Author Archive for JohnL

US ED resource on restraint and seclusion

The US Department of Education (ED) published Restraint and Seclusion: Resource Document today. After the extensive discussions the last few years about abuses of management procedures (see , especially those used with children and youths with Emotional and Behavioral Disorders, ED contracted with an agency to create this document that provides guidelines for the appropriate use of restraints and seclusion.

The foundation of any discussion about the use of restraint and seclusion is that every effort should be made to structure environments and provide supports so that restraint and seclusion are unnecessary. As many reports have documented, the use of restraint and seclusion can, in some cases, have very serious consequences, including, most tragically, death. There is no evidence that using restraint or seclusion is effective in reducing the occurrence of the problem behaviors that frequently precipitate the use of such techniques.

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Toilet training Webinar

My colleague, Annie McLaughlin, who is the Outreach Supervisor for the Virginia Institute of Autism (VIA), will be hosting a Webinar on toilet training 15 May 2012. Annie—who completed teacher education work at the University of Virginia’s Curry School and Ph.D. studies at the University of Washington and has doctoral-level certification from the Behavior Analyst Certification Board—told me that the focus won’t be on rapid toilet training a la Azrin and Foxx, but more on a data-based, schedule training that increases the likelihood that the individual will learn that the toilet is the stimulus for voiding.

Dr. Annie McLaughlin will lead an online, interactive parenting workshop on toilet training individuals of all ages with Autism Spectrum Disorders and other related disabilities. Learn how to recognize if your child is ready for toilet training, design a toilet training plan for your child, and learn practical tips for overcoming common problems. Cost $65. Limit space. After registering, participants will receive instructions on how to view the online lecture and live chat.

Registration for the Webinar is available on the Web as is a contact for additional information. Here’s a link to an antique post about toilet training

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De novo mutations and Autism redux

In articles published online by Nature, Professors Stephan Sanders and colleagues and Brian J. O’Roak his colleagues reported additional evidence that rare mutations contribute to risk for Autism. By analyzing genetic material from parents who had children with Autism, the researchers were able to focus on differences in specific genes, what changed from one generation to the next. One team, working in the research lab of Professor Matthew State at Yale University, found strikingly unusual matches for a specific mutation at SCN2A. The other team, under the direction of Professor Evan Eichler at the University of Washington, found several candidates (including SCN1A) and a strong (4 to 1) relationship for older fathers.
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First Step supported by WWC

The US What Works Clearinghouse (WWC) reviewed research about First Step to Success, an early intervention program for K-3 children who are at risk of developing antisocial behavior, and identified it as having positive effects on ratings of student behavior and potentially positive effects on ratings of emotions, social skills, and academic outcomes. The WWC based its review on two studies by the developers of First Step, Hill Walker and colleagues—alert readers of EBD Blog will recognize one of them (see “First Step Takes Off“).

What Works—which some folks have taken to calling “what doesn’t work,” because they say it rarely identifies practices that are effective—gave the research undergirding First Step a strong review:

The WWC review of interventions for Children Classified as Having an Emotional Disturbance addresses student outcomes in seven domains: external behavior, emotional/internal behavior, social outcomes, reading achievement/ literacy, math achievement, school attendance, and other academic performance. The two studies that contribute to the effectiveness rating in this report cover five domains: external behavior, emotional/internal behavior, social outcomes, reading achievement/literacy, and other academic performance. The findings below present the authors’ estimates and WWC-calculated estimates of the size and statistical significance of the effects of First Step to Success on children classified as having an emotional disturbance….

Two studies reported findings in the external behavior domain.

Walker et al. (1998) found, and the WWC confirmed, four positive and statistically significant differences between treatment and comparison groups on academic engaged time, the Child Behavior Checklist–Teacher Report Forms (CBCL-TRF) Aggression Subscale, the Early Screening Project (ESP) Adaptive Behavior Subscale, and the ESP Maladaptive Behavior Subscale.

Walker et al. (2009) found, and the WWC confirmed, four positive and statistically significant differences between treatment and comparison groups on academic engaged time, the Social Skills Rating System (SSRS) Problem Behavior Subscale for Parents, the SSRS Problem Behavior Subscale for Teachers, and the SSBD Maladaptive Behavior Index. Although the overall design of the Walker et al. (2009) study meets evidence standards, there was high attrition on one outcome: the SSRS Problem Behavior Subscale for Parents outcome. The authors established equivalence for the analytic sample for this outcome; thus, this finding meets evidence standards with reservations.

The mean effect size from the four outcomes in Walker et al. (1998) and the mean effect size from the four out- comes in Walker et al. (2009) were both statistically significant. Thus, for the external behavior domain, two studies with strong designs showed statistically significant positive effects. This results in an intervention rating of positive effects for the domain, with a small extent of evidence.

Walker, H. M., Kavanagh, K., Stiller, B., Golly, A., Severson, H., & Feil, E. (1998). First Step to Success. An early intervention approach for preventing school antisocial behavior. Journal of Emotional and Behavioral Disorders, 6, 66–80.

Walker, H. M., Seeley, J. R., Small, J., Severson, H. H, Graham, B. A., Feil, E. G., . . . Forness, S. R. (2009). A randomized controlled trial of the First Step to Success early intervention: Demonstration of program efficacy outcomes in a diverse, urban school district. Journal of Emotional and Behavioral Disorders, 17, 197–212.

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CEC pre-conf session on MH and PBIS

The Council for Exceptional Children will host an “Institute on School-based Mental Health and Positive Behavioral Interventions and Supports” prior to its annual convention in Denver in April 2012. Readers of EBD Blog understand the importance of MH and its connections with schools for many students. This session, chaired by Krista Kutash and George Sugai, promises to help educators make and strengthen appropriate connections. Learn more about building positive bridges between mental health and positive school environments.

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CCBD Webinar on seclusion and restraint coming soon

The Council for Children with Behavior Disorders of the Council for Exceptional Children will present a Webinar 8 March 2012 entitled “Physical Restraint and Seclusion in Schools: Issues, Policies and Practices.” This is a terrifically important issue for practitioners and administrators.

Federal legislation is pending that, if passed, would regulate the use of physical restraint and seclusion procedures for students in school settings. This webinar will discuss the legislative, policy, and practice issues that have arisen because of the deaths and injuries of students due to these procedures. The webinar will provide an overview of the content that will be covered in more detail during the strand on restraint and seclusion at the CEC Convention & Expo in April 2012.

The session, which runs from 4:00PM – 5:00PM ET, requires registration for a fee ($114; save lots if you’re a CEC member!). Visit the CEC page devoted to the CCBD Webinar on seclusion and restraint to learn more. Entire teams can register for the price of one and later download the slides for review.

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Infant eye gaze predicts ASD

When they look at models who are looking toward them versus away from them, the variation in brain activity in infants who later develop Autism Spectrum Disorders (ASD) is different than that of their peers who do not develop ASD, according to Mayada Elsabbagh and colleagues in a study published in Current Biology. Infants who do not later develop ASD apparently are already tuning into whether human-like models are looking at them, but those who develop ASDs are doing so to a lesser degree.

Professor Elsabbagh studied 104 children, about half of whom were classified as at risk for ASD because they had an older sibling who had an ASD. They initially tested them at six months of age and, later, broke them into four groups: (a) A control group, (b) children who were at-risk but had not developed ASD by age three, (c) children who were at-risk and developed ASD symptoms by age three, and (d) children who were at-risk and developed ASD early.

detail from Elsbbagh et al. graph

At 6 to 10 months of age, the brain activity of the infants in the control group and the at-risk-without-ASD group already showed sensitivity to whether a model was looking toward or away from the children. However, the brain activity of infants who later developed ASD showed less sensitivity. The accompanying graph illustrates the results on one of their measures. (Note that the measure shown in the figure here is not the one of greatest interest to the researchers.)

Even though it is difficult to find overt behavioral markers of ASD during the first year of life, these findings support the idea that there are brain function measures that can discriminate between groups of infants at risk for ASD. It’s important to note that these data are at the group level. They can’t be taken at the individual level, so the data are not ready for diagnostic purposes.

The researchers included a group from the collaborative network supporting research with infants at risk for autism in the UK, the British Autism Study of Infant Siblings (BASIS). This group and comparable groups elsewhere are wonderful partners for research and deserve great credit for the collaboration in efforts such as this.

Here is the abstract from the article:

Autism spectrum disorders (henceforth autism) are diagnosed in around 1% of the population [1]. Familial liability confers risk for a broad spectrum of difficulties including the broader autism phenotype (BAP) [ [2] and [3]]. There are currently no reliable predictors of autism in infancy, but characteristic behaviors emerge during the second year, enabling diagnosis after this age [ [4] and [5]]. Because indicators of brain functioning may be sensitive predictors, and atypical eye contact is characteristic of the syndrome [ [6], [7], [8] and [9]] and the BAP [ [10] and [11]], we examined whether neural sensitivity to eye gaze during infancy is associated with later autism outcomes [ [12] and [13]]. We undertook a prospective longitudinal study of infants with and without familial risk for autism. At 6–10 months, we recorded infants’ event-related potentials (ERPs) in response to viewing faces with eye gaze directed toward versus away from the infant [14]. Longitudinal analyses showed that characteristics of ERP components evoked in response to dynamic eye gaze shifts during infancy were associated with autism diagnosed at 36 months. ERP responses to eye gaze may help characterize developmental processes that lead to later emerging autism. Findings also elucidate the mechanisms driving the development of the social brain in infancy.

Elsabbagh, M., Mercure1, E., Hudry, K., Chandler, S., Pasco, G., Charman, T.,…the BASIS Team. (2012). Infant neural sensitivity to dynamic eye gaze is associated with later emerging autism. Current Biology. Advance online publication. doi:10.1016/j.cub.2011.12.056

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Virginia mental health needs

In a statement entitled “A proposal that would assist troubled youths in Virginia” the Washington Post editorial board lent its support to efforts to fund mental health services for children and youth. The editorial, published 11 January 2012, recounted a history of rueful cost cutting and encouraging advocacy in my commonwealth.

A YEAR AGO, Virginia Gov. Robert F. McDonnell (R) proposed slashing millions of dollars from the state’s already badly fragmented and underfunded programs for at-risk children and teenagers. The cuts targeted funding for specially trained foster families and other services for children, including some who posed a danger of violence to themselves and others. The cuts were rejected, and funding restored, thanks to a bipartisan group of lawmakers responding to an outcry from advocacy groups and local governments, which would have borne the brunt of the governor’s proposal. In the end, the debate turned a useful spotlight on a critical hole in the state’s social services safety net.

The Post editorial team explained that the current budget does not contain such cost-cutting measures, but that difficulties for mental health services persist because of other problems (e.g., local government fiscal shortages). In the end, the need for services is great and, as the editorial shows, the need for serious discussion about funding of them is clear. Read the full editorial on the Post’s Web site.

If you’re in Virginia and you can make it to Richmond, join Voices for Virginia’s Campaign for Children’s Mental Health for “Advocacy Day at the General Assembly” Thursday 26 January 2012. If you live somewhere else, scout about for ways you can help support mental health services in your local or regional government.

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EBD historical foundations yet again

Readers of EBD Blog who have been following along will recognize this post as the third of three reporting on a three-part series about the history of behavior disorders that has been appearing in the Journal of Emotional and Behavioral Disorders. Thanks to the stewardship of the Donald D. Hammill Foundation and Sage Publishers, readers may download free copies of this third installment in the series. The articles are based on interviews conducted in association with the Janus Oral History Project and the Midwest Symposium for Leadership in Behavior Disorders.

Kaff, M. S., Zabel, R. H., & Teagarden, J. M. (2011). An oral history of first-generation leaders in education of children with emotional/behavioral disorders, part 3: The future. Journal of Emotional and Behavioral Disorders, 19(4).

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“Thinking Person’s Guide to Autism” released

The authors of the blog, Thinking Person’s Guide to Autism (TPGA), announced the release of the book under the same title 19 December 2011. From what I can garner by reviewing the list of contributors provided on the blog (I’ve not had a chance to review the book), the collected essays in TPGA will be informative, honest, and evidence-based observations and commentaries written in clear and heartfelt language. It’s a strong enough entry that Steve Silberman, who has the NeuroTribes blog for the PLoSBLOGs (Public Library of Sciences), called it the book of the year.

The editors’ names—Shannon Des Roches Rosa, Jennifer Byde Myers, Liz Ditz, Emily Willingham, and Carol Greenburg—will be familiar to many readers, as I have mentioned their work and they have left comments here on EBDBlog or on sibling projects. They harvested what they considered to be top-notch material about Autism from around the Internet (the list of contributors includes many familiar names), and organized it into this collection so that people searching for the good stuff would have a lot of it in one place.

That’s the point that captured Mr. Silverman’s attention. After setting the stage by providing a capsule history of many of the mistaken paths and some of the productive steps that Autism has taken, in “Book of the Year: Thinking Person’s Guide to Autism,” he points to TPGA and writes,

With this sea-change in mind, my favorite book of the year on autism was curated and self-published by a group of parent-warriors with the express purpose of sparing other parents the grief, isolation, and confusion that followed their own kids’ diagnoses. Called the Thinking Person’s Guide to Autism, it offers helpful, positive, pragmatic, evidence-based advice for making the life of your kid and your family more rewarding and more joyful, starting today. I can’t think of a better holiday gift for someone with a loved one on the spectrum. With current estimates of autism prevalence running at 1 in 110 people in the US, the book deserves a wide readership.

Mr. Silverman’s extensive review echoes much of what the editors wrote about their book. On release of the book, they blogged:

For all today’s smiles and pride, the truth is Thinking Person’s Guide to Autism’s inspiration was our persistent frustration with the negative autism stereotypes and misinformation we faced in parenting our children with autism, or advocating with/amplifying the signal of the amazing Autistic communities. As stated in our Mission, this book is the resource we wish we’d had when autism first became part of our lives: a one-stop source for carefully curated, evidence-based information from autism parents, autistics, and autism professionals.

You can read the complete content of that entry on their blog. Also, here’s a link to the press page about the book and, if you’re already convinced, here’s a link for those who’re looking to go directly to Amazon.

Given the relationship I noted between the editors and me, as minor as it may be, I should also explain that there is no financial relationship among us. I’m not being paid to shill for the book.

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Important newspaper coverage of Autism

Beginning 11 December 2011, journalist Alan Zarembo (with the help of Doug Smith and Sandra Poindexter) of the Los Angeles Times began presenting what could turn out to be a landmark series of articles about Autism. In the first of four installments (which runs over ~3800 words), Mr. Zarembo introduces several cases and many important—and controversial—ideas about diagnosis and prevalence of Autism. Subsequent segments cover other important topics.

The four parts of the series are as follows:

  1. An epidemic of disease or of discovery? (11 December 2011)
  2. Services go to those who fight hardest (13 December 2011)
  3. Families chase the dream of recovery (15 December 2011)
  4. Finding traces of autism in earlier eras (17 December 2011)

In addition to the extensive report, there are multiple multimedia and other sidebar supplements. This promises to be an event worth following. I encourage readers to start with the first installment in the series and follow it from there.

Links updated 17 December 2011.

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Webinar on FBA and positive behavior support plans


Tim Lewis

If you and your colleagues need to obtain a good foundation on the use of functional behavioral assessment and positive behavior support plans, there is an opportunity coming to satisfy that need.Tim Lewis will present another Webinar under the auspices of the Council for Exceptional Children (CEC), and this one is entitled “Designing Individual Student Positive Behavior Support Plans Through Functional Behavioral Assessment.” It is scheduled for Tuesday 25 October 2011 from 4:00 to 5:00 PM (Eastern Time, US).

Professor Lewis is among the leaders in the area of Emotional and Behavioral Disorders and positive behavior interventions and supports (PBIS). He co-edits the journal Behavioral Disorders and co-directs major projects on PBIS. Follow this link to learn more about the event and how to register for it; it is the third in a series of Webinars on the topic of PBIS that Professor Lewis is providing via CEC. (I don’t have a financial interest in them; I’m just shilling for them for free here.)

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