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SLHS 418 Exam 5
Terms in this set (148)
evidence-based treatment (or evidence-based practice)
Intervention that research has shown to be effective
To be considered an evidence-based practice for individuals with ASD, efficacy must be established through peer-reviewed research in scientific journals using:
1. Randomized or quasi-experimental design studies
2. Single-subject design studies
3. Combination of evidence
Randomized or quasi-experimental design studies
Two high quality experimental or quasi-experimental group design studies
Single-subject design studies
three different investigators or research groups must have conducted five high quality single subject design studies
Combination of evidence
One high quality randomized or quasi- experimental group design study and three high quality single subject design studies conducted by at least three different investigators or research groups (across the group and single subject design studies)
Complementary and Alternative Treatments are _________ evidence-based and can be ______________
are not evidence-based and can be dangerous
What are some treatments that are dangerous and not evidence-based practices?
Biologic substances (secretin)
Non-biological treatments: AIT, SIT
Omega-3 Fatty Acids
Casein- and Gluten-free diets
brain balance (neurofeedback treatment 'train the brain")
What percent of children with autism have been provided with complementary treatments?
What is secretin?
is a gastro-intestinal hormone which has been presented as an effective treatment for autism based on anecdotal evidence
Three cases the administration of secretin during endoscopy was seen to positively affect the behavior of children with autism
Is there evidence that single or multiple dose intravenous secretin is effective?
no, as such it should not currently be recommended or administered as a treatment for autism
What is ASD caused by?
toxic metals in the body: Thimerosal, a preservative that was included in some MMR
Why is it that a single dose of secretin was no more effective than placebo?
30% of both secretin group and the placebo group showed significant improvement after infusion, according to parent and teacher reports.
75% of the parents, when informed of the study results, continued to believe in the potential benefit of secretin
What does the Chelation treatment involve?
giving an individual various chemical substances for the purpose of binding and then withdrawing specific metals from the person's body
What are some side effects of Chelation treatment?
fever, vomiting, diarrhea, loss of appetite, hypertension, hemorrhoid symptoms, metallic taste, hypotension, cardiac arrhythmias, hypocalcemia (cardiac arrest)
Facilitated communication study
There wasn't a clear description 20% of the time
80% the answers were incorrect
better results to the object shown compared to the when the subject saw it
They showed the facilitator completely different object than the subject, so they only put what their object was infant of them
Is facilitated communication still common today?
Yes, although it isn't "hand over hand"
What are some evidence based practice that have been identified but the National Professional Development Center on ASD?
Applied behavior analysis techniques: reinforcement, extinction, prompting
Assessment and analytic techniques: functional behavior assessment, task analysis
Combination of behavioral practices used in a systematic way that fit together as a replicable procedure: functional communication training, pivotal response training
What are some effective interventions for ASD?
Early entry into intervention
Intensive: full-day and full year (> 25 hours per week)
Direct, 1:1, and small group instruction
Systematically planned and developmentally appropriate educational activity toward measurable objectives
Individualized according to a child's chronological age, developmental level, specific strengths and weaknesses, and family needs
If consistent with educational goals, specialized instruction should occur in setting with typically developing peers
Systematic inclusion of parents as interventionists
Treatment selection in ASD
No single therapy works for each child
Children's needs change over time and as they develop skills
Importance of assisting parents in becoming educated consumers
and advocates for their child
What does the ABA approach to Teaching do?
focuses on events (what happens before) and the consequences (what happens after) of a behavior
teaches skills to preface problem behaviors
increase positive behavior, academic, cognitive, social, and self-help skills
focuses on maintenance and generalization of skills for parents to use outside of therapy
Five Parts to a Trial in DTT
1. Teacher presents brief, distinctive instruction or question•e.g., "do this", "what is it?"
2.If needed, a prompt is provided after or along with the instruction
3. Child responds correctly or incorrectly
4. Teacher provides a consequence (reinforcer, ignore, or
5. Inter-trial Interval - teacher pauses 1-5 seconds before presenting the next trial
Discrete Trial Training
structured learning environment
teacher-selected materials and reinforcers
child-selected materials and reinforcers
Floortime / Relationship Development
Intervention focuses on what six developmental areas?
1. Self-regulation and interest in the world
2. Intimacy and engagement
3. Two-way communication
4. Complex communication
5. Emotional ideas
6. Emotional thinking
DIR / Floortime
interactive experiences, which are child-directed, in a low stimulus environment, ranging from two to five hours a day
Greenspan (DIR; Floortime)
Greenspan contends that interactive play in DIR / Floortime, in which the adult follows the child's lead, will encourage the child to "want" to relate to the outside world
no peer review studies show the effectiveness for children with autism
Early Start Denver Model (ESDM)
Comprehensive behavioral early intervention for children 12-48 months
Integrates relationship-focused developmental model with principles of ABA
principles of ABA
Naturalistic and behavior analytic strategies
Sensitive to normal developmental sequence
Significant parental involvement
Focus on interpersonal exchange and affect
Shared engagement with joint activities
Language and communication taught within a positive, affect-based relationship
Early Start Denver Model Focus
social orientation, attention, affect sharing and attunement, imitation, joint attention, language development, and functional and symbolic play
has an interactive communication- and relationship- based framework that fosters active experiential learning by supporting child spontaneity and initiative
Social Skills Training (Reichow & Volkmar), Cochrane Collaboration and social skills interventions
Children ages 6 - 21
Small group with high ratio of students to interventionists
Often meet once weekly for 12+ weeks
Structured skill-based lessons
UCLA Program for the Education and Enrichment of Relationship Skills (PEERS)
Social Stories (Carol Gray)
scripted stories for social situations help children understand social interactions, situations, expectations, social cues, the script of unfamiliar activities, and social rules
Instructional Method in which an individual develops a skill/behavior by viewing images of someone demonstrating that skill/behavior
effective across almost all age ranges, but may not be as affective in lower-functioning individuals
Anxiety in children with ASD
Approximately 47 to 84 percent of children with ASD experience clinically significant anxiety
Children with ASD may be at a greater risk for developing anxiety due to
- Inhibited temperament
- Physiological hyperarousal
-Information processing biases
Coping Cat CBT Program
Coping Cat CBT Program
16-session manual-based treatment program for children and
Most widely disseminated CBT treatment package for typically
developing children (Velting et al., 2004)
Preliminary support for use with children with co-occurring psychiatric
and physical conditions
Picture Exchange Communication (PECS)
Functional communication system that utilizes pictures
Appropriate for any child with communication difficulties
Child is taught to exchange pictures with a listener to make requests and comments
-Proceeds in six phases of increasing complexity
-Behavioral teaching methods used
Only prerequisite is that that child indicates what is reinforcing to him/her
Picture Exchange Communication (PECS): Goals for Child
Have a more functional means to communicate
Positive Aspects of PECS
Strong behavioral basis•Skills generalize well
Reduces frustration and decreases problem
In children with some speech - helps to increase amount and independence of use
Visual modality works well for many children
Early Intensive ABA (Ivor Lovaas)
Used Children less that 4 years old; intensive 40 hours/week 365 days a year
Those that perceived the 40 hrs a week 47% were in the avg. range, 40% in mild ID range and 10% in the profound ID range
results were were in the control group
Nine of Nineteen (47%) in the experimental group (40 hours/week intensive ABA) successfully completed regular first grade in a public school and had an average or better score on IQ tests
Only 2% of control group
Is recovery from ASD possible? Why or why not?
No, ASD is a lifelong condition however, in longitudinal studies 3-25% no longer meet criteria for autism on followup
How do you define recovery?
Optimal outcomes: having a clear diagnosis based on our gold standard rules
no longer meeting the criterial for autism
What are some potential explanations fro this loss of diagnosis?
they were misdiagnosed
Why don't we use the word recovery?
it implies that ASD is something you'd want to recover from
can be seen as offensive to those with ASD
if there is a standard set for what is recovery and child doesn't reach it, parents will believe that their child can't recover. Even if the child meets optimal outcomes they may not reach what is considered recovery
word revokes strong reactions
What factors may be predictive of optimal outcomes in a child age 2-4?
developmental / cognitive level at 2 is average or better
amount of comorbidities- attention, etc.
milder kids with less social skills
What measures at 2-years are associated with loss of diagnosis at 4-years?
18% no longer show signs of ASD on follow-up, about 1 in 5 kids
best motor abilities at age 2 are more likely to lose diagnosis
low motor abilities as age 2 are more likely to keep diagnosis
63% of those diagnosed at 2 retain diagnosis at 4
Optimal outcome children with accelerated head and body growth study hypothesized what and what did they find?
brain size is appears kind of like the typically developing
brain size is similar around birth, but those with optimal outcomes showed the greatest brain overgrowth within the first year of life
Optimal outcome children with accelerated head and body growth study conclusion
it is possible that if intervention is provided during the abbreviated window of time, before deceleration begins, might alter a child's growth and potentially head growth deceleration
Is there a relationship between treatment and recovery?
yes, birth-to-3 program: HFA (48%) Optimal outcome (83%)
HFA much more likely to be on meds (69%) compared to optimal outcome
Does "normalized" (TD brain) behavior reflect "normalized" brain function, OR, alternatively, the action of compensatory systems?
no evidence of normalization: there was no regions in the OO group in which the brain activity differed from HFA group, and did not differ from the TD group
OO > HFA, TD
OO = HFA > TD
What should the target of optimal outcomes be?
What are 3 potential activation patterns?
3 Developmental Trajectories
1. Low levels across time
2. Typical early, but fail to develop
3. High-levels early, decrease over time
Risk factors of ASD
ASD is caused by what 3 things? (Heterogeneous ASD Phenotype)
behavior / brain
When are ASD signs visible and when are children usually diagnosed?
Applied Behavior Analysis (ABA)
Application of behaviorism to socially significant behavior
Systematic procedures based on principles of behavior
Demonstrates that procedures used led to behavior change
Operant Conditioning in ASD
reinforcement (increase the behavior)
punishment (decrease the behavior)
What do specialized interventions do?
Maximize structure and predictability
Teach communication and social skills like academics
Functional Communication Training (FCT)
Find out what the function of behavior is (FBA)
Teach a socially appropriate alternative response
What supports the results of functional analysis?
Decrease in challenging behavior and increase in appropriate communica?on
Why do people benefit from animal interaction?
make you healthier
intervention that intentionally includes or incorporates animals as part of a therapeutic or ameliorative process.
provide opportunities for motivation, education, or recreation to enhance quality of life
goal-directed and documented interventions as part of a treatment process
planned and structured intervention with specific academic or education goals
What do sessions look like with animal assisted (therapy) with ASD?
animals : participants : personnel 1 : 1 : 1
Dose: 12 weeks, 1 per week, 35 minutes = 10 hrs
Population: 2-20 years old
M = 9 years
What were the outcomes of Animal-assisted studies? (positive)
language and communication
What were the outcomes of Animal-assisted studies? (negative)
Which are legally allowed to go into public establishments such as stores, restaurants, etc?
emotional support dogs
Which are legally allowed to live with their handler, regardless of any "No Pets" policies and legally allowed to travel on commercial airlines with their handler?
emotional support dogs
emotional support dogs
Which become registered or certified and carry identification with them?
emotional support dogs
What do ASD service dogs do?
Improve social communication
Help manage behavior
Prevent wandering or running off in public
Decrease stress and burden
Allow family to travel, go in public more
Improve family functioning
ASD service dog research has severe lack of research in these three areas
1. anecdotal findings
2. small sample sizes and lack of control conditions
3. lack of clinically-validated, standardized measures for ASD
Psychopharmacology in ASD: Goal
reduce challenging behaviors and improve response to behavioral and educational interventions
Is there pharmacological treatments that targets core symptoms of ASD?
there is no available drug treatment
Studies have shown that approximately __________% of children with ASD suffer from moderate-to-severe irritability
What are 2 FDA approved atypical antipsychotic drug treatments?
atypical antipsychotic used to treat irritability associated with ASD
atypical antipsychotic used to treat irritability associated with ASD
What are some side effects of anti-psychotics?
increased weight gain
fatigue, constipation, dizziness
the swelling of the breast tissue in boys or men, caused by a hormonal imbalance
What system plays a crucial role in synaptogenesis during development and what does it influence?
the serotonin system
cognition, learning, behavior
Animal research has indicated that ____________ can reduce the drive for social attachment by inhibiting separation distress
it is also in one-third of people with autism
Selective Serotonin Reuptake Inhibitors (SSRIs)
primary used in the treatment of depression and anxiety
prevent reuptake of serotonin in the brain
two types of stimulants
most commonly used in treatment of ADHD and work by increasing concentrations of dopamine and norepinephrine in the brain
Methylphenidate treatment may show benefit in some patients with
ASD and ADHD-like symptoms
seizures occur up to 30% of those with AsD
used for epilepsy, mood stability, aggression, and irritability in syndromes
Mechanism: may enhance GABA activity, may inhibit glutamatergic transmission
those exposed to Oxytocin
Make more eye contact
Feel increased in-group trust
Are better able to infer emotions from other peoples' facial
influences social bonding
blocks a receptor in the brain for the hormone
Those who took Vasopressin/ balovaptan showed that:
showed no benefit for the drug on the SRS, but the men who took the drug scored four or five points higher on the Vineland Adaptive Behavior Scales than did those who got the placebo
Rett Syndrome prevalence
1 in 10,000
Phenotype of Rett Syndrome
-what is mutation and what are some characteristics
affects mostly females
degenerative - loss of skills
little social contact and no language
mutation MeCP2 on x chromosome
What does MeCP2 do?
the protein is essential for normal brain development
it is involved in synapse formation
regulates other genes involved in neural development
controls the production of proteins in nerve cells
What is MeCP2 most needed by during development?
most MATURE neurons
at a certain point, the deprivation of MeCP2 is too much for the developing brain to handle.
What is this point?
What does MeCP2 do in Rett syndrome?
it disrupts the production of protein critical for healthy brain development
What is the cost of autism?
1 in 59 pay $268 billion
What are types of costs?
direct medical costs
physician, hospital and emergency department services, drugs,
equipment, and medically-related travel and time costs
direct non-medical costs
special education, transportation,
child care and babysitting, respite care, out-of-home placement, home and vehicle modifications, and supported employment services
the value of lost or impaired work time
(income), benefits, and household services of individuals with autism and their caregivers because of missed time at work, reduced work hours, switching to a lower-paying but more flexible job, or leaving the workforce
make up 59.3% of total lifetime costs
lifetime cost of ASD exceeds £________.
annual societal cost for the UK was estimated to exceed £_________.
The lifetime per capita incremental societal cost of autism is $_______________.
$_________ for an entire birth cohort of people with autism
$ 3.2 million
ASD and intellectual disability during his/her lifespan was $_____________ and an individual with an ASD without intellectual disability was $_________ in the United States
during childhood the largest cost components were ____________________ and ____________________.
while during adulthood _____________ or ______________ and individual productivity loss contributed the highest costs
special education services and parental productivity loss
residential care or supportive living accommodation
parents of autism show significantly higher levels of _________ and lower levels of ___________ than other groups
higher levels of stress and lower levels of marital intimacy
several surveys and comparative studies suggest that parents of ASD report elevated levels of ___________, ______________ and _____________.
stress, depression and anxiety
siblings who have a brother or sister with ASD reported ___________ and were satisfied with their relationship, others experienced less closeness and decreased number of interactions and viewed their brother or sister as a ___________.
admiration and a burden
a follow-up study by DeMayer found that out of 120 adolescents with autism, _______% lived with their parents or foster parents while the other ________% lived in institutions
58% and 42%
psychopharmacological studies in ASD show that side effects from drugs are generally?
side effects tends to be worse for individuals with autism
class of drug that is prescribed to increasing positive sociocommunicative behaviors
there is no drugs to target sociocommunicative behaviors
for children with ASD, atypical antipsychotics (Risperdal) are often used to treat what?
what is Chelation therapy?
it removes heavy metals from the body, found to be very dangerous as a child has died from it
predictor of optimal outcomes in children with ASD?
if their motor function age two is great then they are more likely to be undiagnosed at age 4
individuals with less severe ASD symptoms are more likely to be an optima outcome
higher IQ, motor abilities and milder social symptoms
what is functional communication training (FCT)?
teaches socially appropriate behaviors to replace inappropriate behaviors to communicate child's needs
list 3 characteristics of effective intervention
Intensive (40+ hours per week)
siblings who have a brother or sister with ASD report?
they either admire them or think of them as a burden
which of the following is NOT an evidence-based practice for improving social skills in ASD?
a. social stories
b. social skills groups
c. video modeling
d. peer-mediated intervention
all are evidence based practices
who is more likely to be prescribed medication in ASD?
People in Midwest, rural areas
Comorbid diagnoses; intellectual disabilities
what is the current role of psychopharmacology in ASD?
how are medications used to treat ASD?
to treat comorbid symptoms and help those with ASD benefit from those interventions
no drugs target the core features of ASD, they target associated features such as ADHD and irritability
we know the least about evidence-based interventions for what age group?
older individuals with ASD
neuroimaging studies of brain function in children with ASD and optimal outcomes (OO) show?
ASD with optimal outcomes used different parts of the brain than those who are TD and ASD alone. although ASD and optimal outcomes showed similar patterns
how has the living situation of adolescents and adults with ASD changed from Kanner's time to the present?
less institutionalized, most live with parents and caregivers
Explain the "dual challenge" faced by parents of children with ASD.
Taking care of the child while taking care of oneself
Greater rates of depression in moms of children with ASD
Greater likelihood of another sibling with a developmental disability
Developing friendships requires several complex skills and competencies. Name one, and the intervention method that may help
Social skills/Communication --> ABA therapy, video modeling
what is the percentage of families that use C+A treatments?
30-95% use complementary and alternative treatments
which of the following is not an evidence-based practice?
a. parent-implemented interventions
b. discrete trial teaching
c. pivotal response training
d. floortime / relationship development intervention
floortime / relationship development intervention
how many evidence-based practices currently exist for ASD?
Talk about the facilitated communication diagram. Will the child say what he sees or what the facilitator sees?
if the child sees a car and the facilitator sees bread, then the child will "see" bread
Compared to children with ADHD, stimulant medications in children with ASD are...
helpful for comorbid ADHD, but not ASD alone
Atypical antipsychotics (risperdal) are often used...
to treat irritiability
what are the indirect costs and how do they contribute to the overall financial burden for families of individuals with ASD?
money lost from not being able to work
when child becomes an adult and does not work = financial burden
individual with ASD will have reduction of earnings in their lifetime
in a systematic review of studies focused in animal-assisted intervention in ASD, several studies showed what?
increased language, communication, and social communicative interactions
pattern of early brain growth for children with ASD and optimal outcomes
brain size is similar at birth, but those with optimal outcomes showed the greatest brain overgrowth within the first 2 years of life
intermediate growth of individuals with ASD compared to TD
what do we know about treatment selection and ASD?
no single therapy works for each child, the child's needs change over time as they develop skills, assisting parents in becoming educated consumers and advocates for their child
what is a common approach to treating comorbid anxiety in high-functioning children with ASD
cognitive behavioral therapy
the ABA approach to teaching focuses on what two aspects of behavior?
focuses on antecedents (what happens before) and the consequences (what happens after) of a behavior
what factors account for the poorer wellbeing of parents of children with ASD?
career restrictions of child
uncertainty of diagnosis and long-term prognosis associated with the diagnosis
the stressfulness of ASD itself
lack of research on adults with ASD
approximately how many children diagnosed with ASD end up losing their diagnosis ( no longer meeting criteria for ASD)?
3-25% no longer meet requirements
what is the importance and broader implications of the null findings from randomized-controlled trials of Secretin in ASD?
Parents saw improvements even with no treatment (Placebo effect)
Parents could be looking for improvements where there are none.
list one reason why the word recovery has been avoided and one reason why we should begin using the word recovery
avoided: recovery sets up false hope, implies ASD is something you want to recover from, offensive to those with ASD
use again: it shows the progression of improving ASD symptoms so the child can be more independent
what is the criteria for evidence-based practice?
quasi-experimental design, single subject design, combination of evidence
What sorts of drugs are used for individuals with ASD?
antipsychotics, anticonvulsants, mood stabilizers, SSRI's, stimulants
What were the results of the AAI study discussed by Dr. O'Haire?
They had more prosocial behaviors than the toy condition; more smiling, engaging, touching, & talking
Explain the differences between discrete trial training and incidental training.
DTT is interventionist-led and usually takes place at a table
IT is child-led and occurs in a natural environment
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