John G. Youngbauer, Ph.D. MFT BCBA-D North Los Angeles County Regional Center. Copyright, 1996 Dale Carnegie & Associates, Inc.

Transcription

1 Intensive Applied Behavior Analysis in the Treatment of Autism* * Smith, T (2001). Discrete Trial Training in the Treatment of Autism., Focus on Autism and Other Developmental Disabilities 16, John G. Youngbauer, Ph.D. MFT BCBA-D North Los Angeles County Regional Center Copyright, 1996 Dale Carnegie & Associates, Inc.

2 Natural Science: Biology & Behavior Analysis Biology factually verified empirical Theory of Evolution by Natural Selection Behavior Analysis factually verified empirical Principle of Reinforcement Natural Selection: Environment Selects Species Principle of Reinforcement: Environment Selects Behavior

3 Natural Science: Biology and Behavior Analysis Parallel Processes: Natural Selection: Environment Selects Species Species adapt and evolve due to environmental demand Principle of Reinforcement: Environment Selects Behavior Behavior is learned, adapts, & evolves due to environmental reinforcement

4 Natural Science: Behavior Analysis Asserts: Behavior is a product of the interaction of an individual and the environment Individuals learn new behavior through repeated environmental interaction Behavior problems are defined as too much behavior or too little behavior, thus a mismatch with environmental demands

5 Behavior Analytic Knowledge of Child Development Children learn continuously from interaction with their environment through observation exploration creative play modeling conversation And the above activities are reinforced by approval from significant others

6 Behavior Analytic knowledge of Child Development By three years of age children will have: Approximately 3 million interactions with their environment and the people in it Approximately 2 million of those interactions will be initiated by the child A child with autistic disorder typically does not initiate contact and will not have comparable # interactions as peers

7 Diagnosis & Treatment of Autistic Disorder Autism Diagnosis: No clear etiology, thus No Genetic test No Definitive Physiological tests The Diagnosis is based on observed Behavior

8 Diagnosis & Treatment of Autistic Disorder Generally: Deficits in social interaction & communication Deficits in repertoire of activities & interests Excesses of repetitive, stereotyped behavior Excessive adherence to routines & rituals

9 Behavior Analytic Therapy Behavior analytic treatment is selective and focuses on targeted problem behavior [excesses & deficits] Expanding social interaction & reducing nonfunctional behavior is the focus of ABA & Discrete Trial Therapy* Parallel Process: 1. Teach new functional behavior to the child 2. Teach people [family] in the child s environment to reinforce the new behavior.

10 Important Aspects of DTT DTT is designed to catch the child up to same aged peers by entry to school Highly individualized instruction using error free learning procedures [prompt hierarchy] Precise format - definite start and stop, components are simple & predictable Each Trial is short, thus many opportunities to learn [2-3 per minute]

11 Important Aspects of DTT Usually hours per week = trials per week [1/4 million p/yr.] Typically 30 to 36 months in duration DTT breaks the continuous flow of adultchild interactions into distinct easily discriminated events Skills must be used outside of therapy to promote generalization and maintenance.

12 The Alaska Model: Goals of a Month Discrete Trial Treatment ** Goal 1. Home life will be organized to support needs of child [consistent routines] Goal 2. Child will be responsive to parents guidance & limits in all settings Goal 3. Autistic behavior reduced to nonclinical levels [standardized assessments] ** Alaska Autism Intensive Early Intervention Project

13 The Alaska Model: Goals of a Month Discrete Trial Treatment ** Goal 4. Developmental Delays corrected to approach typical levels in social, language, & intellectual function [standardized assessment] Capstone Goal: Child will have a Prognosis for Continued Normal Development Successful first year in regular classroom ** Alaska Autism Intensive Early Intervention Project

14 The Alaska Model: Adapted by NLACRC to Southern California NLACRC uses three member treatment team exactly as the Alaska Model, but no Bush- Pilots * are needed. The Team: Parents Behavior Analyst & Agency* Regional Center

15 The NLACRC Model: Three Member Treatment Team Individual Program Plan 1 hour Behavioral Orientation for Parents Parent choice Behavior Analyst & Agency 16 hours of Principles of Behavior group instruction for parents & family 16 hour Behavioral Assessment

16 The NLACRC Model: Three Member Treatment Team Roles & Responsibilities: [Lanterman Act ]: Behavioral Agencies Conduct assessment Design treatment plan specifying protocols, hours of therapy, parent participation, and evaluation of progress and of reports. Provide treatment plan to RC for review.

17 The NLACRC Model: Three Member Treatment Team Roles & Responsibilities: [Lanterman Act ]: Regional Center Only Purchase ABA services that are evidence-based, promote positive behavior, & ameliorate behavioral problems Only purchase ABA services when parents participate given the critical nature of their role in their child s therapeutic success.

18 The NLACRC Model: Three Member Treatment Team Roles & Responsibilities: [Lanterman Act ]: Regional Center Not purchase ABA for respite, day-care, or school services Discontinue ABA when IPP & treatment goals have been achieved & ABA services are no longer needed.

19 The NLACRC Model: Three Member Treatment Team Roles & Responsibilities: [Lanterman Act ]: Regional Center Review ABA treatment plan and hours of intervention no less than every 6 months for for each consumer & revise if needed. Not reimburse a parent for participating in ABA treatment plan. No more than 40 hours per week across all settings.

20 The NLACRC Model: Three Member Treatment Team Roles & Responsibilities: [Lanterman Act ]: Parents [Parent Participation] Complete group instruction on ABA. Implement strategies in treatment plan. If needed, collect data and share it with ABA provider to be included in progress reports. Participate in any needed clinical meetings. Purchase suggested materials or community involvement if a reward system is used.

21 Contact Information & Links