Little Star Center (LSC) — created by a family of a child with autism — was the first in Indiana to employ Applied Behavior Analysis (ABA) treatment, which has long been considered the most effective intervention method for children with autism. ABA features several instructional approaches for consideration when developing a learner’s personal program. One of the ABA evidence-based procedures used by the Little Star clinical team is ‘errorless learning’ or ‘errorless teaching.’ Errorless learning is a strategy to ensure independence in the learner and foster success by systematically fading out assistance. Learners (or all people, actually) , at times, become frustrated or discouraged if they make a mistake and may hesitate to try a skill again. Or, the learner learns a skill incorrectly, which then needs to be corrected. Frequently making errors or being asked to do work that is too difficult may provoke problem behavior such as tantrums, aggression or self-injury.
Errorless learning is the technique of making sure the learner provides the right answer to a question every time, reducing or eliminating mistakes. A key element of errorless teaching is the therapist prompting the answer when the learner appears uncertain; increasing the likelihood the learner makes the correct response. Prompts are extra cues or hints to help the learner know what to do in a particular situation or time (including physical assistance, pointing, demonstrating, showing a picture, writing a checklist, or asking what the learner wants). In addition to prompts, errorless learning uses positive reinforcement to assure the skill is performed again.
The process at Little Star sometimes involves flashcards with pictures or words on them or pointing to something. The learner is asked to identify the appropriate item, by matching, selecting or naming it. If the learner hesitates in responding, the therapist prompts him/her as many times as needed for the learner to understand what is required. The therapist monitors how often the learner needs prompting and how often he/she responds unaided in order to determine when to decrease prompting.
If the learner makes an error during the process of learning something new, the therapist does not make negative comments, nor provide reinforcement or reward. In these cases, the therapist withholds reinforcement and presents the instruction again providing an immediate full prompt of the correct answer or presents a new instruction.
As the learner performs the targeted skill independently, the therapist reduces prompting. Once the learner has mastered the skill, it is revisited periodically for maintenance purposes and the process begins again with a new skill.
Sensory integration therapy (SIT) has been commonly used in the treatment of individuals with autism since the 1970s. The primary theory behind SIT is that some children with intellectual/developmental disabilities commonly have sensory needs (related to the five senses of sight, sound, taste, touch, and smell) that are not adequately met. The goal of this method – which includes the brushing of skin, swinging and/or wearing a weighted vest — is to improve attention, reasoning and perception and decrease disruptive or repetitive behaviors. However, because this form of therapy remains largely untested, the success rate cannot be validated and the effectiveness of SIT remains questionable.
“Parents want to provide the best and most useful treatment for their children. They mean well when they specifically request this method because it is popular” said Bruce Golde, Little Star Center Occupational Therapist. “Some 80% of occupational therapists working with children today still use sensory integration as a basis for treatment. Sensory integration proponents believe it helps a child learn and develop normally, purporting to influence behaviors, improve learning and help with motor development. However, after more than forty years in practice, sensory integration still has very few studies that include a control group, making it difficult to determine if improvement a child may realize could be due to other factors such as natural maturation. Over the past eight years, more objective analysis has found other treatment inventions to be more effective than sensory integration.”
The2012 Research in Autism Spectrum Disorders journal features an article on a research project on this topic which reviews and analyzes 25 studies on sensory integration therapy: Sensory Integration Therapy for Autism Spectrum Disorders: A Systematic Review by Russell Lang, Mark O’Reilly, Olive Healy, Mandy Rispoli, Helena Lydon, William Streusand, Tonya Davis, Soyeon Kang, Jeff Sigafoos, Giulio Lancioni, Robert Didden, and Sanne Giesbers. Because many of these 25 studies were flawed, the reviewers determined that the evidence does not support the use of SIT as a treatment for children with autism spectrum disorders (ASD).
In addition, a recent article in the June 2012 issue of ADVANCE for Occupational Therapy Practitioners, titled “AAP Against SPD Diagnosis,” describes a new policy released by the American Academy of Pediatrics (AAP) recommending that pediatricians no longer diagnose sensory processing disorder (SPD) for children with sensory issues. This decision is based on the lack of research on SPD as a condition unique from other developmental disabilities and the limited and inconclusive research on the effectiveness of sensory integration therapy on children with autism spectrum disorder. (The AAP Policy Statement “Sensory Integration Therapies for Children with Developmental and Behavioral Disorders” appears in the June issue of Pediatrics, an official peer-reviewed journal of the American Academy of Pediatrics that serves authors and readers of the general medical profession as well as pediatricians.)
“The truth of the matter is…we simply don’t know what is going on in the brain of a child with autism,” said Golde. “We don’t know why a particular child has a preference for repeated touch. Certainly, a child may enjoy the sensory integration activity, but beyond that, the therapy doesn’t result in significant behavioral changes. Other forms of proven therapy are a better use of the child’s time. Parents should explore and discuss treatment options before making a decision.”
Mary Rosswurm, Executive Director of Little Star Center and the parent of a young adult with autism, says “Bottom line, there is a difference between enjoyment and benefit.”
Little Star Center highly recommends parents visit the Association for Science in Autism Treatment (ASAT) website as a reference for unbiased and reliable information not only on sensory integration therapy but other intervention methods they may be considering. ASAT is a not-for-profit organization established in 1998 to disseminate accurate, scientifically-sound information about autism and its treatment and combat inaccurate or unsubstantiated information.
There has been much international attention on the recent publication in BMC Medicine of a study by Harvard University and Children’s Hospital Boston on EEG testing in young children as young as two years of age. The study aimed to identify factors that separate children with autism spectrum disorder (ASD) from those without. One such article in ScienceDaily (June 25, 2012) summarizes the research conducted by Dr. Frank H. Duffy, Dept. of Neurology, and Heidelise Als, PhD., Dept. of Psychiatry, both at Boston Children’s Hospital.
The results revealed that children with autism exhibit consistent EEG patterns indicating altered connectivity between brain regions, “generally, reduced connectivity as compared with controls.” In the ScienceDaily article, Dr. Duffy was quoted, “We studied the typical autistic child seeing a behavioral specialist — children who typically don’t cooperate well with EEGs and are very hard to study. No one has extensively studied large samples of these children with EEGs, in part because of the difficulty of getting reliable EEG recordings from them.”
The study offers hope that EEG may provide a diagnostic test for the disorder on several levels, including early diagnosis which would enable children to begin therapy right away. In addition, it may help determine if Asperger’s should be considered a separate condition; indicate whether or not siblings of children with ASD may develop the same disorder; and track the effect of different types of autism treatment on the condition.
“We at Little Star Center want to start applied behavior analysis (ABA) therapy as early as possible. We are really excited about the possibility of individuals being diagnosed as early as 18 months of age,” said Tim Courtney, Little Star Center Research & Training Director. “Little Star has had one learner undergo an EEG scan already to help us evaluate behavioral strategies to get kids to comply with EEG, and begin evaluating the effectiveness of ABA at changing the structure of the brain. We hope to get more done moving forward as EEG diagnosis has an 80% accuracy rate. In practice, we’d like to have the test done before a learner begins ABA training then scan a year later to determine the value of ABA. The child we scanned had already been receiving ABA training; so, we can’t do the type of comparison we ideally want in that case. However, the doctor with whom we are working (Dr. Jane Yip) believes she saw ABA greatly helping the child.”
Dr. Jane Yip, PhD. is familiar with this study and is conducting more EEG’s in young children. She noted that they are finding that “coherence” is affected in autism. “Brain activity as a whole is functioning in a different way (in individuals with autism) from the neurotypicals (normals),” she said. “It’s like a person who has broken a leg will limp and the entire gait will be affected no matter which angle you choose to look at it from. This is a new frontier. It will be beneficial to further development of autism research to have data showing pre- and post changes of (brain) profiles and look for the biomarker that is most sensitive to treatment. Better visualization of results, both in behavior and brain performance, will help the children improve in a way previously undreamt of. The test is confirming to parents that ABA intervention can produce rewiring in the brain.”
Dear Mary is a bimonthly column whereby readers may submit questions to email@example.com and receive answers related to autism. Mary Rosswurm is executive director of Little Star Center and also the mother of a son who has been diagnosed with autism. She understands…
My son’s doctor recommended ABA therapy for him. He is four years old and doesn’t like loud places, lights on or other kids. I would like a home program for him.
The reasons you described (dislike of loud places, lights or other children) strongly suggest why your son needs a center-based program and not a home-based program. A robust center-based program offers access to other children, a variety of staff, the speech therapist, occupational therapist, outings, group activities and multiple layers of supervisors. Since your son is four, the goal is to get him prepared for kindergarten, and it will be essential that he can tolerate noise, lights and other people. Addressing these concerns require clinical expertise and closely monitored programming.
While I know that as a mom you want to make your child comfortable — and he may be more comfortable at home with one familiar person working with him each day — that is not real life. He needs to be able to be around new people, in novel situations. Let’s face it – the world is bright, loud and full of kids. As he gets older, he will become more and more isolated if we don’t begin to get him used to these things.
For example, two years ago I was terrified of the iPhone – I had my old flip phone and I didn’t want to learn about this new kind of phone. It seemed very complicated to me and I didn’t see why I needed access to my email or the Internet constantly. I really resisted it until finally my supervisor insisted that I get one. Period, end of story.
So, at first I HATED it. I dropped calls all the time and couldn’t figure out how to turn the stupid thing off while I was on a plane that was heading for take off. I couldn’t work the tiny key pad (that wasn’t even real keys) and every time I tried to hit the “M” key, I would hit the “backspace” instead. I hated it and I was miserable. BUT…the more I used it, the better I got and I learned new things about it everyday. My co-workers would gently encourage me to try new features like the GPS or face-time.
Now two years later, I can’t imagine how I lived without it. I am comfortable with it. It simply was a new skill that I needed to learn, which is exactly what these obstacles are for your son – things he needs to learn to tolerate. It will take time, he may be upset at first, but he will get comfortable and be able to be around these things that he finds annoying right now. Don’t lose sight of the big picture – where do you want him to be when he is 8, 12, 15 and 30? Not home alone, but out with people in different places.
I would encourage you to look at a center-based program for your son and stretch his comfort zone!
ABAI is the primary membership organization for those interested in the philosophy, science, application, and teaching of behavior analysis. Its events, research, education, journals, and resources help develop, enhance, and support the growth and vitality of the science of behavior analysis and contribute to success in the field. “This is the largest conference in the U.S. for those interested in behavior analysis,” said Tim Courtney, MS, BCBA, Research & Training Director for Little Star. “Thousands of people take part. Every year, we are exposed to innovative intervention methods, a number of which we bring back and implement at Little Star. It is a terrific learning opportunity.”
The 12 Little Star attendees enjoyed a variety of symposia, workshops, and clinical research poster sessions. Little Star was also recognized for its help in providing data and feedback on assessment techniques for a presentation by Dr. Thomas Zane, BCBA-D, which focused on addressing problem behavior. Dr. Zane is a professor of education and director of the Applied Behavior Analysis Online Program at the Institute for Behavioral Studies, Endicott College in Beverly, MA. Tim said, “Dr. Zane visited Little Star as part of a free community training on fad treatments in autism that Little Star hosted. It was a very good experience for all of us. We were honored to assist Dr. Zane and his important research evaluating assessment techniques to decrease problem behavior.”
ABAI poster 2012 on Comparing the Frequency and Diversity of Mands When Using Modified Sign English and Augmentative and Alternative Communication via an iDevice.
Little Star Center also submitted six research posters. The poster sessions provided the opportunity for one-to-one discussions with other conference participants who have experienced similar situations on how they may use our successful procedures for their own implementation. Posters topics comprised:
Comparing verbal behavior programming via sign language to an iDevice (iPad and iPod) shown in Figure 1;
Evaluating an intervention to help individuals with autism who experience heightened anxiety when encountering essential procedures such as medical, dental, or even haircuts;
Determining the feasibility of direct care therapists implementing two different commonly used assessment procedures to address problem behavior; trial-based functional analysis and traditional analogue functional analysis with limited training;
Evaluating a procedure to reduce a child with autism’s phobic avoidance of hair and hand dryers;
Assessing perseverative speech in a teenager with autism (repeatedly making the same request) using two types of contingent attention;
Teaching a learner with autism to respond to group-based instructions.
“The posters are scientific in nature and summarize the process and results,” said Tim. “One of the posters is shown above. Anybody interested in learning more about these posters may contact me at the center, 317.249.2242.”
Conference clinical workshops were intensive, day-long trainings on specific topics. Some personnel toured Morningside Academy, a nonprofit school for elementary and middle school students that integrates several behavior analysis activities and methods including research-based instructional technologies, direct instruction, precision teaching, and talk-aloud problem solving. “I am very impressed with what they are doing with precision teaching,” said Tim.
Other workshops attended by Little Star staff covered subject matter including:
Teaching Social Skills That Change Lives: Developing Meaningful Relationships for People Diagnosed with Autism;
Competency-Based Staff Training Within an Applied Verbal Behavior Program;
Applied Behavior Analysis and Speech Language Pathology: An Integrated Approach to Promoting Language in Learners With Autism;
Beyond Successive Approximations: Useful Shaping Strategies and Tactics to Improve Your Teaching;
Addressing Problem and Replacement Behaviors in Home and School Settings;
Advanced Verbal Behavior Programming for Intermediate Learners;
Teaching Advanced Language and Verbal Behavior Skills to Students With Autism: Inference Training, Reading Comprehension, and Communication Skills;
Evidence-Based Practices in Error Correction;
Intensive Early Intervention: Staff Training and Management Through a Dynamic Programming System;
Use of Web, Apple, and Android Applications to Increase Information Management and Skill Acquisition in Intensive Community-Based Instruction for Individuals With Autism and Other Disabilities;
Teaching Executive Functioning Skills to Adolescents With Challenging Behavior; Identifying Priorities for Teaching Children With Autism: Where Do We Begin?;
Assessing and Teaching Functional Skills to Children With Autism in Home, School, and Community Settings;
Technology and Learning: Developing Innovative Teaching Methods for Individuals With Autism Spectrum Disorders;
Fitness and Autism: Evidence-Based Practices to Promote Healthy Lifestyles and Inclusion Opportunities for Individuals With Autism Spectrum Disorders;
Teaching “Learning to Learn” Skills to Children Diagnosed With an Autism Spectrum Disorder;
Using the iPad to Aid Students with Autism to Communicate and Be Included in General Education Settings and the Community.
“The conference was exceptional this year,” said Tim. “We are very excited about the possibilities for our learners moving forward. Technology is providing lots of opportunities for assisting individuals with autism in the areas of communication, social skills, leisure and academics. I received a wonderful resource at one of the workshops that lists several iPod, iPad, and iPhone applications. (Click the links below for your area of interest.) Attending the conference is a great way to stay ahead of the rapidly advancing field of behavior analysis.”
ADOS training instructor works with a LSC learner during a May 2012 workshop.
Several Little Star Center (LSC) clinical team members participated in a two-day Autism Diagnostic Observation Schedule (ADOS-2) workshop in mid-May. This diagnostic tool is considered “the gold standard” for observational assessment of autism spectrum disorder (ASD). The workshop was hosted by Purdue University.
“Several LSC learners helped during the workshop as their presence was essential,” said Tim. “It was a great way to learn about the assessment and how children are affected by autism,” said Tim Courtney, MS, BCBA, LSC Research & Training Director.
“The participants – from as far away as Michigan, Ohio, and Kentucky — had the opportunity to practice scoring while observing the instructor administer the ADOS-2 to a child with ASD. Results of the assessment were later shared with workshop attendees.”
Mary Rosswurm - Executive Director, Little Star Center, Dana Renay - Executive Director, Autism Society of Indiana
Saturday, August 20th, 2011
A great crowd came out to support the Autism Society of Indiana and their 2011 Excellence Awards. Little Star Center was there to receive the Excellence in Direct Care Award, an award for providers who demostrate excellence in direct care services to infants, toddlers, children, youth and adults with ASD (Autism Spectrum Disorder) through their work in medical, therapeutic, recreational and other settings using innovative and scientifically supported best practices in partnership with families and other professionals.
Little Star Center Staff
This was the first time a center received the award, not an individual. The nominations came from our great families, friends and civic leaders.
Thank you so much for your support. We are honored to receive this award and will continue providing these services we were awarded for.