Intervention, support and context Flashcards
Interventions
-potential therapies
zinc music therapy art therapy diet homeopathy holding therapy sensory integration therapy EXERT CAUTION: -check for scientific evidence --> often people make enthusiastic statements about therapy
Early intervention
3 main types?
psychoeducational programs (more scientific basis behind these interventions)
1) to support communication (eg. PECS)
2) behavioural intervention (eg. ABA)
3) general developmental/educational strategies
(often take elements from elsewhere to meet requirements)
PECS (picture exchange communication systems)
- phases?
- positives?
begins by teaching an individual to give a picture of a desired item to a ‘communicative partner’, who immediately honours the exchange as a request
(eg. food, so child is motivated to attain)
- the system goes on to teach discrimination of pictures and how to put them together to form a sentence
- more advanced stages, individuals are taight to answer questions and to comment
PHASES:
1 - child learns how to communicate
2 - distance and persistence - generalise skill learnt in phase 1 (eg. people/ places)
3 - picture discrimination - children learn to select 2 or more pictures to ask for their favourite things (use Velcro strips)
4 - sentence structure used eg. ‘I want’
5 - begin to answer questions
6 - comment on different aspects of environment
+ useful in helping to develop communication
+best for moderate-severe range of difficulty (less used for those with lesser problems)
+ can be used for multiple disorders eg. autism, fragile X, Williams and sotos
Using staged intervention can be helpful to develop communication
difficult behaviour may be self-injurious = begin with stage 1
it can help with challenging behaviour (as they often engage in this behaviour due to frustration of having a barrier to communication)
Applied behavioural analysis (ABA)
Lovaas (1987) recommendations: start before age 3 -at least 40 hours a week - therapy should last at least 2 years - multiple 121 discrete trials intense intervention with a rigid structure can be applied to a range of conditions
Early start Denver model
sally rogers
created for early intervention (v young children)
as young as 12 months
- at this age, everyone is learning to speak so its used to help these children ‘catch up’ at this young age
- 20hrs therapy a week
-rather than just analysing communication or eye contact it looks at many skills
- learning oppurtuity every 10 seconds (lots of exposure to communication skills)
5 months later = often successfully caught up
BUT
is this treatment appropriate? should we be training autism out of children?
Review of 14 behavioural studies found it to be ‘effective’, what does this mean?
Key predictors of improvement?
behavioural programs are effective in improving several developmental aspects 'effective' = reducing autistic traits, acting more neurotypical key predictors: - program intensity - program duration - parental training - age at intake - adaptive behaviour at intake
Early start Denver model pros and cons?
pros:
-looks at multiple types of communication
-helps child catch up
-takes pressure off parents = enable positive interaction
-reduce challenging behaviour
-improve adaptive behaviour
- facilitate communication
cons:
- time commitment
-money/ financial cost
- very young = harder to diagnose child as needing ABA (only works well at young age)
- training someone to be neurotypical
-give parents false hope
-outcome not necessarily positive
Michelle Dawsons comments( autistic herself) - finds it wrong to try and change the way individuals with autism think
Controversies around early intervention
what does effective mean?
- less ‘autistic’ behaviour?
- higher IQ?
- more adaptive behaviour?
- long-term social outcomes?
Family support
considering the family perspective: find what family are hoping to achieve for their child
consider: worries, values/disvalue abut childs language, behaviour and education
Family focused research
bi-directional influence on family
impact on:
- daily routines
- stress increased
- may need support with self-care/mobility/communication and cog + emotional tasks
Research could inform clinical support services
Coping and support mechanisms identified
consider different family members separately
Why? - Guite et al (2004) found mothers report more sibling adjustment problems than the siblings do themselves
Positive impact on families?
- improved communication skills
- higher levels of empathy and patience
- increased compassion
- refocus of energy to positives
- improved self-concept and self-confidence
family systems approach def boundaries permeability boundary ambiguity resilience traumatic growth
family systems = all individuals a family counts on over time for comfort, care, nurturance, support and emotional closeness
boundaries = hypothetical borders between and within a family system and its environment.
- The external boundary defines the family in relation to other systems
- the internal boundaries determine who is included and excluded from subsystems
Permeability = degree of difficutly or ease that information and system members have in crossing the boundaries
-Open systems can be weak as boundaries are loosely defined resulting in confusion about family roles/ identities and goals.
- Closed systems can be rigid and restrict info permitted into the system = limits physical/ psychological and social growth of the individual
Boundary ambiguity = confusion about roles and responsibilities experienced by family members resulting from poorly regulated boundaries
resilience = ability to cope with challenging life circumstances. Includes physical, psychological, emotional and social resilience
Traumatic growth = extension of resilience where coping involves a positive change as a result of challenging life circumstances such as increased appreciation of life, personal strength, family solidarity and quality of relationships
Future of research
recommendations:
- use of theoretical frameworks when trying to understand impact on families (social-ecological model)
- research can help identify appropriate resources
- don’t over rely on maternal self-reports
-expand family wellbeing research beyond the autistic childs early years
= a move away from a deficit model of family functioning, towards and appreciation of a strength-based approach
Context
variability
sample size
variability:
- universality of deficit = does it affect every individual of that population?
- inter-individual variability = could share some features, but there will be a lot of variability between individuals
- intra-individual variability = differences within an individual - could be affected by mood/ sleep/ hormones/ environment
sample size:
- larger the better? not necessarily
- practical considerations -> funding/resources
- what effect size is expected?
- anticipated drop-out rate (more likely with non-neuro typical due to extra challenges)
- participant fatigue - necessary to do multiple testing?
Use of standardised measure
-which measures?
based on neurotypical = can compare
BAS = British Ability Scale
WASI = Weschler Abbreviated Scale of Intelligence
ADOS = autism diagnostic observation schedule
VABS = Vineland adoptive behaviour scale
- appropriate for population? - performance may be underestimated as its based on neurotypical performance
- absolute or relative deficit?
(absolute is compared to neurotypical population eg. those who don’t have a diagnosed developmental condition. Relative is a comparison between the individuals own abilities)
- control group
- look at developmental trajectories
Developmental trajectory
beyond group comparison
- neuro-cognitive development is dynamic across the lifespan
- there is no static end state (still acquire skills as adults)
- potential changes as people age?
- tendency to recover/ plateau/ decline in certain areas?
What can studying neurodevelopmental disorders tell us?
- better understanding of alternative ways of thinking
- no single correct way of thinking or being
- individual differences contribute to a rich and vibrant society
- acceptance is vital
