Tag Archive for 'Treatment'

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.

Continue reading ‘US ED resource on restraint and seclusion’

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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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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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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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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.)

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Denny Reid in C’ville!

Dennis Reid, a renowned researcher and clinician who for more than 35 years has worked with individuals who have Autism, will speak on 22 September 2011 on “Evidence-Based Strategies for Promoting Enjoyment among People with Autism” in Charlottesville (VA, US). The talk by Mr. Reid, which is free and open to the public (but registration is required), is part of the Virginia Institute of Autism (VIA) Autism Speaker Series and is sponsored by VIA and the University of Virginia Children’s Hospital. It is scheduled for 5:30-6:30 at St. Anne’s-Belfield Greenway Rise Campus, Randolph Hall Auditorium. To register, go to VIA’s Web site viaschool.org or call (434) 923-8252.

For those who are unfamiliar with Mr. Reid’s research, he has an extensive record of work in behavior analysis, having published repeatedly in the Journal of Applied Behavior Analysis. He’s based at the Carolina Behavior Analysis and Support Center in Mogantown (NC, US) which, oddly, doesn’t seem to have a Web site.

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ASAT newsletter pending

Do you want to know more about evidence-based interventions for Autism? Are you weary of wading through a lot of over-hyped-and-not-well-tested methods hoping to find one gem? Do you come back to EBD Blog because you pine for trustworthy news about Autism?

There is an alternative, another source: The Association for Science in Autism Treatment has a regular newsletter and a new one is about to be released. If readers hustle their bustles, they can register in time to receive the next issue which includes (according to a mailer I received)

  • A feature article in which Dr. Thomas Zane discusses the adoption of Fad Treatments in Autism.
  • Four research article summaries (ranging from treatment comparisons to prevalence of adults with autism).
  • Spotlight on a new organization Advancing Futures for Adults with Autism.
  • Two Clinical Corners (Food Selectivity and Help with the Dentist).
  • Consumer Corner (Review of Transition Resources for Adolescents and Adults with Autism).
  • An in-depth group interview about fostering positive portrayals of science-based treatment in the media.

…and for the rest, you’re just going to have to read to find out!

Here’s a link to register for the newsletter: http://www.asatonline.org/signup. I encourage folks to do.

And, if you ever forget how to find ASAT, you don’t have to poke around looking for this message. Just check over there in the siderail. You’ll find it listed in the “Web Resources.”

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Research participation opportunities

In an accompanying PDF I have listed studies that are currently seeking children (both female and male) with Emotional of Behavioral Disorders (especially autism spectrum disorders) as participants (some include adults, as well) that are registered with ClinicalTrials.gov, a service of the US National Institutes of Health (NIH). The studies have diverse purposes: They may be observing different events (whether overt behavior or neurochemical activity) or they may be testing different therapies (ranging from behavioral to medical methods). Many are sponsored at least in part by the NIH, but some have funding from universities or even private industries. Because of its affiliation with NIH, ClincialTrials.gov is more likely to represent medically oriented studies and studies that use rigorous scientific methods (i.e., randomized clinical trials or RCTs), but this is not exclusively the case. Readers should examine the studies carefully.

The list is not exhaustive (I used “autism” in the search, so there are many more studies that could be located by using other terms), and I’ve provided only some of the data about each study in the table, but you can learn a fair bit about individual studies. For example, one can learn about study number NCT00198107 that is entitled “Evaluating the Effectiveness of Aripiprazole and D-Cycloserine to Treat Symptoms Associated With Autism.” It focuses on individuals with Autistic Disorders and examines an intervention (in this case, comparing drugs called Aripiprazole D-cycloserine to placebo in a randomized design with double-blind (Subject, Caregiver, Investigator, Outcomes Assessor) | Primary Purpose: procedures. The study began 1-Sep-05 and will end 1-Sep-11 (making it odd that it is still listed as open, no?).

To locate additional information about a particular study, copy the NCT ID number, go to ClinicalTrials.gov, and enter that number into the search box. Download the PDF here (10 pages).

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Cog mod for PTSD

In the Journal of Behavior Therapy and Experimental Psychiatry, Joanna Kowalik and colleagues reported that their review of studies on the use of cognitivie behavioral therapy for treating posttraumatic stress disorder (PTSD) revealed that cog-mod appears effective in changing raters’ responses on some of the widely used scales of the Child Behavior Checklist. However, the results of their literature review are not as powerful as one might hope, given the small number of studies and substantial variability in the studies themselves.

Abstract

Background and objectives There is no clear gold standard treatment for childhood posttraumatic stress disorder (PTSD). An annotated bibliography and meta-analysis were used to examine the efficacy of cognitive behavioral therapy (CBT) in the treatment of pediatric PTSD as measured by outcome data from the Child Behavior Checklist (CBCL).

Method A literature search produced 21 studies; of these, 10 utilized the CBCL but only eight were both 1) randomized; and 2) reported pre- and post-intervention scores.

Results The annotated bibliography revealed efficacy in general of CBT for pediatric PTSD. Using four indices of the CBCL, the meta-analysis identified statistically significant effect sizes for three of the four scales: Total Problems (TP; ?.327; p = .003), Internalizing (INT; ?.314; p = .001), and Externalizing (EXT; ?.192; p = .040). The results for TP and INT were reliable as indicated by the fail-safe N and rank correlation tests. The effect size for the Total Competence (TCOMP; ?.054; p = .620) index did not reach statistical significance.

Limitations Limitations included methodological inconsistencies across studies and lack of a randomized control group design, yielding few studies for meta-analysis.

Conclusions The efficacy of CBT in the treatment of pediatric PTSD was supported by the annotated bibliography and meta-analysis, contributing to best practices data. CBT addressed internalizing signs and symptoms (as measured by the CBCL) such as anxiety and depression more robustly than it did externalizing symptoms such as aggression and rule-breaking behavior, consistent with its purpose as a therapeutic intervention.

Because they are integrating so few studies it is very difficult to have a sensitive meta-analysis in this case. However, that Professor Kowalik and her collaborators found differences at all is encouraging. I hope they’ll continue to follow this literature. Also, I hope researchers will be using other measures of outcomes and that those other measures will be examined in future integrative literature reviews, too.

Kowalik, J., Weller, J., Venter, J., & Drachman, D. (2011). Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: A review and meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 42, 405-413. doi:10.1016/j.jbtep.2011.02.002

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FC goes to MIT

According to Robert T. Carroll at the Skeptic’s Dictionary, several people associated with facilitated communication have been working with Professor Rosalind W. Picard of the Affective Computing research group at the Massachusetts Institute of Technology (MIT) Media Lab. In “Facilitated Communication Infiltrates MIT’s Media Lab,” Mr. Carroll reports about Professor Picard’s connections with supporters of what he says is now called “supported typing.”

Why would MIT’s Media Lab be involved with something that is clearly a discredited pseudoscience?

MIT’s Media Lab’s involvement with FC goes back several years.

A private FC conference occurred in May 2008 involving Douglas Biklen, Head of the FC Institute, Rosalind Picard, Head of the MIT Affective Computing Group, Margaret Bauman of the Massachusetts General Ladders Program (a long time FC advocate; she tried to get the New England Center to use FC in the early 1990s; she just got $29 Million from Nancy Lurie Marks a major, major FC supporter), Martha Herbert of Harvard Medical (supports the view that autism is a movement disorder, justifying FC)…That meeting seems to have been designed to establish liaisons between FC advocates in the Media Lab, the Ladders Program at Massachusetts General, the Syracuse FC Institute [now the Institute on Communication and Inclusion], and the University of Buenos Aires (i.e., Daniel Orlievsky), and cannot be unconnected to this upcoming event in July.

Mr. Carroll has much more on this. Given the problems with FC, one must wonder what a prestigious institution such as MIT would gain from such a connection. Is it possible that the researchers are legitimately investigating FC?

What about other developments from this lab? How valuable are they? One can’t dismiss them simply by association. Does this bracelet that seems to capture galvanic skin response and feed it wirelessly to computers actually have much value? Tracking GSR across time does look interesting to me. What clinical applications might emerge? Will they be beneficial?

You can read Facilitated Communication Infiltrates MIT’s Media Lab in its entirety on the Skeptic’s Dictionary.

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Virginia campaign promotes action agenda

The Campaign for Children’s Mental Health outlined an agenda for improving mental health policy for children and youths in the US commonwealth of Virginia on 14 June 2011. The “Action Agenda” expresses the need for Govenor Bob McDonnell to exert leadership in three policy areas so that the problems of 100,000 minors with mental health issues are addressed:

  • Children with mental health disorders and their families need to have a full array of high quality treatment and support services in their own communities, no matter where in Virginia they reside.
  • Children with serious mental health disorders who require public sector services need to have access to the same array of services regardless of payment source or custody status in order to maximize the impact of and curb inappropriate use of public dollars in the treatment system.
  • Children with mental health disorders and their families should be recognized and included as experts on their own and their children’s treatment needs.

Visit the 1 in 5 Website (see it over in the sidebar, too) and download the full statement of the Action Agenda.

I am very glad to have and I hope others will join me in signing a petition to support this effort. Isn’t it great to have this effort right here in Virginia? Do you have similar efforts in the area where you live?

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New review of early intervention in Autism from Pediatrics

Zachary Warren and colleagues from Vanderbilt University published a review of 34 studies of early intervention efforts with children who have Autism in Pediatrics in April of 2011. The authors interpret their results as providing tempered supported for the the early intervention methods often described as “UCLA,” “Lovaas–based,” “EIBI,” or the “Early Start Denver Model.” Here is the abstract.

A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders
by
Zachary Warren, Melissa L. McPheeters, Nila Sathe, Jennifer H. Foss-Feig, Allison Glasser and Jeremy Veenstra-VanderWeele

CONTEXT: Early intensive behavioral and developmental interventions for young children with autism spectrum disorders (ASDs) may enhance developmental outcomes.

OBJECTIVE: To systematically review evidence regarding such interventions for children aged 12 and younger with ASDs.

METHODS: We searched Medline, PsycINFO, and ERIC (Education Resources Information Center) from 2000 to May 2010. Two reviewers independently assessed studies against predetermined inclusion/ exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of evidence ratings using predetermined criteria.

RESULTS: Thirty-four unique studies met inclusion criteria. Seventeen studies were case series; 2 were randomized controlled trials. We rated 1 study as good quality, 10 as fair quality, and 23 as poor quality. The strength of the evidence overall ranged from insufficient to low. Studies of University of California Los Angeles/Lovaas–based interventions and variants reported clinically significant gains in language and cognitive skills in some children, as did 1 randomized controlled trial of an early intensive developmental intervention approach (the Early Start Denver Model). Specific parent-training approaches yielded gains in short-term language function and some challenging behaviors. Data suggest that subgroups of children displayed more prominent gains across studies, but participant characteristics associated with greater gains are not well understood.

CONCLUSIONS: Studies of Lovaas-based approaches and early intensive behavioral intervention variants and the Early Start Denver Model resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs, although the literature is limited by methodologic concerns.

Warren, Z., McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra-VaderWeele, J. (2011). A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics, 127, e1303–e1311. Published online Apr 4, 2011; DOI: 10.1542/peds.2011-0426

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