Lecture 5 Intervention, Support & Context

Question 1

What are some potential therapies of ND disorders?

Answer 1

Zinc, music therapy, diet, art therapy, homeopathy, holding therapy, sensory integration therapy

• Exert caution and check for scientific evidence around these therapies

Question 2

What is the Picture Exchange Communication System (PECS)?

Answer 2

It is a communication programme which helps people with severe difficulties in developing their communication skills
Developed in 1985
Originally specifically designed for ASD children

Question 3

What is involved in Phase 1 of PECS?

Answer 3

Phase 1: How to communicate

- Learn to exchange single pictures for items/activities they really want

Question 4

What is involved in Phase 2 of PECS?

Answer 4

Phase 2: Distance & Persistence

• Learn to generalise new skill by using it in difference places, with different people, and across distances
• They are also taught to be more persistent communicators

Question 5

What is involved in Phase 3 of PECS?

Answer 5

Phase 3: Picture discrimination

• Students learn to select from two or more pictures to ask for their favourite things
• These are placed in a communication book, a ring binder with velcro strips where pictures are stored and easily removed for communication

Question 6

What is involved in Phase 4 of PECS?

Answer 6

Phase 4: Sentence structure
- Students learn to construct simple sentences on a detachable sentence strip using an “I want” picture followed by a picture of requested item

Question 7

What is involved in Phase 5 of PECS?

Answer 7

Phase 5: Answering questions

- Learn to use PECS to answer the question “what do you want?”

Question 8

What is involved in Phase 6 of PECS?

Answer 8

Phase 6: Commenting

- Taught to comment in response to Qs, such as “what do you see?”, “what do you hear?”, “what is it?”

Question 9

What is Applied Behavioural Analysis?

Answer 9

First published in 1987 as part of the UCLA Young Autism Project. The program recommends:

• starting before age 3
• at least 40 hours per week
• therapy should last at least 2 years
• one to one discrete trials

A very strict and intense intervention

Question 10

What is an important consideration for these kind of interventions?

Answer 10

Is it appropriate to train the autism out of people?

Question 11

What is the Early Start Denver Model?

Answer 11

Developed by Sally Rogers, a development of the ABA
For children as young as 12 months
20 hours a week, teach exercises to parents that they can continue at home
Works on improving several skills at once e.g. communication, eye contact, vocal imitation
Aims to have a learning opportunity every 10 seconds
BUT what is the goal of the program and is it appropriate?

Question 12

What are the key predictors of improvement?

Answer 12

In a review of 14 studies finding these programs to be effective, the key predictors of improvement were:

• Program intensity
• Program duration
• Parental training
• Age at intake
• Adaptive behaviour at intake

Question 13

What are the pros of these interventions?

Answer 13

Parents an experience positive interactions
Challenging behaviour can reduce
Can improve adaptive behaviour
Can facilitate communication

Question 14

What are the cons of these interventions?

Answer 14

Can be seen as training to be neurotypical when someone isn’t
Can give parents false hope
Financially
Outcomes may not necessarily be positive

Question 15

What does “effective” mean?

Answer 15

• Less autistic behaviour?
• Higher IQ?
• More adaptive behaviour?
• Long term social outcomes?

Question 16

What is the bi-directional influence on family?

Answer 16

• Daily routines
• May need support with self care, mobility, communication and cognitive or emotional tasks daily
• Increased experience of stress

Research on family could inform clinical support services, and facilitate coping and support mechanisms

Question 17

What did Guite et al. (2004) find?

Answer 17

That we should consider different family members separately

Found that mothers report more sibling adjustment problems compared to sibling self-report

Question 18

What is the positive impact of ASD on family?

Answer 18

• Improved communication skills
• Higher levels of empathy & patience
• Increased compassion
• Refocus of energy
• Improved self-concept and self-confidence

Question 19

What is the family systems approach?

Answer 19

It is useful for understanding what the family system is and how they impact one another (Cridland et al., 2014)

Question 20

Outline the boundaries aspect of the FSA

Answer 20

Boundaries are hypothetical borders between and within a family system and its environment
The external boundary defines the family in relation to other systems
Internal boundaries determine who is included and excluded in the sub systems

Question 21

Outline the permeability aspect of the FSA

Answer 21

The degree of difficulty or ease that information and system members have in crossing the boundaries
Open systems can be weak as boundaries are loosely defined results in confusion about family roles, identities and goals
Closed systems can be rigid and restrict info permitted into the system, limiting physical, psychological and social growth

Question 22

Outline the boundary ambiguity aspect of the FSA

Answer 22

Confusion about roles and responsibilities experienced by family members resulting from poorly regulated boundaries

Question 23

Outline the resilience aspect of the FSA

Answer 23

Ability to cope with challenging life circumstances. Includes physical, psychological, emotional and social resilience

Question 24

Outline the traumatic growth aspect of the FSA

Answer 24

An extension of resilience where coping involves positive changes as a result of challenging life circumstances such as increased appreciation of life, personal strength, family solidarity and quality of relationships

Question 25

What are Tint & Weiss’s (2015) recommendations for the future of family and wellbeing research?

Answer 25

Use of theoretical framework
Research can help to identify appropriate resources
Don’t over rely on maternal self report
Expand the research beyond the autistic child’s early years
There is a move away from a deficit model of family functioning and more towards a strength-based approach

Question 26

Outline variability in ND disorder research

Answer 26

Have to consider whether there is a universality of deficit i.e. is it experienced by everyone with the disorder like part of the diagnostic criteria, or just in some
Inter-individual variability
Intra-individual variability - age, amount of sleep, life events

Question 27

What can be said about sample size in ND disorder research?

Answer 27

It is generally assumed that the larger sample the better. But have to think about practical considerations such as funding and resources.
Also have to think about anticipated drop out rate which is more common in NDDs, what effect size is expected, participant fatigue may influence methodological choices, and essentially what is the research question you are trying to answer.

Question 28

What use of standardised measures is there in ND research?

Answer 28

• British Ability Scale (BAS)
• Wechsler Abbreviated Scale of Intelligence (WASI)
• Autism Diagnostic Observation Schedule (ADOS)
• Vineland Adaptive Behaviour Scale (VABS)

Are these appropriate for the population? Absolute/relative deficits? Need for a control group?

Question 29

Why is it important to track the changing of gene expression over time?

Answer 29

If a gene is expressed widely initially and becomes increasingly confined to certain brain regions, then the mapping from gene to phenotype will change
Need to consider findings within the CONTEXT of development, not just looking at individual snapshots

Question 30

How does the TD brain and WS brain differ?

Answer 30

The TD brain has a gradual specialisation and hemispheric localisation of function over time, this does not happen in the development of the WS brain
Even when WS individuals score in the normal range on face processing tasks, it doesn’t mean there is a selective ‘sparing’ of disability, because it has been shown that the cognitive and neural processes underlying this behaviour are still different from those of TD controls

Question 31

In ND research, why is it important to look at developmental trajectory?

Answer 31

Look beyond group comparisons
As neuro-cognitive development is dynamic across the lifespan
See whether there is recovery/plateau/decline