EvidenceBased Interventions for Asperger Syndrome

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Evidence-Based Interventions for Asperger Syndrome

• Lisa Barrett Mann, M.S.Ed.
• Overland Park, KS
• [phone]
• www.AspergersInterventions.com

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ASD Intervention Research

• Most research into interventions for autism
  spectrum disorders has been done with children
  with classic autism
• IQ of 70 or less
• Significant challenges in verbal communication
• Best evidence of effectiveness has been shown
  with ABA

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Question

• Asperger syndrome is considered an autism
  spectrum disorder
• Does that mean we should be using the same
  intervention techniques?

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Common Characteristics of Asperger Syndrome

• Average to gifted IQ
• Significantly impaired social skills
• Good formal language skills
• Difficulty carrying on back-and-forth
  conversations

• Stilted, formal way of talking
• All-encompassing special interests
• Eccentric play behaviors
• Unusual sensory sensitivities

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Masters Project

• A systematic review of all published scientific
  research on interventions for individuals with
  Asperger syndrome
• Employing a group experimental or
  quasi-experimental design or a single-subject
  design with at least three changes of condition

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Purpose of Study

• To determine which interventions have the most
  evidence of effectiveness for students with
  Asperger Syndrome

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Systematic Review Procedure
300 peer-reviewed articles initially identified
in database search
Titles/abstracts assessed for possible fit
63 studies chosen for prelim evaluation
28 fit criteria for review
Experimental or quasi-experimental design
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Data Analysis (Each study)

• Target behavior
• Subject(s)
• Study design
• Setting
• Intensity of intervention
• Additional relevant information
• Measurement method
• Findings

• Generalization probes
• Maintenance probes
• Limitations
• Treatment integrity
• Interobserver agreement
• Replicability
• Evaluation
• Implications for future research

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Categorization Analysis

• Initial analyses grouped by methodology, then
  overall category
• Some interventions fit multiple categories
• Overall evidence supporting each intervention
  evaluated
• Including quality of supporting studies

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Results

• 28 scientific studies on interventions for
  individuals w/Asperger syndrome
• 25 demonstrated evidence of effectiveness
• 20 utilized cognitive or cognitive-behavioral
  technique

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Cognitive Behavior Therapy

• 4 AS studies (total N 163)
• Demonstrated effectiveness with
• Anxiety
• Social Skills

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What is Cognitive Behavior Therapy?

• Intervention that focuses on the important role a
  students thought processes have on their
  feelings and resultant behaviors.

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4 Steps of CBT

• Assessment
• Affective education
• Cognitive restructuring, (correcting distorted or
  dysfunctional beliefs) and
• Schedule of activities to practice new cognitive
  skills in real-life situations

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Video Modeling/Self-Modeling

• 4 AS studies
• Demonstrated effectiveness with
• Social Skills
• Written Language

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What is Video Modeling Self-Modeling?

• Student views a video representation of a desired
  behavior and then attempts to imitate that
  behavior.
• Typically used in combination with other
  intervention elements
• Prompting
• Rehearsal

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Social Skills Training

• 7 AS studies
• Demonstrated effectiveness with
• Social skills
• Self-esteem
• Adaptability
• Behavioral problems
• Great variability in techniques results make
  it difficult to generalize conclusions

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What is Social Skills Training?

• Broad term used to describe interventions that
  are designed to teach students the skills
  necessary to
• navigate their social environments,
• assimilate into their peer groups, and
• interact with both familiar and unfamiliar
  people.

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Parent Management Training

• 6 studies with AS
• Evidence of effectiveness with
• Social skills
• Self-esteem
• Adaptability
• Behavioral problems
• 4 of these studies included PMT as one part of a
  multi-modal intervention

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What is Parent Management Training?

• PMT programs help parents understand some of the
  underlying reasons for their childrens behavior
  problems and train them how to better manage
  these behaviors at home and at school.
• Traditional PMT programs emphasize behavioral
  techniques, but 5 of the 6 AS studies emphasized
  cognitive-behavioral techniques

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3 Steps of PMT

• Explain characteristics of Asperger Syndrome and
  how they can affect behavior
• Model a technique for dealing with a behavioral
  issue
• Coach parents on implementing the technique

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Social Stories

• 6 AS studies
• Only 4 of acceptable quality to be considered
  evidence of effectiveness
• Misleadingly simple technique

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What are Social Stories?

• Short, individualized narratives, written to help
  a student understand an activity and its
  associated behavioral expectations.
• Should give the child positive examples of what
  to do in a given situation, rather than what not
  to do.

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Social Stories

• Evidence of effectiveness with
• Cooperative behavior
• Social interaction
• Problem behaviors
• Appropriate play
• Table manners
• Social skills

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Errorless Learning

• 2 studies w/Asperger syndrome
• Evidence of effectiveness with
• Compliance with parental demands
• Bicycle riding

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What is Errorless Learning?

• Teaching technique that involves presenting the
  command/instruction in a manner that maximizes
  the likelihood of a correct response
• The opposite of trial-and-error learning
• Shaping technique usually associated with
  ABA/discrete trial training

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Emotion Recognition (Mind Reading) Software

• 3 studies w/AS showed
• Students learn to better recognize facial
  expressions and tone of voice in program
• Doesnt generalize to real world situations (so
  far)

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Promising initial research

• 1 single-subject study each
• FBA elements of TEACCH was effective in
  improving a childs morning routine
• Assistive technology (a PDA) was effective in
  improving a childs recording of homework
  assignments

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No evidence of effectiveness

• Animal-assisted therapy
• 1 published study claimed statistical
  significance, but analysis of article found
  numerous problems in both study design and
  conclusions

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Overall Recommendation

• Cognitive-behavioral interventions have best
  overall evidence of effectiveness for individuals
  w/AS
• Generalization of skills must be addressed
• Include visual strategies
• Tailor to take AS characteristics into
  consideration

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Awards for Evidence-based Interventions for
Asperger Syndrome

• University of Kansas, School of Education,
  Outstanding Masters Thesis Award, 2007-2008
• University of Kansas, 2007-2008 Graduate Research
  Competition, 2nd Place
• Invited Presentation, Capitol Graduate Research
  Summit, Kansas State House, Feb. 2008

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Lisa Barrett Mann, M.S.Ed.

• Summer social skills
• groups now forming!
• www.AspergersInterventions.com
• 913-544-2883 ? lisabmann_at_gmail.com