entre/home Autism Speaks RESEARCH link ( UC Davis MIND institute: Distinguished Lecturer Series (**Connie Kasari engagement research, Wendy Stone Early detection to early intervention research, Helen Tager-Flusberg language and communication research, Stephen Scherer-Genetics, Temple Grandin, etc )

9 Review of the development of NDBI, theories, common features, and research support Examples include: PRT, Early Start Denver, SCERTS, JASPER, Milieu Teaching, etc... Increase in NDBIs grew as a response to limitations in Discrete Trial Training (DTT) Lack of spontaneity, failure to generalize, escape/avoidance behaviours, prompt dependence Explains confusion between ABA & DTT Common features = individualized goals, 3 part contingency, manualization, measurement of progress, child initiation, fidelity, progress measures, environmental arrangement, natural methods to motivate, prompts and fading, modeling & imitation NDBIs are a new generation of early intervention models and are efficacious treatments New framework to categorize models

10 Systematic Review of the literature of treatments for under 3 years old Peer-reviewed articles published up to Dec 2013 No statistical analysis of the data in the articles Key findings: 10 Summary Statements 1. Current best practice should include a combination of developmental and behavioural approaches, as early as possible 2. Current best practice should include active involvement of families and/or caregivers 3. Interventions should improve functioning in both core and associated features of ASD (i.e., social communication, regulation, and adaptive behaviours) 4. Interventions should include consideration of social/cultural, economic, family dynamics, and supports

11 Key findings: 10 Summary Statements 5. Intervention research should include socially and culturally diverse populations to evaluate familial factors that affect participation in services 6. Future research should include high quality research methods and meaningful outcome measurements 7. Research is needed to determine the active ingredients of treatments 8. Adopting a common set of research-validated core measures of ASD symptoms for < 3 yrs old 9. Future research needs to examine biological and behavioural heterogeneity of RTI (response to intervention) 10. Interventions need to consider medical disorders and refer to appropriate health care providers

12 Question: What moderates the association between JA and language development? TD vs ASD? type of JA (RJA, CA, IJA, SJE, CJE)? or other participants factors? Methods: Included: 71 datasets, 605 effects sizes, 1,859 participants with ASD, 1,835 TD participants, correlation stats Results: 1. Significant differences between ASD and TD (higher association between JA and language), 2. Only RJA had sufficient effect sizes to compute, 3. Most moderator factor were not significant Implications: 1. Need to be clear about type of JA, 2. RJA may have a biological origin, 3. Other types of JA need to be investigated, 4. Engagement states must be defined measured as well, 5. All of these can/will impact our services

13 Question: Does language or social skills explain reversals in ASD and TD? Participants: 15 ASD children matched on language to 18 typical toddlers, ADOS, CDI, Vineland, Mullen (pre & post) Methods: 30 minute mother-child play sessions, half coded for JA (joint attention), every 4 months for 2 years Results: Results: Few reversals were noted in both groups overall, ASD: 3%, TD:1% (significant difference), TD stopped mid study: ASD continued to reverse; JA significantly different, in duration and frequency, Both early language and JA predicted pronoun reversals in ASD Implications: Consider assessing and targeting JA and general language skills (vocab), rather than pronouns directly

14 A simplified diagnostic observational assessment of autism spectrum disorder in early childhood. Autism Research, 2016, 9: Brief Report: Joint Attention and Information Processing in Children with Higher Functioning Autism Spectrum Disorders pp 1-6, Journal of Autism and Developmental Disorders. 09 April 2016 Exploring the Autisms at a cognitive level. Autism Research, 2016, (online release) Reasoning on the Autism Spectrum: A Dual Process Theory Account. Journal of Autism and Developmental Disorders June 2016, Volume 46, 6, pp

15 Screening for co-occurring conditions in adults with autism spectrum disorders using the Strengths and Difficulties Questionnaire: A pilot study. Autism Research, 2016, (online release) The Need for an Ecological Approach to Parental Stress in Autism Spectrum Disorders: The Combined Role of Individual and Environmental Factors. Journal of Autism and Developmental Disorders. June 2016, Volume 46, Issue 6, pp