EFFECTIVE THERAPEUTIC ENHANCEMENTS TO ABA

Presenter: Debo'rah Merritt, PhD, LPC, NCC, CMIII

ASD Diagnosis/Behaviors

Autism Defined –

1. A pervasive developmental disorder characterized by impaired communication, excessive rigidity, and emotional detachment

2. Autism spectrum disorder (ASD) is a complex developmental disability that affect’s a person’s ability to communicate, and interact with others

3. ASD is defined by a certain set of behaviors and is a “spectrum condition” that affects individuals differently and to varying degrees

ASD Behaviors

ASD diagnosis is based on analysis of behaviors & their severity:• Lack of or delay in spoken language

• Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)

• Little or no eye contact

• Lack of interest in or difficulties in peer relationships

• Lack of spontaneous or make-believe play

• Persistent fixation on parts of objects; Narrow interests

• Difficulty with Executive Functioning, which relates to reasoning and planning

• Poor motor skills

• Sensory sensitivities

Established Behavioral Treatments

• ABA Based Treatment (25-40 hours per week)

• Lovaas Model or DTT (Discrete Trial Training)

• DIR (Floortime)

• PRT (Pivotal Response Therapy)

• ESDM (Early Start Denver Model)

• VB (Verbal Behavior Therapy)

• RDI (Relationship Development Intervention)

• TEACCH (Training & Education of Autistic & Related Communication Handicapped Children)

• SCERTS (Social Communication/ Emotional Regulation/ Transactional Support)

Established Biological/Medical Treatments

• Speech & Language Therapy

• Occupational/Physical Therapy

• Psychiatrist/Psychologist

• Neurologist

• Sensory Integration

• Gastroenterologist

• Nutritionist (GFCF)

• Social Skills

• Picture Exchange Communication System (PECS)

• ‘Listening Therapy’

• Medication

Multidisciplinary Approach Recognized

J. McCleery, PhD., Autistica, April, 2013; meta-analysis of 200 published papers on autism

“there is real hope for progress by using interventions based on the role of motor and ‘motor mirroring’ behavior in toddlers”

“interventions which focus on motor skills alongside speech and language intervention are showing promising preliminary results”

Sensory Integration is Key

Mark Wallace, PhD, Vanderbilt Univ., Journal of Neuroscience Jan., 2014;

“children with autism have difficulty integrating simultaneous information from eyes and ears”

“There is a huge amount of effort and energy going into the treatment of children with autism, virtually none of it is based on a strong empirical foundation tied to sensory function . . . if we can fix this deficit in early sensory function then maybe we can see benefits in language and communication and social interactions.”

Foundations of Learning

Regulation and Behavior/Learning

Courtesy of the SPD Foundation

Which Comes First?

Body Organization

• Fine Motor Control

• Gross Motor Coordination

• Muscle Tone & Reflex Maturation

• Balance & Posture

• Sensory Input: touch, vision, hearing, vestibular, joint & muscle

Brain Organization

Body Then Brain Organization

Brain Organization

• Improved Learning and Social Skills

• Improved Memory & Language

• Increased Speed of Information Processing

• Auditory, Visual, Motor

• Attention & Concentration

• Improved Energy

• Emotional Regulation/Improved Mood

• Body Organization

Behavior Learning Readiness

Tools for Body/Brain Organization

Effective Tools –

• Must be complimentary across all therapeutic models and environments

• Must strengthen foundational systems ie vestibular, autonomic, auditory, visual, sensory and language

• Must be based in scientific principal and backed by pre-post data

One tool which addresses multiple systems simultaneously is Integrated Listening Systems (iLs)

Developmental Learning Centre Video

https://www.youtube.com/user/IntegratedListening/

iLs and AutismAutism survey conducted by Spiral Foundation*

Conducted by Dr. Teresa May Benson; survey of therapists with collective experiences using iLs with over 1300 children with autism. See ntegratedlistening.com/research for full report.

OUTCOME MEASURE PERCEIVED FREQUENCY OF IMPROVEMENTS

Never Rarely Sometimes Often + Always

Self-Regulation 10% 87%

Attention 13% 87%

Transitions 1% 10% 85%

Following Verbal Directions 14% 84%

iLs Research: ASD & SPD

Arousal Study by Drs. Lucy Jane Miller and Sarah Schoen,

Sensory Processing Disorder Foundation

• Accepted for publication in peer review Journal of Occupational

Therapy, Schools & Early Education

• Used physiological measure (electrodermal response) to gauge

arousal levels in children with sensory processing disorder

• After a 3-month iLs program, both over-responsive and under-

responsive children measured at ‘normal’ levels.

iLs Research: ASD & SPD

iLs Home Program Autism Study by Spiral Foundation

• Single subject design, each child compared with their own baseline

• 18 children (ages 4-10) in 4 different locations

• 3-month iLs program

Results: significant reduction in autism-like behaviors and

improvement in social skills, attention and sensory processing

Multiple Modalities in One

integratedlistening

.com

Visual Tracking Movement Exercises

AuditoryComponent

Dr. Merritt Video

https://www.youtube.com/watch?v=hhBLOUMZ-9c

iLs Program Structure

• Frequency is important: 3 – 5 times per week, 15 – 60 min per session, depending upon client

• Complimentary - used alongside or simultaneously with other methods (e.g. ABA, Floortime, RDI)

• All components of iLs (music, movement, program schedule, and difficulty levels) are customizable for each client

Neuroplasticity

New neural connections are created through stimulation• we have an estimated 100 billion neurons• each neuron has thousand of connections

Neurons that fire together, wire together• iLs sound and movement protocols strengthen the neural

circuitry for sensory processing: auditory, visual, balance

Frequent repetition of the iLs protocol makes these changes solid; improved processing becomes functionally integrated

Music: External & Internal

Interactive Language

• Social Skills – engagement, turn taking• Expressive Language – dialogue,

rhythm/pattern of speech, articulation • Functional Language – communicating

needs• Reading – sound sequencing,

fluency, voice inflection• Auditory Processing –

following commands, staying on task

The Dreampad

• Improve sleep, both falling asleep and staying asleep

• Reduce stress

• Readiness for therapy

Tracking Change

• Online portal for logging sessions and assessing progress

• Report shows progress over time in 6 categories

• % improvement as well as scores by category

Kingsway Elementary School

Controlled study K – 5th students with ASD

Auditory Processing Results (SCAN-3:C TEST)

iLs Group: +36 %ile points

Control Group: - 6 %ile points

Behavior (Learning Readiness Evaluation)

iLs Group: + 32% change

Control Group: + 2% change

48%

34%

26%

36%

17%

11%8%

-8%

2%

-2%

-20%

-10%

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60%

Balance, Gross & FineMotor Control

Sensory Social / Emotional Auditory / Language Organization / Attention/ Cognitive

Learning Readiness Evaluation % Improvement by Category

iLs Group

Control

iLs Intervention vs Control

Auditory Processing Results

iLs-a iLs-b iLs-c iLs-d iLs-e ctrl-a ctrl-b ctrl-c ctrl-d

Pre-iLs %ile 19 2 4 30 63 1 0.1 25 3

Post-iLs %ile 50 50 23 73 95 3 1 0.5 0.1

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Ran

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SCAN-3:C Auditory Processing Composite

iLs Intervention Group Control Group

Kingsway Study Video

https://www.youtube.com/watch?v=sM5amBGn9Eo

Thank you!

www.integratedlistening.com