Parent Implemented Intervention for Children with Autism Spectrum Disorders Dawn R. Hendricks, Ph.D. National Professional Development Center on Autism Spectrum Disorders (2008). In Foundations of autism spectrum disorders: An online course. Chapel Hill: FPG Child Development Institute, The University of North Carolina at Chapel Hill. Parent Implemented Intervention: Session Topics • Rationale for parent involvement in their child’s • • • program Measures of efficacy for parent implemented intervention Skills targeted through parent implemented intervention Effective components of parent training programs Objective #1 Describe the rationale to involve parents in their child’s program Parent Involvement: Why is it needed with children with ASD? • Early intervention • Intensive intervention • Intervention agents throughout his/her lifespan • Challenging behavior • Generalization Parent Involvement: Why use it with individuals with ASD? • Parents of children with ASD report higher levels of stress and depression • Two of the most frequently described sources of stress for family members are: Potentially disruptive behavior in public places The corresponding restrictions this behavior places on family activities • Involved parents report increased feelings of competence and decreased feelings of depression and stress Objective # 2 Describe the measures used to determine the efficacy of parent implemented intervention Measures of Efficacy Child Progress • Immediate • Long Term **12- 18 months Aldred, Green, & Adams (2004) [Expressive language/ Initiations] Moes & Frea (2002) [Reduction of aggression & disruption] 19-36 months Buschbacher, Fox, & Clarke (2004) [Compliance/On task] Charlop & Trasowech (1991) [Expressive communication] Smith, Buch, & Gamby (2000) [Cognitive] Smith, Groen, & Wynn (2000) [Cognitive] Wetherby & Woods (2007) [Expressive Language] 10 years Lucyshyn, Albin, Horner, Mann, et al. (2007) [Reduction of aggression & disruption/ Community participation] Measures of Efficacy Koegel, Koegel, Harrower, & Carter (1999) • Family/environment “goodness of fit” • Parents’ implementation (frequency & fidelity) • Parents’ generalization to novel skills/situations • Parents’ concerns/issues/values Symon (2001) • Cost-benefit analysis Objective # 3 Describe the skills targeted through parent implemented intervention **Child Progress Sufficient Evidence Base: -Reduction of problem behaviors -Improvement in adaptive behavior -Improvement in communication -Improvement in social skills -Improvement in cognitive performance -Improvement in on task behavior Across Preschool Elementary Middle Ages and High Problem Behavior Adaptive Behavior Communication Cognitive On Task Social Skills Strategies Employed to Reduce Problem Behavior Functional Behavior Assessment Functional Communication Training Prompting Reinforcement Natural Environment Strategies Environmental Arrangement Visual Strategies Social Stories Pivotal Response Training Strategies Employed to Improve Communication / Social Natural Environment Strategies Imitation and Modeling Joint Action Routines/Joint Attention Pivotal Response Training Prompting Reinforcement Environmental Arrangement Functional Behavior Assessment Functional Communication Training Discrete Trial / Structured Teaching Picture Exchange Communication System Objective #4 Describe the components of parent training programs that have been demonstrated to be effective Six Essential Steps: 1) Determine needs of the family 2) Determine goals 3) Develop the intervention plan 4) Train parents 5) Implement the intervention 6) Monitor progress Presented by the Virginia Autism 16 Step 1 Determine Needs of the Family • • • • • • Areas of concerns and needs regarding the child Strengths of the child and family Child behaviors that impact family functioning Parent-child interactions including type, frequency, nature, and reciprocity of interactions Family activities, routines, and physical layout of the home Supports and resources within the immediate and extended family and community Presented by the Virginia Autism 17 Step 2 Determine Goals • Address areas of concern and priority for the • • • child, parents, and/or family members Create a positive impact on family functioning and not cause additional stress to the parents or family Can be implemented by parents with consistency Are appropriate for parents to implement in home and/or community settings 18 Goals Access to community Interaction patterns Home disruption Safety concern Stress 19 Goals: Examples Jake will use a spoon to feed himself pudding, yogurt, and other viscous foods for a minimum of 10 bites during snack. Megan will make a choice between two items visually presented by pointing to the desired item on at least 3 out of four occasions. Jamar will independently complete the 5 steps of his bed time routine on Friday and Saturday evenings. • Callie will state 3 things she did at school when asked by her parent. 20 Goals: Examples • Jake’s sister will participate in motor exercises • • • three times each week by modeling the exercises and interacting with Jake. Megan’s brother will present two choices for a play activity and will play for five minutes. Paris will independently clean up her play area when visiting her grandmother. When asking Callie a question or giving an instruction, Callie’s family members will first gain her attention by standing in front of her, tapping her on the shoulder, and pointing to his/her mouth. 21 Step 3 Develop the Intervention Plan • Incorporates intervention within the context where • • • target behaviors occur incorporates intervention into naturally occurring daily routines to the maximum extent possible Includes practices that have an evidence base and have been shown to be effective when implemented by parents Includes instructional practices that are compatible with parent knowledge, characteristics, routines, and preferences 22 Step 3 Develop the Intervention Plan • Instructional strategy broken down into step-by• • • • • • step directions Frequency and duration of instruction When and where to provide instruction Who will implement Materials required How long to implement Consequences / reinforcement 23 Step 4 Provide Training Location Format • • • • • Individual Sessions • Group Workshop Home Community Clinic School Teaching Activities • Modeling • Didactic Instruction • Live Feedback / Coaching Teaching Activities • Role Playing / Behavioral Rehearsal • Individual videotape analysis • Videotape vignettes • Individualized discussion of concerns / individualized problem solving Objective # 5 Describe the areas of need for future research Development of a Standardized Protocol Standardization should include: • Components that have empirical support • Training that can be implemented in a variety of settings, including a school or clinic • Components that can be delivered uniformly in a multi-site study • Components that can be replicated • Components that can be applied more broadly Summary The literature demonstrates that parent training does work to produce a positive effect on the skills of the child and the performance and mental health of the parent.