Assessments of the effectiveness of non-‐behavioural interventions
Given the devastating impact that ASD can have on parents and families, it is not surprising that parents often seek “cures” for ASD (e.g., sensory integrative therapy, camel milk, brain training, chelation therapy, special diets, hyperbaric chambers, etcetera) and there is no shortage of businesses offering them. Those businesses usually make seductive claims and many parents are perplexed by those claims because they are unable to find and/or evaluate the quality of evidence supporting them. Although behavioral interventions for children with ASD are usually called Applied Behaviour Analysis (ABA), ABA is in fact a set of scientific methods that can be used to validate ANY intervention aiming to change behavior. Thus, we will teach parents how to use these methods to assess whether the supposed treatment can be credited with producing desirable behaviour changes in their child. Parents can then request that the cure/treatment provider accommodate the requirements of their experiment to assess effectiveness. Providers with nothing to hide will likely cooperate with these requests.
Centre-‐based EIBI Services
The provision of EIBI at a centre where other children are also being served is a natural intermediate step between a home-‐based programme and the group instruction methods seen in mainstream kindergartens and schools. However, centre-‐based services offer a number of other important benefits to the child including closer supervision of therapists working with the child, quicker adjustments of teaching methods and targets, more opportunities to assess and teach generalization of skills, and a near seamless transition to group-‐instruction methods, school-‐readiness programmes (see below), and groups of children receiving social-‐skills training.
Challenging behaviour refers to those behaviours that threaten the quality of life and/or physical safety of an individual or others around him/her. Some common examples include: aggressive outbursts, property destruction, self-‐injury, ingesting inedible objects (pica) and eloping. Although BASES teaching staff will continue providing interventions to reduce challenging behaviour that interferes with their ability to teach skills in sessions, families can now contract separately our services to address challenging behaviour that occurs at other times and in other environments. Rather than simply providing advice to caregivers and following up with occasional conversations, we will conduct a formal functional assessment of the challenging behaviour and, where possible, teach alternative behaviours that serve the same function. The aim of our programmes will be to produce behaviour changes that last over time, can be maintained by multiple people, spread to a range of environments, and do NOT rely on people avoiding so-‐called “triggers” for the challenging behaviour. To that end, we will use only those assessment and intervention techniques that have been empirically validated in peer-‐reviewed and published research.
Expedited Diagnostic Assessments
Many parents seek services for their children prior to having received a formal diagnosis of ASD and so prior to being eligible for government funding for those services. They recognize their child’s need for intensive instruction and/or interventions to manage problem behaviour, understand the importance of early intervention, but have been waitlisted for diagnostic assessments via the public health system. We have often helped these parents by formally referring them to a Developmental Paediatrician, a Speech-‐Language Therapist and a Clinical Psychologist with whom we work closely. The expedited diagnostic assessment that ensues results in expedited government funding for intervention, and that earlier funding offsets the cost of the private-‐consultation assessment fees. Moreover, our consulting professionals are aware of the research literature on best practice for children with ASD and so advocate the need to provide EIBI. In fact, our consultant Clinical Psychologist likely has greater expertise in EIBI that any other Clinical Psychologist in Australia after having trained for over 10 years at one of the leading agencies in the US.
Fear and Phobia Programmes
Many children with a developmental disability escape from certain situations and/or avoid those situations altogether. Consequently, people often infer that they fear those situations and to a point where they might be said to have a phobia. Some go as far to say that the child has a “sensory issue”. We will conduct formal assessments of these behaviours and design individualized interventions to eliminate them when they impede a child’s (or his/her family’s) access to valued and useful activities. Our work will always be informed by the behaviour-‐analytic research published on a specific problem.
Language assessments using the VB-‐MAPP
The Verbal Behavior Milestones Assessment and Placement Program (VB-‐MAPP) is a criterion-‐ referenced assessment tool, curriculum guide, and skill tracking system that is designed for children presenting language delays. It is based on B. F. Skinner’s (1957) behavioural analysis of language
(a.k.a. verbal behaviour) and over 30 years of research, clinical work, field-‐testing, and revisions (Partington & Sundberg, 1998; Sundberg, 1983, 1987, 1990; Sundberg & Michael, 2001; Sundberg & Partington, 1998; Sundberg, Ray, Braam, Stafford, Rueber, & Braam, 1979). This assessment tool allows us to compare a child’s language and social skills with those of typically developing children, identify skills that require explicit teaching, and measure the progress we make in that teaching. It will be administered by specifically trained BASES staff, and is ideal for children for whom limited language and social-‐skills are the main concerns. More information about the VB-‐MAPP can be obtained at this website: http://www.marksundberg.com/vb-‐mapp.htm
Parent-‐Training Course on ASD, ABA and EIBI
Considerable research has shown that the effectiveness of professionally administered EIBI increases with greater parental involvement in the programme (e.g., Strauss, Vicari, Valeri, D’Elia, Arima & Fava, 2012). To that end, we will soon begin offering a 20-‐hour course, broken into 2 hours per week for 10 weeks, and offered on a weekday evening. Our new Clinical Director – Dr Max Jones – has much experience teaching these topics and so will direct the course. It will involve didactic teaching, practical exercises, small-‐group discussions, video demonstrations of procedures, and a small amount of homework applying principles with your child(ren).
The over-‐arching goal we have set for the younger children we serve is to have them attend a mainstream school with no need for special attention from his/her teacher or a teacher-‐aide. At present, we work toward this goal by teaching various language and academic skills in one-‐on-‐one sessions. However, successfully preparing a child for school requires establishing additional skills (e.g., following common instructions issued to students, imitating peers, independently completing assigned tasks, responding in unison with others when invited, learning from group-‐instruction methods, etc.), and many of these skills can be taught only by working with multiple children simultaneously in a simulated classroom. The Accelerated Learning Centres for Autism in Heathridge and Beckenham serve as useful models of how this can be achieved, but they offer only a very limited number of places. We will soon be offering a similar facility but funded by parents and/or their FaHCSIA grant rather that the WA Department of Education.
A child’s first few weeks at school (or first few weeks in a new classroom at a familiar school) are often very difficult for the child, the parent, and his/her teacher. It is also critical for the future that all parties have positive experiences during these early weeks. The BASES Case Manager for that child is well placed to assist with optimizing the outcomes of these transitions if the child has been one of our clients for a reasonable period. She has a detailed understanding of the child’s skills, deficits, preferences, and barriers to learning. She might also have experience managing some challenging behaviour the child has shown or is still showing. This information will allow her to anticipate difficulties, plan and implement strategies to avoid problem behaviour, ensure that teachers don’t under-‐ or over-‐estimate a child’s skill level, and advise parents and teachers on unanticipated issues.
It is imperative for any child’s physical growth that he/she has a nutritious and well-‐balanced diet. Moreover, although normal growth does not assure normal behavioural development, compromised growth will unavoidably impair behavioural development. Unfortunately, it is not uncommon for children with a developmental disability to be very selective with what they eat and drink, and this increases the risk of their receiving a poor diet. BASES staff will assist parents of “picky eaters” by assessing the child’s diet, identifying foods that might be added to the child’s diet, and implementing (or overseeing) interventions that will systematically add those foods.
Few other behavioural problems in a child impact the well-‐being of that child’s parents and siblings more than sleep disturbances; it’s as if these disturbances are contagious. Sleep disturbances in a child have also been found to predict his/her rates of stereotypy (aka self-‐stimulatory behaviour), aggression and self-‐injury during waking hours, obesity, and impaired learning ability (Gruber et al., 2010; Koulouglioti, Cole, & Kitzman, 2008; Richman, 1981; Schreck, Mulick, & Smith, 2004; Wiggs & Stores, 1996). These disturbances include settling difficulties (& delayed sleep onset), frequent night waking, co-‐sleeping with parents, and early waking. BASES staff will closely supervise parents collecting relevant data and implementing interventions that are tailored to the individual child.
Social-‐Skills Training Programmes
Children with a developmental disability seldom learn to interact appropriately with their peers when simply given opportunities to do so (e.g., at regular day-‐care facilities); instead, they usually require explicit teaching of these skills. Indeed, the majority of tasks in our regular programmes aim to teach skills that will later culminate in normal social behaviour. However, numerous social skills can be taught only when our staff work with two or more children simultaneously, and this is why we offer targeted programmes. Our staff will apply a strictly behavioural approach to teaching social skills. The usual process is as follows: 1) Identification of skill deficits by observing a child in close proximity to other children and contriving situations when some social behaviour would normally occur; 2) Formulation of individualised teaching objectives; 3) Grouping together children with similar deficits, or strength-‐weakness complements; and 4) Teaching by way of facilitating, prompting and reinforcing specific interactions between children in engineered situations. Staff will collect data on specific target behaviours in baseline and then during intervention, and teaching will continue until pre-‐set mastery criteria have been reached. A child will usually be ready for such a programme once he/she has learned some amount of language and presents little, if any, challenging behaviour.
Teacher and/or Teacher-‐Aide Training
Although BASES staff will not train other professionals in all the procedures of EIBI, they will (on request from a parent or staff at an educational facility) train a client child’s teacher and/or teacher aide how to implement a specific teaching task, and/or a specific behaviour-‐management technique, that is being (or has been) used in that child’s BASES programme. This will involve our staff member describing the specific technique, modeling it for the teacher/aide, and then providing feedback to the teacher/aide when they practice the technique. Training will also be provided in how to collect data for the purpose of evaluating learning in the specific task or behaviour-‐management technique. Common reasons why parents request this service include the following: 1) The task was mastered in the child’s BASES programme but it is not being performed at school; 2) the teacher and/or aide want to add new target stimuli or responses to a task (e.g., adding “put on your hat” and “take off your hut” to an instruction-‐following task); and 3) some problem behaviour has been managed effectively in the BASES programme but occurs at high rates in school environments. BASES staff will strive to train as effectively and efficiently as possible but cannot assume responsibility for the effectiveness of the teaching provided by school staff.
A child’s ability to independently use a toilet is an important developmental milestone that opens up various new social environments (and so many new learning opportunities) for the child because it reduces the hand-‐on care that adults need to provide. Unfortunately, many parents of children with a developmental disability struggle to teach their child to use a toilet and face a high risk of the child learning problem behaviours. BASES offers two types of toilet-‐training: an intensive staff-‐led programme and a less-‐intensive caregiver-‐led programme. Both aim to teach the child to sense a full bladder and initiate a trip to the toilet rather than wait for an adult to announce that it is time to use a toilet as in the method known as toilet timing. In addition, both incorporate empirically validated procedures published in peer-‐reviewed scientific journals (e.g., Azrin & Foxx, 1971; Cicero & Pfadt, 2002; Foxx & Azrin, 1973; LeBlanc et al., 2005; Luiselli, 1997) to teach the child a complex chain of behaviours. This chain often includes seeking permission from various adults to use the toilet, undressing and re-‐dressing, using toilets in different locations, and hand washing/drying using a range of materials and equipment. In the intensive programme, a BASES trainer works continuously with the child, and exclusively on toilet training, for between 8 and 10 hours per day, for multiple consecutive days, and until a specific mastery criterion – negotiated with the parents -‐ has been met. In the caregiver-‐led programme, a BASES staff member provides intermittent supervision of the training being offered by parents, extended family members, nannies, etcetera. The intensive programme has proven more effective than the less-‐intensive one, but it is also more expensive.