EARLY INTERVENTION PROGRAM FOR CHILDREN WITH AUTISM

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EARLY INTERVENTION PROGRAM FOR CHILDREN WITH
AUTISM

• Jaruwan Kittisopit, M.D.

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The Walden Program

• Research based Early Childhood Program
• Established 1985
• Emory Autism Center, Department of Psychiatry and
  Behavioral Science, Emory Medical School,
  Atlanta, Georgia, USA
• Systematic replication of the Toddler Center
  Model for typical childrens day care by OBrien,
  Porterfield, Herbert-Jackson, Risley 1979.

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The Walden Program Hallmarks

• Naturalistic ABA approach
• Incidental Teaching concepts

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Behavioral approach Applied Behavior Analysis,
ABA

• Traditional ABA
• Discrete-trial procedure ( Lovaas 1981)
• Comprehensive or Naturalistic ABA
• Incidental Teaching (McGee et.al.,1983,1999)
• Pivotal Response Training ( Koegel,1999)
• Peer-mediated strategies ( Strain and
  Kohler,1998)

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Program Mean Age at entry (range) in months Hours per weeks Usual Setting a Concepts Orientation b Primary Teaching Procedure
Childrens unit 40 (13-57) 27.5 School (s) t-B Discrete trial
Denver community Based approach 46 (24-60) 20 School(I),home, community D Playschool curriculum
Developmental Intervention model 36 (22-48) 10-25 Home, clinic D Floor time therapy
Douglass 47 (32-74) 30-40 School (S, I), home t-B Discrete trial, naturalistic
LEAP 43 (30 -64) 25 School (I),home c-B Peer-mediated intervention naturalistic
Pivotal Response Training 36 (24-47) varies School(I),home, community, clinic c-B Pivotal response training
TEACCH 36 (24 up) 25 School (s), clinic M Structured teaching
UCLA Young Autism Project 32 (30-46) 20-40 Home t-B Discrete trial
Walden 30 (18-36) 36 School(I), home c-B Incidental teaching
a (S) Segregated classroom (I) Inclusive
classroom b(t-B) Traditional Behavioral approach
(c-B) Comprehensive Behavioral approach (M)
Mixed approach Lord C, McGee JP, eds. National
Research Council (2001). Educating Children with
Autism. Committee on Educational Intervention for
Children with Autism. Division of Behavioral and
Social Sciences and Education. Washington, D.C.
National Academy Press, 2001.
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The Incidental Teaching

• Definition A systematic protocol of instruction
  that is delivered in the context of natural
  stimulus conditions of everyday environments
• Origin Teaching complex language in the
  disadvantaged, typical children
• ABA concept
• Peer Incidental Teaching Inclusion setting
• Hart Risley 1968,1974, 1975,1982
• McGee GG, Almeida MC, Sulzer-Azaroof B, Feldman
  RS. Promoting reciprocal interactions via peer
  incidental teaching. J Appl Behav Anal 1992
  25117-26.

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The Incidental Teaching Procedure

• Environmental is arranged
• Child initiates
• Teacher prompts Use least to most prompts
• Child responds
• Teacher immediately provide
• Access to the desired item/activity (
  Contingent Reinforcer)
• Praise and Confirm the correct response
• Child enjoys the desired item Keep interaction
  enjoyable
• Teacher keeps looking for child initiation, or
  Create the next Teachable Moment

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Incidental teaching Discrete Trial

• Child friendly session
• Natural setting
• Child initiated
• Correlation of the response and the reinforcer
• ( internal reinforcer)
• Slower to master the skill
• Overcome generalization and initiation problem

• Highly structured session
• Distract free setting
• Teacher directed
• No correlation btw the response and the
  reinforcer
• (external reinforcer)
• Faster to master the skill
• Less generalization and initiation

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The Walden Program Hallmarks

• Naturalistic ABA approach
• Incidental Teaching concepts
• Positive Behavioral Interventions and Supports
• Promote Social and Language development
• Verbal-only-program
• Early inclusion
• Active family collaboration
• Family training 2 hr/ 2 wk for Home
  based-program 10 hr/wk

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The Walden Program Hallmarks

• Environmental arrangement Cubby, Toy shelves,
  Hobby boxes, Name tags, Seats, Gates, Physical
  zones
• Toy rotation system
• Teaching theme
• Reinforcer assessment system

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The Walden Program Hallmarks

• Overlapping activities schedules
• Designated teaching zones Goal Individual
  goal
• Free play Play skill, Vocabulary
• Snack Communication
• Outdoor Peer interaction
• Table Peer interaction Academic readiness

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The Walden Program Structure

• Combined Center and Home-based Program
• ( 25-30 hr plus 10 hr/ wk)
• Classrooms Toddler, Preschool, Pre-Kindergarten
• 5 d/ wk, Full day , 830-1530 , all year
• Teacher Child 13 14 15
• CWA TYP 12 (total 12-15)
• Staff

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Individual Educational Plan, IEP
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Sequences of Social Goals across the Walden
treatment continuum

• Social Responsiveness
• Play Skills
• Tolerance of Peer Proximity
• Focus on Peers
• Synchrony of Play
• Response to Peer interaction
• Conversation with peers
• Peer Negotiation
• Attraction of Peer bids
• Initiation of Interactions
• Sustained Interactions
• Community Participation

• Toddler
• Preschool
• Pre-K

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Sequences of Communication Goals across the
Walden treatment continuum

• Initial Verbalizations
• Verbal Requests
• Vocabulary
• Pragmatics of Conversation
• Amount of talking
• Complexity of Language
• Correct of Syntax
• Elaborated Vocabulary
• Vocabulary and Corrections

• Toddler
• Preschool
• Pre-K

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Sequences of Behavioral Goals across the Walden
treatment continuum

• Engagement
• Independent Daily Living
• Decreased Behavior Problems
• Conventional School Behaviors
• Academic Readiness

• Toddler
• Preschool
• Pre-K

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The Walden Program Structure

• Ongoing Objective Assessment
• Entry-Exit VDO
• Daily probes
• 11 records
• Biweekly review of individual case
• Program Evaluation
• Teachers
• Classrooms

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Outcomes of The Walden Graduates McGee GG,
Morrier MJ, Daly T. Walden Early Childhood
Program. In Handleman JS, Harris SL. eds.
Preschool Education Programs for Children with
Autism 2nd ed. Austin Pro-ed, 2001157-90.
N 34 (10 _at_ Neuro Dx) Entry Exit
Age, yr 3.6 ( 2.0-5.6) 6.0 ( 4.11- 7.4)
Peer Interaction 3 11 (1 -27 ) ( 17/34 in TYP range 6-39)
Verbal cases 0 80 NV- 4/34 ? ¾ NeuroDx
of Verbalization 6 16
Regular School 26/33
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