Parent Training Pres-5-10.b

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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.
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