START Orientation Young Children with Autism Spectrum Disorders

Amy Matthews, Ph.D. & Jamie Owen- DeSchryver, Ph.D.Grand Valley State University

Linda Elenbaas, M.A.Ottawa Intermediate School District/Spring Lake Schools

Agenda for Today

Orientation to START and Early Childhood (EC)

Training

Effective Practices for Young Children with ASD

Logistics for the Year

Working as a Team and Guiding Principles

Foundations of ASD

Next Steps

Assumptions

Early childhood programming is not a foreign concept

You know at least the basics of autism spectrum disorders

You have experience working as a teamYou are interested in young children with

ASD

Latest CDC Report

If 1 in 88 children have an autism spectrum disorder…

The average elementary building will have 3-5 children with ASD

The average middle school building will have 7-9 students

The average high school will have about 14-15 students

*Center-based programs

Latest CDC Report

Autism is no longer a low incidence disorder

ASD in the 21st Century

1222% increase in ASD in Michigan from 1990 to the present, so… what used to be a rarity in an ECSE classroom is now

commonplace 11,258 research articles (just in one database) 3,655 books on Amazon 17,800,000 hits on Google New MI definition of ASD in 2004 EBP standards and National Research Council report

published NCLB and IDEIA legislate an increase in inclusion and

access to gen ed Insurance coverage legislation passed

We need to change our approach to educating young

children with ASD

Purpose of START

START serves as a coordinating and

supporting entity for regional sites across the

state of Michigan to increase access to local resources, training and

support for students with autism spectrum

disorder.

Primary Components

Training & Support

Intensive TrainingK-12Early interventionBuilding Your Future (BYF) Post high

Coaching

START Intensive Training

Intensive yearlong training with multidisciplinary school based teams in

the areas of teaming and problem solving, effective educational

programming for students with Autism Spectrum Disorders, and systems

change.

Making Professional Development EffectiveLang & Fox (2003)

Traditional professional development (training without follow up to support implementation) yields a 5-10% implementation of strategies success rate

With follow up, that number can rise to 75-90%

Training Focus

Not the “START Model,” but…

Effective Practices organized into the START Training Curriculum

Intervening Early and Effective Practices

START Effective Practices Definition

Evidence-based approaches

Family and individual preference

Professional judgment

Data-based decision making

Effective Practice

Wrightslaw“All available research strongly suggests that intensive early intervention makes a critical difference to children with autistic spectrum disorders. Without early identification and diagnosis, children with autism are unlikely to learn the skills they need to benefit from education.”

What are the Critical Components of Effective Programs?

Early is better (by 3½) Intervention at identification Identification/intervention before age 3

Intensity matters (at least 25 hours/wk, full year, with low ratio) Model programs range from 15-40 hours a week with an

average of 25 hours per week Active engagement/Structured teaching time

Minimal “free time” Lots of learning opportunities Each moment is a teachable moment

Family participation Individualized goals, regularly monitored

National Research Council, 2001

Critical Components of Effective Programs

Curriculum content Highly supportive teaching environment

and generalization strategies Need for predictability and routine Functional approach to problem

behaviors Transition planning

Rogers & Vismara, 2008; Iovannone, et al., 2003; Dawson & Osterling, 1997

Critical Components of Effective Programs

Team approachOpportunities with typical peers

Language and social modelsExposure to typical curriculum and

activitiesMore natural transition to kindergartenSpecial education teachers keep the

“typical” perspective

Rogers & Vismara, 2008; Iovannone, et al., 2003; Dawson & Osterling, 1997

Where do we get information about evidence-based approaches?

National Research Council Report http://www.nap.edu/openbook.php?isbn=0309072697

National Autism Center National Standards Project (http://www.nationalautismcenter.org)

National Professional Development Center on ASD (NPDC) (http://autismpdc.fpg.unc.edu/)

Ohio Center on Autism and Low Incidence (OCALI) AIM website (http://www.autisminternetmodules.org)

Preschool Autism Programs (2008) by Handleman and Harris

IndependenceSelf-managementStructured work systems

SocialPeer-mediated interventionSocial skills training groups

MotivationFunctional behavior assessmentFunctional communication training

BehavioralDiscrete trial training (DTT)Differential reinforcementExtinctionPromptingReinforcementResponse interruption/ redirectionStimulus controlTask analysisTime delay

Evidence-Based Practices (NPDC)

CommunicationSpeech generating devicesPECS

TechnologyComputer-aided instruction

ParentParent-implemented interventions

VisualVisual supportsVideo modelingSocial narratives

Natural environmentPivotal Response Training (PRT)Naturalistic interventions

Evidence-Based Practices (NPDC)

All practices must align with…

LawIDEA

Literature Evidence Based Practice

Student DataOutcomes

We Know What W

orks

Why do we have such trouble getting public school programs to fit the recommendations and needs for young children with

ASD?

Implementation challenges in public school settings

Ratios (ECSE classrooms)Intensity/Time (0-3 and 3-6)

Training of staffPhilosophy

Getting families involved

Changing Systems

Innovative practices do not fit well in old organizational structures

--Dean Fixsen

Systems Change

Big change only happens when we change whole systems

We did what we did when we knew what we knew

Once we know different, we are accountable

Getting Critical Mass

Getting enough people moving in the right direction in order to move

the whole system forward

This is what the START

Project is all about !

What do we want to impact?

Students*Classrooms*BuildingsDistricts

In sum…systems that are supporting students to have better outcomes

Working Together This Year: What is our goal?

Help you develop a program that allows children to make

the most progress

Big Ideas for Early Intervention

Identify and intervene early Use evidence based practices Increase learning opportunities (i.e. opportunities

to respond with feedback) and student engagement

Focus on meaningful, functional goals and tasks (independence and socialization)

Use effective instructional delivery (3 Rs: Request, Response, Reaction)

Establish a classroom structure to ensure learning

Big Ideas for Early Intervention

Establish positive patterns of behavior early on Many problem behaviors are preventable with

planned supportsProvide lots of meaningful integration

opportunities Use data to confirm that what you are doing is

working Carefully plan for transition to elementaryWork as a team and include families

Stop for a minute…

What would a highly effective classroom for young children with ASD look like?

Early Intervention Assessment Tool

Early Childhood Assessment ToolStatewide Autism Resources and Training (START)

Effective Practices Assessment Tool for Young Children with Autism Spectrum Disorders

Team: ____________________________ District: ____________________ Date: _________________

AREA 1: Critical Program Components

Current Status/Progress

Not in Place Partially In Place In Place 1------------------------------2---------------------------- 3------------------------------4------------------------------- 5

Pri

orit

y L

evel

1

– 5

1=lo

w, 5

=h

igh

CRITICAL COMPONENTS

1. Students are actively engaged with many learning opportunities throughout the day

1 Students each receive less than 5 learning opportunities (including entire request, response, reaction sequence) per hour on average. Students are actively engaged in

productive activities less than 50% of the time.

2 3 Students each receive

approximately 10 learning opportunities (including entire

request, response, reaction sequence) per hour on average. Students are actively engaged in productive activities more than

80% of the time.

4 5 Students each receive more than

20 learning opportunities (including entire request,

response, reaction sequence) per hour on average. Students are actively engaged in productive activities more than 80% of the

time.

Priority

1 2 3 4 5

CRITICAL COMPONENTS

2. Programming is individualized to meet student needs

1 Students receive traditional preschool instruction with minimal adjustments for

individual needs.

2 3 Programming is individualized for some students, some of the

time, but not consistently enough to make rapid progress toward

IEP goals.

4 5 Instructional goals, methods,

prompts and response requirements are individualized to meet the student’s abilities, needs,

and developmental level.

Priority

1 2 3 4 5

Everyone is at a Different Stage of Learning

During this training we will talk about how to teach…

o Early Learners

o Emerging Learners

o Transitioning Learners

Everyone is at a Different Stage of Learning

In this training, everyone is at a different stage…

o Early Learners

o Emerging Learners

o Transitioning Learners

Everyone is at a Different Stage of Learning

Evaluate what you hope to get out of this trainingo Content – I am an early learner and I just need some

information to get started!o Implementation – I am an emerging learner. I know

quite a bit, but I want to better implement effective practices in my classroom

o Specific skills – I am a transitioning learner and I think my classroom is running pretty well; now I want to tackle some more advanced practices

o CEUs – I have to get CEUs and this is as good as anything else

Logistics

Location All trainings will run from 8:30-3:30 Breaks in am and pm Lunch will be provided CEUs will be offered Binders for each participant and flashdrive for

each sub team We will always leave with an action plan Schedule

Working as a Team

Habits of Effective Teams

Time is prioritized. An agenda is developed and used. Members attend beginning to end. Meetings begin and end on time. Ground rules are established and violations addressed. Action plan items are developed and follow up is

addressed. Developed plans are implemented until the team

decides otherwise. The team uses a systematic problem solving process

Working as a Team

Team Process Agenda

Calendar Follow Up New Items

Action Plan Development Who / Does What / By When

Meeting Agenda and Organization

Team Meeting Agenda, Minutes, and Action Plan Date:

ROLES and RESPONSIBILITIES

List Members Present and Roles: Facilitator: (sets meeting agenda; facilitates meeting) Note taker: (take and type up notes; email to group) Timekeeper: (keeps facilitator to time specified)

Agenda

Calendar

Activity (ex. Staff meeting / Training / Vacation) Date(s)

New I tems / Standing I tems

Agenda I tems Discussion Topics Notes / Minutes

Action Plan

Agenda I tem WHO I s doing WHAT By WHEN

Follow Up: Review action plan from previous meeting

Action Plans

Don’t Leave a Meeting without an Action Plan!

Purpose of Action Plan? ______________________________________________________________________ WHO will do WHAT by WHEN STATUS

This form created by: Kelly Dunlap, S.Psy.S.; School Psychologist/Behavior Consultant

Today’s Date______________

ACTI ON PLAN Worksheet From VI SION to ACTION

KD 10/04

Are we a well-functioning team?

Use the Team form to rate how your team is functioning back in your school building

What is working well? What needs more work? What would be helpful to you and your

team to become more effective? Complete form

Getting STARTed…just a little

How is everyone working together in your program?

Are you all on the same page?

Do you all agree?

What can help you come to some consensus?

Guiding Principles

A cohesive set of beliefs, grounded in effective practice, that govern programming for

students with ASD.

EXAMPLE Principles

Regular team meetings are essential for supporting young children with ASD.

An appropriate functional communication system will be provided at all times.

Student independence will be promoted throughout the day by all staff.

Inclusion opportunities must be provided on a daily basis.

Develop Your Own Guiding Principles

What are the principles that guide your early intervention programming for children with ASD?

Are they established?

Are they posted and shared?

Are they followed?

Guiding Principles Development

Start work on your group’s guiding principles, or

Develop a plan to meet and discuss guiding principles

Foundation in Autism Spectrum Disorders: Just the Facts

Foundations of ASD

Autism identified in 1943 by Leo Kanner

Asperger Syndrome identifed in 1944 by Hans Asperger

Autism’s First Child

The Atlantic Monthly

In 1943, Donald Triplett of Forest, Mississippi

became the first person to be diagnosed with ASD.

His parents chose not only to accept him as he was, but created a hometown environment of love and friendship that refused to

allow others to misinterpret or

misrepresent him or his “oddity.” 

Autism Spectrum Disorders

Biologically-based, developmental disability

Characteristics are evident by the age of 3

Occurs 4 times as often in males than in females

Historically 70-75% were thought to have some degree of cognitive impairment; recent estimates closer to 40%

Definition of Autism:

Autism means that someone is really smart in some things but

needs a lot of help in other things.

Mrs. Fizell’s 2nd Grade class (1999)

from Barry Prizant

Restricted & Repetitive Behavior

Impairment in Socialization

Impairment in Communication

Impairment in Social-

Communication

Restricted & Repetitive Behavior

Joint Attention

The core symptoms of autism are represented in the triad of impairments. Yet the earliest sign of autism is often manifested as a deficit in joint attention, which has a significant and pervasive impact on all developmental domains.

Social Characteristics

Theory of mind deficits – difficulty with understanding and appreciating the thoughts and feelings of others

Theory of mind is the ability to attribute mental states—beliefs, intents, desires, pretending, knowledge, etc.—to oneself and others and to understand that others have beliefs, desires and intentions that are different from one's own

Theory of Mind

Sally Anne Test Video

Early Signs

Researchers at the UC Davis M.I.N.D. Institute have found that infants later diagnosed with autism exhibited unusual exploration of objects long before being diagnosed. Studying a group of children at high risk for developing autism, the researchers found that those eventually diagnosed with the disorder were more likely to spin, repetitively rotate, stare at and look out of the corners of their eyes at simple objects, including a baby bottle and a rattle, as early as 12 months of age.

-Ozonoff et al., 2008

First Signs Videos

http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Autism vs. ASD

Move toward the term Autism Spectrum Disorders (ASD)

Different people with autism can have very different symptoms.  Health care providers think of autism as a “spectrum” disorder, a group of disorders with similar features.  One person may have mild symptoms, while another may have serious symptoms.  (NICHD, 2009)

All share core impairments

Similar assessment, education, and treatment approaches are often beneficial

Continuum of Skills for Individuals with Autism

Severe CI Gifted Aloof Passive Active/Odd Non-verbal Verbal Awkward Agile Hyposensitive Hypersensitive

The Advocate (2003)

Cognitive Ability

Social Interaction

Communication

Motor Skills Fine & Gross

Sensory

Neurbiological disorder that impacts:

Processing

Attention and shifting

Basic social behaviors

Interaction with the environment

Learning

Lord, 2010

Early Identification

Learn the Signs. Act Early.

Centers for Disease Control (CDC)www.cdc.gov/actearly

Autism: What do we know?

Characteristics are evident by the age of 3 (DSM-IV criteria)

70-95% with a documented developmental concern before the age of 2 years

13–30% of children had a reported developmental regression by 2 years of age

(Mandell et al., 2009)

Factors associated with a younger age of identification

Being male

Having an IQ of 70 or lower

Developmental regression

(Shattuck et al., 2009; Giarelli et al., 2010)

What motivates the search?

Mean age of autism diagnosis is 34 – 61 months

Mean age of first parental concern is 18 – 19 months

Gap of 1-2 years before autism treatment begins

Earlier identification earlier intervention

Intensive early intervention = better outcomes

Mandell et al, 2005

n = 965

Critical Periods

Intervening early and intensively is key to skill development and avoiding behaviors

before they happen

Critical aspects of brain architecture begin to be shaped by experience before and soon after birth, and many fundamental aspects of that architecture are established well before a child enters school.

The timing and quality of early experiences combine to shape brain structure. Center on the Developing Child, Harvard University (February 2008)

Age

Developmental rates from 6-24 months: language development

9 children with ASD; 27 with typical development

Months Rogers, et al, in progress

The convergence of neuroscience and

economics tells us that the clock is always ticking, and

the costs of ignoring problems keep rising

True Costs

Over a lifespan, the average societal cost for caring for one person with autism is $3.7 million if adequate intervention isn’t provided (Harvard School of Public Health, 2006).

What is the cost to the family over a lifetime?

What is the cost to the person with ASD?

Next Steps

Next meeting date

Bring a copy of your classroom schedule

Work on guiding principles

Review early intervention readings