A Place To Be And Something To Do:
Evidence-based Practices for
Children with Autism
Samuel L. Odom
FPG Child Development
Institute
Goals of the Presentation
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Provide basic information about ASD
Examine goals of inclusion
Discuss forms of inclusion
Describe measure of quality of programs for
children with ASD
• Identify comprehensive treatment models
• Describe evidence-based focused intervention
practices
• Process of working from goal to practice selection
Introduction
1 in 68
DSM 5 Diagnostic Criteria
• Impairment in social
communication
• Restricted repetitive
and stereotyped
patterns of behavior
• Onset prior to the age
of three years
Demographics
• 75% are male
• Multiple etiologies related
to neurobiological causes
• Unrelated to
socioeconomic status or
race
• Range of IQ scores, but
stretches across the
continuum
History of Disorder and Trends in
Treatment
• Kanner’s Discovery in
1940s
• Psychodynamic
approaches (KannerBettleheim-Greenspan)
• Lovaas application of
Applied Behavior Analysis
• Structured psychoeducational approach
(Project TEACCH)
• LEAP and Walden
programs among first
inclusive programs
Autism Mystique
• Probably more than any disability, or unique
set of abilities, autism has been shrouded in a
treatment mystique
• The etiology has gone from refrigerator
mothers to epigenetics
• Treatments are more diverse than any known
disabilities
• Treatment claims range from amelioration to
recovery
Defense Against the Dark Arts
• Many interventions
with no scientific
evidence have been
recommended for
children with ASD
Cutting Edge Interventions for Autism (Seri
& Lyons, 2011)
• Antifungal treatment
• Aquatic therapy
• Berad Auditory
Integration Therapy
• Chelation Removal of
Toxic Metals
• Craniosacral and
chiropractic therapy
• Dietary interventions
• Hyperbaric oxygen therapy
• Medicinal marajuana
• Neuroimmune dysfunction
and antiviral therapy
• Sensory gym
• Traditional and indigenous
healing
• Stem cell therapy
• Transcranial Direct Current
Stimulation
Evidence-Based Practices
• Translation of the
intervention research
literature
• Most based on
applied behavior
analysis
• Some from other
theoretical
perspectives
What Do We Mean By Practice?
Comprehensive Models vs. Focused Interventions
• Focused interventions are procedures that
promote individual skills or learning within a
specific skill area.
• Comprehensive models are multi-component
programs designed to positively and
systematically affect the lives of children with
ASD and their families
Definition of Inclusion
• Placement of children with disabilities in
programs with typically developing children
• Inclusion defined in different ways (Odom,
2002)
• Forms of inclusion
– Community-based
– Team teaching
– School-based
• Blended model
Choice of Outcomes (Goals) Determine
Supports Needed
• Social Integration
– Activities promoting
social interaction with
members of the class
and community
• IEP Objectives and
Learning Outcomes
– Procedures supporting
learning goals
Equity as a Fundamental Benchmark
• Britto, Yoshikawa, & Bollers (2011) social
policy report for Society for Research on Child
Development
• Equity is the key concept in establishing early
child development programs in internation
context
– Access
– Quality
Outcomes of Inclusive Settings (Schwartz,
Staub, Gallucci, & Peck, 1995)
• Participation
– As other classmates
• Engagement
– Meaningful involvement
• Relationships
– Formation of friendships
Comprehensive Treatment Strategies
• Multiple
components
• Broad scope
• Intensity
• Longevity
• Manualized
procedures
Examples of Comprehensive
Treatment Program
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Lovaas Institute
Pivotal Response Treatment
Early Start Denver Model
LEAP**
TEACCH
Project DATA**
Princeton Child Development Institute**
Walden**
May Institute
Features of CTMs that Focus on
Inclusion
• Assessment and goal
development
• Majority of children are
typically developing
• Class-wide and individual
program designed for
children
• Naturalistic and direct
instruction
• Structure and predictability
• Intensity
• Parent program
• Trained Staff
A Technical Eclectic Approach
• Local programs can and do create their own
service models
• Important to have a conceptual framework or
theory of change
• Necessary to have a proscribed (manualized)
system of assessment, treatment selection,
and evaluation
• Necessary to stay close to the science in
selecting interventions
Influences
Family &
Student
Priorities
Goals
Process
Model Features
• Social
• Communication
• Behavior
Student
Characteristics
Current
Environment
Selection
of EBP
Program
Quality
Professional
Development
Technical Assistance &
Support
Future
Environment
Implementation
Outcomes
Quality is Important
Interdisciplinary
Teaming
Program Ecology
Learning Environment
Structure & Schedule
Positive Learning Climate
Curriculum & Instruction
Communication
Social Competence
Personal Independence
Functional Behavior
Assessment & IEP
Transition (MHS only)
Family
Participation
Program
Quality
Learner
Outcomes
Autism Program Environment Rating Scale
(APERS) Formats
• Preschool-Elementary
– Inclusion preschools
– Self-contained preschools
– K-5 (or beginning of middle school) inclusive
– K-5 self contained
• Middle School-High School
– Inclusive classes (assumes multiple classes)
– Self-contained classes
– Transition programs
APERS Preschool-Elementary
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Classroom Environments
Class Structure/Schedule
Positive Classroom Climate
Assessment
Curriculum and Instruction
APERS Preschool-Elementary
• Communication
• Staff/Peer Relationships
• Functional behavior (Challenging and
Adaptive)
• Family Involvement
• Teaming
Evidence-Based
Practices
Basing Early Intervention on
Evidence-based Practices
• Should draw from the current scientific
information available that documents what
works.
– DEC Recommended Practices
– National Standards Project
– National Professional Development Center on ASD
Systematic Reviews of the Literature
for
Evidence Based Practices (EBPs)
• In 2009, 11 “treatments” or practices with an evidence base
– Reviewed by National Standard Project from National Autism Center
• In 2010, 24 EBPs
– National Professional Development Center (NPDC)
– Included 10 years, 1997-2007
• In 2014, 27 EBPs
– Second review by NPDC
– Included 22 years, 1990-2011
• 29,101 possible studies 456 studies
• RCT, quasi-experimental, single case design
– Strength of evidence for assessment
– Based on number, type of studies using each EBP
Odom, Collet-Klingenberg, Rogers, & Hatton., 2010.; Wong, Odom et al., 2014
RCT: randomized clinical trial
autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/2014-EBP-Report.pdf
Evidence – Based Practices
(2014)
Antecedent-based interventions
Cognitive behavioral intervention*
Differential reinforcement
Discrete trial training
Exercise*
Extinction
Functional behavior assessment
Functional communication training
Modeling*
Naturalistic interventions
Parent-implemented intervention
Peer-mediated instruction/intervention
Picture Exchange Communication
System
Pivotal response training
Prompting
Reinforcement
Response interruption/redirection
Scripting*
Self-management
Social narratives
Social skills training
Structured play groups*
Task analysis
Technology-aided intervention/instruction*
Time delay
Video modeling
Visual supports
* Added from 2014 literature review
Evidence-based Practice Approach
Wong, Odom et al. (2014)
Selecting an Evidence-Based
Practice
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Goal: skill being promoted
Your professional wisdom
The learner’s learning style
The learner’s temperament
The learner’s interests and motivators
Supports already in place*
History of what has and hasn’t worked
Evidence-Based Practices are Delicious
Facilitators of Early Childhood
Inclusion
• Programs, not children, have to be ready for
inclusion
– Accepting philosophy
– Quality of program (ECERS, ICP, CLASS, APERS)
• Collaboration is the cornerstone
• Specialized instruction is essential
• Adequate support is necessary
– Advocate in the administration
– Resources for training and collaboration
Delivery of Services
• Initial training
• Itinerant coach/
consultant in
community child care or
school setting
http://autismpdc.fpg.unc.edu/sites/
autismpdc.fpg.unc.edu/files/NP
DC_CoachingManual.pdf
Elements of Successful Coaching
Relationships
Includes:
• Trust and mutual respect
• Training
• Willingness to change
• Professional attitude
• Reciprocity
• Communication
Trust and Mutual Respect
• Understand topic-comfort levels
• Respect coaching partner’s professional
skills
• Use shared terminology
• Express feelings honestly with compassion
• Be open to each other’s belief system
Issue of Program Intensity
• National academy
report recommended
25 hours per week of
service
• What do you think
about this issue?
• Intensity defined as
engagement and
opportunity to learn
• Intensity directed
toward learning goals:
what if social
integration is a goal?
Questions and Comments?