Natural Environment Intervention for Young Children with Autism

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Natural Environment Intervention for Young
Children with Autism

• Debra Leach, Ed.D., BCBA
• Winthrop University
• leachd_at_winthrop.edu
• 803-323-4760

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Outline

• Overview of NEI
• NEI for Young Children with ASD
• Ten Steps for Implementing NEI with Children with
  ASD and Their Families

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Overview of Natural Environment Intervention (NEI)

• NEI systematically maximizes teaching and
  learning opportunities throughout the day using
  naturally occurring routines and activities
• Everyday routines and activities provide young
  children with many different kinds of learning
  opportunities (Raab Dunst, 2004 Tomlin, 2002
  Dunst, Hamby, Trivette, Raab, Bruder, 2000
  McWilliam, 1999)
• When children are actively engaged in everyday
  routines and activities, they have multiple
  opportunities to practice existing abilities and
  acquire new skills
• By receiving training and support from
  professionals, primary caregivers can provide
  effective intervention embedded within the
  context of daily routines and activities
• Table 1 provides a comparison between tradition
  service delivery models and NEI

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NEI for Young Children with ASD

• The most important aspect of NEI is increasing
  the childs active participation across a variety
  of activities
• NEI can overcome motivation and generalization
  difficulties that often arise when implementing
  therapeutic intervention programs such as DTT and
  other applications of ABA
• However, the ABA conceptual framework can and
• should be applied during NEI for children with
  ASD
• Kashinath, Woods, and Goldstein (2006) showed
  positive results of NEI with children with ASD
  using behavioral interventions, but more research
  is needed

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Implementing NEI with Children with ASD and Their
Families

• Provide an overview of NEI to caregivers
• Assess strengths and interests
• Assess present abilities
• Assess caregiver priorities
• Assess daily routines and activities
• Conduct observations
• Set goals
• Provide training and coaching
• Collect and analyze data
• Continuous data-based decision making

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Provide an Overview of NEI to Caregivers

• Early intervention for children with disabilities
  should focus on empowering caregivers to make
  them feel competent and confident in meeting the
  needs of their child (Dunst, Leet, Trivette,
  1988)
• Thus, the main goal for NEI is to provide support
  to caregivers so they can positively impact their
  childs development
• In 2001, a national research council made up of
  leading researchers in autism provided
  recommendations specifically related to providing
  intervention to children with autism in a book
  entitled, Educating Children with Autism
• Table 2 provides a list of some of the
  recommendations made in that publication
• Table 3 provides a rationale for NEI for children
  with ASD

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Assess Strengths and Interests

• Parents identify the childs favorite toys,
  preferences in activities, and unique skills
• Guide parents in identifying their childs
  strengths and interests as opposed to listing
  deficits
• Start off with an open statement such as, Tell
  me about your childs strengths and interests.
• If parents have difficulty, ask some probing
  questions to help guide parents
• See Figure 1 for a tool to assess a childs
  strengths and interests

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Assess Present Abilities

• The service provider conducts caregiver
  interviews to gather information on the childs
  present abilities
• Assess present abilities related to
  communication, social interaction, behavior, and
  cognition, and any other appropriate domain
• Figure 2 provides a tool for assessing a childs
  present abilities

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Assess Caregiver Priorities

• The childs present abilities should be
  considered as parents select priorities for
  intervention
• Figure 3 provides a tool that can be used for
  assessing caregiver priorities
• Parents may have several priorities in a
  particular domain, or they may have none at all
• Check boxes are provided in the assessment tool
  to help organize which priorities will be
  targeted at the present time
• Help caregivers in making reasonable commitments

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Assess Daily Routines and Activities

• Caregiver provides a list of home and community
  routines in which their child currently
  participates or may participate
• School staff members list school routines and
  activities
• Caregiver selects routines and activities for
  intervention (assist in making reasonable
  commitments)
• The goal is to select routines that have the
  potential to address caregiver priorities and
  occur often enough to provide multiple learning
  opportunities for the child
• Figure 4 can be used to record the childs
  routines and activities that occur across home,
  community, and school contexts

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Conduct Observations

• Begin by observing parent-child interactions
  during the routines and activities selected for
  intervention
• This provides an opportunity to see what supports
  the caregiver may already be using and assess the
  childs current participation in the routine or
  activity
• The service provider observes the childs
  responsiveness to attempts made by caregivers and
  gathers additional information about the childs
  present abilities across the communication,
  social interaction, cognition, and behavioral
  domains
• The service provider may also choose to interact
  directly with the child to further assess present
  abilities and test out the childs responses to
  various intervention strategies
• Figure 5 provides a tool that can be used to
  assess the childs current participation and
  possibilities for intervention for each routine
  or activity selected

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Set Goals

• Goals should address the childs strengths and
  interests, caregiver priorities, and be based on
  the childs present abilities reported by the
  parent and observed by the service provider
• All goals should be functional and
  developmentally appropriate and be observable,
  measurable, and contain criteria for mastery
• While goals are typically created based on a
  deficit, it is important to build upon the
  childs strengths and address the childs
  interests to increase participation and
  motivation
• Table 4 provides examples of goals across the
  four domains

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Provide Training and Coaching

• Parent training that uses a traditional sit and
  get method of disseminating information alone is
  not enough to empower caregivers to implement
  quality intervention
• Service providers must also use conferencing,
  modeling, and coaching
• Schedule visits during specific routines and
  activities for purposes of modeling intervention
  procedures and providing immediate coaching
• Table 5 provides a format for conducting
  video-stimulated recall conferences with
  caregivers

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Collect and Analyze Data

• For each goal selected, data collection
  procedures should be set forth
• It is important to choose data collection methods
  that caregivers are likely to implement (ex.
  levels of independence ratings, lists)
• Service providers should also collect some
  objective data in the form of probes on a
  periodic basis that can be used in the data-based
  decision making process along with the data
  collected by caregivers

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Continuous Data-Based Decision Making

• Service providers should continually be
  responding to the data being collected
• If progress is not being made, the following
  questions should be asked
• Are the teaching procedures being implemented
  correctly?
• Do the teaching procedures need to be altered or
  changed?
• Does the goal need to be changed?

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References

• Dunst, C.J., Hamby, D., Trivette, C.M., Raab, M.,
  Bruder, M.B. (2000). Everyday family and
  community life and childrens naturally occurring
  learning opportunities. Journal of Early
  Intervention, 23, 151-164.
• Dunst, C. J., Leet, H. E., Trivette, C. M.
  (1988). Family resources, personal well-being,
  and early intervention. Journal of Special
  Education, 22, 108-116.
• Kashinath, S., Woods, J., Goldstein, H. (2006).
  Enhancing generalized teaching strategy use in
  daily routines by parents of children with
  autism. Journal of Speech, Hearing, and Language
  Research, 49, 466-485.
• McWilliam, R. A. (1999). Controversial practices
  The need for reacculturation of early
  intervention fields. Topics in Early Childhood
  Special Education, 19(3), 189-193.
• National Research Council. (2001). Educating
  children with autism. Committee on Educational
  Interventions for Children with Autism. Division
  of Behavioral and Social Sciences and Education.
  Washington, DC National Academy Press.
• Raab, M, Dunst, C (2004). Early intervention
  practitioner approaches to natural environment
  interventions. Journal of Early Intervention,
  27(1), 15-26.
• Tomlin, A.M. (2002). Partnering with parents with
  personality disorders Effective strategies for
  early intervention providers. Infants and Young
  Children, 14(4), 68-75.