Archive for the 'Treatment' Category

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Are insurers dragging their feet?

Are some insurance companies slow in providing coverage for behavioral therapies that families deserve for their children with Autism? According to a report by Alan Zarembo in the Los Angeles (CA, US) Times, the problem is great enough in California that a government agency is considering emergency regulations to force insurers to comply with their obligation to provide coverage.

Insurers have been skirting their obligation under recently enacted state law to provide costly behavioral therapies for autism, according to the Department of Insurance, which is proposing emergency regulations aimed at enforcing the law.
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Autism, recovery, CAM, placebo, and research

Thought experiment: Suppose that scientists want to compare a new therapy for children with Autism. They’ll need to compare the New Therapy to a control condition and evaluate it over time using multiple different outcome measures. I’m going to describe this because I want to talk about the effects of “recovery” in Autism in the control group, the perception of the effectiveness of complimentary and alternative therapies, and the placebo effect.

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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

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.

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.

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.)

Addressing bullying via PBIS


Tim Lewis

Do you want to learn how to do something about bullying in schools? Here’s a way to get started.

Under the auspices of the Council for Exceptional Children (CEC), Tim Lewis will present an online seminar (“Webinar”) entitled “Addressing Bullying Behavior Through Schoolwide Positive Behavior Supports” on Thursday 20 October 2011 from 4:00 to 5:00 PM (Eastern Time, US). Professor Lewis, who teaches and conducts research at the University of Missouri, has a wealth of experience and expertise in the area of Emotional and Behavioral Disorders and positive behavior interventions and supports (PBIS), so this an excellent opportunity to get a good grounding in how to use the features of PBIS to help a school manage bullying problems. Follow this link to learn more about the event and how to register for it; it is one 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.)