ENGLISH 7_Q4_LESSON 2_ Employing a Variety of Strategies for Effective Interp...
Connie Kasari 2012 Science and Sandwiches
1. Engaging Autism: Considerations for underserved,
under-represented and under-resourced
Connie
Kasari,
PhD
University
of
California,
Los
Angeles
ASF Science and Sandwiches
December 6, 2012
AIR-B --Autism Intervention
Research Network for
Behavioral Health
2. UCLA Kasari Lab Intervention Studies
Targeted
Interventions
Core
deficits
(beyond
dose
and
approach)
Underserved,
under-‐represented
Infants,
toddlers
Minimally
verbal
School
aged,
included
in
general
education
Under-‐resourced
Community
based
Schools
are
where
all
children
can
be
found
3. Engagement
as
Critical
Intervention
Target
Young
children:
focus
on
joint
attention,
play,
engagement
with
parents
(the
core
de?icits)
Look
to
behavioral
signs
of
engagement
Shared
attention
and
affect
Joint
attention
Social
play
with
others
Conversation
4. Targeted
Intervention
Approach
to
Address
Problems
of
Engagement
To
affect
engagement,
intervention
needs
to
be
targeted,
dense
and
long
term
The
targets
of
intervention
change
with
development,
and
with
amount
of
impairment
in
individual
children
Debate
in
the
field
as
to
how
much
direct
teaching
versus
naturalistic
methods
should
be
used
5. JASPER
Joint
Attention,
Symbolic
Play,
Engagement,
Regulation
Joint Attention Initiations:
-Point to share
-Show #
-Symbolic Play
6. Change
in
proximal
outcomes:
Joint
attention
and
play
Joint Attention Initiations
Play Level
7. Why
are
these
targets
important?
They
predict
to
distal
language
outcomes
Follow
up
1
year
later:
JA
and
SP
Follow
up
for
Low
Language
Group:
groups
better
language
JA
group
best
outcomes
Kasari, Paparella, Freeman & Jahromi , 2008, JCCP
8. Pay
off
from
early
focus
on
joint
attention/
joint
engagement
Follow
up
of
children
in
original
study,
5
years
later
40
out
of
the
58
children
32
became
verbal
and
8
minimally
verbal
Predicting
Expressive
Language:
Treatment
group
CA
IJA
Play
Level
Expressive
Language
DQ
Gender
9. Pay
off
from
early
focus
on
joint
attention/
joint
engagement
9
Follow
up
of
children
in
original
study,
5
years
later
40
out
of
the
58
children
32
became
verbal
and
8
minimally
verbal
Predicting
Expressive
Language:
Treatment
group
CA
Initiates
joint
attention
Play
Level
Expressive
Language
DQ
Gender
Kasari, Gulsrud, Freeman, Paparella,
Hellemann, 2012, JAACAP
10. What
did
we
learn
from
this
study?
Active
ingredient
to
early
intervention
is
a
focus
on
early
developing
core
de?icits
Joint
attention
Play
Results
suggest
the
mechanism
is
likely
engagement
as
JA
and
SP
interventions
led
to
similar
outcome
Suggestion
that
APPROACH
also
matters-‐-‐-‐the
fusion
of
developmental
and
behavioral
approaches
JASPER
11. Difference
between
preverbal
and
nonverbal
children
Most
young
children
are
preverbal…..we
can
get
them
to
talk
Concern
is
for
the
children
who
remain
nonverbal
at
age
5-‐-‐-‐entering
kindergarten
(about
30%
of
all
children)
Best
social
and
adaptive
outcomes
are
often
found
for
children
who
are
verbal
by
school
age
Children
who
are
nonverbal
(minimally
verbal)
at
school
age
are
UNDERSERVED,
UNDER-‐STUDIED
13. School
aged
Studies:
What
is
the
Issue?
For children with ASD:
More issues about social inclusion/acceptance than academic
support for some children
Others---issues about intervention in general—minimally
verbal, low verbal, learning
Level of support needed (or if it is needed)
1:1 assistant?
Concerns mostly about feeling connected, belonging for
ASD
Intervention for ASD---or for those around ASD?
14. UCLA
School
aged
Studies:
Children
have
different
views
about
friends,
relationships
Important to ask children
Gives you window into their world
Provides clues as to what is needed for intervention, and
if intervention is needed
15.
16.
17. Information
gained
from
asking
How
connected
child
is
to
other
children
in
the
class
How
popular
(salient)
the
peer
group
is
If
children
they
nominate
as
best
friends
nominate
them
back
(reciprocity)
How
many
children
they
nominate
as
friends
How
many
children
nominate
them
as
a
friend
18. Charlotte (8)
4.5 Erick (6)
Luke (5)
Cori (7) 7.5
Adam (3)
Len (7)
Olive (9)
8
Alex (4)
Ellen (7) 5.5 Leah (4)
Stan (4) Nancy (2)
Thomas (4)
2 Miguel (4)
5 Gerry (6)
Maggie (3) Nora (1)
Alejandro (4)
Lonnie (2)
Isolate: Nick (3), Noel (4)
19. Connection to Social Groups at School—
few children with ASD are isolated!
First
to
Fifth
Graders
(n=60
ASD;
matched
TYP
Second, Third Graders (n=17 ASD;
matched TYP)
Chamberlain, Kasari, Rotheram-Fuller, 2007, JADD; Kasari et al, 2011, JADD; Rotheram-
Fuller et al, 2010, JCPP
20. Friends and Reciprocity
Reciprocity is limited ……
Nearly all children can identify a 20 to 34% of children with
friend and/or best friend ASD have a reciprocal
friendship depending on study
Over 90% of children with ASD
can identify a friend during 60% for typical children
elementary ages, but this
drops to less than 50% for
adults
21. What
about
children
who
are
doing
well
(socially
connected)?
20%
of
children
had
a
reciprocal
friendship
(best
or
top
3)
These
same
children
had
higher
social
network
status
Were
they
also
more
engaged
on
the
playground?
NO…..playground
may
be
just
too
difficult
an
environment
22. UCLA
study
on
peer
intervention
study
in
the
schools
23. Modular,
individualized
approach
Child
Assisted
Peer
Mediated
Observed
child
on
3
peers
willing
from
the
playground,
obtained
class
teacher
reports,
peer
Had
peers
identify
some
networks,
self
reports
children
who
had
difficulty
Determine
top
3
problems
on
playground
for
child
engaging
with
Had
peers
generate
ideas
peers
to
help
engage
all
children
Worked
on
1
at
at
time
on
the
playground
24. Summary
of
UCLA
Peer
Study
CHILD
PEER
• PEER
Mediated
(1:1)
(3
peers)
Interventions
>
CHILD
Assisted
Interventions
NO
Treatment
CHILD+PEER
• Primary
Outcome
• Social
Network
Salience
(d=.79)
6 WEEK TREATMENT
(12 SESSIONS)
12 WEEK FOLLOW UP
Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012, JCPP
26. Summary
of
UCLA
Peer
Study
CHILD
PEER
• Other
Findings
favoring
Peer
(1:1)
(3
peers)
Mediated
Interventions:
NO
Treatment
CHILD+PEER
• Number
of
Received
Friend
Nominations
(d=74)
• Less
isolated
on
playground
(growth
6 WEEK TREATMENT
curves
over
tx)
(12 SESSIONS)
• Improved
rating
of
social
12 WEEK FOLLOW UP skills
(by
Teachers)
(d=.44)
27. Other
Findings
Effect
of
the
1:1
assistant
About
half
of
the
children
had
a
1:1
assistant
They
were
the
least
engaged
on
the
playground
(with
peers
or
with
the
aide)
Need
to
think
about
how
to
train
aides
better
Just
completed
para-‐educator
intervention
on
the
playground
Can
change
adult
behavior
and
improve
child
engagement
28. What
Needs
to
Happen
to
deploy
evidence
based
interventions
into
schools
Researchers
need
to
conduct
research
in
school
settings;
effectiveness
research
from
beginning
not
last
step
Distillation
and
matching
approaches
to
intervention
Isolating
active
ingredients
of
intervention
Matching
to
needs
of
child
in
context
New
approaches:
Researchers
and
school
staff
need
to
work
together….community
partnered
research
(balance
of
power)
NEW:
partnered
research
with
LAUSD
for
low
resourced
schools
Testing
playground
intervention
Functional
routines
in
special
education
classrooms
29. Next
Steps/New
Studies
Determine
active
ingredients
of
intervention
Importance
of
building
adaptive
strategies
(a
potential
sequence
of
interventions
for
particular
children…new
ACE
network
project
as
example)
Deploying
interventions
into
the
community
that
can
be
sustained
Preschools
Teaching
teachers
to
engage
children
in
ways
to
increase
social
and
communication
skills
Elementary
schools
Playground
intervention
Functional
routines
in
special
education
classrooms
30. Acknowledgements
Funding!
NIH,
HRSA,
Autism
Speaks,
Private
donors
Jason
Lee
Current
Caity
McCracken
Gail
Fox
Adams
Charlotte
Mucchetti
Kathleen
Berry
Chris
Osborn
Ya-‐Chih
Chang,
PhD
Jonathan
Panganaban
Michelle
Dean
Stephanie
Patterson
Amy
Fuller
Wendy
Shih
Lizzy
Fuller
Shawna
Ueyama
Jordan
Gibson
Hilary
Gould
• Community
Kelly
Stickles
Goods,
PhD
Sonia
Dickson-‐Bracks,
MBUSD
Amanda
Gulsrud,
Phd
Carolyn
Gelfand,
LAUSD
Alison
Holbrook
Nancy
Huynh,
PhD
Eric
Ishijima,
PhD
Dahlia
Kabab
Mark
Kretzmann,
PhD
Kelley
Krueger