Rebecca Landa, Ph.D., CCC-SLP
Center for Autism and Related Disorders
Kennedy Krieger Institute
(c) Rebecca Landa, Ph.D., CCC-SLP
Agenda
Part I:
Part II:
Part III:
Big Picture – EI
Family-Centered Approach
Classroom-Based EI
(c) Rebecca Landa, Ph.D., CCC-SLP
Part I: Big Picture - EI
(c) Rebecca Landa, Ph.D., CCC-SLP
Goal of EI
 Improve outcomes
 Maximize quality of life
 _______________
(c) Rebecca Landa, Ph.D., CCC-SLP
Accomplished through good
intervention
 Intervention is intentional creation of experiences that
maximize learning
 Life is the practice field for learning
(c) Rebecca Landa, Ph.D., CCC-SLP
Introduction to Parts II and III
 Early Achievements Model
Rebecca Landa, Ph.D., CCC-SLP
Children with ASD need to build the
infrastructure to do what you just
did so effortlessly
(c) Rebecca Landa, Ph.D., CCC-SLP
Early Achievements
 What it is
 What it spawned
 Achievements for Little Learners
 Parent Mediated manualized approach
 IES grant (3-5 year olds in public schools)
(Rebecca Landa, Ph.D., CCC-SLP
What are your treatment priorities?
Rebecca Landa, Ph.D., CCC-SLP
Your objective
1. Improve child functioning and hence, improve
outcomes
2. Ensure a developmental milieu that will cultivate
change and sustain growth/maintenance of new skills
©Rebecca Landa, Ph.D., CCC-SLP
The 4 E’s: How they help
Engagement with people:
Reciprocity
Event-based: Predict and contribute
Maintaining meaningful, reciprocal
engagement
How to engage with others
Imitation
Joint attention
Conversation
Understanding and remembering
sequences of actions and event
components
Forming representations and symbols
Flexibility and generativity
Reading comprehension
Embodiment of experience: Motor
planning and making sense
Ecological validity (relevant to child’s
life experiences): Generalization
Planning
Motivation
Initiation
Multi-modal mapping
Understanding others’ actions
Difficulty with implicit learning
Play
Using learned ‘forms’ (gestures, words)
meaningfully
Extracting relevant information
(c) Rebecca Landa, Ph.D., CCC-SLP
The world consists of representations:
Of events
Of objects
Of people
© Rebecca Landa, Ph.D., CCC-SLP
We have to be purposeful in
 Selection of treatment targets (curriculum and goal
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sequence)
Selection of intervention materials
Intervention strategies
Planning ecologically valid experiences
Helping parents learn to implement at home
Selecting intervention contexts
© Rebecca Landa, Ph.D., CCC-SLP
Families: Parent Mediated
Rebecca Landa, Ph.D., CCC-SLP
Myths
 What you want for the child is what the parent wants
 What you understand about the child’s level of
functioning is how the parent sees the child’s
developmental level (repetitive actions video)
 How you read the child’s intended messages is how the
parent reads them
 You utilize the tools of our trade and child will change
© Rebecca Landa, Ph.D., CCC-SLP
Many factors contribute to change
 Child factors (temperament, cognition, social
cognition, preferences, motor, language, past
experiences, biology, regression or fluctuating
plateau/regression?)
 Parent factors (expectations for child, expectations for
self, how they were raised, time, stress, mental health,
resources, etc)
 Cultural factors (macro, micro)
 ____________________
© Rebecca Landa, Ph.D., CCC-SLP
To achieve developmental gains
 Alter early experiences through
 Strategically designed early intervention
 Therapist-mediated (+peers)
 Parent-mediated (+parent education)
 Intervention is nourishment to the brain (embodied
cognition)
© Rebecca Landa, Ph.D., CCC-SLP
Part II: Family-Centered Approach
Rebecca Landa, Ph.D., CCC-SLP
When the expected doesn’t
happen in child’s development…
 Parents experience:
 Fear
 Lack of confidence
 Drawing at straws
 Strain in the family: disagreement about what to do
 Friends and family don’t understand
 Feelings of isolation
 Fragility in ‘connection’ with child
©Rebecca Landa, Ph.D., CCC-SLP
Change
Parents
Context
Child
©Rebecca Landa, Ph.D., CCC-SLP
Change:
Rebecca Landa, Ph.D., CCC-SLP
Culture
 Each family is a culture
 Beliefs about the child
 Beliefs about autism (India)
 Spousal/partner/family roles
 Expectations for outcomes, child behavior, self,
school…
 Discipline
 Etc.
© Rebecca Landa, Ph.D., CCC-SLP
Basics for getting started
 In delivery of parent-mediated intervention
Rebecca Landa, Ph.D., CCC-SLP
Helping parents feel acknowledged
and understood
 Be a good ‘teacher’ AND listener.
 Be ready to lay your paradigms aside.
 Cross cultural competency. What is the currency (eg do chores vs play) to get
buy-in? (chores vs play; role of other family members)
 Can’t arrive in the family’s home with your goals. Process to jointly establish
goals for child.
 Where do they see their child and what are their expectations? Their
expectations may exceed what would be expected for TD kids.
 Observe the child AND parent (style, priorities, challenges, signatures).
 Permission to take time for themselves.
 Change is executed within the system. Not trying to change the system.
 Shape what needs shaping.
 Co-problem solving (enlist parent’s input).
 Want to feel validated. Acknowledge what they are doing right.
©Rebecca Landa, Ph.D., CCC-SLP
Responsivity literature
 In DD, TD, ASD, parents can learn to engage in responsive
interactions with their children (e.g., BackersmansKranenburg, van Ijzendoorn, & Juffer, 2003; McCollum &
Hemmeter, 1997; Trivette, 2003)
 Responsivity:
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Parents respond to children’s verbal and nonverbal acts
Recode these communicative acts
Take a turn and wait
Follow the child’s lead
Imitate the child
 Need relationship base, but also need to take steps to
directly teach specific gestures, vocalizations, coordinated
gaze, and communication (Fey et al., JSLHR, 2006)
Rebecca Landa, Ph.D., CCC-SLP
Adult learning
 What you teach parents must be directly relevant to their lives
 Need demonstrations and models of the skills being taught
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(Winton & McCollum, 1997)
Need to teach to generalize
As new knowledge is applied at home, parents will encounter
challenges for which they must generate creative solutions
Problem solving results in consolidation of recently gained
knowledge (Kolb, 1984)
Over time, parents begin to be able to problem solve in more and
more complex situations
Skills become ‘automatized’ and flexible, with parents being able
to utilize their knowledge in more and more challenging
contexts to arrive at creative and effective solutions (Feldon,
2007)
Rebecca Landa, Ph.D., CCC-SLP
Mantra:
Simplify, sensible, sensitive
Rebecca Landa, Ph.D., CCC-SLP
Child
Adult strategy
Social
disengagement
Imitate
Motivate
Sustain engagement
Core vocabulary
Language
learning
Model
Communicative
temptations
Select toys
Follow child lead
Play
Expand, persist
Developmentally appropriate
Embedded in Routines
©Rebecca Landa, Ph.D., CCC-SLP
Remember!
 The child has a language delay
 Possibly a cognitive delay
 The child has ASD
 Implications of ASD:
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Behavior
Self regulation
Resistance to change
Perspective taking
Social understanding and initiative
etc
©Rebecca Landa, Ph.D., CCC-SLP
Steps:
1. Know the child
a. developmental levels (established, emerging,
undeveloped abilities/skills/behaviors)
b. preferences (activities, reinforcers)
c. temperament and ‘triggers’
2. Know the parents’ perspectives and priorities, concerns,
perceived barriers
3. Define child goals & parental goals/roles
4. Define activities & materials
5. Define schedule
6. Define data keeping system
7. Select a curriculum
© Rebecca Landa, Ph.D., CCC-SLP
Goals
Child
Parent
 Communication
 Empowerment & paradigm
 Social & engagement
 Play
 Self-regulation
shifting
 Scaffolding for positive
behavior & self-regulation
(predictability, consequences,
defining what is okay & not
okay)
 Environmental restructuring
 Strategies to foster child
communication, social
connection, play
©Rebecca Landa, Ph.D., CCC-SLP
1. Insights into child
Actions child does Child’s attempts to
with the object
communicate
Toy 1
Toy 2
Toy 3
Toy 4
© Rebecca Landa, Ph.D., CCC-SLP
What does child do
when you play next to
him or her and
imitate?
2. Build relationship with parents
 Affirming and validating the parents
 Decoding the child’s behavior
 Helps them regulate child’s behavior
 Helps them scaffold for increased child learning
 Understanding development
 Simplifying
 Relaxing and having fun during interaction
 Goals
 Realizing that their behavior affects child
 Developing insights into what they do, say, expect
 Parents have choices, these impact the child
 Realizing that they CAN optimize learning environment
 Toy and book selection
 Home arrangement
 Home schedule
 Parents reach consensus
© Rebecca Landa, Ph.D., CCC-SLP
Getting metcognitive
3. Changing behavior, expectations
 Putting the strategies into the hands of the parents
 Let them experience, first hand, with the protection of
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your guidance and scaffolding, the bi-directional
influences of parent-child interaction
Imitate your child
Getting routines established
What to say and when
Pitching it at the right level
© Rebecca Landa, Ph.D., CCC-SLP
Predictability: Routines
Rebecca Landa, Ph.D., CCC-SLP
Types of Routines
Social
Daily life
Book
sharing
© Rebecca Landa, Ph.D., CCC-SLP
Songgesture/action
Toy -based
Classroom-based model
(c) Rebecca Landa, Ph.D., CCC-SLP
2-year-olds
 STAART (NIMH)
 HRSA
 Autism Speaks
(c) Rebecca Landa, Ph.D., CCC-SLP
STAART: RCT
Multi-modal Classroom
Multi-modal Classroom
+ Interpersonal synchrony
curriculum
AEPS curriculum
AEPS curriculum
2.5 hours/day; 4 days/week
2.5 hours/day; 4 days/week
6 months
6 months
Parent education class twice
per month
Parent education class twice
per month
Group and 1:1 work
Group and 1:1 work
Theme-infused
Theme-infused
Interpersonal synchrony
curriculum: imitation, affect
sharing, joint attention
(c) Rebecca Landa, Ph.D., CCC-SLP
Classroom segments
 Circle: Teacher leads
 Play: Child leads (extend from Circle)
 1:1 (DTT priming new skills; automaticity of emerging
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skills; TEACCH-type activities)
Art
Snack
Sensory-motor and motor circuit
Outside
End of session – Music and Parting activities
(c) Rebecca Landa, Ph.D., CCC-SLP
STAART RCT: Participants
24 in IS condition, 25 in Non-IS condition
Domain
Non IS mean
(sd)
IS mean (sd)
Age
28 (2.7)
27 (2.9)
Visual
Reception
Receptive
Language
Expressive
Language
31 (11.6)
27 (8.8)
22 (7.2)
24 (9.7)
24 (7.0)
23 (6.1)
(c) Rebecca Landa, Ph.D., CCC-SLP
Active ingredients
 Curriculum and strategic selection of learner goals
(don’t try to teach an unreasonable amount)
 Instructional strategies
 Instructional activities guided by:
 The 4 E’s
 Strategically engineered environmental components
©Rebecca Landa, Ph.D., CCC-SLP
Major content areas
 Comprehensive curriculum (can use any- just use
one!)
 Cognition
 Language and communication
 Social
 Play
 Motor
©Rebecca Landa, Ph.D., CCC-SLP
Thinking (Cognitive)
 What can I do with this object? How can I make it go?
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How can I make it work?
Does it still exist when I can’t see it?
What is the same/different about these things?
(categories)
What other things can I play with when I play with this
toy? (ball, bucket; cup, spoon)
What causes what to happen?
What happens first, second, ….?
©Rebecca Landa, Ph.D., CCC-SLP
Language
 How are objects the same?
 And What ‘group’ of objects go together? They are
called the same thing (such as “ball”).
 What can I say about this?
 How do I communicate about it?
 Gestures
 Words
 Phrases
 Icons
 Facial expression
©Rebecca Landa, Ph.D., CCC-SLP
Social
 What can we do together?
 Imitate
 Take turns
 Show and share
 Comment
 Laugh and be silly
© Rebecca Landa, Ph.D., CCC-SLP
The Ingredients
Rebecca Landa, Ph.D., CCC-SLP
Your checklist
Curriculum
 Does my intervention target goals that are
Easy (at the child’s level- maintenance and generalization)
 Harder but within reach
 Relevant to the child’s life
 Building the skills needed in order to learn the next set of
skills the child needs to develop

© Rebecca Landa, Ph.D., CCC-SLP
Your checklist
 Instructional strategies
 Face to face
 Clear and appropriate cues
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Clear enough that s/he knows what I want him/her to do?
Am I cueing something that is developmentally appropriate (refer to curriculum)?
 Imitate and expand
 Motivating activities
 Am I incorporating child’s interests?
 Sufficient predictability? (Routines?)
 Prompting
 Am I scaffolding and prompting, as needed, to promote success?
 Strategic use of modeling
 Reinforcing
 Are the reinforcers relevant to the behavior?
 Did I deliver the reinforcement quickly enough for the child to know s/he was
being reinforced?
© Rebecca Landa, Ph.D., CCC-SLP
Your checklist
Instructional activities
 Motivating?
 Theme-related?
 Tools related to skills you are trying to teach?
Duplicates
 Location
 Steps to completion
 Developmentally appropriate
 Extenders
 Books

© Rebecca Landa, Ph.D., CCC-SLP
Putting it into action: 4 E’s
Embodiment: Opportunities for child to experience
the ‘skill’ with his/her own body?
Ecologically valid: Does the activity relate to anything
the child will experience in real life?
Event-based: Am I scaffolding a set of events that
enable the child to learn how things happen in his/her
life?
Engagement: Are there opportunities for using the
skill in interaction with adults and peers?
© Rebecca Landa, Ph.D., CCC-SLP
Seeing the ingredients in action
 Play
 Circle
 Snack
© Rebecca Landa, Ph.D., CCC-SLP
Concluding remarks
 Early intervention a must
 Context: need options (center-based, home-based; parent
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mediated)
Parent-child interactions can be shaped – changing
perspectives and behaviors and dynamics
Must be strategic in use of strategies and principles to
effect change
Need to play for sustainability of change
Strategies will change with child change
More to be done… support systems, peers, community
engagement…
(c) Rebecca Landa, Ph.D., CCC-SLP
Questions?
(c) Rebecca Landa, Ph.D., CCC-SLP