Autism Spectrum Disorder Archive 2014
Ann England, M.A. CCC-SLP-L
Ann has 27 years of special education experience and has extensive training and certification in the assessment and teaching of students with an Autism Spectrum Disorder (e.g., TEACCH, PECS, ADOS, etc.) She participates on a multidisciplinary assessment team at the Diagnostic Center to determine if students have an Autism Spectrum Disorder. She also provides the all day training “Teaching Students with an Autism Spectrum Disorder” to school staff throughout northern California. Additionally, she provides onsite consultation and mentoring to school district administrators and teaching teams to assist in the development and implementation of evidence-based public school programs for students with an Autism Spectrum Disorder. Ann has served on several California Department of Education committees related to Autism Spectrum Disorders and most recently was invited to participate on the Task Force on Education and Professional Development of The Legislative Blue Ribbon Commission on Autism.
Click a topic below to expand the full question and answer.
National Autism Center Completes Comprehensive Review of ASD Interventions
National Autism Center Completes Comprehensive Review of ASD Interventions
Press Release April 2, 2015
Researchers at the National Autism Center at May Institute released the results of the largest systematic review to date of interventions for ASD on April 2, 2015.
Their findings identify 14 “Established Interventions” for children and adolescents that have the most research support, produce beneficial outcomes, and are known to be effective, and one Established Intervention for adults on the autism spectrum:
UNDER 22 YEARS OF AGE
|1. Behavioral Interventions||
|2. Cognitive Behavioral Intervention Package||
|3. Comprehensive Behavioral Treatment for Young Children||
|4. Language Training (Production)||
|6. Natural Teaching Strategies||
|7. Parent Training||
|8. Peer Training Package||
|9. Pivotal Response Training||
|13. Social Skills Package||
|14. Story-based Intervention||
“The National Standards Project is an ongoing effort designed to give educators, families, practitioners, and organizations the information and resources they need to make informed choices about effective interventions that will offer individuals with ASD the greatest hope for their futures,” said Hanna C. Rue, Ph.D., BCBA-D, Executive Director of the National Autism Center, May Institute’s Center for the Promotion of Evidence-based Practice.
The report released on April 2, 2015, Findings and Conclusions: National Standards Project, Phase 2, updated the Center’s first summary of the ASD intervention literature for children and youth under age 22. Phase 1 of the project was published in 2009. The combined the results of Phases 1 and 2 have produced the largest compilation of studies ever reviewed.
Nationally recognized experts in autism, as well as other leaders representing diverse fields of study, were involved in both phases of the National Standards Project and guided the process of evaluation. Dozens of article reviewers analyzed 1,165 studies related to interventions for ASD throughout both phases of the project. The interventions were subsequently categorized as 1) Established, and producing beneficial outcomes known to be effective; 2) Emerging, with some evidence of effectiveness, but still requiring more research, and 3) Unestablished, and having little or no evidence of effectiveness.
The new report is available for free download on:
Evidence-based Practices for Adolescents with ASD, New Research Information, EBPs
I work with older students and wondered if there is anything available so I can learn more about working with them.
I’ve been asked this question several times so first I want to encourage you to check out the Ask A Specialist- ASD archives and read my answer to the following questions:
- How do you interact with an adult with ASD?
- What can I do to prepare students for the workforce 12 years down the road?
And, while you’re at it you can also search our Ask A Specialist archives by typing in the search box: “older students with ASD” and you’ll get several results that other Ask A Specialist authors have written about on this topic.
Now, to answer your question!
The NPDC on ASD has just published the newest report about EBPs for students with ASD. If you go to the CAPTAIN website: www.captain.ca.gov and click on CAPTAIN Summit Resources you’ll find a two-page matrix of the 27 evidence-based practices (EBPs) that shows for what ages the research has demonstrated efficacy.
Next, check out The Center on Secondary Education for Students with Autism Spectrum Disorder (CSESA) website at:
Examples of resources on this website include:
- Understanding Autism: A Guide for Secondary School Teachers
- Supporting Independence in Adolescents on the Autism Spectrum
- Promoting Social Competence and Peer Relationships for Adolescents With Autism Spectrum Disorders
- Autism at-a-Glance: Supporting Communication in High School
- Introduction to the Special Issue: Autism, Adolescence, and High School
While you’re at it, check out this resource from the Organization For Autism Research (OAR):
They have produced The Understanding Autism: Professional Development Curriculum DVD which is a comprehensive professional development tool designed to provide middle and high school teachers with the knowledge and evidence-based strategies needed to support their students with ASD in the general education classroom.
And, finally, take a look at the following article:
Addressing the Needs of Adolescents With Autism Spectrum Disorder:Considerations and Complexities for High School Interventions, by Kucharczyk, S., et.al.
Exceptional Children, published on January 20, 2015:
From the abstract: "The outcomes of students with autism spectrum disorder (ASD) are driving the field to address how secondary education might be optimally designed and delivered. We conducted 28 focus groups across four states to explore the contexts, considerations, and complexities associated with delivering and combining evidence-based interventions to meet the needs of adolescents with ASD from the vantage point of 152 practitioners, parents, and other key stakeholders. Participants emphasized the inadequacy of prevailing intervention approaches in secondary schools, underscored the importance of attending to feasibility and alignment with the diverse needs of students with ASD, and stressed the need for broader awareness and training efforts surrounding autism. We offer recommendations for designing comprehensive interventions and incorporating stakeholder feedback into such undertakings."
Good luck! For sure working with individuals with an ASD requires ongoing professional development as the research reveals evidence-based practices!
Cognitive Behavioral Intervention (CBI) for Individuals with ASD
I know you’re a Leader of CAPTAIN so I thought I’d ask you this question! In the new EBPs released by the NPDC in March 2014, it lists Cognitive Behavioral Intervention as an effective focused intervention for individuals with ASD. But I noticed that there isn’t an NPDC Brief or an Autism Internet Module on this practice yet. Do you know anything about this EBP that you can share?
Thanks from one of your CAPTAIN Cadre!
Ahoy CAPTAIN Cadre!
Excellent question and I really appreciate your ambitiousness! So, here’s what I know so far!
DEFINITION OF COGNITIVE BEHAVIORAL INTERVENTION (CBI) FOR INDIVIDUALS WITH ASD:
The following is the definition from: National Professional Development Center on Autism Spectrum Disorders March 2014 Report, Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder (http://autismpdc.fpg.unc.edu/):
“Cognitive Behavioral Intervention (CBI) is based on the belief that behavior is mediated by cognitive processes. Learners are taught to examine their own thoughts and emotions, recognize when negative thoughts and emotions are escalating in intensity, and then use strategies to change their thinking and behavior. These interventions tend to be used with learners who display problem behavior related to specific emotions or feelings, such as anger or anxiety. Cognitive behavioral interventions are often used in conjunction with other evidence-based practices including social narratives, reinforcement, and parent-implemented intervention.”
PURPOSE OF CBI FOR ASD:
CBI can be used effectively to address social, communication, behavior, cognitive, adaptive, and mental health outcomes for individuals with ASD.
INTENDED IMPLEMENTERS OF CBI FOR ASD:
Professionals who are trained and experienced in CBT/I and ASD.
CBI for ASD is sometimes implemented as a collaborative effort in clinic sessions, school and/or home in individual and/or group contexts (e.g., mental health professional, educators, speech-language pathologists, school psychologists, parents, etc.)
APPLICABLE POPULATIONS * GRADE LEVELS OF CBI FOR ASD:
According to the NPDC March 2014 report evidence-based studies, this intervention has been effective for elementary school-age learners (6-11 years) to high school-age learners (15-18 years) with ASD.
RELIABLE RESOURCES TO LEARN MORE ABOUT CBI FOR ASD:
National Professional Development Center on ASD March 2014 Report, Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder:
- Cognitive Behavioral Intervention (CBI) Fact Sheet Brock, M. E. (2013), Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders. http://autismpdc.fpg.unc.edu/
Research Studies Providing Evidence (CBI meets evidence-based criteria with 3 group design and 1 single case design studies:
- Drahota, A., Wood, J. J., Sze, K. M., & Van Dyke, M. (2011). Effects of cognitive behavioral therapy on daily living skills in children with high-functioning autism and concurrent anxiety disorders. Journal of Autism and Developmental Disorders, 41(3), 257-265. doi: 10.1007/s10803-010-1037-4
- Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S., Singh, A. N., Singh, J., & Singh, A. D. (2011). A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 1153-1158. doi:10.1016/j.rasd.2010.12.012
- Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152-1160. doi: 10.1111/j.1469-7610.2005.00411.x
- Sofronoff, K., Attwood, T., Hinton, S., & Levin, I. (2007). A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. Journal of Autism and Developmental Disorders, 37(7), 1203-1214. doi: 10.1007/s10803-006-0262-3
HOW DID COGNITIVE BEHAVIORAL INTERVENTION (CBI) BECOME AN EVIDENCE-BASED PRACTICE FOR ASD?
- The National Professional Development Center (NPDC) on Autism Spectrum Disorders (ASD) published the report, Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder, in March 2014 and is available online at: http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/2014-EBP-Report.pdf
- The purpose of this current NPDC review is to identify focused intervention practices that have evidence of effectiveness in promoting positive outcomes for learners with ASD. Articles included in this review were published in peer-reviewed, English language journals between 1990 and 2011 and tested the efficacy of focused intervention practices.
- Twenty seven EBPs were identified and Cognitive Behavioral Intervention (CBI) is designated as an EBP that service providers and teachers may select when designing an individualized education or intervention program.
- CBI meets evidence-based criteria included 3 group design and 1 single case design studies.
- According to the evidence-based studies, CBI has been effective for elementary school-age learners (6-11 years) to high school-age learners (15-18 years) with ASD and can be used effectively to address social, communication, behavior, cognitive, adaptive, and mental health outcomes.
- Cognitive Behavioral Interventions are often used in conjunction with other Evidence-Based Practices including:
- social narratives/social stories
- social skills training
- parent-implemented intervention
- visual supports/schedules
- special interests
DOES THE NPDC HAVE INFORMATION AND/OR GUIDELINES ABOUT CBI FOR ASD AVAILABLE OR ON THE WAY?
- CBI Fact Sheet
- Appendix 2 of the NPDC March 2014 report contains a CBI Fact Sheet that includes the definition of CBI, the type of outcomes it has generated, the age range of participants, and citations for the specific articles that provide the evidence for the efficacy of the practice.
- CBI Brief
- Although the NPDC has EBP “briefs” for the first round of 24 identified EBPs, CBI is a brand new EBP as of March 2014. The NPDC anticipates that the CBI Brief (i.e., a file that contains key documents including an overview of the practice, evidence-base for the practice, step-by-step implementation strategies, and implementation checklists for fidelity) will be available in the Fall of 2015 and posted on the NPDC website http://autismpdc.fpg.unc.edu/.
- Autism Internet Module
- The NPDC anticipates that an Autism Internet Module (online learning module) will be available in the Fall of 2015 at www.autisminternetmodules.
- Peer Reviewed Journal Articles
- The specific articles that demonstrated the evidence for the efficacy of the EBP of CBI are listed above and in the CBI Fact Sheet.
IN GENERAL CAN YOU DESCRIBE CBI FOR ASD?
Traditional CBT/I tends to require strong linguistic and abstract thinking abilities and these can be a challenge for individuals with ASD.
Researchers have been developing modifications to make it more effective with individuals with an ASD by making it better suited to the learning styles of individuals with ASD, for example, by making it more repetitive, visual, and concrete.
Also, generally, CBT programs for youth with ASD have been clinic based and have not specifically and/or typically included a school component as well as working collaboratively with others involved in the individual’s treatment and education (e.g., parents and school personnel) as a modified CBT/I might.
HERE ARE JUST A FEW EXAMPLES OF WHAT THE CURRENT RESEARCH IS SHOWING AS TO HOW TO INCLUDE EBPS FOR ASD IN AN INDIVIDUALIZED MODIFIED CBI:
- Instead of just asking the individual with ASD to verbally rate their anxiety on a scale of 1 to 10, the interventionist might use the EBPs of Visual Supports and Self-Regulation (i.e. a graphic representation of a thermometer showing anxiety from low to high would be presented to which the individual would point to show how high their anxiety is around a certain situation; another tool would be the Incredible 5 Point Scale.)
- Incorporating the EBP of Special Interests in the sessions to motivate children to engage in treatment activities. For example, using favorite cartoon characters to model coping skills, or interspersing conversations about their special interest throughout treatment sessions to promote motivation and engagement.
- Including social skills development and implementing the EBPs of Social Narratives/Social Stories and Social Skills Training would give the individual increased skills to be socially successful because the core social deficits of individual’s with ASD contribute to the experience of anxiety, which then serves to intensify the social problems.
- Incorporating peer supports such as the EBP of Peer Mediated Instruction and Intervention.
- Decrease making verbal demands and also incorporating the use of the EBP of Visual Supports/Schedules. For example, a written or graphic weekly agenda showing when each session will occur and the detailed structure of each session allows the individual with ASD to predict activities and breaks throughout the session.
- Including the EBP of Reinforcement to keep the individual with ASD motivated and engaged.
- Working with parents collaboratively because Parent-implemented Intervention is an EBP for individuals with an ASD.
WHAT INFORMATION IS AVAILABLE NOW FOR MODIFIED CBI?
- For now, it’s advised that you read the aforementioned peer reviewed articles to learn about the research that demonstrated efficacy for CBI and ASD.
- However, within those peer reviewed articles are references to modified CBT/I programs. One example is a modified version of CBT by Clinical Psychologist Jeffrey Wood, Ph.D. of the Center for Autism research and Treatment at UCLA. This modified CBT/program is described in the 2009 article, Cognitive Behavioral Therapy For Anxiety In Children With Autism Spectrum Disorders: A Randomized, Controlled Trial, Journal of Child Psychology and Psychiatry, 50, 224–234, Wood, J. J., et.al. available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231198
- Wood, et.al. has developed an enhanced CBT program by expanding the traditional aspects of existing CBT treatments for anxiety in typically developing children by:
- including a school consultation component
- incorporating concurrent skill building in core ASD symptoms suspected to contribute to anxiety symptomatology (e.g., social skills or preoccupation with restricted interests)
- providing in vivo parent training to address both the complex needs of youth with ASD and promote generalization of skills to school and community settings
- targeting aspects of ASD that contribute to school adjustment—for example, providing skills and support for building friendships that can lead to inclusion in activities and games, and a more satisfying daily routine.
Evidence-based Practices for ASD, New Research Information, EBPs
I’ve been using the new evidence-based practices that were published by the National Professional Development Center for ASD in March 2014. Do you know when the National Autism Center is going to update their National Standards Project report that was published in 2009?
First, I’m so glad that you are using the newest 27 evidence-based practices (EBP) published by the National Professional Development Center on Autism Spectrum Disorder! You can also check out the EBP Matrix we developed and posted on the CAPTAIN website at www.captain.ca.gov that provides you with an easy to read two-page overview!
Your question about the National Autism Center’s (NAC) National Standards Project (NSP) on Autism Spectrum Disorder (ASD) couldn’t have come at a better time! As you may know, the first NSP on ASD report was published in 2009, and the findings were based on 775 published research studies in peer reviewed scientific journals (1957-2007) about interventions for individuals below 22 years of age.
The NAC has just announced on their website www.nationalautismcenter.org that on February 11, 2015 they will release a review and analysis of treatments for ASD based on research conducted in the field from 2007 to February 2012.
The NAC has updated the original findings, added information, and evaluated whether any of the “Emerging” interventions in NSP1 had moved into the “Established” or “Unestablished” categories in NSP2. In addition, the NAC has also announced that this report will include studies evaluating treatments for adults (22+), which have never been systematically evaluated before now.
This NSP project report is designed to give educators, parents, practitioners, and organizations the information and resources they need to make informed choices about effective treatments that will offer children and adults on the spectrum the greatest hope for their future.
Like you, I will be waiting to see what new evidence-based/research-based information is available!
ASD, Autism, Holidays
It’s the holidays and it’s such a hard time for my son and our family. Do you have any suggestions for us?
With much appreciation,
Yes, December is certainly a month with a lot of special events and holidays. Consequently, families of and individuals with an Autism Spectrum Disorder (ASD) often find this a challenging time of year because schedules and routines are disrupted. The following are a few strategies that may help to make it a more enjoyable time for everyone.
Include your events on the monthly calendar and individual schedule. If the event results in a change in the usual schedule and/or routine, use whatever symbol you have previously selected to designate this change (e.g., highlighter, change tab, etc.) Use your judgment as to how much in advance you want to alert the individual about the change. Some individuals require and do well with a lot of advanced notice while others may become too anxious with too much lead time. And, it’s probably best to maintain schedules and routines as much as possible.
Create a social story about the new events, rituals and/or ceremonies. Make sure to personalize the story about your specific activity, read the social story to him/her regularly in preparation, and especially, right before the event. If possible, use the evidence-based practice of Video Modeling to help him/her understand the event, ritual and/or ceremony experience.
To learn more about Social Stories or Video Modeling, visit the Autism Internet Modules at http://www.autisminternetmodules.org
If the individual has difficulty with change, try pacing your activities. For example, if your holiday incorporates decorations, perhaps you might try decorating a little at a time and schedule these times on the calendar/schedule. Consider writing a social story about decorating. Then add in a visual support (mini-task schedule) that reflects each step of making the decoration that s/he can check off after each step is completed. You can also develop a photo album or video that shows the home or community before and after the holiday season. This would serve as a type of “First our house looks like this and then it looks like this!”
SELF REGULATION STRATEGY:
Even with all of your preparation efforts, the individual with an ASD may become overwhelmed. These are times when you will need to remind him/her to use those self-regulation strategies such as the Incredible 5 Point Scale (see autisminternetmodules.org). If the individual isn’t at the level at which they are able to self-regulate, provide the support s/he needs to recognize their emotional state and what s/he can do. For younger individuals, you can use a photo self-regulation card that shows several emotional states (frustrated, angry) and the corresponding activities to self-soothe (e.g., listen to music, read a book, play on the computer, go to their room or a quieter area, etc.). Older individuals can have a written list of emotional states with the corresponding activities; they may need a reminder to use this if they are upset. If you are visiting friends or family, make sure you have brought along these activities and reviewed these self-regulation strategies before you arrive. Ask your host if there’s a quiet place available just in case.
If your activity involves a ritual or ceremony make sure to practice this ahead of time. You can support role playing with the evidence-based practices of social stories, visual supports (e.g., photographs), video modeling, reading a book, etc. The important thing is to reduce the novelty so your child/individual with ASD knows what to expect.
MAKE OTHERS AWARE:
When possible, communicate with family and friends. Maybe just a quick phone call before you arrive to explain that although you have prepared your child/individual with ASD for the visit, you may be bringing some special food, need to have a quiet space available to which to retreat if things become overwhelming, you may need to leave a bit earlier, or that your child/individual prefers not to be hugged, etc. Having discussed all of this ahead of time will allow you the time you need to be attentive to your child/individual at the event and not have to also explain your actions to others in the midst of all the activity.
INDIVIDUAL SHOULD CARRY IDENTIFICATION:
Individuals with ASD should always carry identification even if you’re just going to a neighbor’s or relative’s home because wandering off is so very common. You can order medical bracelets/ necklaces to wear and/or tags to attach to shoelaces, for example. Additionally, if the individual can carry it in his or her pocket, make an ID card with a current photo, date and phone numbers. Be sure to put any information that is important to know, such as allergies, medications, and any special information (i.e. non-verbal). In this new age of technology there are also various GPS tracking devices that can be worn around the wrist or ankle.
TRAVELING TIPS FOR INDIVIDUALS WITH ASD AND THEIR FAMILIES
Autism Speaks has some resources on their website dedicated to traveling with individuals with ASD. It has a lot of great ideas for how to be prepared and proactive for travel for both the family and airline personnel, free at:
Remember that the most important thing is to enjoy your family and friends and the meaning of your activities. Preparation is the key as is remembering to keep it simple!
Have a wonderful holiday season,
ASD, Autism, Spanish Speaking
I work with a lot of students with ASD who are Hispanic. I would like to help their families understand the diagnosis of ASD and about the interventions but I need some informational materials in Spanish. Do you know of any that are helpful?
What a great question and quite timely, too!
CAPTAIN (California Autism Professional Training and Information Network) has some helpful information in Spanish on our website at www.captain.ca.gov:
1. We just developed a nice chart about the 27 Evidence Based Practices (EBPs) that were released in March 2014 by the National Professional Development Center – ASD.
- Click on CAPTAIN Summit Resources and you can find the EBP Chart in in Spanish (and English).
2. Another link on the CAPTAIN website called ADEPT (Autism Distance Education Parent Training) will take you to parent informational training resources in Spanish (and English) about the following two topics:
- Strategies For Teaching Functional Skills
- Positive Behavior Strategies For Your Child With Autism
3. The CAPTAIN website has a link called: Autism Fact Sheet which is available in Spanish (as well as English and many other languages.)
Autism Speaks is a helpful resource that has information in Spanish at www.autismspeaks.org:
- Autism Speaks has an Autism Response Team who are specially trained to connect families with information, resources and opportunities and are available to answer calls and emails from 9am to 1pm local time in Spanish at (888) 772-9050 (and in English (888) 288-4762).
- Autism Speaks also has many informational materials in that are in Spanish called, “Tool Kits” that are available free on their website for a variety of topic areas ranging from diagnosis to treatment.
CDC (Centers for Disease Control and Prevention) also has a lot of materials in Spanish as part of their “Learn the Signs. Act Early” campaign at: http://www.cdc.gov/ncbddd/actearly/freematerials.html
Good luck and thank you so much for asking this very important question!
Updated California Eligibility Criteria for Autism
Someone told me that the California eligibility criteria for special education for Autism, has changed. Is this true?
Great question! Yes, the special education regulations found in the California Code of Regulations, title 5, sections 3001-3088, have been updated and became effective July 1, 2014.
And, yes, one of the key changes is the updated eligibility criteria in Section 3030 Autism.
The new regulation:
- deletes the term "autistic-like behaviors"
- adds the term "characteristics often associated with autism" (5CCR 3030(b) (1).)
The new list of "characteristics often associated with autism" replaces the former seven "autistic-like behaviors" but is highly similar:
- engagement in repetitive activities and stereotyped movements;
- resistance to environmental change or change in daily routines; and
- unusual responses to sensory experiences.
Why did the California Department of Education (CDE) make this change? Well, CDE explained that aligning California's criteria with federal requirements:
- removes "confusion among educators when state and federal eligibility requirements for determining whether a student has autism are inconsistent"
- helps "ensure that students with autism are appropriately identified, and receive the appropriate services for their needs."
I’ve included the new eligibility criteria for Autism below for you to review.
Thanks for the great question!
California Department of Education: http://www.cde.ca.gov/sp/se/lr/ccramendments062514.asp
California Office of Administrative Law: http://ccr.oal.ca.gov
Fagen Friedman Fulfrost LLP http://www.f3law.com/newsflash.php?nf=424