E-Book, Englisch, 666 Seiten
Reihe: Practical Resources for the Mental Health Professional
Granpeesheh / Tarbox / Najdowski Evidence-Based Treatment for Children with Autism
1. Auflage 2014
ISBN: 978-0-12-411618-4
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark
The CARD Model
E-Book, Englisch, 666 Seiten
Reihe: Practical Resources for the Mental Health Professional
ISBN: 978-0-12-411618-4
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark
This manual is a user-friendly, comprehensive description of the Center for Autism and Related Disorders (CARD) model of autism treatment-the latest scientific information on what truly works in treating autism in an integrated, organized, consumable format. The book details effective early behavioral intervention, covering topics such as challenging behavior, visual modification, parental involvement, improving language, cognition, and social skills, and ends with a section that explains how all of the treatments can be put together in real-life service provision organizations. The CARD model is highly comprehensive and provides useful clinical information to form cutting-edge treatment programs. - Describes in detail the world-renowned, state-of-the-art CARD model of treatment for children with autism spectrum disorders - Provides practitioners critical guidance in how to combine the best components into comprehensive treatment programs for individuals with autism that are not only backed by research, but also the most effective, and the least intrusive - Includes practical information, presented in a user-friendly, professionally-oriented format, with tables, figures, and flowcharts to help guide real-life clinical decision making
Dr. Jonathan Tarbox is the Co-Founder and Program Director of the Master of Science in Applied Behavior Analysis program at the University of Southern California, as well as Director of Research at FirstSteps for Kids. Dr. Tarbox is the past Editor-in-Chief of the journal Behavior Analysis in Practice, a Board Member of the ABA Task Force to Eradicate Social Injustice, and a member of the Advisory Board of the Women in Behavior Analysis (WIBA) conference. He has published five books on applied behavior analysis and autism treatment, is the Series Editor of the Elsevier book series Critical Specialties in Treating Autism and Other Behavioral Challenges, and an author of over 90 peer-reviewed journal articles and chapters in scientific texts. His research focuses on behavioral interventions for teaching complex skills to individuals with autism, Acceptance and Commitment Training (ACT), and applications of applied behavior analysis to issues of diversity and social justice.
Autoren/Hrsg.
Weitere Infos & Material
1;Front Cover;1
2;Evidence-Based Treatment for Children with Autism: The CARD Model;4
3;Copyright;5
4;Contents;6
5;Preface;14
6;Acknowledgments;20
7;Chapter 1: Introduction;22
7.1;Introduction to Early Intensive Behavioral Intervention;23
7.2;Format of This Book;24
7.3;History of the CARD Model;25
7.4;Tone of this Book;25
8;Chapter 2: Philosophy and Mores;28
8.1;All Humans Are Capable of Learning;28
8.2;Children with Autism are Whole People;29
8.3;Fearlessness;29
8.4;Innovation;31
8.5;Open-Mindedness;31
8.6;Insistence on Highest Quality;32
8.7;The Right to Evidence-Based, Effective Treatment;35
8.8;Global Reach;35
8.9;Recovery from ASD is Possible;36
8.10;Personal Dignity and Self-Determination;37
8.11;Summary;38
9;Chapter 3: The Diagnosis of Autism Spectrum Disorder;40
9.1;Professionals Who Can Diagnose ASD;40
9.2;Diagnostic Criteria;41
9.2.1;Criterion 1: Social Communication and Social Interaction Deficits;41
9.2.2;Criterion 2: Restricted, Repetitive Patterns of Behavior, Interests, or Activities;42
9.2.3;Symptoms Must Appear During Early Development;43
9.2.4;Symptoms Must Cause Clinically Significant Impairment;43
9.2.5;Intellectual Disability and Global Developmental Delay;44
9.2.6;Specifiers;44
9.3;Changes from DSM-IV;45
9.3.1;Implications of Changes in DSM-5;47
9.4;Diagnostic Assessments;48
9.4.1;Autism Diagnostic Observation Scale, Second Edition;48
9.4.2;Autism Diagnostic Interview, Revised;49
9.5;Summary;49
10;Chapter 4: Principles and Procedures of Acquisition;52
10.1;Background;53
10.2;Positive Reinforcement;53
10.2.1;Principles Versus Procedures;54
10.2.2;Negative Versus Positive Reinforcement;54
10.2.3;Motivating Operations;58
10.2.4;Preference Assessment;60
10.2.5;Conditioned Reinforcers;62
10.2.6;Steps for Implementing a Young Learner’s First Token System;65
10.3;Prompting and Prompt Fading;65
10.3.1;Types of Prompts;66
10.3.2;Prompt Fading;68
10.4;Discrete Trial Training;71
10.4.1;The Antecedent;71
10.4.2;Guidelines for Effectively Presenting Instructions During DTT;72
10.4.3;The Response;73
10.4.4;Guidelines for Responses During DTT;73
10.4.5;The Consequence;73
10.4.6;Guidelines for Effective Reinforcement During DTT;74
10.4.7;Discrimination;75
10.4.7.1;Common Lessons Requiring Successive Discriminations;76
10.4.7.2;Common Lessons Requiring a Simultaneous Discrimination;77
10.4.8;Mastery Criteria;80
10.5;Natural Environment Training;83
10.5.1;Defining Features of Natural Environment Training;83
10.5.2;Balancing Discrete Trial Training and Natural Environment Training;87
10.6;Chaining and Shaping;89
10.6.1;Task Analysis;89
10.6.1.1;Sample Hand-Washing Task Analysis;90
10.6.2;Forward Chaining;90
10.6.3;Backward Chaining;91
10.6.4;Total Task Chaining;91
10.6.5;Shaping;92
10.7;Behavioral Skills Training;93
10.8;Fluency-Based Instruction;94
10.9;Summary;95
11;Chapter 5: A Functional Approach to Challenging Behavior;96
11.1;The Need for Functional Assessment and Treatment of Challenging Behavior;96
11.1.1;Prevalence and Type of Challenging Behavior;96
11.1.2;When Challenging Behavior Warrants Treatment;97
11.1.3;Why Challenging Behavior Occurs;99
11.1.4;Traditional/Historical Interventions;99
11.1.5;Function-Based Interventions;100
11.2;Step 1: Identify, Define, and Prioritize the Target Behavior;100
11.2.1;Identify and Define;100
11.2.2;Prioritize;101
11.3;Step 2: Determine Outcome Goals;102
11.4;Step 3: Conduct a Functional Assessment;103
11.4.1;Common Functions of Behavior;104
11.4.2;Secondary Functions of Behavior;104
11.4.3;Types of Functional Assessments;106
11.4.3.1;Steps to Follow When Conducting an Indirect Assessment;107
11.4.3.2;Pros and Cons of Indirect Assessment;108
11.4.3.3;Descriptive Functional Assessment;108
11.4.3.3.1;Steps to Follow When Conducting a Descriptive Functional Assessment;110
11.4.3.3.2;Pros and Cons of Descriptive Functional Assessments;110
11.4.4;Analyzing the Results of Functional Assessments;111
11.5;Step 4: Design a Function-Based Behavior Intervention Plan;112
11.5.1;Antecedent Interventions;112
11.5.2;Replacement Behavior Intervention Procedures;116
11.5.3;Consequence-Based Interventions;121
11.6;Step 5: Write the Behavior Intervention Plan;128
11.6.1;Description of the Child and Background Information;128
11.6.2;Identification of the Target Behavior and Its Function;129
11.6.3;Description of the Intervention;129
11.6.4;Replacement Behaviors;130
11.6.5;Consequence Modifications;130
11.6.6;Description of the Data Collection Methods and Reporting Requirements;131
11.6.7;Short-Format Intervention Plan for Daily Use;132
11.7;Step 6: Evaluate the Effectiveness of the Plan;132
11.8;Step 7: Troubleshoot and Follow Up;132
11.9;Summary;134
12;Chapter 6: Visual and Other Sensory Modifications;136
12.1;The Response Modification;138
12.2;Clinical Indicators for Use of Response Modifications;139
12.2.1;Response Forms;139
12.2.2;Commonly Used Forms of Response Modifications;140
12.2.3;System/Device Options;142
12.2.4;Choosing a Response Form and Device;143
12.2.5;Introducing and Implementing the Response Modification;144
12.2.6;Fading the Use of Response Modifications;145
12.3;The Stimulus Modification;146
12.3.1;When to Introduce Stimulus Modifications;146
12.3.2;Fading;148
12.4;Visual Supports for Organizing the Environment;149
12.4.1;Visual Schedules;149
12.4.2;Wait Cards;149
12.4.3;Visual Timers;150
12.4.4;First-Then Contingencies;150
12.5;Other Sensory Modifications;151
12.5.1;Visual Challenges;151
12.5.2;Auditory Challenges;151
12.5.3;Tactile Challenges;152
12.6;Summary;152
13;Chapter 7: Generalization and Maintenance;154
13.1;Generalization;155
13.1.1;Procedures for Promoting Generalization;156
13.1.2;Generalization as Mastery Criteria;158
13.1.3;Overgeneralization;159
13.2;Maintenance;161
13.2.1;Maintenance Procedures;161
13.2.2;Tracking Maintenance;163
13.3;Summary;164
14;Chapter 8: Treatment Settings;166
14.1;The Home Setting;166
14.1.1;Designing the Therapy Environment;167
14.1.2;Home-Based Therapy Team;169
14.2;School-Based Services;170
14.2.1;School Shadowing;170
14.2.2;Team Meetings;171
14.2.3;Advantages of School-Based Services;171
14.2.4;Disadvantages of School-Based Services;172
14.3;Center-Based Services;174
14.3.1;Physical Layout;175
14.3.2;Materials;176
14.3.3;Scheduling;176
14.3.4;Communication with Parents;177
14.3.5;Dropping Off and Picking Up;178
14.3.6;Medication;178
14.3.7;Absences;179
14.3.8;Severe Behavior;179
14.3.9;Advantages of Center-Based Services;179
14.3.10;Disadvantages of Center-Based Services;180
14.4;Licensed Private Schools;181
14.4.1;Staff;181
14.4.2;Related Services;182
14.4.3;Scheduling;182
14.4.4;Other Regulations;183
14.4.5;Advantages of the Licensed Private School Setting;183
14.4.6;Disadvantages of the Licensed Private School Setting;184
14.5;Summary;184
15;Chapter 9: Parent Involvement;186
15.1;Building A Therapeutic Relationship with Parents;187
15.1.1;Establishing Expectations;187
15.1.2;Establishing Effective and Empathetic Trainers;188
15.1.3;Building Collaborative Relationships with Parents;189
15.1.4;Knowledge;189
15.1.5;Flexibility;190
15.2;Designing the Parent Training Program;190
15.2.1;Format;190
15.2.2;Setting;191
15.2.3;Intensity and Duration;192
15.2.4;Trainees;192
15.2.5;Prioritization of Treatment Targets;193
15.2.6;Setting Parent Goals;195
15.2.7;Considering Context;196
15.2.8;Cultural, Educational, and Socioeconomic Variables;196
15.2.9;Parent Stress;198
15.3;Delivering Parent Training;199
15.3.1;Training Procedures;199
15.3.2;Generalization and Maintenance;205
15.3.3;Data Collection and Treatment Evaluation;206
15.4;Troubleshooting;208
15.4.1;Skill Deficit Versus Nonadherence;209
15.4.2;Problematic Private Events;209
15.5;Summary;211
16;Chapter 10: Introduction to the Center for Autism and Related Disorders Curriculum Series;212
16.1;History and Background;212
16.2;Philosophy Behind the CARD Curriculum Series;214
16.3;Development and Framework of the CARD Curriculum Series;215
16.3.1;Using the Assessment and Curriculum Series;218
16.3.2;Skills®;218
16.4;Summary;219
17;Chapter 11: Language;220
17.1;Verbal Behavior;221
17.2;Verbal Operants Versus Concepts;222
17.3;Echoics;224
17.3.1;Vocal Imitation;224
17.3.2;Free Operant Reinforcement of All Vocalizations;224
17.3.3;Embedding Echoics in Motor Sequences;225
17.4;Mands;225
17.4.1;Naturally Occurring Establishing Operations;225
17.4.2;Contrived Establishing Operations;226
17.4.3;Reinforcing Mands;227
17.4.4;Complex Mands;228
17.4.5;Spontaneous Mands;228
17.4.6;Disguised or Softened Mands;228
17.5;Matching;229
17.6;Understanding the Verbal Behavior of Others;230
17.6.1;Receptive Identification;230
17.6.2;Following Instructions;231
17.7;Tacts;233
17.7.1;Discrete Trial Training;233
17.7.2;Natural Environment Training;233
17.7.3;Spontaneous Tacts;234
17.8;Intraverbals;236
17.8.1;Discrete Trial Training;237
17.8.2;Natural Environment Training;237
17.8.3;Prompting and Shaping Intraverbals;238
17.9;Improving Articulation and Increasing Complexity;238
17.9.1;Articulation;238
17.9.2;Complete Sentences and Grammar;239
17.10;Strategies for Success;241
17.10.1;Shaping;241
17.10.2;Chaining;241
17.10.3;Maximize Learning Opportunities;241
17.10.4;Focus on Establishing Useful Language;241
17.10.5;Nonvocal Options;242
17.11;Summary;242
18;Chapter 12: Play;244
18.1;Why Bother Teaching Play?;244
18.2;Domains of Play;246
18.2.1;Independent Play;247
18.2.2;Interactive Play;249
18.2.3;Pretend Play;250
18.2.4;Constructive Play;252
18.2.5;Electronic Play;253
18.3;Progression Through Play Training;253
18.3.1;Imitation;253
18.3.2;Narration;254
18.3.3;Increasing Complexity: Chains and Themes;255
18.3.4;Increasing Independence;255
18.3.5;Teaching How to Extract Reinforcement Out of Play;255
18.3.6;Conditioning Play to Be a Source of Reinforcement;256
18.3.7;Requesting Play;258
18.4;Strategies for Success in Teaching Play;258
18.4.1;Be Creative, Fun, Energetic, and Positive;258
18.4.2;Pick Compatible Play Partners;259
18.4.3;Include Items and Activities That Are Motivating;259
18.4.4;Teach Skills in Social Context, Not Mere Mastery of Particular Behaviors;259
18.4.5;Picture Activity Schedules for Increasing Independence in Play;260
18.4.6;Have Two Sets of Materials Available;260
18.5;Common Pitfalls in Teaching Play;260
18.5.1;Being Overly Repetitive;260
18.5.2;Completely Unmodified Free Play;261
18.5.3;Waiting Too Long to Include Peers;261
18.6;Summary;261
19;Chapter 13: Adaptive;264
19.1;Adaptive Skill Domains;265
19.1.1;Personal;266
19.1.2;Domestic;270
19.1.3;Safety;271
19.1.4;Community;273
19.2;When Are Adaptive Skills a Priority?;274
19.2.1;As Children Get Older;274
19.2.2;Limited Treatment Intensity;275
19.3;Strategies for Success;275
19.3.1;Reinforcement;275
19.3.2;Plan Sufficient Time for Teaching;276
19.3.3;Adapt Teaching to Customs and Contexts of Everyday Family Life;276
19.3.4;Consider the Learner’s Motor Abilities;277
19.3.5;Include Parents;277
19.3.6;Visual Supports;278
19.4;Common Pitfalls in Teaching Adaptive Skills;278
19.4.1;Don’t Start Too Early!;278
19.4.2;Targeting Too Many Skills at Once;279
19.4.3;Inadvertently Prompting Already Mastered Skills;279
19.4.4;Ensure That Focused Learning Environments Are Relevant to Real Life;279
19.4.5;Balancing Values and Efficiency;280
19.5;Summary;280
20;Chapter 14: Motor;282
20.1;Motor Domains;283
20.1.1;Visual Motor;283
20.1.2;Gross Motor;285
20.1.3;Fine Motor;286
20.1.4;Oral Motor;287
20.2;Teaching Procedures;288
20.2.1;Discrete Trial Training (DTT);288
20.2.2;Natural Environment Training (NET);288
20.2.3;Prompting;289
20.2.4;Chaining and Shaping;289
20.2.5;Increasing Independence;290
20.2.6;Maintenance and Generalization;290
20.3;Strategies for Success in Teaching Motor Skills;291
20.3.1;Build Gross and Fine Motor Strength;291
20.3.2;Teach Fluent Motor Behavior;291
20.3.3;Don’t Forget to Consider Fatigue;292
20.4;Common Pitfalls in Teaching Motor Skills;292
20.4.1;Teaching Irrelevant Skills;292
20.4.2;Poor Communication Across Service Providers;292
20.5;Summary;293
21;Chapter 15: Academics;294
21.1;Academic Domains;296
21.1.1;Language Arts;296
21.1.2;Mathematics;297
21.2;Teaching Procedures;298
21.2.1;Discrete Trial Training;298
21.2.2;Multiple Exemplar Training;299
21.2.3;Natural Environment Training;299
21.2.4;Worksheets;300
21.3;Strategies for Success;300
21.3.1;Teach Independence;300
21.3.2;Teach Test-Taking Strategies;301
21.3.3;Readiness to Learn in the Classroom;301
21.3.4;Collaborate with the Academic Team;302
21.3.5;Promote Generalization to the Classroom Setting;302
21.3.6;Maintenance;303
21.3.7;Fluency-Based Instruction;303
21.4;Common Pitfalls;304
21.4.1;Progressing to Advanced Skills Before Foundational Skills Are Fluent;304
21.4.2;Overfocusing on What Is Age Appropriate or Being Taught in Class;304
21.4.3;Irrelevant/Nonfunctional;304
21.4.4;Too Difficult or Too Easy;305
21.4.5;Difficulty with Handwriting and Written Assignments;305
21.4.6;Decoding Versus Comprehension;305
21.4.7;Working on the Same IEP Goals for a Long Time;306
21.5;Summary;306
22;Chapter 16: Social;308
22.1;Common Social Difficulties in Autism Spectrum Disorder;309
22.1.1;Developmentally Appropriate Relationships;309
22.1.2;Non-vocal Social Behaviors;309
22.1.3;Sharing Experiences with Others;310
22.1.4;Social Reciprocity;310
22.2;Domains of Social Skills Instruction;311
22.2.1;Non-vocal Social Behavior;311
22.2.2;Social Interaction;311
22.2.3;Social Language;312
22.2.4;Social Rules and Rule-Governed Behavior;312
22.2.5;Group-Related Social Behavior;313
22.2.6;Self-Esteem;314
22.2.7;Absurdities;314
22.3;Teaching Strategies;314
22.3.1;Beginning-Level Instruction;315
22.3.2;Intermediate-Level Instruction;318
22.3.3;Advanced-Level Instruction;322
22.3.4;Settings for Social Skills Instruction;325
22.3.5;Playdates;325
22.4;Strategies for Success in Teaching Social Skills;329
22.4.1;Build Rapport;329
22.4.2;Targets and Expectations Should Be Developmentally Appropriate;330
22.4.3;Take Baby Steps;330
22.4.4;Use Effective Reinforcement;330
22.4.5;Consider Cultural Perspectives and Differences;331
22.4.6;Be Proactive;331
22.4.7;Actively Program for Generalization;332
22.4.8;Fine-Tune Prompting;332
22.4.9;Integrate Skills from Other Domains;333
22.4.10;Incorporate Self-Management Strategies;333
22.5;Common Pitfalls in Social Skills Instruction;333
22.5.1;Memorization/Rote Learning;333
22.5.2;Adult-Centered Social Interaction Styles;334
22.5.3;Targeting Too Many Skills at Once;334
22.5.4;Focusing on the Negatives;335
22.5.5;Don’t Worry About the Number of Friendships;335
22.5.6;Confusing Verbal Behavior with Genuine Skill Proficiency;335
22.5.7;Sabotaging the Social Environment;335
22.6;Summary;336
23;Chapter 17: Cognition;338
23.1;Perspective-Taking Deficits in Children with Autism;340
23.1.1;Real-World Applications of Perspective Taking;340
23.1.2;Development of the Cognition Curriculum;341
23.1.3;General Teaching Methods;342
23.1.4;Structure of the Cognition Curriculum;342
23.2;Desires;343
23.2.1;Learner’s Desires;344
23.2.2;Identifying and Inferring Others’ Desires;344
23.3;Preferences;345
23.3.1;Learner’s Preferences;345
23.3.2;Others’ Preferences;345
23.4;Emotions;346
23.4.1;Emotion Identification;347
23.4.2;Cause and Effect;347
23.4.3;Desire and Belief-based Emotions;348
23.4.4;Application to Social Interaction;348
23.5;Physical States;349
23.5.1;Identifying Physical States;349
23.5.2;Cause and Effect;350
23.5.3;Social Application;350
23.6;Sensory Perspective Taking;351
23.6.1;Learner’s Senses;351
23.6.2;Others’ Senses;352
23.7;Knowing;353
23.7.1;Identifying What the Learner Knows;353
23.7.2;Identifying What Others Know;354
23.8;Beliefs;356
23.8.1;Learner’s True and False Beliefs;356
23.8.2;Others’ True and False Beliefs;357
23.8.3;Predicting Beliefs and Belief-based Actions;357
23.9;Deception;358
23.9.1;Tricks;358
23.9.2;Identifying Deception in Others;360
23.9.3;Using Advanced Deception;361
23.10;Thinking;362
23.10.1;Using the Word Think ;362
23.10.2;Others’ Thoughts;363
23.10.3;Facts versus Opinions;364
23.10.4;Think-feel-say-do;365
23.10.5;Thinking Before Doing;367
23.11;Detecting Sarcasm;368
23.12;Intentions;369
23.12.1;Inferring Intentions from Actions;369
23.12.2;Inferring Intentions of Current, Incomplete Actions;370
23.12.3;Responding to Intentional and Unintentional Actions;370
23.12.4;Inferring Intention in Scenarios Involving Others;370
23.13;General Tips for Success;371
23.13.1;Identify Prerequisite Skills;371
23.13.2;Use Naturalistic Teaching Procedures Across Multiple Exemplars;372
23.13.3;Prompting;373
23.14;Common Pitfalls When Teaching Perspective-Taking Skills;373
23.14.1;Knowing the Response vs. Applying the Skill;373
23.14.2;Teaching Age-Appropriate Skills;374
23.15;Summary;374
24;Chapter 18. Executive Functions;376
24.1;Teaching Procedures;377
24.2;Structure of the Executive Functions Curriculum;378
24.2.1;Inhibition;378
24.2.1.1;Identifying Deficits in Inhibition Skills;379
24.2.1.2;Teaching Inhibition;379
24.2.1.2.1;Waiting;379
24.2.1.2.2;Simple inhibition instructions;380
24.2.1.2.3;Role-play inhibition of highly probable responses;380
24.2.1.2.4;Extend to the natural environment;380
24.2.1.2.5;Inhibition rules;381
24.2.2;Attention;381
24.2.2.1;Identifying Attention Deficits;382
24.2.2.2;Teaching Attention Skills;382
24.2.2.2.1;Orienting;382
24.2.2.2.2;Disengagement;383
24.2.2.2.3;Sustained attention;383
24.2.2.2.4;Shifting attention;384
24.2.2.2.5;Divided attention;385
24.2.2.2.6;Determining saliency;385
24.2.2.2.7;Paraphrasing and summarizing;387
24.2.3;Flexibility;388
24.2.3.1;Identifying Inflexibility;388
24.2.3.2;Teaching Flexibility;389
24.2.3.2.1;Hypothetical situations;389
24.2.3.2.2;Role-play situations;390
24.2.3.2.3;Extend to the natural environment;390
24.2.3.2.4;Flexibility rules;390
24.2.4;Memory;391
24.2.4.1;Identifying Memory Deficits;391
24.2.4.2;Teaching Memory;392
24.2.4.2.1;Commonly used memory strategies;393
24.2.5;Self-Management and Related Skills;394
24.2.5.1;Identifying Deficits in Self-Management Skills;394
24.2.5.2;Teaching Self-Management;395
24.2.5.2.1;Expanding self-awareness;396
24.2.5.2.2;Emotional self-control;397
24.2.6;Problem Solving;399
24.2.6.1;Identifying Deficits in Problem Solving;400
24.2.6.2;Teaching Problem Solving;400
24.2.7;Planning;402
24.2.7.1;Identifying Planning Deficits;403
24.2.8;Teaching Planning;403
24.3;General Tips for Success;404
24.3.1;Teach Relevant and Practical Skills;404
24.3.2;Make Sure the Child Has the Prerequisite Skills;405
24.3.3;Use Rules;405
24.3.4;Use Visual Supports;406
24.4;Common Pitfalls in Teaching Executive Function Skills;407
24.4.1;Teaching Children to Memorize/Failing to Generalize;407
24.4.2;Creating Prompt Dependency;407
24.4.3;Not Involving Parents;408
24.5;Summary;408
25;Chapter 19: Clinical Supervision;410
25.1;Supervising the Child’s Learning: Programming;411
25.1.1;ABA Procedures Versus Principles;411
25.1.2;Chronological Age Versus Mental Age;411
25.1.3;Curriculum;412
25.2;Supervision Across the Treatment Life Cycle;414
25.2.1;Intakes;414
25.2.2;Ongoing Clinical Supervision;416
25.2.3;Reports and Accountability;416
25.2.4;Discharge;417
25.3;Ongoing Clinical Problem Solving;418
25.3.1;Motivation;418
25.3.2;Procedural Integrity and Consistency;419
25.3.3;Prerequisite Skills;421
25.3.4;Skill Difficulty;422
25.3.5;Challenging Behavior;422
25.3.6;Poor Data Collection;423
25.3.7;Interference;424
25.3.8;Insufficient Learning Opportunities;424
25.3.9;Ecological Variables;425
25.4;Critical Repertoires of Clinical Supervisor Behavior;425
25.4.1;Confidence;425
25.4.2;Humility;426
25.4.3;Flexibility;426
25.4.4;Goal Oriented;427
25.4.5;Empathy;427
25.4.6;Professionalism;428
25.4.7;Urgency;428
25.4.8;Work Ethic;429
25.4.9;Positive Attitude;429
25.5;Common Pitfalls in the Supervision Process;430
25.5.1;Caseload;430
25.5.2;Inadequate Experience with Similar Learners in the Past;430
25.5.3;Being Defensive;431
25.5.4;Blaming the Diagnosis/Learner/Teacher/Parent;431
25.6;Supervising the Therapy Team: Staff Management;433
25.7;Staff Training;433
25.8;Staff Performance Management;434
25.9;Parent Training and Support;436
25.10;Summary;437
26;Chapter 20: Data Collection and Treatment Evaluation;438
26.1;Data Collection;439
26.1.1;Discrete Trial Data;439
26.1.2;Task Analysis Data;442
26.1.3;Free Operant Data;442
26.2;Treatment Evaluation and Data Analysis;445
26.2.1;Interpreting Data;448
26.3;Summary;452
27;Chapter 21: Organizational Structure;454
27.1;Clinical Job Descriptions;455
27.1.1;Therapist;455
27.1.2;Senior Therapist;457
27.1.3;Case Manager;458
27.1.4;Care Coordinator;459
27.1.5;Therapist Liaison;459
27.1.6;Clinical Supervisor;460
27.2;Higher Level Clinical Leadership;460
27.2.1;Clinical Manager;460
27.2.2;Regional Clinical Manager;461
27.2.3;Clinical Director;461
27.3;Management and Administration;462
27.3.1;Scheduler;462
27.3.2;Operations Managers;463
27.4;Summary;464
28;Chapter 22: Training and Quality Control;466
28.1;Therapist Training;467
28.1.1;Initial Training;468
28.1.1.1;Classroom Training;468
28.1.1.2;Field Training;470
28.1.2;Ongoing Training;472
28.2;Senior Therapist;473
28.2.1;Initial Training;474
28.2.2;Ongoing Training;476
28.3;Therapist Liaisons;477
28.3.1;Initial Training;477
28.4;Clinical Supervisor Training;478
28.4.1;Qualification Exam;478
28.4.2;Initial Training;479
28.4.3;Mentorship;481
28.4.4;Ongoing Training;485
28.5;Clinical Supervisor Ongoing Quality Assurance;486
28.5.1;Supervisor Performance Evaluations;486
28.5.2;Program Reviews;487
28.5.3;Yearly Clinic Attendance;487
28.6;Summary;487
29;Chapter 23: Ethics;488
29.1;Why Do ABA Providers Need Professional Ethics?;488
29.2;Scenario: Integrity;489
29.3;Scenario: Dual Relationships;490
29.4;Scenario: Dual Relationships;491
29.5;Scenario: Professional Relationship;492
29.6;Scenario: Professional Development;493
29.7;Scenario: Competence and Consultation;494
29.8;Scenario: Functional Assessment and Punishment;495
29.9;Scenario: Integrity and Harmful Reinforcers;496
29.10;Scenario: Data Collection;497
29.11;Scenario: Data-Based Program Modifications;497
29.12;Scenario: Consent for Program Modifications;498
29.13;Scenario: Medical Consultation and Least Restrictive Treatments;498
29.14;Scenario: Treatment Efficacy and Third-Party Relationships;499
29.15;Summary;500
30;Chapter 24: Medical Treatment and Interdisciplinary Collaboration;502
30.1;Medical Treatment for Autism;503
30.1.1;Medical Treatment for the Pathophysiology of Autism;503
30.1.2;Interacting with Parents over Unproven Treatments;504
30.1.3;Medical Treatment for Comorbid Medical Conditions;506
30.1.4;Effect of Comorbid Medical Disorders on Learning;506
30.1.5;Research on Medical Factors in Autism;507
30.2;Building Productive Collaborative Relationships;507
30.2.1;Being Respectful;507
30.2.2;Cooperative Communication;508
30.2.3;Modeling;510
30.2.4;Use a Behavior Analytic Perspective;511
30.2.5;Assessment and Evaluation;512
30.2.6;Implementing Preventative and Protective Strategies at the Professional Level;514
30.2.7;Taking Turns with Treatment Approaches;516
30.2.8;Be a Translator and an Interpreter;517
30.2.9;Self-Check;518
30.3;Summary;520
31;Chapter 25: Standardized Assessment;522
31.1;Categories of Standardized Assessment;523
31.1.1;Norm-Referenced Tests;523
31.1.2;Structured Interview;524
31.1.3;Structured Observation;524
31.2;Psychometrics;525
31.2.1;Norms;525
31.2.2;Reliability and Validity;526
31.2.2.1;Types of Reliability;526
31.2.2.2;Types of Validity;527
31.3;Interpreting Standardized Assessment Scores;527
31.4;Bell Curve;528
31.5;Raw Scores;528
31.5.1;Percentile;528
31.5.2;Standard Score;528
31.5.3;Age and Grade Equivalents;529
31.5.4;Cut-Off Scores;529
31.6;Assessments;529
31.6.1;Adaptive Measures;529
31.6.2;Intelligence Testing;530
31.6.3;Social Skills;532
31.6.4;Language;532
31.6.5;Neuropsychological, Executive Function, and Problem Solving;533
31.6.6;Achievement Tests;534
31.6.7;Developmental Assessments;534
31.7;Using the Results of Standardized Assessments;535
31.7.1;Identifying Targets for Treatment;535
31.7.2;Progress Tracking;536
31.8;Summary;537
32;Chapter 26: Technology;538
32.1;Assessment and Curriculum;538
32.2;Assessment;538
32.3;Curriculum;538
32.4;Teaching Technology;542
32.5;Games and Applications;542
32.6;Communication Applications;543
32.7;Challenging Behavior Management;544
32.8;Other Clinical Tools;544
32.9;Data Collection;545
32.10;Care Coordination and Case Management;547
32.11;Training;548
32.12;Institute for Behavioral Training (IBT);548
32.13;Telemedicine;549
32.14;ABA Business Management Solutions;549
32.15;Community Outreach;549
32.16;Summary;550
33;Chapter 27: Research;552
33.1;The Importance of Research;552
33.1.1;Importance of Single-Subject Research Methodology;553
33.2;Foundational Research of which You Should be Aware;554
33.2.1;Studies;554
33.2.2;Reviews and Meta-Analyses;557
33.2.3;Reviews by Independent Agencies and Associations;558
33.3;Research at the Center for Autism and Related Disorders;559
33.3.1;Teaching Cognitive Skills;559
33.3.2;Technology in Autism Treatment;560
33.3.3;Challenging Behaviors;560
33.3.4;Safety Skills;560
33.3.5;Recovery from Autism;561
33.3.6;Biomedical Factors;561
33.4;Autism Research Group;562
33.5;How to Stay Connected to New Research;562
33.5.1;Journal Club;563
33.5.2;Journal Access;563
33.5.3;Continuing Education Seminars;564
33.6;How to Do Research in Your Organization;564
33.6.1;Rule #1: Make It Someone’s Job to Do Research;564
33.6.2;Rule #2: Involve Someone With Research Experience;565
33.6.3;Rule #3: Support Conference Attendance;566
33.6.4;Rule #4: Start Small;566
33.7;Summary;567
34;Chapter 28: Global Dissemination;568
34.1;Remote Clinical Services Model;568
34.1.1;Initial Training Workshop;568
34.1.2;Cycle of Services;569
34.1.3;Training Tools;570
34.1.4;Therapists;571
34.1.5;Funding;572
34.1.6;RCS Supervisors;573
34.2;Affiliate Sites;574
34.3;Cultural Challenges;575
34.4;Summary;577
35;Appendix A: CARD Indirect Functional Assessment (CIFA);578
36;Appendix B: Behavior Intervention Plan Short Format;580
37;Appendix C: Sample Curriculum Lesson from Skills® (abridged for length), Reprinted with permission from the Center for Aut ...;582
38;Appendix D: CARD Language Curriculum;590
39;Appendix E: Card Play Curriculum;596
39.1;I. Level One;596
39.2;II. Level Two;596
39.3;III. Level Three;597
39.4;IV. Level Four;598
39.5;V. Level Five;598
39.6;VI. Level Six;598
39.7;VII. Level Eight;599
40;Appendix F: Card Adaptive Curriculum;600
40.1;I. Level One;600
40.2;II. Level Two;600
40.3;III. Level Three;601
40.4;IV. Level Four;602
40.5;V. Level Five;602
40.6;VI. Level Six;603
40.7;VII. Level Seven;603
40.8;VIII. Level Eight;603
40.9;IX. Level Ten;603
40.10;X. Level Eleven;604
40.11;XI. Level Twelve;604
41;Appendix G: Card Motor Curriculum;606
41.1;I. Level One;606
41.2;II. Level Two;607
41.3;III. Level Three;608
41.4;IV. Level Four;609
41.5;V. Level Five;609
41.6;VI. Level Six;609
42;Appendix H: Card Academic Curriculum;610
42.1;I. Level Three;610
42.2;II. Level Four;610
42.3;III. Level Five;611
42.4;IV. Level Six;612
42.5;V. Level Seven;613
42.6;VI. Level Eight;614
42.7;VII. Level Nine;614
42.8;VIII. Level Ten;615
43;Appendix I: Card Social Curriculum;618
43.1;I. Level One;618
43.2;II. Level Two;618
43.3;III. Level Three;619
43.4;IV. Level Four;619
43.5;V. Level Five;620
43.6;VI. Level Six;621
43.7;VII. Level Seven;621
43.8;VIII. Level Eight;622
43.9;IX. Level Nine;622
43.10;X. Level Ten;623
43.11;XI. Level Eleven;623
43.12;XII. Level Twelve;624
44;Appendix J: CARD Cognition Curriculum;626
44.1;I. Level Two;626
44.2;II. Level Four;626
44.3;III. Level Six;626
44.4;IV. Level Seven;627
44.5;V. Level Eight;627
44.6;VI. Level Nine;628
44.7;VII. Level Ten;628
44.8;VIII. Level Eleven;629
44.9;IX. Level Twelve;629
45;Appendix K: Card Executive Functions Curriculum;630
45.1;I. Level One;630
45.2;II. Level Two;630
45.3;III. Level Three;631
45.4;IV. Level Four;632
45.5;V. Level Five;632
45.6;VI. Level Six;633
45.7;VII. Level Seven;634
45.8;VIII. Level Nine;634
45.9;IX. Level Ten;634
45.10;X. Level Eleven;635
45.11;XI. Level Twelve;635
46;References;636
47;Glossary;642
48;Index;652
Preface
Doreen Granpeesheh, Ph.D., BCBA-D Thirty-six years ago, I took a class at UCLA called Behavior Modification. It was an upper division course in psychology taught by a charismatic, funny, and very popular professor named O. Ivar Lovaas. Little did I know then that I was embarking on a journey that would shape the rest of my life. I studied with Ivar for 12 years. He taught me a great deal about autism, and he showed me how the environment can change behavior. As my mentor, Ivar gave me the foundation for what would eventually become the CARD Model. During those 12 years, Ivar introduced me to B.F. Skinner, whose work exemplified everything we now call applied behavior analysis (ABA), and to Bernie Rimland, whose foresight taught me to look beyond ABA when treating autism and to consider the value of biomedical interventions because autism is so often accompanied by comorbid conditions whose resolution optimizes the effectiveness of ABA. When I started working with children with autism in the late 1970s, it was a very different world. Autism was rare, with a prevalence of 1 in 15,000 children. Very little research had been done on the etiology of autism, and we knew only that autism was a very debilitating, severe, and lifelong disorder. We didn’t know it could be treated, we didn’t think it could be overcome, and we most certainly never imagined it would one day affect 1 in 68 children. In 1979, I started working at the Young Autism Project at UCLA. We were in the midst of experimenting with behavioral procedures to find a way to reduce the severely self-injurious behaviors of a handful of children who were living at the Autism Unit at Camarillo State Hospital, and we had just started fine-tuning the steps for teaching attention, compliance, and basic language. We called these teaching steps “Discrete Trial Training.” The Young Autism Project consisted of a handful of graduate students who were training undergraduates how to use behavior modification to teach a small number of children whom we had been treating for a few years. This “clinic” was the setting of the 1987 seminal study, Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children (Lovaas, 1987), which proved not only that children with autism can learn but also that they can learn to overcome the symptoms of autism as a whole. I enjoyed providing therapy to the children in that study. I learned the importance of good documentation and data collection from that study, and I realized for the first time in my life that, with perseverance and courage, we can overcome even those things we think are impossible to change. In 1990, I earned my doctorate from UCLA and began working with children with autism outside of UCLA. Treating children with autism was, to be honest, the only thing I knew how to do well. I had completed my training with Ivar, had worked with and supervised many children of all levels of functioning, and had conducted research on many different aspects of autism; it was time to move on. Opening my own center was really not something I had planned. A couple of Ivar’s previous graduates were running autism programs at other University of California campuses, and Ivar had suggested that I consider doing the same. While the idea appealed to me, my parents had just emigrated from Iran and were living near me in Los Angeles. We had been separated by thousands of miles for years, and I was determined to stay in Los Angeles and be with them. When I left UCLA, a few children had aged out of the Young Autism Project (then called the Clinic for the Behavioral Treatment of Children). Ivar asked me to take over the treatment of these children, and so my practice began. I was supervising a handful of children and had hired ten or so therapists to work with them. Since I had never really run a business before, I was driving from house to house, often training therapists at local coffee shops at night and paying them from my personal checkbook to make sure the children got the hours of therapy they needed. It wasn’t long until I realized I needed an actual location, so I wouldn’t have to waste so much time driving. Initially, I subleased an office near UCLA in Westwood, but, within a few months, I had met so many new families who needed help that I outgrew my Westwood space. I moved just north of Westwood to the San Fernando Valley, where I leased my first actual clinic space in Encino. That’s where I chose the name CARD, and that’s where I incorporated the business as well. CARD officially opened in June 1990. From 1990 to 1993, the business grew from 5 children to 25. I hired therapists from the UCLA program, and I myself supervised the treatment, wrote the reports, scheduled the therapists, conducted the school observations, issued the billing, and completed the payroll. Many of those original CARD employees still work with me. One of the therapists, Niloufar Ardakani, offered to help me with some of the administrative tasks. One day, as we were filling out billing forms, with excitement over our growth, Nilou asked me, “How many children do you think we can treat?” I remember saying that I couldn’t imagine we’d ever be able to handle more than 40 to 50 children since I was only able to supervise that many. It hadn’t yet occurred to me that I could train supervisors as well. In 1995, when I was expecting my first child, I realized it was time to choose a supervisor to cover for me on maternity leave. That was when I suddenly realized that CARD could grow beyond the 50 children I had envisioned. With that supervisor (Evelyn Kung, who is now CARD’s clinical director), we doubled our clients and began a rapid phase of expansion. (Nilou, by the way, is now in charge of one of our billing departments at CARD.) With the realization that I could train supervisors and expand the impact of CARD, I began to establish new CARD locations. I opened a second CARD clinic in New York as a result of my relationship with Catherine Maurice, an early autism advocate and author of Let Me Hear Your Voice (1993), a book about the impact of ABA therapy on Catherine’s two children. By this time, it was the mid-1990s, and the Internet age was just upon us. A group of families who believed in Lovaas’s style of ABA had formed a group on the Internet called “ME-List,” taking its name from Lovaas’s first book on autism, Teaching Developmentally Disabled Children – The Me Book (1981). We relied on this book early in autism treatment when applying the principles of ABA to treat the symptoms of autism. The Me-List parents created a very rudimentary form of a chat room on Prodigy, one of the two existing Internet portals available at that time. Many of these families knew me from when I had supervised their children at UCLA. One of the parents, a dad who lived in the San Jose area in Northern California, had asked for my help, and I had been flying to San Jose to help his team of therapists. One day, he asked me if I could open a CARD clinic in his area, and I explained that I would need 25 families in order to make it work. He posted the following notice on the ME-list: “CARD will open a clinic anywhere there are 25 families who need help.” Over the next 5 years, I opened 10 clinics, all because of that one posting on the Internet. CARD now has clinics throughout the United States, and we are opening more clinics every year. At any one time, we work with over 1,500 families and have close to 2,000 employees (therapists, senior therapists, care coordinators, case managers, supervisors, administrators, managers, and directors). I didn’t build CARD alone. The core of the company consists of people who joined me in the early years, and they have continued to grow and develop beside me. These people are called “seniors.” They do almost everything, including training (Theresa Contreras, Monique Ericson, Cecilia Knight, Denise Rhine, Jennifer Yakos), quality assurance (Evelyn Kung, Sienna Greener-Wooten), family counseling and training (Vince Redmond), curriculum development (Carolynn Bredek, Kathy Thompson), administration (Hank Moore, Cathy Vizconde), daily operations (Sarah Cho), expansion (Catherine Minch, John Galle), CARD Academy (Mary Ann Cassell), training of our affiliate international sites (Soo Cho), and specialized areas of programming (Lisa Bancroft, Renat Matalon). A few non-clinical people have also made significant contributions to CARD since the early days. These include Andrea Harrington (finance), Anderson Raminelli (information technology), and Nicole Simpson, who has managed numerous projects since 1995. These seniors have been with CARD through decades of change, and they have always welcomed new talent with humility and adjusted to change with flexibility. Their spirit and character have deeply influenced the CARD culture in which we are determined never to stop learning. Without a doubt, CARD would not be what it is today without my colleagues Cathy Vizconde and Dennis Dixon. Cathy has literally been at my side since 1994, spending two decades helping me develop the structure that enables CARD to continue to grow. Dennis, who joined CARD in 2007, has helped take CARD into the next century. With his uncanny ability to organize our goals while always keeping our mission directly in view, we have now built educational games that will help our children learn, even when they are playing. Together, we have learned a great deal more than we ever imagined. We have learned that autism is different from any...
