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Our FREE journal club met on Monday night. We discussed Fallagant & Pence 2017. You may access the article here or here.

The introduction to the paper consisted of a nice review of some of the work done to date in this area. The authors discussed why the Preschool Life Skills are so essential. 

The authors also discussed using a Response to Intervention (RTI) model for teaching these skills. You can learn more about RTI here or here. Essentially, in Tier 1, skills would be taught to a larger group or entire class. In Tier 2, small group instruction would be provided to the students who didn’t acquire the skills in Tier 1. Then in Tier 3, 1:1 instruction would occur for the students who didn’t learn the skills in Tier 1 or Tier 2.

The research was scientifically sound in terms of demonstrating experimental control. The authors used a multiple baseline across behaviors and then replicated that over 6 students. Like most research, a few flaws existed. For example, by using a multiple baseline across behaviors, experimenters lose a little bit of experimental control when the student demonstrates response generalization to an untrained behavior.

The participants in the study may have come from a convenience sample which was most likely a university affiliated preschool program. Each of the special education teachers in the school held master’s degrees in special education. The assistant teachers all held bachelor degrees.

The data in the study consisted of measuring the life skills being taught: responding to name, requesting/manding adult attention, requesting/manding adult assistance, delay tolerance, denial tolerance, and independent versus prompted responses. The authors indicated they also collected data on challenging behaviors but those data were not presented in the paper. The authors also reported high IOA data as well as high fidelity data (which is not always reported).

The authors provided a great description of the modifications provided to students who did not acquire the skills in Tier 1, 2, or 3. For these students, this included the use of an AAC device (i.e., proloquo).

One of our big discussion points occured around the author’s use of least to most prompting during Tier 1. We discussed if the results would have been different had they used most to least prompting and decided this should be a point of focus in a future study!

Another area of discussion for us revolved around the authors’ use of only 8 trials per session. This hardly seemed like enough practice for a preschooler, let alone a pre-k student with disabilities (the children had autism, Down syndrome, or DD).

We discussed, and the authors mentioned, the use of AAC and whether the students would have acquired the skills in Tier 1 had the AAC been available during that phase of instruction.

We also discussed the lack of preference assessments and whether the authors’ use of social reinforcement may have been potent enough to reinforce skill acquisition.

And finally, we discussed the limited generalization observed to peers. Some of the kids generalized skills to the adults who are obviously more skilled than the peers. But we also discussed the fact that with such few learning trials (N=8), that the kids may not have developed fluency in the skills thereby limiting their ability to readily generalize the skills. And of course, the authors mentioned that they did not program for generalization so this may have impacted generalization as well.

Bottom line, these seem to be some essential skills that we could easily teach in classrooms to increase the social skills of students.

I have identified a few extra resources. First because of all the tolerance discussion, we should look at some of the original tolerance studies. The following studies utilized FCT combined with Tolerance training.

  1. Bird, F., Dores, A. P, Moniz, D., Robinson, J. (1989). Reducing severe aggressive and self-injurious behaviors with functional communication training. American Journal on Mental Retardation, 94, 37-48.
  2. Brown, K. A., Wacker, D. P., Derby, K. M., Peck, S. M., Richman, D. M., Sasso, G. M., Knutson, C. L., & Harding, J. W. (2000). Evaluating the effects of functional communication training on brief functional analyses of aberrant behavior. Journal of Applied Behavior Analysis, 33, 53-71.
  3. Carr, E. G., & Carlson, J. I. (1993). Reduction of severe behavior problems in the community using a multicomponent treatment approach. Journal of Applied Behavior Analysis, 26, 157-172. 
  4. Day, M. H., Horner, R. H., O’Neil, R. E. (1994). Multiple functions of problem behaviors: Assessment and intervention. Journal of Applied Behavior Analysis, 27, 279-289.
  5. Fisher, W. W., Thompson, R. H., Hagopian, L. P., Bowman, L. G., & Krug, A. (2000).  Facilitating toleraance of delayed reinforcement during functional communication training. Behavior Modification, 24(1), 3-29.
  6. Hagopian, L. P., Wilson, D., & Wilder, D. (2001). Assessment and treatment of problem behavior maintained by escape from attention and access to tangibles. Journal of Applied Behavior Analysis, 34, 229-232.
  7. Harding, J., Wacker, D. P., Berg, W. K., Barretto, A., & Ringdahl, J. (2005).  Evaluation of relations between specific antecedent stimuli and self-injury during functional analysis conditions.  American Journal on Mental Retardation, 110(3), 205-215.
  8. McConnachie, G., & Carr, E. G. (1997). The effects of child behavior problems on the maintenance of intervention fidelity. Behavior Modification, 21, 123-158.
  9. Symons, F. J., Fox, N. D., & Thompson, T. (1998). Functional communication training and naltrexone treatment of self-injurious behavior: An experimental case report. Journal of Applied Research in Intellectual Disabilities, 11, 273-292.

And here are some extra resources on Preschool Life Skills

  1. Hanley et al 2007
  2. Luczynksi & Hanly (2013)
  3. Luczynski, Hanley, & Rodriguez (2014)
  4. Beaulieu, Hanley, & Roberson 2012
  5. Beaulieu, Hanley, & Roberson 2013
  6. Hanley, Fahmie, & Heal 2014 (in headstart)
  7. Francisco & Hanley (2012)
  8. Robison, Mann, & Ingvarsson (in press)
  9. Dogan et al 2017 (training parents)
  10. Halfdanardottier, Sveinbjornsdottir & Ingvarsson (in process but looking at life skills in older students)
  11. Ala’i-Rosales et al 2018
  12. Fahmie & Luczynski 2018 (review of studies)

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What is Autism Recovery?

If you know anything about me, you know that I am passionate about providing quality services for children with autism as early as possible to ensure that every child has the opportunity to progress as far as possible and to potentially recover from autism. I’ve written about this topic here, here, and here.

If you think I’ve already had a few too many to drink today, please check out this professional video from the University of Connecticut. The researcher in this video is a Licensed Clinical Psychologist. Her name is Deb Fein and she is really good at diagnosing children. She realized she needed to study this further when a child she had previously diagnosed returned to her several years later and did not meet the criteria for autism.

So she began researching this very topic. While recovery from autism describes what she sees, Dr. Fein has chosen to use the words Optimal Outcome to describe the children who ultimately obtained optimal outcome and no longer met the criteria for autism.

In our journal club meeting on Monday, we read and discussed the following article:

Moulton, E., Barton, M. Robins, D. L., Abrams, D. N., & Fein, D. (2016). Earlycharacteristics of children with ASD who demonstrate optimal progress between age two and four. Journal of Autism and Developmental Disorders, 46, 2160-2173. You may access a free copy of the article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860351/pdf/nihms761908.pdf

We were a little disappointed in this paper in that it didn’t address treatment and optimal outcome but rather predictors of optimal outcome. 190 children participated in the study with 19 of them achieving optimal outcome.

At the beginning of the study, researchers classified all children into 4 groups: PDD-NOS; Asperger’s; ASD; and ASD Low MA (mental age less than 12 months). On average, all children were diagnosed around 26 months of age. Re-assessment occurred around 48 months.

Before we go further, it is important to note that the children in this study were Caucasian and far above the poverty line. Also, the study didn’t control for early intervention so it’s hard to really say other than the obvious:

  1. Children who were originally diagnosed with PDD-NOS were more likely to lose their diagnosis at re-evaluation.
  2. No children with ASD-Low MA met the criteria for optimal progress (OP) at follow up assessment. 
  3. Children in the OP group showed less severe symptoms in the area of social skills, stereotypies, and sensory abnormalities
  4. Children in the OP group showed fewer DSM-V symptoms at initial diagnosis
  5. Children in the OP group showed stronger adaptive abilities
  6. Lesser symptoms of restricted interests and  repetitive behaviors predicted OP.

​It is super important that we not think of this as mis-diagnosis but rather, the earlier the diagnosis, the earlier the intervention, the more quantity of intervention, and thus, better outcomes that result in losing the autism diagnosis.

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If you are in the Fort Pierce area, stop by to see us! Scenes from this morning.

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We are super excited to attend the MassABA event on the new CPT Codes with Dr. Wayne Fisher. It should be a very informative event. And we will have until 1/1/19 to prepare.

ABAI and BACB and APBA have released the crosswalk. Does it make your head spin too?

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About 1.5 years ago, we expanded our services to the east coast of Florida (Melbourne area). While it took some time to build our brand recognition there, we are excited to say that our reputation for quality, home-based services, behavioral feeding therapy, behavioral toilet training, and effective school consultation is getting out. It is now time to hire quality, experienced, BCBAs and RBTs to meet the need of all the referrals we have received. 

If you think you have what it takes to join our team, please fax a cover letter and your updated resume to our office. We will keep your inquiry confidential.

If you live somewhere cold and want to escape to the beach, NOW IS THE TIME!

Our pay surpasses all others and we offer a cadre of benefits. Feel free to write or call for more information.

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We are pleased to announce the opening of our Florida WCity_Hallest Coast (AKA Cultural Coast) office!

We have no wait for ABA services! We accept most forms of insurance. We provide services in your home, in your child’s school, in your child’s daycare, and other community locations.

 

Please contact our office if you are interested in obtaining services.

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You know, I like to be positive. But today on this International Autism Day (AKA Light It Up Blue #LIUB), I’m not getting the feeling that we have the “awareness” we need. And it makes me ANGRY.LIUB

Yes, I’m happy that thanks to Autism Speaks we have 45+ states with insurance mandates!

 

But I’m boiling red mad because “awareness” is not enough! 😡

We need:

  1. Children identified EARLY. Pediatricians should lose their license when they send a family away and tell them to wait. REFER! A licensed clinician, with expertise in early identification, can determine if it’s autism.
  2. When the child is diagnosed, early intervention happens IMMEDIATELY without waiting lists or delays.
  3. Every child should be able to receive applied behavior analysis (ABA) therapy at the intensity recommended by the professional and based on assessment. This should be without regard to race, native language, socio-economic status, or type of insurance coverage. If you want to know more about ABA, read here.
  4. Every child with symptoms should be screened for appropriate medical treatment of any GI problems such as reflux, constipation, diarrhea, or food allergies/insensitivities.
  5. Every child should have access to quality behavioral feeding intervention if assessment indicates it is warranted.

Until these things happen, I will stay mad or “I mad” as one of my clients told me recently (when he found out he couldn’t have chocolate ice cream.) Go ahead, light it up blue but let’s turn awareness to ACTION!

 

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