2019 Events
Social Relationships of Girls with ASD
Featuring Michelle Dean, Ph.D. – 12/05/2019
The literature indicates there are challenges diagnosing and treating females with autism spectrum disorder (ASD; Girelli et al., 2010). This may partly be due to a male bias in ASD research, as our understanding of ASD is largely based on samples that are predominately male. Gender differences in the social behaviors and expectations of males and females may also lead to delayed diagnosis or misdiagnosis of females with ASD. These challenges have important implications for the diagnosis and treatment of females with ASD and additional research is warranted to address the unique needs of females with ASD.
What We Learned
- Typically developing elementary school boys and girls often socialize in different ways during recess. Boys tend to participate in games, while girls tend to engage in conversation (Maccoby, 1998). These differences may make detecting the social challenges of girls more difficult to identify than the social challenges of boys.
- Girls with ASD often adopt compensatory behaviors, such as hovering, initiating, and entering social activities, allowing them to “camouflage” with their typically developing peers. Camouflaging helps girls with ASD to fit in and make connections, but can be exhausting and threatening to self-identity (Hull et al., 2017).
- The social challenges of girls with ASD are often different from the social challenges of boys with ASD. Girls may have difficultly developing and maintaining friendships with neurotypical peers due to the complexity of female relationships, the subtlety of social negotiations, and the fast-paced dynamics of girl groups. Therefore, special consideration and preparation are essential when developing interventions for girls on the spectrum.
Ethical Dilemmas and Realistic Solutions: Grappling with the Challenges of Practicing Behavior Analysis in the Real World
Featuring Ilene Schwartz, Ph.D. – 10/17/2019
The Professional and Ethical Compliance Code (PECC) for Behavior Analysts provides a framework regarding both professional and ethical requirements for BCaBAs, BCBAs, and BCBA-Ds and has been in effect since January of 2016, replacing the BACB Guidelines for Responsible Conduct for Behavior Analysts. With the PECC, there is now a set of rules that defines ethical behavior under all circumstances for behavior analysts. It is important that all behavior analysts, applicants for these certifications, and authorized continuing education providers understand and implement appropriate strategies when facing ethical dilemmas. Additionally, it is important to brainstorm realistic solutions that are appropriate to the context of the situation.
What We Learned
- A helpful process for ethical decision making includes clarifying the problem, brainstorming solutions, evaluating solutions, identifying an acceptable solution, implementing a solution with fidelity and careful documentation, and reflecting on the results.
- When facing an ethical dilemma, it is important to clarify the issue in terms of context and cultural background in order to identify the relevant codes within the PECC and to guide the solution-making process.
- It is important to reflect on solutions and implementations, especially through documentation, to ensure effective ethical decision-making and acceptable client safety, dignity, self-determination, and overall outcomes and impacts.
Summer Training Workshop for Preschool Educators - July 2019
The two-day training workshop was for Preschool Special Education and General Education Teachers, Teaching Assistants, Behavior Interventionists, Speech and Language Pathologists, Occupational Therapists and School Psychologists from local school districts. The workshop included demonstrations, guided observation, behavioral rehearsal activities to practice new skills, interactive instruction, handouts outlining new skills, and an overview of the research underlining the content. Attendees became familiar with developing play skills, utilizing strategies for challenging behaviors in the classroom, and increasing social communication.
UCLA CART Overview
Dr. Patricia Renno is a Clinical Instructor in the Department of Psychiatry at UCLA and a licensed Clinical Psychologist. She specializes in the assessment and treatment of autism spectrum disorder (ASD) and related psychiatric conditions in children and adolescents.
- Core symptoms of autism spectrum disorder (ASD) include deficits in social communication and the presence of restricted and repetitive behaviors.
- No single cause of autism has been identified, rather most cases are a combination of genetic risk and environmental factors.
- Psychiatric and medical comorbidities (e.g., anxiety disorder, ADHD) are very common in individuals with ASD with up to 71% of youth with ASD presenting with a co-occurring condition.
- There are many evidence-based treatments, such as applied behavior analysis (ABA), social skills training, and cognitive behavioral therapy (CBT). Many of these types of treatments are available at UCLA.
Executive Functioning
Dr. Alex Sturm is an Assistant Professor of Psychology at Loyola Marymount University. She was a Postdoctoral Scholar at the UCLA Center for Autism Research and Treatment, where she co-developed the thinkSMART intervention that targets executive functioning weaknesses in teens.
Ms. Caitlin McCracken is the director of the Summer Scouts Program at the UCLA LAB School and received her Master’s Degree in Special Education. She has worked in the field of special education supporting children, families, and school districts for over 8 years.
- Executive functions are higher order cognitive processes (i.e. inhibitory control, cognitive flexibility, and working memory) that enable goal-directed action and adaptive responses to ambiguous or novel situations.
- Executive functioning impairment often manifests as cognitive inflexibility and challenges with planning and inhibition in children with ASD.
- Using the steering wheel of executive function, targeted interventions can be integrated into a classroom setting; for example: planning using a schedule, inhibition and flexibility during games, etc.
AAC Devices
Dr. Charlotte DiStefano is a Clinical Instructor in Psychiatry and Biobehavioral Sciences, and a Clinical Psychologist in the UCLA Child and Adult Neurodevelopmental (CAN) Clinic. She provides assessments for children with ASD and related neurodevelopmental disorders, and she is primarily interested in language development and minimally verbal children with ASD.
- Approximately 30% of school-aged children with ASD are minimally verbal (Anderson et al., 2007); predictors of language outcome include joint attention, gestures, motor skills, imitation, and nonverbal cognition.
- Augmentative and alternative communication (AAC) devices can increase a child’s access to communication and build other communication skills; they do not impede spoken language development.
- AAC devices should be introduced at the child’s level, implemented across environments, and incorporated into learning activities.
Remaking Recess
Mr. Kyle Sterrett is a Clinical Psychology Trainee and Graduate Student Researcher in the Department of Education at UCLA under Dr. Connie Kasari. He is interested in the development and evaluation of early interventions targeting core social communication deficits in children with ASD.
- Children with ASD often have more difficulty in unstructured environments, such as recess and lunch, and peer connections are predictive of positive school outcomes.
- Remaking Recess is an intervention developed for school-aged children to target social skills, peer engagement, and friendships.
- Strategies include monitoring the playground, transitions and setting up activities, preparing and beginning activities, facilitating engagement, and facilitating conversation.
NDBIs
Dr. Amanda Gulsrud is an Assistant Clinical Professor in the Department of Psychiatry in the David Geffen School of Medicine and a licensed Clinical Psychologist. She also directs the UCLA Child and Adult Neurodevelopmental (CAN) Clinic and the UCLA CAN REACH Training program.
- There are many interventions that have been developed for individuals with ASD. Some are based on highly structured behavioral principles (e.g., discrete trial training), while others are based on more naturalistic, developmental behavioral principles (e.g., pivotal response training, JASPER, ESDM).
- Naturalistic Developmental Behavior Interventions emphasize naturalistic, spontaneous types of learning situations that target child interests. They focus on early core deficits of social communication and play, engagement and parent synchrony, natural settings, and prompting and contingencies.
- The approach for targeting core social communication deficits matters, and the field should strive to individualize targets and the approach for teaching these targets.
Modified Cognitive Behavior Therapy
Dr. Patricia Renno is a Clinical Instructor in the Department of Psychiatry at UCLA and a licensed Clinical Psychologist. She specializes in the assessment and treatment of autism spectrum disorder (ASD) and related psychiatric conditions in children and adolescents.
- There is a high prevalence of anxiety in youth with ASD (approximately occurring in 40% of children with ASD), including separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, specific phobias, and obsessive compulsive disorder.
- The Cognitive Behavioral Therapy framework focuses on how thoughts, behaviors, and emotions are related and addresses anxiety through psychoeducation, skills training, and skills practice.
- For children with ASD, modifications such as rewards systems, visual aids, and use of special interests can be used to increase a child’s engagement and progress in therapy.
Think Outside the Box: Approaching Behaviors
Dr. Stephanny Freeman is a Clinical Professor in the Department of Psychiatry at UCLA and a licensed Clinical Psychologist. She co-directs the Early Childhood Partial Hospitalization Program (ECPHP) at UCLA.
Ms. Sarah Gross is a licensed Speech and Language Pathologist at the Early Childhood Hospitalization Program (ECPHP) at UCLA. She is currently a student of Northwestern’s speech language pathology clinical doctorate program.
- When approaching behavior, providers should avoid paradigm paralysis, where they are unable to see alternative points of view and cannot develop effective interventions based on other theories.
- There are many different types of models that explain behavior: internal influences, external influences, and internal with external influences. Internal influences include the medical model and sensory processing model. External models include the behavioral model, social learning theory, ecological sociological model, and family systems model. Internal with external influences models include the psychodynamic model, developmental model, and cognitive behavioral model.
- Providers are encouraged to think theoretically, and apply systematically.
From Assessment to Treatment: What Should Providers Know?
Featuring Somer Bishop, Ph.D. - 06/06/2019
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and interaction and the presence of restricted, repetitive behaviors. Many factors, including age, developmental level, and expressive language level, significantly affect how behaviors present in individuals with ASD. Recent research suggests that the vast majority of individuals with ASD develop some functional language (i.e., less than 20% of children with ASD are minimally verbal); however, research also indicates that the majority of children with ASD continue to exhibit ASD-related difficulties into adulthood. It is important that researchers continue to develop appropriate treatments and treatment goals, as no one treatment is necessarily appropriate for all individuals with ASD.
What We Learned
- When assessing ASD, it is important to consider an individual’s age, cognitive functioning, language ability, daily living skills, social communication skills, and restricted and repetitive behaviors in order to identify developmentally appropriate intervention targets.
- Assessment should be individualized and conducted at regular intervals to provide a baseline and measure progress over time and treatment efficacy.
- It is essential that providers help families plan for the future and discuss issues they are likely to face over time.
Executive Function Development and Targeted Treatment Approaches for Preschool-Aged Youth with ASD and ADHD
Featuring Alex Sturm, Ph.D. and Caity McCracken, M.A. - 05/09/19
Executive functioning skills include planning, problem solving, inhibition, organization, flexibility, working memory, and emotional control. Deficits in executive functioning skills are often observed in children with ASD as young as three years old and impact all domains of functioning including school readiness, academic achievement, social communication, and adaptive behavior. In particular, children with ASD often struggle with cognitive flexibility, planning and inhibition. Children with ASD and ADHD show additional difficulties with planning, verbal fluency, working memory, and emotional control. Preschool is a critical period to target executive functioning skills because it is when the greatest gains in executive functioning skills occur; however, few executive functioning interventions for young children with ASD exist.
What We Learned
- Children with ASD often have deficits in their executive functioning skills related to cognitive flexibility, planning, and inhibition that are present early in childhood.
- There is a need for interventions targeting executive functioning skills in preschoolers with ASD. Pilot studies suggest important components of an executive functioning intervention for young children with ASD are teaching skills and strategies through play and structure of sessions, parent involvement, and scaffolded teaching of skills.
- Approximately 40% of Individuals with ASD have co-occurring ADHD. Individuals with ASD and ADHD have a greater discrepancy between their cognitive ability and adaptive behavior and a lower quality of life.
Putting the Pieces Together: Using a Modular-Based Intervention to Support Students with ASD in Classrooms
Featuring Suzannah Iadarola, Ph.D. - 03/07/19
Interventions found to be effective in research studies conducted at universities often fail to translate to real-life settings, such as schools and community-based mental health agencies (Damschroder et al., 2009). This is also true for evidence-based interventions for children with ASD and their implementation in school settings (Kasari & Smith, 2013). Common barriers to implementation of evidence-based interventions for children with ASD in schools are lack of resources (training, people, funding), lack of educator skills to implement evidence-based practices, and need for a modular approach that can adjust contextually to diverse school environments (Iovannone et al., under review). To address these challenges, the Modular Approach to Autism Programs in Schools (MAAPS) was developed as a comprehensive intervention for students with ASD to address core and associated features of ASD in the school setting.
What We Learned
- The modular intervention, MAAPS (Modular Approach to Autism Programs in Schools), was created to support students with ASD in school classrooms. The modular approach addresses barriers to implementation of evidence-based practices in the school setting due to its flexibility, efficiency, and focus on collaboration.
- MAAPS is a framework for school teams to assess skills, select interventions, design implementation, and make data-based decisions. It also provides active coaching support for teachers. Modules are chosen based on the needs of the student (e.g., social communication, repetitive behavior, cognitive-academic, problem behavior).
- Based on a randomized control trial to evaluate the feasibility and preliminary outcomes of MAAPS, results showed good feasibility and improvements in students’ overall functioning and social functioning.
Transitions for Young Adults with Autism Spectrum Disorder: What We Know and What We Need
Featuring Caroline Grantz, Ph.D. - 01/24/19
Young adulthood can be an exciting time for many individuals as they transition to community college, university, employment, trade school and other opportunities. However, the transition into young adulthood can be a particularly difficult time for those with autism spectrum disorder (ASD; Schall & Wehman, 2008; Sitlington & Clark, 2006). Most individuals with ASD face challenges as they try to negotiate college, work, social life, and independent living (Hendricks & Wehman, 2009). Transition planning for individuals with ASD has received growing attention in educational research and practice; however, there continues to be unmet needs.
What We Learned
- There is NO “One-size-fits-all” transition program. It is important for families to consider services and supports in the following areas when transition planning: legal, financial, medical, employment, and housing.
- Students with Individualized Education Programs (IEPs) must have transition goals by age 16. Transition plans should focus on independent daily livings skills, executive functioning skills, distress tolerance and emotional functioning, and ASD symptoms.
- The UCLA College to Careers program works with young adults with ASD to build employment-related skills and connect them with local businesses for internships. Businesses and community partners can create structured programs that recruit young adults with ASD and support their integration into work settings. Some local businesses that are currently supporting young adults with ASD are TranZitions Consulting, Northwestern Mutual, and Exceptional Minds Studio.