Overview of Current Research

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• Overview of Current Research
• Keen, Rodger Braithwaite

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Whats Important?

• Treatment approach
• Teaching content
• Intensity of services
• Child/family characteristics
• Kasari, C. (2002). Assessing change in early
  intervention programs for children with autism.
  Journal of Autism and Developmental Disorders,
  32, 447-461.
• Luiselli, J., OMalley Cannon, B., Ellis, J.,
  Sisson, R. (2000). Home-based behavioral
  intervention for young children with
  autism/pervasive developmental disorder. Autism,
  4, 426-438.

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Elements of Best Practice

• Family-centred
• Natural contexts/ecologically valid
• Synchrony
• Effective Evaluation

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Family-centred

• Parent/professional relationship
• Parental priorities/goals
• Individualizing
• Family needs, strengths and resources
• Family routines
• Dunst, C.J., Trivette, C.M. and Deal, A.G. (Eds).
  (1994) Supporting and strengthening families.
  Volume 1 Strategies and practices. Cambridge,
  MA Brookline Books Inc.
• Knox, M., Parmenter, T.R., Atkinson, N.
  Yazbeck, M. (2000). Family control - The views of
  families who have a child with a disability.
  Journal of Applied Research in Intellectual
  Disability 13, 17-28

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Natural contexts

• Generalisation
• Meaningful change
• Intervention within context
• Techniques within routines
• Lucyshyn, J., Albin, R., Nixon, C. (1997).
  Embedding comprehensive behavioral support in
  family ecology An experimental, single-case
  analysis. Journal of Consulting and Clinical
  Psychology, 65, 241-251
• Vaughn, B., Dunlap, G., Fox, L., Clarke, S.,
  Bucy, M. (1997). Parent-professional partnership
  in behavioral support A case study of
  community-based intervention. Journal of the
  Association for Persons with Severe Handicaps,
  22, 186-197.

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Synchrony

• Parent sensitivity to childs focus of attention
• joint attention
• Higher synchrony leads to greater language
  competence
• Counter to therapies that require directing style
• Sigman, M. Ruskin, E. (1999). Continuity and
  change in the social competence of children with
  autism, Down syndrome, and developmental delays.
  Monographs of the Society for Research in Child
  Development, 64, Serial No. 256.
• Siller, M. Sigman, M. (2002). The behaviors of
  parents of children with autism predict the
  subsequent development of their childrens
  communication. Journal of Autism and
  Developmental Disorders, 32, 77-89.

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• Strengthening the family and community networks
  of young children with ASD by increasing
  knowledge of best-practice and promoting the
  childs social, communication and behaviour
  skills within natural contexts and routines.

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2-day workshop
home facilitation
community session
family links
community links
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Participants

• Baron-Cohen, S., Allen, J., Gillberg, C.
  (1992). Can autism be detected at 18 months? The
  needle, the haystack, and the CHAT. British
  Journal of Psychiatry, 161, 839-843.
• Robins, D. L., Fein, D., Barton, M. L., Green,
  J. A. (2001). The Modified Checklist for Autism
  in Toddlers An initial study investigating the
  early detection of autism and pervasive
  developmental disorders. Journal of Autism and
  Developmental Disorders, 31, 131-144.

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2 day workshop

• Day 1
• Social communication and play
• Understanding ASD
• Community supports

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2 day workshop

• Day 2
• Understanding your child
• Using a balanced approach at home

•  

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Interaction techniques

• play face-to-face
• follow the leader
• keep it short, go slow, show
• arrange
• silly mum/silly dad
• imitate
• turn-take
• offer choice

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Home facilitation

• Family is the expert
• Require support to apply new knowledge
• Techniques need to be integrated into everyday
  routines
• Learning occurs in natural, motivating contexts

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Home facilitation

• Supports family
• Identify priorities
• Set goals
• Implement techniques

Law, M., Baptiste, S., Carswell, A., McColl, M.,
Polatajko, H., Pollock, N. (1998). Canadian
Occupational Performance Measure Manual. (3rd
ed.). Ottawa CAOT Publications.
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Priority area Communication

• Importance - 10
• Performance 5
• Satisfaction 2
• Goal To exchange picture symbol to request up to
  5 items, with physical prompting, at home.

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Suggested techniques

• Follow the leader
• Play face-to-face
• Keep it short go slow show

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Suggested techniques

• Arrange
• Add communication supports (e.g., PECS)
• Bondy, A. S., Frost, L. (1994). The Picture
  Exchange Communication System (PECS). Focus on
  Autistic Behavior, 9, 1-19.

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Family links
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Community links
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Action Research Framework

• What is action research?
• Why is it suitable for this type of project?
• Philosophically aligned with SF values and
  community capacity building.

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What is Action Research?

• Action research is a process and method of
  learning and knowing through action and
  experience.
• It is a form of collective self-reflective
  enquiry undertaken by participants in social
  situations to improve their own practices.
• It is participative and collaborative.
• Kemmis, S McTaggart, R. (1988). The action
  research planner. Victoria Deakin Uni.

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Action research

• Action research has four stages plan, act,
  observe and reflect which leads to another cycle
  of planning, acting, observing, reflecting.
• Kemmis, S McTaggart, R. (1988). The action
  research planner. Victoria Deakin Uni.

Plan
Act
Reflect
Observe
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Action research

• Cycle A pilot workshop (3 families) and in home
  facilitation (1 family)
• Cycle B Weekend workshop and in home
  facilitation 6 (families), community workshop and
  trial research measures Cycle C Weekend
  workshop and in home facilitation with 8
  children, community workshop, pre-post-research
  design.
• Cycle D Same as Cycle C with 8
  children/families.

cycle a
cycle b
cycle d
cycle c
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Research Questions for Cycles B-DParent Outcomes

• Does SF workshop lead to an increase in parent
  knowledge about ASD?
• Does SF approach impact on parenting sense of
  competence?
• How family-centred do parents perceive the SF
  approach and project team to be?
• Does SF approach lead to improved parent
  interaction techniques?

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Research Questions Cycles B-DChild Outcomes

• Does the SF approach improve childs
  communication and symbolic behaviour?
• Does SF approach achieve the goals set by parents
  for their child?
• Does SF approach increase childs initiations and
  responses to parent initiations?

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Research Measures (Child)

• Communication and Symbolic Behaviour Scales
  (CSBS-DP)
• Modified Canadian Occupational Performance
  Measure (M-COPM)
• Videotaped observations of parent-child
  interactions during play.
• Law, M., Baptiste, S., Carswell, A., McColl, M.,
  Polatajko, H., Pollock, N. (1998). Canadian
  Occupational Performance Measure Manual (3rd
  Ed.). Ottawa CAOT Publications.
• Wetherby, A. M., Prizant, B. M. (2002).
  Communication and Symbolic Behavior Scales
  Developmental Profile. Baltimore Paul H.
  Brookes.

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Research Measures (Parent)

• Parent knowledge questionnaire
• Parenting Sense of Competence
• Measures of Processes of Care MPOC-56
• Videotaped observations of parents interaction
  techniques during play interactions.
• Johnston, C., Mash, E. J. (1989). A measure of
  parenting satisfaction and efficacy. Journal of
  Clinical Child Psychology, 18(2), 167-175.
• King, S., Rosenbaum, P., King, G. (1995). The
  Measure of Processes of Care A means to assess
  family centred behaviours of health care
  providers. Hamilton CANCHILD.

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When are measures taken in each cycle?

• Baseline (3 videotape observations 15 mins,
  CSBS-DP)
• Pre workshop (Parent competence, parent
  knowledge)
• Post workshop/Pre in home facilitation (3
  videotape observations 15 mins, parent knowledge,
  M-COPM for goal setting)
• Post in home facilitation (3 videotape
  observations, M-COPM, parent competence, MPOC,
  CSBS-DP)

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Child Outcomes

• M-COPM parents ratings of change in performance
  and satisfaction on child goals.
• CSBS-DP.

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Type of Goals Chosen in Cycle B using M-COPM
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Cycle B Results

• M-COPM Performance (Rated 1-10 for each goal)
• Pre-post test performance scores
• (t (5)4.05, plt.05)
• Change scores for performance (2) Clinically
  signif.
• M-COPM Satisfaction (Rated 1-10 for each goal)
• Pre-post test satisfaction scores
• (t (5)3.45, plt.05)
• Change scores for satisfaction (2) Clinically
  signif.

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Cycle C Results

• Types of Goals
• M-COPM Performance
• M-COPM Satisfaction
• Change Scores

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Types of Goals Chosen in Cycle C using M-COPM
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Parent Outcomes

• Parent Knowledge about ASD
• Parent Sense of Competence

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Evaluation of Program

• Family Centredness of Program measured using
  MPOC-56 (King et al. 1995).
• MPOC measures how family centred parents perceive
  the services they are provided to be.
• 56 item self-report questionnaire rated on 7
  point scale.
• 5 subscales Enabling Partnership, Providing
  General Information, Providing Specific
  Information, Coordinated Comprehensive Care,
  Respectful Supportive Care.

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Where to from here?
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Web site

• Information
• Networking and support for SF families

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Training manual

• Focus on workshop knowledge and skill
  development.
• Available late 2004 distributed to support
  groups and relevant organisations.

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Future research

• Comparison groups
• Extend to more families and children
• Develop for older children (preschool age)