AJ DREXEL AUTISM INSTITUTE http://drexel.edu/autisminstitute/ EARLY - PDF document

7/30/17 AJ DREXEL AUTISM INSTITUTE http://drexel.edu/autisminstitute/ EARLY START DENVER MODEL A NATURALISTIC DEVELOPMENTAL BEHAVIORAL INTERVENTION DESIGNED FOR PRESCHOOLERS WITH AUTISM SPECTRUM DISORDER Prof. Craig Newschaffer, Autism Institute Director Giacomo Vivanti PhD Assistant Professor, Associate Prof. Diana Robins Early Detection and Intervention AJ Drexel Autism Institute, Drexel University, Philadelphia Program Leader Associate Editor , Associate Prof. Paul Shattuck Journal of Autism and Developmental Disorders Life Course Outcomes Program Leader THE EVOLVING LANDSCAPE OF ASD EARLY INTERVENTION EARLY DETECTION AND INTERVENTION RESEARCH – CHANGES IN QUANTITY PROGRAM Goal: understanding how early detection and early intervention practices improve outcomes in ASD Focus on characteristics of the: Context Child Program 1

7/30/17 THE EVOLVING LANDSCAPE OF ASD EARLY INTERVENTION THE EVOLVING LANDSCAPE OF ASD EARLY INTERVENTION RESEARCH – CHANGES IN QUANTITY RESEARCH – CHANGES IN QUALITY MODELS SUPPORTED BY AT LEAST ONE RANDOMIZED CONTROLLED TRIAL ABA/DTT (Smith et al., 2000) More studies published between 2013 and 2017 than in the previous 3 decades combined THE EVOLVING LANDSCAPE OF ASD EARLY INTERVENTION THE EVOLVING LANDSCAPE OF ASD EARLY INTERVENTION RESEARCH – CHANGES IN QUALITY RESEARCH – CHANGES IN QUALITY MODELS SUPPORTED BY AT LEAST ONE RANDOMIZED CONTROLLED TRIAL MODELS SUPPORTED BY AT LEAST ONE RANDOMIZED CONTROLLED TRIAL ABA/DTT (Smith et al., 2000) ABA/DTT (Smith et al., 2000) LEAP (Strain & Bovery, 2011) LEAP (Strain & Bovery, 2011) ESI/SCERTS (Wetherby et al., 2014) ESI/SCERTS (Wetherby et al., 2014) JASPER (Kasari et al., 2010, 2014) JASPER (Kasari et al., 2010, 2014) PLAY (Solomon et al., 2014) PLAY (Solomon et al., 2014) PACT (Pickles et al., 2016) PACT (Pickles et al., 2016) ESDM (Dawson et al., 2010) ESDM (Dawson et al., 2010) TEACCH (Turner-Brown et al., 2016) TEACCH (Turner-Brown et al., 2016) PRT (Hardan et al., 2015) PRT (Hardan et al., 2015) IMPACT (Ingersoll et al., 2016) IMPACT (Ingersoll et al., 2016) Adapted Responsive Teaching (Baranek et al., 2016) Adapted Responsive Teaching (Baranek et al., 2016) Joint Attention Mediated Learning (Schertz et al., 2013) Joint Attention Mediated Learning (Schertz et al., 2013) 2

7/30/17 EARLY START DENVER MODEL (ROGERS AND COLLEAGUES) Those who fall in love with practice without science are like a sailor who enters a ship without a helm or a compass, and who never can be certain whither he is going (Leonardo Da Vinci, circa 1490) • RESEARCH ¡INFORMING ¡ESDM • RESEARCH ¡INFORMING ¡ESDM • ESDM ¡PRACTICES ¡ • ESDM ¡PRACTICES ¡ • ESDM OUTCOME ¡RESEARCH • ESDM OUTCOME ¡RESEARCH 3

7/30/17 RESEARCH ON THE SELECTIVE NATURE OF EARLY LEARNING NEED TO EXPAND RESEARCH KNOWLEDGE TO INFORM EFFECTIVE INTERVENTIONS • Early learning driven by selective responsivity to: v Early intervention focuses on facilitating the acquisition (learning) of novel skills in children with ASD 1. Ostensive pedagogical cues, including: • Verbal Labels (Baldwin & Markman, 1989; Bloom, 2002) v Therefore, interventions should evolve when our knowledge • Eye-Contact and gaze cues (Csibra & Gergely, 2011; Wang et al., 2010 ) on how children with ASD learn changes • Affect (Nielsen et al, 2008; Brand & Shallcross, 2008) v Lack of cross-fertilization between research and practice – • Goals (Over & Carpenter, 2012) 80% of applied research in ASD fails to cite basic science 2. Novelty versus repetition (Stahl & Feigenson, 2015; Mather, 2013) research, and viceversa (Kazdin, 1999; Vivanti, 2017, Curr Dir Psychol Sci; (Vivanti & Rogers, 2014, Phil Trans R Soc B; Vivanti et al., 2017, Cognition) Vivanti & Nuske, 2016, Behav Brain Res; Critchfield et al., 2015) EARLY ¡LEARNING ¡IN ¡AUTISM ¡SPECTRUM ¡DISORDER EARLY ¡LEARNING ¡IN ¡AUTISM ¡SPECTRUM ¡DISORDER Children with ASD can and do learn – not a learning disability Children with ASD can and do learn – not a learning disability • Intact ability to learn from own actions via trial & error (Vivanti et al 2016, Mol Aut) • Intact ability to learn from own actions via trial & error (Vivanti et al 2016, Mol Aut) • Intact implicit learning (Foti, Vivanti et al 2015, Psych Med) • Intact implicit learning (Foti, Vivanti et al 2015, Psych Med) However difficulties in social learning – However difficulties in social learning – learning from (and about) actions and learning from (and about) actions and communication of other people communication of other people Early differences in early emerging preferences and responses that support social learning ‘System preferences’ facilitating learning in typical development are reversed More independent as children, but in most cases more dependent as adults (Vivanti & Rogers, 2014; Vivanti, Dawson & Rogers, 2017) (Vivanti & Rogers, 2014; Vivanti, Dawson & Rogers, 2017) 4

7/30/17 Ability ¡for ¡Social ¡Learning Motivation ¡for ¡Social ¡Learning Social ¡Modulation ¡of ¡Learning Attention to the demonstration Fre Frequency St Style F (2,60)=12.89; p <0.001, η 2=0.30 001, η 2=0. F (2 (2,58)= )=10.68, p p <0. <0.001, 2=0.49 49 90 80 70 60 ASD 50 ID 40 F ¡(2, ¡54)=4.55;Ϳ ¡p=0.01, ¡η2= 0.15 30 TD 20 10 0 Action Face 5

7/30/17 Fixation Duration Number of Trials DD Visual ¡Attention P = ¡.001, ¡η2 ¡= ¡.20 ASD Performance Fixation Duration Fixation Duration ASD WS TD Number of Trials Number of Trials P < ¡.05, ¡η2 ¡= ¡.09 Group X Condition interaction F (2, 74) = 4.61, p =.01. η 2p = .11 6

7/30/17 Group X Condition interaction ( F (1,38) = 9.42, p = .004, η 2 = .20) Social vs Instrumental Imitation Group X Condition Interaction – F (2, 52)=5.5; p<0.05, η 2= .09 Playful vs Neutral Model - WS (Vivanti et al., 2016, Mol Aut) 7

7/30/17 Learning by watching vs learning by doing Playful vs Non-Playful Imitation Playful model Non-playful model Gr Group , η 2= F F (2, , 52 52)= )=12 12.61 61; ; p<0. 0.001 01, 2= .2 Group X Gr X Co Condition Interaction – , η 2= .1 F F (2, , 52 52)= )=5.5; ; p=0. 0.02, • No group differences between ASD and WS • TD at ceiling 8

7/30/17 Importance of individual differences Visual attention Goal understanding P = .001, η 2 = .29 Group X Condition Interaction - F (2, 60)=4.23; p=0.01, η 2 p = 0.13 (Vivanti et al., 2016b, JNDD) (Vivanti et al., 2014, Exp Brain Research) Implications for teaching practices v Visual attention and learning less modulated by pedagogical cues and novelty v Relevance of goals v Individual differences v Implication for teaching Same response to goal-directed and non goal-directed actions (in TD p <.001) (Pokorny et al., 2015, Autism Research) 9

7/30/17 Early ¡Start ¡Denver ¡Model Comprehensive comprehensive early intervention for toddlers with autism ages 12–48 months. • RESEARCH ¡INFORMING ¡ESDM • ESDM ¡PRACTICES ¡ “Denver Model” Sally Rogers and colleagues, 1984 “Early Start Denver Model” • ESDM OUTCOME ¡RESEARCH Rogers & Dawson, 2010 CRITICAL TREATMENT TARGETS ESDM - DEVELOPMENTAL APPROACH Behaviors that enable social learning and engagement in naturalistic social interaction and cooperative activities Curriculum follows Developmental Sequences Imitation Social Orientation Scaffolding, shared control, Social ¡Learning ¡ Joint Attention Infrastructure use of child-preferred Emotion Sharing activities for meaning, Communication motivation and reward 10