1. No category

3/23/2015
Using Evidence Based Practices
for ASD within a
Multi-Tiered System of Support
Ann England, M.A., CCC-SLP-L
Assistant Director, Diagnostic Center, Northern CA, CDE, PENT Leader
CAPTAIN
Patty Schetter, M.A., BCBA
Coordinator, ASD Education Initiative CEDD at the MIND Institute
CAPTAIN
CAPTAIN Vision
• Develop a Training and Technical Assistance
Network for practitioners with a focus on EBPs for
individuals impacted by ASD inclusive of agencies
who will disseminate information at a local level
• Trainer of Trainers From:
– SELPAs
– Regional Centers
– Family Resource Centers; Family Empowerment Centers; Parent
Information Centers and Other Parent/Family Agencies
– UCEDD (Higher Education), CDE and DDS
Year Two 2014-2015
CAPTAIN Cadre Members =
378*
(Note: 89 are new nominees for 2014-2015!)
•SELPAs:
306
•Regional Centers:
44
•FRCs/FECs:
17
•UCEDDs
5
•Diagnostic Centers:
6
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Who are your CAPTAIN Cadre?
www.captain.ca.gov
EBP Definition
(NPDC)
NPDC definition of an EBP:
“Focused intervention practices that have
substantial evidence for effectiveness in
promoting positive outcomes for learners
with ASD”
NPDC Criteria for EBP
To be considered an EBP for individuals with ASD,
efficacy must be established through peer-reviewed
research in scientific journals using:
– At least two high quality experimental or quasi-experimental group design
articles conducted by at least two different researchers or research groups
OR
– At least five high quality single case design articles conducted by at least
three different researchers or research groups having a total of at least 20
participants across studies
OR
– A combination of at least one high quality experimental or quasiexperimental group design article and at least three high quality single case
design articles conducted by at least two different research groups
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March
2014
captain.ca.gov
http://autismpdc.fpg.unc.edu
CAPTAIN WEBSITE
WWW.CAPTAIN.CA.GOV
(Website hosted by Diagnostic Center, North)
Serves as a clearinghouse to
provide:
 Evidence-based practice resources
 Summit resources
 Links to important agencies
 Cadre contact information
So Many Changes!
How do they all work together?
EBPs
MTSS
CCSS
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What Are These Changes Telling Us?
•
•
•
•
•
What matters are Results
Can no longer afford to React
Focus on Prevention
Transparency with student outcome Data
Integrated services and Flexible use of
resources
• Data-Based decisions
• Use of Evidenced-Based Practice
We must shift thinking from..
• Procedural Concerns to Instructional Focus
• Reliance on Formulas and Checklists to Systematic
Problem-solving
• Territorial Silos to Blended Expertise
• Label-seeking to Instructional Solution-seeking
• “Testing” to Instructionally Relevant Assessment
• Categories to Whole Child as a General Education
Student, regardless of educational needs
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Multi-tiered System of Supports (MTSS):
A Comprehensive Framework for Implementing the CCSS
www.mydigitalchalkboard.org
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MTSS
• A term used to describe an evidence-based model of
schooling that uses data-based problem-solving to
integrate academic and behavioral instruction and
interventions
• The integrated instruction and intervention is delivered
to students in varying intensities (multiple tiers) based
on student needs
•
“Needs-driven” decision-making seeks to ensure that
resources reach the appropriate students at the
appropriate levels to accelerate the performance of
ALL students to achieve and/or exceed proficiency
Multi-tiered System of Supports (MTSS):
A Comprehensive Framework for Implementing the CCSS
www.mydigitalchalkboard.org
Multi-tiered System of Supports (MTSS):
A Comprehensive Framework for Implementing CCSS
www.mydigitalchalkboard.org
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EBPs and MTSS
• Many of the EBPs for ASD can and should be part
of ANY class structure (Tier 1)
– Good for ALL students and are Universal Design for
Learning (UDL)
– Can prevent the need for more intensive supports
• Many EBPs for ASD are ideal for small group and
early intervening for students who need more than
UDL (Tier 2)
• Some EBPs ideal for intervention and should be
part of BIP following the FBA (Tier 3)
Tertiary
Some Can Benefit
Often Done in Small
Group Context
A Few Can Benefit
Often Done 1:1
Supplementary
All Can Benefit
Typically Done in
Large Group
Context
Universal
What We Will Share
Today….
Tertiary
Supplementary
Reinforcement
Self Management
Visual Supports
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Tertiary
(A few
Can
Benefit)
What We Will Share
Today….
Peer-Mediated Instruction and Intervention
Social Skills Training
Social Narratives
Universal
(All Can Benefit)
What We
Will Share
Today….
FBA/BIP (Assessment and Plan
Structure)
Antecedent Based Interventions
(Prevention)
Behavior Reduction Strategies
(Extinction, Dif R+, RIR)
FERB Teaching Strategies (FCT, PECS,
DTT, PRT/NLP, Prompting/Fading)
***Therapeutic Interventions (CBI,
Coping/Self Mgmt.)
Supplementary
Universal
Tertiary
Supplementary
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What is Reinforcement (R+)
• Describes a relationship between a behavior
and it’s consequences
• If a behavior increases in probability when a
consequence is delivered, that consequence
is considered a REINFORCER
• If a behavior decreases in probability when a
consequence is delivered, that consequence
is considered a PUNISHER
Types of Consequences
Positive
(Give)
Reinforcement Increases
Behavior
Negative
(Take)
Increases
Behavior
Punishment
Decreases
Behavior
Decreases
Behavior
Types of Reinforcers
• Primary: Needs it for survival. Is
reinforcing at a “biological” level.
– Food, drink, physical contact, physical
movement/sensory stimulation, warmth
• Secondary: Acquires value often by being
paired with a primary.
– Objects, social interactions, activities
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The quickest way to change
behavior….in anyone.
Research indicates that you
can improve behavior
by 80% just by pointing out
what someone is doing
correctly!
5:1
Gets the
job done!!!
Rationale
What Does 5 Positives to 1 Negative Mean?
 Students should experience predominately
positive interactions (ratio of 5 positives for every
negative) on all locations of school.
 Positive Interactions=
• Behaviorally specific feedback as to what the student did
right (contingent)
• Smile, nod, wink, greeting, attention, hand shake, high five
(non-contingent)
 Negative Interactions=
• Non-specific behavioral corrections
• Ignoring student behavior (appropriate or inappropriate)
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How is Reinforcement Somewhat
Unique for Those With ASD?
Token Economy
• A system where the
learner is taught to
exchange a token or
tokens for other
items
• Tokens are earned
for appropriate skills
and behaviors
29
Visual Supports
• Any tool presented visually that supports
an individual as he or she moves through
the day
• Might include written words, objects within
the environment, arrangement of the
environment using physical or visual
boundaries, schedules, maps, labels,
organization systems, timelines, and
scripts
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Visual/Physical
Boundaries and Structure
• Visual/Physical Boundaries and Structure
are a specific type of visual support that
use furniture arrangement, labeling, and
color coding to make the use of a
particular space more obvious
Who Needs Physical/Visual Structure?
• Is there a safety concern?
• Does the learner have difficulty staying in one place?
• Does the learner know what s/he is to be working on in an
area?
• Does the learner ever leave a location because of
frustration?
• Does the learner ever have difficulty with entering others’
work space and or making use of others’ work or personal
materials?
If yes to any of these, consider using Physical/Visual
Structure…
Photo Examples of Visual/Physical
Structure
Structured Reading Area
Home Base
Structured Work Area
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Visual Cues
• Pictures, Icons or Written Cues that
provide additional information or perhaps
sequence that will assist the student in
being successful with the activity
• Work Systems
• Maps, Flow Charts, Scripts, Rubrics
Who Needs Visual Cues?
• Does the activity, event, or concept cause anxiety
or frustration for the learner?
• Is a great deal of adult support required for the
learner to be successful with the activity, event, or
concept?
• Is the activity, event, or concept difficult for the
learner to understand when only verbal information
is provided?
If yes to any of these questions, it is likely that
the learner would benefit from a visual support
EBP
Visual Supports
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Visual Schedules Should:
• Be visual and easily understood by the target
student
• Indicate what activities will occur and in what
sequence
• Be arranged left to right or top to bottom or
provided by the teacher one at a time (Teacher
as Schedule)
• Have a way to indicate that each activity is
finished
Whole Class Schedules
Whole Class Schedule
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Using a Whole Class Schedule
• Stationary in the classroom
• States specific order of activities
• Reflects activity of every adult and student
• Actively used by teacher throughout the day
to indicate completion and transition to new
activities
• A consistent signal should be used to indicate
change in activities or change to schedule
Individual Student Schedules
• Stationary: Student goes to schedule
• Portable: Student carries the schedule
• Teaches important self-management skill
• Allows student to see how activities apply
INDIVIDUALLY, not just the group
Portable
Object Schedule
Most concrete
type of visual
schedule
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Stationary
Object Schedule
Stationary: Single Photo
Stationary: Part-Day Photo
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Stationary Full-Day
Icon Schedule
Stationary
Activity Schedule for Arrival
Portable
Activity Schedule
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Activity Schedule for Art
Activity Schedule for
Computer Time
Portable Icon Word Schedules
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Stationary: Written Word
Portable:
Written Word
“Change” Arrows
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Icon Schedule with
Written Sequences Instructions
Self Management
Learners are:
• Taught to discriminate between appropriate and
inappropriate behaviors or performance
• Taught to accurately self monitor and record their own
behaviors or performance
• Taught to self reflect and self reward
• Implementation responsibilities shift from teachers,
families, and other practitioners to the learners
themselves
• Increases Independence and Performance
• Shown to improve Critical Thinking
– Remember this is a MAJOR goal in Common Core!
• Require less supervision and external controls
• Allows students to actively participate in intervention
– Minimizes power struggles
– Increases buy in
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Self‐Assessment = Analysis of the Strengths and Weaknesses of One’s Own Performance Self-Management Cue Card
Is In Jason’s Daily Planner
(Note: all the other students use a school issued Daily Planner!)
Self-Management Reminder
 “Incredible 5-Point
Scale”
 Reminds Jason to
monitor his vocal
volume in the
general education
classroom
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Jason’s Self-Management
Reminders
 It is okay to erase and
fix a mistake.
 Sit quietly.
 Use your finger to
read.
 Look at teacher.
Another Self-Management
Reminder for Jason
Raise your hand to ask for a break or comment on
changes in the routine.
“I Can Talk About Trains 5 Times Today!”
• Give the student 5 tickets/tokens that he turns
in each time he talks about his favorite topic
• Provide the student with a self-monitoring chart
that s/he can use to check off the 5 times s/he
can talk about their favorite topic
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Brady’s Self-Management
Visual Supports
“Quiet!”
Reminder
Raise Your Hand
Reminder
I need help
Tertiary
(A few
Can
Benefit)
Peer-Mediated Instruction and Intervention
Social Skills Training
Social Narratives
Universal
(All Can Benefit)
Peer-Mediated Instruction and Intervention
(PMII)
• Teaches typically developing
peers ways to interact with and
help learners with ASD
• PMII supports the following:
– Acquisition of new behaviors
– Increased communication
– Improved social interactions
– Expanded social opportunities
within natural environments
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When Can PMII Be Used?
• Opportunities occur naturally throughout the
day
• May be many more structured opportunities
for younger children
• Sometimes opportunities must be planned
or contrived
EBP
Social Narrative/Social Story
EBP: Social Narratives (SN)
• Social narratives are interventions that:
–
–
–
–
Describe social situations in some detail
Highlight relevant cues
Give examples of appropriate responding
Individualized according to student needs
• Helping learners
– Adjust to changes in routine
– Adapt their behaviors based on the social and physical cues
of a situation
– Learn specific social skills or behaviors.
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Types of Social Narratives (SN)
• Social Stories ™, Carol Grey
• Comic Strip Conversations™ , Carol Grey
• Power Cards, Eliza Gagnon
Social Story iPad App
Basic Social Story™ Sentences
1. Descriptive sentences: Describe without
assumption what is happening.
2. Perspective sentence: Describes the feelings or
internal perspective of others. Written in the first
person.
3. Directive: Directs the child what to do in the
situation. I will try…, I will work on...
4. Affirmative: Enhances the meaning, expresses
commonly shared value or opinion.
The Basic Social Story™ Ratio
≥2
descriptive,
perspective and/or
affirmative
sentences
----------------------------
0-1
directive + control
sentences
At school, we have recess.
Most of the time we go outside.
Sometimes we have recess
indoors because of rain.
Our teacher tells us when to stay
inside for recess.
I can pick one toy or game to play.
I can play the game by myself or
with a friend.
My teacher is happy when I play
quietly.
I will try to play quietly at inside
recess.
I may feel happy too.
Social Stories 10.0 Carol Gray 2004
Identify the types of sentences in this story
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Other Types of Social Narratives (SN):
Comic Strip Conversation™ is...
• Between two or more people
• Uses simple line drawings
• Illustrates an ongoing communication
• Supports comprehension
• Emphasizes what people may be thinking
Comic Strip Conversations, Carol Gray
Comic Strip Conversations™
• 8 symbols to
represent basic
conversation skills
• Color to represent the
emotional content of:
– statements
– thoughts
– questions
•
GREEN: good ideas, happy, friendly
•
RED: bad ideas, teasing, anger, unfriendly
•
BLUE: sad, uncomfortable
•
PURPLE: proud
•
YELLOW: frightened
•
BLACK: facts, things that we know
•
ORANGE: questions
•
COMBINATIONS OF COLORS: confused
Think Bubble/Talk Bubble
Autism Internet Modules
www.autisminternetmodules.org
Click on: Autism in the Classroom
Select: Social Narratives
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FBA/BIP (Assessment and Plan Structure)
Antecedent Based Interventions
(Prevention)
Behavior Reduction Strategies
(Extinction, Dif R+, RIR)
FERB Teaching Strategies (FCT, PECS,
DTT, PRT/NLP, Prompting/Fading, Video
Modeling)
***Therapeutic Interventions (CBT,
Coping/Self Mgmt.)
Supplementary
Universal
Functional Behavior Assessment
(FBA)
• A systematic set of strategies used to determine the
purpose of a behavior so that an effective intervention
plan can be developed
• Consists of describing the interfering behavior, identifying
antecedent and consequent events that control the
behavior, developing a hypothesis of the behavior, and
testing the hypothesis
• Data collection is an important part of the FBA process
Best Practice Resources for
FBA/BIP
www.pent.ca.gov
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Use the A-B-C’s of Behavior…
• Antecedent: conditions/situations that precede the
inappropriate behavior
• Behavior: action or observable act
• Consequence: conditions or outcomes that follow
the behavior
A
B
C
Let’s Play Behavior Detective:
Solve the Mystery of the Meltdowns
A
 B
Common Triggers
for Behavior in ASD
 C
A
• Tasks are not functional or
interesting to the student
• Student is not motivated to do the
work
81
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• Unexpected or too much sensory input
• Expectations are unclear or are different than
expected
• Expectations are above student ability level
• Attempts at communication go unnoticed
• Instructions are long or have many steps
• Instructions are above students language level
• Student is distracted and misses the instructions
82
Using ABI Procedures for
Positive Behavior Support Planning
1. Using highly preferred activities/items to increase interest level
2. Changing the schedule/routine
3. Implementing pre-activity interventions (e.g., providing a warning
about the next activity, providing information about schedule
changes, priming through social story or video model).
4. Offering choices
5. Altering the manner in which instruction is provided
6. Enriching the environment so that learners with ASD have access
to sensory stimuli that serve the same function as the interfering
behavior
What is/are the
triggers
For your student’s
behavior(s)?
What can we
add or
change?
A
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Determining the
Function of the Behavior
• The outcome of the behavior usually
indicates the function or purpose it serves
for the student
• Common functions are:
– Avoid, Reject, Protest or Escape
– Get or Obtain
Function
Avoid or Escape the following:
• Aversive sensory
input
• Internal state
(fight/flight)
• Activity/demand
• Peer
response/social
situation
• People
Function
Get the following:
• Sensory input
– Regulating input
• Activity
• Object or tangible
item
• Interaction
– For help
– For clarification
– For mediated
regulation
– Affirmation
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Functions
Pos Reinf
Neg Reinf
Reading the Clues
What do you think your student is
trying to obtain or avoid from his
behavior? Look closely at
consequences/outcomes
What is he/she communicating
through the behavior?
How does the nature and impact of
ASD play in???
Functional Equivalent Replacement Behavior
FERB
• Must serve the same function or purpose for the
student
• Must be as efficient as behavior it is replacing
• Can a known behavior be used as the
replacement? YES!
• Must be taught, practiced, and reinforced
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Some Common Replacement Skills =
Functional Communication
• Self Advocacy:
– Asking for a break
– Asking for HELP or clarification
– Identifying and requesting desired items
and activities
– Communicating needs for calming
activities and regulatory input
Functional Communication Training
FCT
• A systematic practice to replace inappropriate
behavior with more appropriate and effective
communication skills (Franzone, 2009)
• Individual is taught an alternative response that
results in the same class of reinforcement
identified as maintaining the problem behavior
(serves same function).
• Problem behavior is typically placed on
extinction while the replacement communication
skills is being taught.
Write a Functional Communication Goal
Given _________________________________
Instead of _________________________ (IB) to
Get/Escape/Avoid _____________________
(what is s/he trying to Get/Escape or Avoid?),
(student) will ______________________ (RB) to
communicate the need to (Get/Escape/Avoid)
_______________ (function), at __________ level
for __________________________ (criterion)
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Functional Communication Goal
Given planned instructions using
appropriate EBPs, Instead of hitting (IB) to
get a toy from a peer (Function), Tiffany
will independently say “My Turn” (RB) and
wait for the peer to give her the toy on 4:5
observed opportunities in the play area as
measured using the behavioral
observation form.
Some Common EBPs for Teaching
FERBs
• DTT
• Video Modeling
• PRT
• Prompting and
Prompt Fading
Evidence-Based
Behavior Reduction Strategies
• Extinction
• Response Interruption or Redirection
• Differential Reinforcement
NOTE – all are used in combination with
FBA, ABI and FCT!
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Extinction
• Strategy based on ABA used to reduce or
eliminate unwanted behavior
• Involves withdrawing or terminating the
positive reinforcer that maintains an
inappropriate behavior
• This withdrawal of reinforcement results in
the stopping or “extinction” of behavior
Extinction Burst
• The interfering behavior is likely to
increase in frequency and intensity before
it is extinguished as the learner seeks to
elicit the reinforcers previously provided
• Extinction is often used with differential
reinforcement to increase appropriate
behaviors while discouraging the use of
inappropriate behaviors.
DRO, DRA and DRI Schedules
• DRO – Differential Reinforcement of Other Behaviors
– Reinforcing any other behavior than the targeted behavior
during or at the end of an interval
• DRA – Differential Reinforcement of Alternative Behaviors
– Reinforcing the functionally equivalent alternative
behavior to the problematic behavior you are trying to
decrease
• DRI – Differential Reinforcement of Incompatible Behaviors
– Reinforcing a behavior that is incompatible with the target
behavior
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Steps for Using DR
1. Take baseline of
target behavior
2. Set an interval or
ratio that is likely to
result in success
3. Reward based on
pre-set criteria
• Example: Johnny
blurts out an average
of every 10 minutes in
class
• DRO schedule =
reward for absence of
blurting out every 8
minutes
Response Interruption/ Redirection
(RIR)
• Used to decrease interfering behaviors,
predominantly those that are repetitive,
stereotypical, and/or self-injurious
• These behaviors often are not maintained by
interactions or escape, but more likely they
are maintained by sensory reinforcement and
are often resistant to intervention attempts
• Ages = Preschool through High School
***Therapeutic Interventions:
For Internalizing Behaviors
Student may need to learn coping
and self management strategies
(with visual supports)
Student may benefit from CBI (with
visual supports)
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Teaching “Wait”
• Often a trigger for behavior problems
• They think wait = NO!
• Waiting needs to be taught very systematically in planned
teaching sessions
• Start with very small intervals for moderately preferred
items
• Work up to longer intervals with highly preferred items
• Use Visuals!
Using A Visual Wait Card or
Symbol
• Shows visually that they
need to wait and what
they are waiting for
• It makes a “wait”
concrete
• It gives them something
to do with their hands
• Use in combination with
a visual timer to give
meaning to the abstract
concept of time
Using A Timer
• The TimeTimer counts
down and graphically
shows you how much
time is left
• You don’t need to focus
on, or understand a
traditional clock face to
understand a TimeTimer
www.timetimer.com
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Teaching “Not Available”
Use Universal “NO” Symbol
Cognitive Behavioral Intervention (CBI)
for Individuals with ASD
www.captain.ca.gov
http://autismpdc.fpg.unc.edu
Ann’s CBI for ASD Info Template
Includes Fact Sheet Information
http://www.pent.ca.gov/
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3/23/2015
What’s the research?
See the Fact Sheet!
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), 11521160. 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
What is CBI for ASD?
“Cognitive behavioral intervention (CBI) is based on
the belief that behavior is mediated by cognitive
processes.
Learners are taught to:
o examine their own thoughts and emotions,
o recognize when negative thoughts and emotions
are escalating in intensity
o 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.
What is the 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”
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Cognitive Behavioral Interventions Are
Often Used In Conjunction With Other
EBPs such as…..
–
–
–
–
–
–
–
social narratives/social stories
social skills training
reinforcement
parent-implemented intervention
self-regulation
visual supports/schedules
special interests
Who are the intended implementers?
• 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
According to the NPDC March 2014
report evidence-based studies, this
intervention has been effective for:
- elementary school-age learners (611 years)
to
- high school-age learners (15-18
years) with ASD
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A Brief Description
• 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.
A Brief Description
Generally, CBT programs for youth with ASD
have been clinic based and have not
specifically and/or typically included:
o school component
o working collaboratively with others
involved in the individual’s treatment and
education (e.g., parents and school
personnel)
as a modified CBT/I might include the following EBPs…
EBPs:
Visual Support * Self Management
• 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 Support and Self-Management
Emotion Thermometer
Incredible 5 Point Scale
• Individual points to show how high their anxiety
is around a certain situation
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The Incredible 5 Point Scale
Kari Dunn Buron and Mitzi Curtis
• Behavioral support that breaks down
behaviors and social interactions into
clear, visual and tangible pieces so that
student can learn appropriate ways to
respond and interact in difficult
situations.
• A scale can be created using colors,
pictures, or a rating system of 1 to 5.
www.5pointscale.com
www.autisminternetmodules.org
EBP: Special Interests
[NAC: Established Treatment EBP, Antecedent Package]
• Incorporating the EBP of Special Interests in
the sessions to motivate individual 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.
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Including Social Skills Development
EBPs: Social Narratives/Social Stories/
Social Skills Training/Video Modeling
Gives 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 Peers
EBP: Peer Mediated Instruction and Intervention
Incorporating natural supports of peers
since the core deficit area is social
communication and interaction and
subsequent lack of friendships….
and this causes anxiety…
…makes sense to incorporate peers as part
of treatment program!
Decrease Verbal Demands
Use EBP: Visual Support/Schedules
For example:
1. Provide a written or graphic weekly
agenda showing when each session will
occur and….
2. Provide detailed structure of each
session allows the individual with ASD
to predict activities and breaks
throughout the session.
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Include EBP: Reinforcement
Including the EBP of
Reinforcement helps to
keep the individual with ASD
motivated and engaged.
Include EBP:
Parent-Implemented Intervention
Working with parents
collaboratively is a proven
EBP that results in better
outcomes!
When will the NPDC have
guidelines available?
• In Fall 2015 the NPDC will have the following
information developed and available:
– Brief: 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)
– Autism Internet Module on CBI for ASD
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Implementation Fidelity is Critical!
What does this mean?
“Implementing an intervention in the same
manner in which it was done in the evidencebased research”
What’s “out there” now?
• 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/PMC42311
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Wood’s Enhanced CBT
Wood, et.al. developed an
enhanced CBT program by
expanding the traditional
aspects of existing CBT
treatments for anxiety in
typically developing children.
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Wood’s Enhanced CBT
• includes a school consultation component
• incorporates concurrent skill building in
core ASD symptoms suspected to
contribute to anxiety symptomatology (e.g.,
social skills or preoccupation with restricted
interests)
Wood’s Enhanced CBT
• Provides in vivo parent training to address
both the complex needs of youth with ASD
and promote generalization of skills to
school and community settings
• Targets 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.
CAPTAIN Website
www.captain.ca.gov
You can easily access all these EBPs, NPDC tools
and Resources through the CAPTAIN website!
Ann England: [email protected]
Patty Schetter: [email protected]
CAPTAIN Email:
[email protected]
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