A Developmental Framework for EBP in ASD Part 1

Emily Rubin Author

09/05/2016 Added

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Description

As a result of this activity, participants will be able identify critical priorities for educational outcomes for students with autism who are: 1. Before words and using gestures and facial expressions to communicate. 2. Using emerging language skills either via speech, pictures or other symbolic forms of communication. 3. Using conversational language to engage with a range of social partners.

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[00:00:01.810]Welcome.
[00:00:03.152]I want to thank my host for offering
[00:00:04.759]to host this two-part lecture series
[00:00:07.030]as part of their tri-state webinars
[00:00:09.173]because I have the opportunity
[00:00:10.413]to share the importance of considering
[00:00:12.325]a developmental framework when we think about
[00:00:14.245]evidence-based practices with children with autism.
[00:00:17.053]All too often we're thinking about
[00:00:18.663]applying evidence-based practices to children with autism
[00:00:21.664]as if autism was some kind of a static condition.
[00:00:25.333]But children with autism grow and mature.
[00:00:27.715]They start out not knowing
[00:00:30.091]that if they're even interested in people.
[00:00:31.843]They might not even have any language
[00:00:33.763]and their needs are very different
[00:00:35.281]than a child who is developing the ability to communicate,
[00:00:37.933]developing words, symbols, sign language and so forth.
[00:00:41.432]Those are children we call emerging language
[00:00:43.421]and then children who are conversational language level
[00:00:46.318]with children with autism
[00:00:47.581]who are learning how to fit in
[00:00:48.989]and follow the social conventions
[00:00:50.640]and social norms around them.
[00:00:52.621]The needs of these children differ significantly
[00:00:54.691]depending on these neurodevelopmental stages.
[00:00:57.227]We need to think about social emotional development
[00:01:00.745]as a part of brain development,
[00:01:02.224]as a part of understanding how children
[00:01:04.104]with autism grow and mature.
[00:01:05.824]And this is truly gonna help us
[00:01:07.333]when we're considering which evidence-based practices
[00:01:09.883]most appropriate at a given time for a child
[00:01:12.075]with autism in their life.
[00:01:15.773]What I hope you gain from this first webinar
[00:01:18.123]is the idea that it's not only critical to think about
[00:01:20.755]what evidence-based strategy to apply,
[00:01:23.081]but what are the goals and objectives
[00:01:24.475]that I need to be thinking about
[00:01:25.839]when a child is before words,
[00:01:27.603]when a child is emerging language,
[00:01:29.403]or when a child is conversational language.
[00:01:32.083]These are very different developmental needs
[00:01:33.933]and so when we select our evidence-based practices,
[00:01:36.551]I hope we're gonna be good consumers
[00:01:37.910]of those evidence-based practices.
[00:01:42.970]My discussion of evidence-based practices
[00:01:45.389]begins with my story.
[00:01:46.952]People often ask me how did I get into the field of autism
[00:01:50.229]and really I just wanted to be a teacher.
[00:01:52.469]I loved being in the classroom and I love children
[00:01:54.686]and I thought this was a great way to
[00:01:56.210]kind of share my passion with the world.
[00:01:57.858]But I was lucky, I had a roommate at that time
[00:01:59.880]who said, "If you're gonna teach,
[00:02:01.147]"you might wanna meet some of the kids
[00:02:02.130]"with autism that I'm working with
[00:02:03.480]"at my psychology internship programs."
[00:02:05.800]And she was right.
[00:02:06.917]The first little boy that I met,
[00:02:08.600]he was so interesting.
[00:02:09.778]He could memorize all the license plates
[00:02:11.688]in the car park that we had outside of the research lab
[00:02:15.348]and he would get very upset
[00:02:16.855]if those eight-digit plates
[00:02:18.997]were not in the same exact spot
[00:02:20.410]as they were the day before
[00:02:21.810]when we went into the clinics the day before.
[00:02:23.930]He could memorize all the series of digits,
[00:02:26.632]he knew what car, what make and model of that car.
[00:02:29.152]And he would get so upset
[00:02:30.312]if the car wasn't right where it was the day before.
[00:02:32.930]But when he would walk up to the clinic
[00:02:34.570]and try to open the door and it was too heavy,
[00:02:36.919]he would just fall to the floor and cry.
[00:02:38.800]He didn't know how to simply say,
[00:02:39.840]"Miss Emily, open the door."
[00:02:41.589]And I thought, my goodness,
[00:02:42.581]this child has such unique skills
[00:02:44.882]and that he's able to memorize
[00:02:46.709]all that visual spacial information and that knowledge,
[00:02:49.029]clearly has the capacity to learn,
[00:02:51.178]but he had struggled with the basic skill
[00:02:52.800]of being able to ask me to open the door for him,
[00:02:55.025]that functional communication skill.
[00:02:57.097]And so, to me, my friend was brilliant when she said,
[00:02:59.880]"If you're gonna be able to teach,
[00:03:00.960]"you got to be able to teach a mind
[00:03:02.109]"that is so unique like that.
[00:03:03.269]"And understand that we need to make sure it's balanced
[00:03:05.520]"and that he has the balance of the communication skills
[00:03:07.738]"in addition some of those academic and cognitive skills."
[00:03:10.509]And I was lucky because the particular internship
[00:03:13.290]that I joined that year
[00:03:14.880]was with Dr. Laura Schreibman at UC San Diego
[00:03:17.428]and she was developing an approach called
[00:03:19.679]the pivotal response treatment approach.
[00:03:21.690]Which was a contemporary behavioral approach
[00:03:23.530]that is very evidence-based
[00:03:25.178]was derived from more traditional behavioral approaches
[00:03:27.898]on the notion that why are we teaching children with autism
[00:03:30.450]every skill that they need to learn theoretically?
[00:03:33.096]Why don't we work on the most critical,
[00:03:35.109]most essential skills?
[00:03:36.378]And if you teach those skills,
[00:03:37.868]the other skills are likely to follow,
[00:03:39.498]they're likely to generate.
[00:03:40.880]And she was brilliant
[00:03:42.178]as were the Koegels in Santa Barbara
[00:03:43.709]who were collaborating with her.
[00:03:45.186]And that they were noticing is
[00:03:46.628]that if you work on spontaneous communication,
[00:03:49.181]a lot of the other language and cognitive skills
[00:03:50.909]also start to flourish and grow.
[00:03:52.959]And I got to see this little boy go
[00:03:54.530]from not being able to communicate with me at all
[00:03:56.349]to being able to speak in couple words
[00:03:58.250]and two-word sentences
[00:03:59.554]for the purposes of requesting objects
[00:04:01.330]and spontaneously communicating with me.
[00:04:03.770]It's very exciting to have that opportunity
[00:04:05.320]to work with him.
[00:04:08.491]My next journey however was by ending up
[00:04:11.371]getting hired by that same family.
[00:04:13.592]They had a younger sibling, a much younger boy
[00:04:16.350]who was also being diagnosed with autism.
[00:04:18.592]So they said, "Will you come and work in this home program?"
[00:04:21.291]And my first thought was,
[00:04:22.482]"Oh, well I know pivotal response treatment
[00:04:24.249]"so I'll go and do that with your younger son."
[00:04:26.563]And they said, "Oh no, no.
[00:04:27.531]"We're gonna have a supervisor
[00:04:28.782]"come and train you in a different approach."
[00:04:30.882]And this particular approach was called
[00:04:33.811]discrete trial training.
[00:04:36.270]And discrete trial training was actually very different
[00:04:38.198]than pivotal response treatment.
[00:04:40.120]In pivotal response treatment
[00:04:41.768]I had been kind of enticing and encouraging children
[00:04:44.328]offering them choices of materials to communicate,
[00:04:47.830]and then rewarding them with the natural consequence
[00:04:49.848]of that choice such as the blue train or the orange train.
[00:04:53.938]And the child would then respond or would initiate
[00:04:56.667]and I would then offer the actual toy.
[00:04:59.058]In discrete trial I was actually asked to
[00:05:01.256]do quite the opposite.
[00:05:02.635]I was asked to kind of have the child follow my direction
[00:05:05.077]and then I would reward him for doing so.
[00:05:07.256]And when I did this with this little boy,
[00:05:08.776]I'll call him Kyle, it was amazing.
[00:05:11.026]I got to see him learn a lot of different skills.
[00:05:13.405]He learned how to match objects to objects,
[00:05:15.563]he learned how to point to objects
[00:05:17.379]on command by their label,
[00:05:18.850]point to the ball, the car, the truck.
[00:05:21.197]He learned how to identify his colors,
[00:05:22.623]point to red, green, yellow.
[00:05:24.667]He learned his numbers, he learned how to categorize things.
[00:05:27.815]He could follow lots of basic instructions
[00:05:30.317]like put this block in the cup
[00:05:32.376]and things of that nature.
[00:05:33.765]Being able to respond to me was something
[00:05:35.645]that I saw was really a result of that particular approach.
[00:05:39.466]Essentially for 20 hours a week for an entire year,
[00:05:42.096]he was two years old when I started
[00:05:43.717]and by the time he was three,
[00:05:45.266]he had learned a whole lot of language-related
[00:05:47.615]cognitive skills and academic and readiness skills
[00:05:50.885]in order to prepare him for school.
[00:05:52.717]It was very different than pivotal response,
[00:05:54.445]he wasn't learning how to request per se
[00:05:56.586]or how to initiate.
[00:05:57.837]He was learning how to comprehend and follow
[00:06:00.816]and I thought he was preparing
[00:06:02.626]or becoming more prepared for school
[00:06:04.485]because of all those academic skills.
[00:06:06.688]But when he transitioned at three years old
[00:06:08.906]to his special education preschool classroom,
[00:06:10.898]it was actually an integrated classroom,
[00:06:12.898]I noticed they requested that I join in
[00:06:16.069]and support him as his educational assistant.
[00:06:22.118]And I don't know if Kyle cried as much as I cried that year
[00:06:25.909]because while I had taught him quite a bit of skills,
[00:06:28.400]I taught him his letters, his colors, his shapes,
[00:06:30.868]how to match objects and all of that,
[00:06:32.371]and how to follow directions,
[00:06:34.650]he wasn't ready for school.
[00:06:35.910]School was a social environment
[00:06:37.468]and I had taught him a lot about things.
[00:06:39.478]He didn't know how to connect with his peers,
[00:06:41.187]he didn't know how to initiate,
[00:06:42.319]how to share attention.
[00:06:43.677]He didn't know how to request comfort,
[00:06:45.370]how to initiate songs and special routines
[00:06:49.428]so that he would find joy
[00:06:50.586]in the natural activities of his school day.
[00:06:53.269]And so, I found myself craving.
[00:06:54.958]I said, you know, that particular approach
[00:06:56.629]is helpful for a certain set of skills
[00:06:58.650]but we were craving this other set of skills
[00:07:00.440]that he was missing so tremendously and I struggled.
[00:07:04.701]But then, in the preschool classroom,
[00:07:07.449]I got to learn a whole bunch of new
[00:07:09.221]evidence-based strategies
[00:07:10.669]that were helpful to Kyle in so many different ways.
[00:07:13.586]For example, I got to learn about the schedule boards
[00:07:16.770]and timetables and visual supports are one of our
[00:07:19.495]many evidence-based strategies out there.
[00:07:21.659]Once he could predict where he was supposed
[00:07:23.278]to go throughout the day,
[00:07:24.240]that really helped him tremendously.
[00:07:26.469]And as you can see in the upper right here,
[00:07:28.830]this is a child beginning to use picture communication.
[00:07:31.560]When Kyle was stressed,
[00:07:32.640]he really benefited from having picture symbols
[00:07:34.661]to help him remember the words.
[00:07:36.541]And picture communication is another tool
[00:07:39.109]that's quite evidence-based.
[00:07:40.890]And finally as you see in the bottom right,
[00:07:43.261]you see the use of scripting or social narratives.
[00:07:46.200]The ability to prepare ahead for certain situations
[00:07:49.080]by using pictures and words
[00:07:50.949]to help identify what might happen
[00:07:52.781]and how they might feel about that,
[00:07:54.148]and get him ready for those things.
[00:07:55.829]I learned a whole bunch of new strategies
[00:07:57.760]that really helped me get ready for,
[00:08:00.312]get Kyle ready for socialization engagement
[00:08:02.530]with the world around him.
[00:08:04.048]But the whole years of working with him in preschool
[00:08:06.280]I kept craving more about speech and language development.
[00:08:09.523]I knew there would be more to think about that.
[00:08:12.261]I ended up getting a degree
[00:08:13.348]in speech and language pathology
[00:08:14.988]and learning quite a bit from my mentor Dr. Barry Prizant
[00:08:18.019]about how children with autism develop language.
[00:08:20.680]And one of the things that I learned
[00:08:22.220]is that children with autism develop language
[00:08:23.741]very differently from other people.
[00:08:25.690]And he said they often talk about nouns and not people
[00:08:29.068]and so, they may learn object labels
[00:08:30.901]but not people's names and verbs,
[00:08:32.530]and therefore have to script a lot or borrow language.
[00:08:35.669]And so, I learned about using picture communication
[00:08:38.280]but for simple phrases such as Emily, open the door.
[00:08:41.949]Emily, pour the milk.
[00:08:43.421]Very different than specifically asking for objects.
[00:08:46.469]I felt really empowered with that
[00:08:48.600]and then I got humbled.
[00:08:50.139]I got humbled by my first job
[00:08:52.520]working alongside an occupational therapist
[00:08:55.035]who told me, "I hear you've got a lot of training
[00:08:56.861]"in behavioral approaches
[00:08:58.410]"and that you've been training
[00:08:59.272]"communication and visual supports.
[00:09:01.642]"But what if this child's central nervous system
[00:09:03.860]"is through the roof and he's really, really stressed out?
[00:09:07.421]"Do you have a way to help him kind of calm his nerves down
[00:09:09.934]"so that he can communicate with you?
[00:09:12.192]"And what if the child's really kind of under responsive,
[00:09:14.402]"not paying any attention to you at all,
[00:09:16.250]"do you have a way to kind of jazz him up?"
[00:09:18.592]And I felt kind of humbled by her
[00:09:20.850]as she taught me different strategies
[00:09:22.290]for children who are before words,
[00:09:23.879]more sensory motor strategies to help them soothe
[00:09:26.907]and modify in the environment,
[00:09:28.138]making it less complex and overwhelming
[00:09:30.050]with language and so forth.
[00:09:31.690]As they develop language to then bring in
[00:09:33.655]the picture symbols and schedules and so forth,
[00:09:37.055]that will help the child understand
[00:09:38.623]what the expectations are.
[00:09:40.305]And as they get into the conversational stages,
[00:09:42.396]helping them use cognitive-based interventions
[00:09:45.096]to help them plan and prepare for social situations.
[00:09:48.723]But I can tell you, at that time,
[00:09:50.703]I had finally learned a whole bunch
[00:09:53.063]of different evidence-based strategies.
[00:09:54.703]I had learned things like
[00:09:55.655]the contemporary behavioral approaches
[00:09:57.255]to encourage spontaneous communication.
[00:09:59.455]I've learned the more traditional behavioral approaches
[00:10:01.293]like discrete trial,
[00:10:02.634]I learned about visual support,
[00:10:04.005]social narrative, picture communication
[00:10:06.015]and now I was learning about
[00:10:06.986]the field of occupational therapy,
[00:10:09.085]and I was kind of burning out.
[00:10:11.075]Because at that particular time,
[00:10:12.428]if a parent had come up to me and said,
[00:10:14.389]"I've got a child with autism, what shall I do?"
[00:10:16.676]I would have thrown my hands in the air and said,
[00:10:18.317]"I have no idea."
[00:10:19.957]There's so many different strategies out there
[00:10:23.301]but I have to tell you, I got really lucky.
[00:10:25.850]I got recruited to the Yale Child Study Center
[00:10:28.279]to do a fellowship in social neuroscience
[00:10:30.738]and actually learn how a child's brain develops over time,
[00:10:34.359]and to learn about autism from the inside out.
[00:10:37.698]What is going on in the minds of children with autism?
[00:10:39.839]Why do they struggle to find people interesting
[00:10:42.269]to connect, to communicate and then ultimately,
[00:10:44.570]to acquire creative language
[00:10:46.277]and then the social executive functioning skills
[00:10:48.319]to be able to succeed in a wide range of situations.
[00:10:51.357]There's a clear neurodevelopmental path
[00:10:53.227]that all children have to go along
[00:10:55.058]to become socially and emotionally competent.
[00:10:57.610]And once we learn about what's going on
[00:10:59.639]with children with autism about their differences,
[00:11:01.759]we can be, work much smarter
[00:11:03.778]and to learn what are the most essential skills
[00:11:05.829]that our children need along this developmental path.
[00:11:09.130]And it starts really with early childhood development.
[00:11:14.178]And as you'll see in this particular image,
[00:11:16.783]you'll see a baby who just looks so addicted to her mother.
[00:11:22.256]How does that happen?
[00:11:23.737]In the first couple of months of life
[00:11:26.257]children are beginning to connect with their parents.
[00:11:29.717]What we see is a need for attachment
[00:11:32.450]and connection and relationship.
[00:11:34.618]There are some children that are born
[00:11:35.829]with genetic advantages toward that social competence
[00:11:38.816]and when they look toward the eyes
[00:11:39.970]in the first two months of life,
[00:11:41.690]what you'll see is that the babies
[00:11:43.706]gets a rush of neuro endorphins
[00:11:45.722]called opioids and dopamine in their brain.
[00:11:48.640]And what that's telling them is that
[00:11:50.021]you're looking at social stimuli
[00:11:51.492]and that is the coolest thing on the planet.
[00:11:53.442]I learned that as we looked at eye tracking research
[00:11:56.651]and neurosensitivity studies
[00:11:58.514]and so forth at the Yale Child Study Center and beyond,
[00:12:01.714]and we found that babies find social stimuli
[00:12:03.925]very stimulating if they have the genetic advantage.
[00:12:06.963]But genetics alone don't play the trick.
[00:12:08.932]You also need oxytocin
[00:12:10.805]which is a hormone that you get
[00:12:12.472]from being nurtured and loved and cared for.
[00:12:14.903]So in that environment,
[00:12:16.272]you're getting even more stimulation.
[00:12:18.503]Oxytocin is a pheromone that goes between
[00:12:20.562]the caregiver and the child,
[00:12:22.333]and when that oxytocin goes on top
[00:12:24.101]of the opioids and the dopamine,
[00:12:26.002]that baby essentially is getting
[00:12:27.331]an oxytocin mix cocktail from heaven.
[00:12:29.983]And what that's allowing that baby to do
[00:12:32.634]is form something that we call the social brain,
[00:12:36.158]and that's that first step along neurodevelopment.
[00:12:38.943]How does it happen?
[00:12:40.263]A child has to find social stimuli
[00:12:42.042]the most important thing on the planet
[00:12:44.234]to get really, really excited about it,
[00:12:45.882]to start initiating, sharing emotion and all of that.
[00:12:49.178]Some children have the genetic advantages.
[00:12:51.202]They get total bunches of chemicals
[00:12:53.394]in their brain to make that happen
[00:12:55.122]and they also get the oxytocin from their caregivers
[00:12:57.548]when they're being nurtured.
[00:12:59.143]But what we're finding out
[00:13:00.113]is that not all children have those genetic advantages.
[00:13:02.912]Children with autism are born with genetic differences
[00:13:06.394]in which they look toward the social world,
[00:13:08.493]they may be slightly indifferent to it.
[00:13:10.898]There's a wide range of genetic causes of autism,
[00:13:13.532]there isn't one caused by any means,
[00:13:15.285]there's probably hundred if not
[00:13:16.543]even a thousand different causes
[00:13:18.423]of these genetic advantages or genetic differences.
[00:13:21.893]But what we're seeing is that
[00:13:23.244]when babies are very young with autism,
[00:13:25.223]they may reflexibly look at the eyes
[00:13:26.693]for the first couple of months,
[00:13:28.233]but what they're not getting is that full dose
[00:13:30.183]of opioid and dopamine.
[00:13:31.868]And we're also seeing some research that shows that
[00:13:34.165]receiving the oxytocin,
[00:13:35.732]it may be a different variable as well.
[00:13:37.893]If they have a lower dose of oxytocin cocktail,
[00:13:40.285]it's gonna be harder to make that connection.
[00:13:42.528]But we know they can.
[00:13:43.932]We have met many a child with autism
[00:13:45.701]who has certainly found people
[00:13:46.943]to be the coolest thing on the planet.
[00:13:48.485]What did they accomplish?
[00:13:49.993]They accomplished falling in love with the social world
[00:13:52.303]and initiating connecting.
[00:13:53.703]That is the most important milestone for a child
[00:13:55.823]who is before words,
[00:13:57.158]who's not even yet communicating,
[00:13:58.663]we got to make sure that social is the most important thing.
[00:14:01.883]And that's really changed the way I think about
[00:14:03.925]selecting evidence-based practices for those early stages
[00:14:07.351]because once we can get hooked on people,
[00:14:10.453]what that means is that
[00:14:11.551]social brain's gonna say connect with people,
[00:14:13.602]connect with people as much as you can.
[00:14:15.301]And high rates of communication equal language acquisition
[00:14:19.271]and language begins to flourish.
[00:14:20.989]A child talks when they have something to say
[00:14:23.573]and if they are not using speech,
[00:14:24.922]they might use picture communication or symbols.
[00:14:27.101]But nonetheless, the language hemispheres
[00:14:28.883]will begin to flourish
[00:14:30.368]if there's a lot of social connections and initiation
[00:14:32.999]while language is developing.
[00:14:34.701]We hope that children don't just simply say
[00:14:37.659]like in this little picture here.
[00:14:39.477]I want yellow block please or iPad please.
[00:14:43.591]We hope that they actually say mommy, daddy, Emily
[00:14:47.381]and that they use verbs.
[00:14:48.679]Emily hug, Emily tickle.
[00:14:50.580]Or Miss Emily, open the door please,
[00:14:52.570]Miss Emily, tie my shoes.
[00:14:54.439]The use of people's names and verbs
[00:14:56.559]is really a result of the social emotional connections
[00:15:00.191]that we're giving them and lots of reasons
[00:15:01.778]to want to be around people.
[00:15:03.327]And subject verb as a speech pathologist myself,
[00:15:06.349]is something we all know
[00:15:07.828]predicts creative language acquisition.
[00:15:10.679]When you have subject verb
[00:15:12.047]and you develop creative language skills
[00:15:14.247]which you're gonna see in the brain
[00:15:15.697]are these language regions starting to flourish
[00:15:18.138]and that's the next kick off of neurodevelopment
[00:15:20.797]is when children can talk about
[00:15:22.098]the present, the past and the future
[00:15:24.338]because they have subject verb noun sentence structure.
[00:15:26.669]We absolutely need to target that
[00:15:28.498]as one of our key outcomes
[00:15:29.708]for the emerging language stage.
[00:15:32.237]Once a child is using creative language,
[00:15:35.308]then they can go into that final milestone
[00:15:37.218]of brain development which is the ability to succeed
[00:15:39.999]in a wide range of social situations.
[00:15:42.618]That's because they have the ability
[00:15:44.239]to talk about the present, the past and the future,
[00:15:47.399]and that leads to something called executive functioning
[00:15:51.098]as you'll see here.
[00:15:52.738]Executive functioning allows a child
[00:15:54.439]to walk into any social situation,
[00:15:56.381]size it up and kind of figure out
[00:15:57.850]where should I sit, who should I talk to,
[00:16:00.029]what language can I use, slang or more formal or polite?
[00:16:04.111]What's my vocal volume?
[00:16:05.442]That's when children begin to develop
[00:16:07.013]those social and emotional skills.
[00:16:08.941]Those children have very significantly different needs
[00:16:12.001]than the children at the earlier part of that
[00:16:13.876]kind of developmental cycle
[00:16:15.122]because they're fully convinced people are worth it,
[00:16:17.541]but boy do they need to learn some social norms
[00:16:19.722]or else they fail quite a bit
[00:16:21.741]which can be very hard on their mental health.
[00:16:24.856]What we have learned is that
[00:16:27.713]the neuroscience in our field is so robust
[00:16:30.583]we have so much to learn from it
[00:16:32.333]but it is not affecting our interventions
[00:16:34.773]as much as it needs to be.
[00:16:36.622]We're learning for example from eye tracking research
[00:16:39.383]in the field of social neurosciences
[00:16:41.103]that babies do look at the eyes
[00:16:42.733]in the first two months of life,
[00:16:44.271]most babies with the exception of those that are blind.
[00:16:47.454]But children with autism struggle
[00:16:49.640]because while they reflexibly look
[00:16:51.112]for the first couple of months,
[00:16:52.662]they don't have the same neural sensitivity
[00:16:54.760]and they decline in their interest
[00:16:56.491]between two months and six months of age.
[00:16:58.560]Our eye tracking studies are showing that
[00:17:00.611]we could even pick up on some of the earliest signs
[00:17:02.781]that children have with these social differences
[00:17:05.310]by six months of age.
[00:17:07.346]And what we're finding is as a whole
[00:17:10.502]that the neuroscience is revealing
[00:17:12.599]children with autism tend to show
[00:17:14.222]less neural sensitivity to social stimuli
[00:17:16.724]in their early childhood years.
[00:17:18.920]Their neurodevelopmental differences contribute basically
[00:17:21.651]to attention to nonsocial stimuli.
[00:17:24.230]They're much more interested in things and toys
[00:17:27.769]and less interested in people.
[00:17:29.960]Early on that's gonna thwart
[00:17:31.640]their development of communication
[00:17:33.689]and as they move into language stages,
[00:17:35.531]they find people are interesting enough
[00:17:36.982]to develop language.
[00:17:38.000]They might just develop nouns
[00:17:39.930]and as they move forward beyond that,
[00:17:42.150]what you'll see is they're really struggling
[00:17:43.781]understanding people's perspectives
[00:17:45.624]and how to fit in and be successful in the social world.
[00:17:50.403]Dr. Ami Klin who was formally the director
[00:17:52.904]of the Child Study Center at Yale
[00:17:54.355]and is now working at Emory University in Atlanta
[00:17:57.304]has used this slide for a number of years.
[00:17:59.600]Is that our children then begin to develop
[00:18:01.962]expertise in their early years
[00:18:04.565]about certain parts of the world around them.
[00:18:07.584]If you have a really high dose of oxytocin cocktail,
[00:18:10.614]your genetic advantage is for social
[00:18:12.344]and really good nurturing,
[00:18:13.846]what you're gonna see is children developing
[00:18:15.854]expertise about the social world.
[00:18:18.395]But if you had a lower dose of oxytocin cocktail
[00:18:20.875]because of genetic differences,
[00:18:22.627]what you then see is that children start to develop
[00:18:25.595]expertise about the physical world.
[00:18:28.294]Our role as practitioners
[00:18:29.931]and speech and language pathologists,
[00:18:31.544]teachers, educators, parents, community members,
[00:18:34.365]all of us, we need to make sure that
[00:18:35.894]our children with autism become well-balanced.
[00:18:38.315]That we can encourage them to develop some skills
[00:18:40.264]about the social world
[00:18:41.464]while they become experts in the physical world.
[00:18:43.966]And so, we need to be careful
[00:18:45.214]with the evidence-based patch strategies that we picked.
[00:18:48.144]For example, not spend 20 hours a week
[00:18:50.743]teaching them how to match objects
[00:18:52.501]or point to objects on command.
[00:18:54.332]While those are important skills
[00:18:55.802]and I might use that evidence-based strategy
[00:18:57.650]for a certain subset of a child's day,
[00:18:59.970]we need to prioritize the social and emotional well-being
[00:19:03.232]that our children need so desperately.
[00:19:07.240]What is your takeaway message from all of these,
[00:19:09.901]the lesson learned?
[00:19:11.231]What we determine as a child's
[00:19:12.655]targeted educational objective should be as important
[00:19:15.640]as how we are providing the accommodations.
[00:19:18.253]When you're thinking about
[00:19:19.261]what is evidence-based in the field,
[00:19:21.373]think about is this goal I'm writing for the child
[00:19:24.154]an evidence-based goal?
[00:19:25.453]Is it based on research that shows
[00:19:27.853]the neurodevelopmental path
[00:19:29.173]that our children go through?
[00:19:30.554]Or am I simply picking goals and objectives
[00:19:33.202]that are okay, they're useful, they're interesting
[00:19:35.373]but they're not high priorities for our children?
[00:19:41.424]And as we've learned,
[00:19:42.274]there are more than two dozen different
[00:19:44.193]evidence-based focused strategies
[00:19:46.843]that have been identified
[00:19:47.676]in several recent systematic reviews.
[00:19:50.350]There's some, I particularly co-authored one
[00:19:52.721]with Lindee Morgan in 2014,
[00:19:54.700]when we specifically looked at the
[00:19:56.909]evidence-based strategies that are available to us
[00:20:00.852]in infants and toddlers
[00:20:02.201]which is a very emerging field.
[00:20:04.142]There's not as much research about babies
[00:20:05.870]under the age of three.
[00:20:07.475]But we have emerging literature base there.
[00:20:10.332]And then Connie Wong and researchers
[00:20:12.320]at University of North Carolina
[00:20:13.830]as well as around the country do the systematic review
[00:20:16.750]looking at a wide range of evidence-based strategies.
[00:20:19.652]These are focus strategies such as visual supports,
[00:20:22.321]technology-assisted instruction, social narratives,
[00:20:25.652]behavioral interventions as well as
[00:20:27.069]cognitive behavioral interventions.
[00:20:28.850]Naturalistic interventions that involve
[00:20:30.650]modifying everyday routines to promote communication
[00:20:33.399]and prevent challenging behaviors.
[00:20:35.328]We have a whole array of approaches to pick from
[00:20:38.364]and to think about when we're helping our children succeed.
[00:20:44.909]What do we know about those strategies?
[00:20:46.730]If we look at the results of those systematic reviews,
[00:20:49.410]these strategies target a wide range of behaviors.
[00:20:52.239]Some of those behaviors are really relevant,
[00:20:54.159]some of them are kind of okay, they're interesting.
[00:20:56.879]But are they critical for the fact
[00:20:58.330]that this child is a social emotional challenge
[00:21:00.699]that is impeding in their barrier
[00:21:01.988]to connect with the social role,
[00:21:03.296]develop creative language
[00:21:04.404]and develop those conversational skills.
[00:21:06.865]To be truly evidence-based,
[00:21:08.345]it's not just that you can replicate
[00:21:09.684]that research in other situations
[00:21:11.595]but it needs to be relevant
[00:21:12.985]to the developmental needs of the child,
[00:21:14.756]and the requirements of the setting
[00:21:16.193]as well as the preferences of those being supported.
[00:21:19.449]These strategies enable us to work toward
[00:21:21.668]more evidence-informed comprehensive frameworks
[00:21:24.981]that are more developmentally sensible.
[00:21:27.233]We need a framework that allows us
[00:21:28.764]to pick and choose these strategies
[00:21:30.183]as they're most needed in our field.
[00:21:35.132]Our jobs in the school setting are really critical.
[00:21:38.033]We need to determine an appropriately
[00:21:40.612]specifically designed instruction
[00:21:42.412]based on the unique needs of a student
[00:21:44.953]from that student's disability
[00:21:46.502]in order to access the curriculum.
[00:21:48.364]We need to do a careful assessment
[00:21:50.072]and actually write goals that are gonna make a difference.
[00:21:52.564]We can't just say we're gonna use this approach
[00:21:54.646]before we think about the goals
[00:21:55.932]that we're gonna write.
[00:21:57.084]The goals are just as much important
[00:21:58.923]as we move forward here.
[00:22:02.823]An example of some of the more comprehensive frameworks
[00:22:05.161]that are being developed right now
[00:22:07.241]are taking ranges of those evidence-based strategies
[00:22:10.303]but thinking about the social emotional outcomes
[00:22:13.100]as the central focus of their approach.
[00:22:15.460]When my colleague, Amy Wetherby
[00:22:16.929]and her colleagues at Florida State University
[00:22:20.041]published in pediatrics a randomized control trial
[00:22:22.641]an approach called Early Social Interaction,
[00:22:25.048]which specifically looked at initiating in high rate,
[00:22:27.951]sharing positive emotion,
[00:22:29.281]really connecting with people,
[00:22:30.607]developing people's names and verbs,
[00:22:32.457]and some of those key goals and areas.
[00:22:34.388]Using a lot of the evidence-based strategies
[00:22:36.627]and techniques that we've learned about in our field
[00:22:39.017]that has also spilled over to
[00:22:41.127]something I've co-authored as well
[00:22:42.377]which is the Classroom SCERTS Intervention,
[00:22:44.838]and that looks at how do we apply
[00:22:46.629]the idea of initiating high rates
[00:22:48.671]in a school-based situation.
[00:22:50.791]Those frameworks use the SCERTS Assessment Process
[00:22:53.239]to select research-based
[00:22:54.979]and developmentally sensible strategies.

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A Developmental Framework for EBP in ASD Part 1

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