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Learning objectives: William
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Scientific basis of speech pathology
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To describe the theoretical principles of evidence-based treatment options suitable for young children with autism in particular
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Behavioural interventions
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Based on operation conditioning theories (Thorndike & Skinner)
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Conditioning and reinforcement brings about behavioural changes
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Antecedent Behaviour Consequence
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Antecedent
WHY: prompt or cue
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Behaviour
WHAT: Response to prompt
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Consequence
WHY: Reinforcement/result
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Led by adults
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Example interventions:
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ABA
Applied behaviour analysis
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PRT
Pivot Response Training
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DTT
Discrete Trial Teaching
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PECS
Picture Exchange Communication System (only good for
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EIBI
Early Intensive Behavioural Intervention
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Developmental interventions
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Based on principles of Zone of Proximal Development
Vygotsky
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What the child can independently do, and what they can do with support
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Skills being obtained in sequences
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Scaffolding child and removing scaffolding as skills acquired
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Five common features of developmental interventions
Ingersoll, 2010
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Following child’s lead or interest
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Setting up the environment to encourage initiations from the child
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Responding to all communication attempts as if they are purposeful
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Emphasising emotional expressions and affect sharing
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Adjusting language and social input to facilitate communicative growth
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Relation based intervention principles
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Learning is complex and takes place within the social context
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Relationships are necessary prerequisite for children learning to:
Relationships are not the product of these skills
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Communicate
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Regulate emotions
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Develop more complex cognitive and social skills
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Apply the developmental theory
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Features
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Takes place in child’s natural environment
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Build on the child’s interests
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Adult responds to any and all attempts on the part of the child to communicate
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Aim to promote relationship between child and carers to support the development of new skills
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Examples:
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Hanen
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It Takes Two to Talk
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To describe the early signs of autism of autism in young children
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Identify the features and diagnostic criteria during play and interaction
Whitehouse, A. J. O., Evans, K., Eapen, V., & Wray, J. (2018). A National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorder in Australia. Retrieved from https://www.autismcrc.com.au/knowledge-centre/resource/national-guideline
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All diagnosis and assessment guidelines require children to be assessed by a paediatrician or a child and adolescent psychiatrist, a psychologist and a speech pathologist and for a consensus diagnosis to have been reached in accordance with existing classification systems, which for children today will be the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) or the International Classification of Diseases and Related Health problems, 10th edition (ICD‐10). All recommend that consideration be given to detailed profiling of strengths and difficulties, beyond what may be needed for making a diagnosis, to enable tailoring of intervention and management strategies. Under DSM‐5, the severity of ASD symptoms and level of functioning should be specified along with the presence of co‐morbid conditions. Information about the child and family from the diagnosis and assessment process can then be used to guide the selection of autism‐specific approaches to intervention, that are in line with current best evidence and parents priorities, that are most likely to be successful.
Roberts, J. M. A., Williams, K., Smith, K., & Campbell, L. (2016). Autism spectrum disorder: Evidence-based/evidence-informed good practice for supports provided to preschool children, their families and carers. Report prepared for the National Disability Insurance Agency (NDIA). Retrieved from http://a4.org.au/sites/default/files/Autism Research Report final.pdf
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Identify the features of best practice
Note: these are not discrete, sequential steps
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Describe the range of features and needs in (pre-school-aged) children with ASD
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Communication, Swallowing within the ICF
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To describe the significance of parental perspectives regarding their child’s skills and needs, ands, and to integrate these into treatment planning.
It is critical for professionals to recognise that parents know their own children very well and that the developmental concerns of the parent or caregiver should be taken seriously, even if these are not shared by others. While levels of parental concern are not reliable indicators of specific diagnoses (e.g. ASD), there is evidence that parents have moderate to high levels of accuracy in identifying clinically relevant developmental concerns that warrant further assessment [17]. If older children or adults have queries about themselves, these should also be taken seriously.
Whitehouse, A. J. O., Evans, K., Eapen, V., & Wray, J. (2018). A National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorder in Australia. Retrieved from https://www.autismcrc.com.au/knowledge-centre/resource/national-guideline
Parent involvement potentially enhances learning opportunities and generalisation across home and community settings. The types of parent training that are supported by evidence ‘aim to increase the understanding of, and sensitivity and responsiveness to, the child’s communication and interaction’ (NICE guidelines, 2013). As with other support and intervention planning, parent values, preferences and capacity are key to decision making about the appropriateness and timing of including parent training and coaching. However, not all interventions based on parent training have an established or emerging evidence base. Those without an evidence base should not be implemented.
Roberts, J. M. A., Williams, K., Smith, K., & Campbell, L. (2016). Autism spectrum disorder: Evidence-based/evidence-informed good practice for supports provided to preschool children, their families and carers. Report prepared for the National Disability Insurance Agency (NDIA). Retrieved from http://a4.org.au/sites/default/files/Autism Research Report final.pdf
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To recognise the variability of individuals’ personal preferences in terms of their identity as a person with autism
Children with autism have highly variable profiles of characteristics and different needs. An individual plan is required to address these characteristics and ensure planned interventions are appropriate to the age and stage of the child. Characteristics can be strengths as well as needs, and strengths can be developed and utilised to compensate for difficulties. Families and environments also vary in their strengths (resources) and needs and this must be taken into account when planning. Engagement with families and other key people in a child’s life is essential when developing an intervention program. Assessment of individual child, family, and environment with a focus on adaptive functioning is essential. Plans should include goals for intervention, strategies, and methods for data collection and review, as further described below in the quality section.
Roberts, J. M., & Williams, K. (2016). Autism spectrum disorder diagnosis in Australia : are we meeting best practice standards. Retrieved from https://www.ndis.gov.au/media/863/download
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Neurodiversity
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Concept developed in late ’90’s
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ASD not a problem to be fixed
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Difference, not disability
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Expression of natural variation/diversity
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“High-functioning” ignores difficulties
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“Low-functioning” ignores ability
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Opposed to compliant/normalisation therapies
e.g., social skills training
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Preferences:
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61% of adults preferred “autistic”
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28% preferred “person with autism"
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All groups like the terms “one the autism spectrum” & “Asperger’s syndrome”
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Families didn’t like “Aspie”
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Strongly disliked: “low functioning,” “Kanner’s autism,” and “classic autism”
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Clinical skills
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To explain the the rationale for recommending specific intervention options or strategies to clients and other professionals
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To describe the purpose and scope of the National Disability Scheme
Lucy’s Learning Issue
www.ndis.gov.au
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The NDIS (National Disability Insurance Scheme) is a national scheme which provides funding to individuals with a disability. To be eligible, one must be between the ages of 7 and 65 years, be an Australian citizen and have a disability that requires some support. If a child under the age of 7 requires support, this is done through the “Early Childhood Early Intervention” approach, which is another branch of the NDIS.
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To apply for government support, a person must make an access request, in which they provide someone from the NDIA with information such as proof of identity.
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If the application is approved, the person requiring funding and/or their carer/s meet with someone who will help them put together a plan, such as the one in case 1 PBL one notes. They will also likely receive funding, which may be in a yearly lump sum, monthly or fortnightly payments, etc. to be spent on supports such as equipment, healthcare sessions, etc.
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Professional and interprofessional practice
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To describe the importance and responsibilities of the multidisciplinary team assessing an individual for autism
Whitehouse, A. J. O., Evans, K., Eapen, V., & Wray, J. (2018). A National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorder in Australia. Retrieved from https://www.autismcrc.com.au/knowledge-centre/resource/national-guideline
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Describe the features, benefits and limitations of a transdisciplinary team approach to early intervention
King, G., Strachan, D., Tucker, M., Duwyn, B., Desserud, S., & Shillington, M. (2009). The application of a transdisciplinary model for early intervention services. Infants & Young Children, 22(3), 211-223. Retrieved from https://journals.lww.com/iycjournal/Fulltext/2009/07000/The_Application_of_a_Transdisciplinary_Model_for.6.as
Features: 212—213
Limitations: 215—216
Benefits: p. 213
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Features
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Role release
Members give up or “release” intervention strategies from their disciplines
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Arena assessment
Professionals from multiple disciplines assess the child simultaneously
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Intensive, ongoing interaction among team members
Enables the pooling & exchange of information, knowledge, and skills
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Limitations
Professional, personal, and interpersonal challenges occur for service providers (Davies, 2007). These include the loss of professional identity, liability implications (including fear that negligent behavior may occur through lack of sufficient supervision) (Ryan-Vincek et al., 1995), and inadequate sharing of knowledge and roles due to the experience of threat (Polmanteer, 1998; Sheldon & Rush, 2001; Warner, 2001).
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Benefits
The presumed benefits of TA include (a) service efficiency, (b) cost-effectiveness of services, (c) less intrusion on the family, (d) less confusion to parents, (e) more coherent intervention plans and holistic service delivery, and (f) the facilitation of professional development that enhances therapists’ knowledge and skills (Foley, 1990; Polmanteer, 1998; Sheldon & Rush, 2001; Warner, 2001). These presumed benefits have not been extensively evaluated. Empirical research on the transdisciplinary model is very much needed (Foley, 1990).
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To identify the roles of speech pathologists and other professionals within an early intervention team
King, G., Strachan, D., Tucker, M., Duwyn, B., Desserud, S., & Shillington, M. (2009). The application of a transdisciplinary model for early intervention services. Infants & Young Children, 22(3), 211-223. Retrieved from https://journals.lww.com/iycjournal/Fulltext/2009/07000/The_Application_of_a_Transdisciplinary_Model_for.6.as
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Each family is assigned a primary therapist, who may be a nurse, occupational therapist, physiotherapist, psychometrist, or speech-language pathologist. Caseload and geography are typically the main factors used to decide which therapist will work with a new family, but therapists’ professional back- ground and expertise also play a role. The pri-mary therapist is responsible for developing a therapeutic relationship with the family; offering emotional support; building advocacy skills; and providing education on issues re- lated to health, development, treatment options, and community resources. As well, the primary therapist is the key contact person between the family and the rest of the team. It is her role to facilitate communication and cohesive teamwork. The primary therapist helps parents set goals with the team and coordinates and monitors the implementation of the plan of care.