ps 572 prompt presentation lit rev

8/7/2019 PS 572 PROMPT Presentation lit rev

1/46


2/46

Overview Article summary

Search terms and parameters

Critique

Guidelines for evidence-based practice

References


3/46

Journal article summary Teaching young nonverbal children

with autism useful speech: A pilot

study of the Denver Model andPROMPT Interventions

Rogers, S., Hayden, D., Hepburn, S.,Charlifue-Smith, R., Hall, T., & Hayes, A.

(2006)


4/46

Introduction Children with autism have significant

deficits in speech and language

production Language proficiency as an indicator for

predicting outcomes

Many interventions focus on

language acquisition


5/46

Two approaches have been usedhistorically:

1. Discrete trial teaching

Didactic, adult-directed instruction deliveredfrom a pre-set curriculum often taught in

massed trials (Rogers et al., 2006) After initial discrete trials, more complex language

skills are taught through associative learning

Motivation is provided through external rewards


6/46

2. Naturalistic teaching methods (I.e.,natural language teaching, incidentalteaching, or pivotal response training)

Child-initiated behavior in a natural interactivecontext (Rogers et al., 2006)

Incorporates modeling, shaping, and naturalreinforcers


7/46

Differences between DTT

and naturalisticapproaches

Adult-directed v. child-directed

Individualization of each learning

opportunity

Type of reinforcement

Role of child as initiator

Degree of generalization promotion


8/46

Both are behavioral approaches

Language impairment for children withautism is a developmental disorder

Developmental interventions (Prizant) focuson:

Social engagement

Imitation skills

Means-ends concepts Understanding language


9/46

The Denver Model A developmental approach to language

acquisition Specific developmental curriculum

Individualized

Based on discrete trials, naturalistic teachingmethods, and dyadic exchanges

Teaching based on attention to bothteaching techniques and interpersonal

relationships (Rogers et al., 2006) Can be implemented in inclusive

classrooms, individual therapies, or 1:1


10/46

The Denver Model (cont.) Only 1 aspect of model implemented

in current study (the communication

curriculum) Frequency: 1x/week, 50-min. session;daily home review by parents

Why?: typical of area programs

Description of session: naturalistic

social-affective teaching interactions(sensory social routines) alternatedwith didactic instruction


11/46

Structure of sessions: Highly motivating social games and activities

Naturalistic teaching High frequency of social interactions

Imitation of actions (objects, body parts, oral-facialmovements, speech sounds)

Massed trials and naturalistic teaching

Receptive understanding (simple instructions)

Naturalistic teaching

Object associations Matching (objects-pictures, pictures-objects)

Verbal approximations Naturalistic teaching

Modeling, shaping, and reinforcement Put in a notebook with goals and objectives,

lesson plans, and data


12/46

PROMPT Therapy PROMPT = Prompts for Restructuring Oral

Muscular Phonetic Targets

Based on neuromotor principles of speechproduction (Chumpelik (Hayden), 1984)

Use of touch can:

Develop, rebalance, or re-establish speech motorcontrol

Provide a foundation for integrating sensory

modalities in developing concepts and expressivelanguage

Enhance social-emotional interaction and trustbetween clinician and client (Rogers et al., 2006)


13/46

Elements of PROMPT Use of tactile-kinesthetic information as a

critical modality for recognizing,developing, re-balancing, and integrating

cognitive, linguistic, and motor behavior Determining a Communication Focus or an

aspect of development in which to embedand focus communication intervention

Developing goals and embeddingobjectives that embody the CommunicationFocus whil working on motor/language,cognitive, and social function


14/46

Elements of PROMPT

(cont.) Analyzing the global and speech motor sub-systems to

determine three priority areas that need immediatedevelopment or rebalancing and create an initial,functional lexicon (core vocabulary)

Deciding on the purpose of prompting and what typesof prompts should be used to support and developmotor control for speech and language and/orinteraction and cognitive development

Concrete understanding of how chosen goals and

objectives will directly affect motor resourcing and,therefore, materials, activity choices


15/46

Elements of PROMPT

(cont.) Insuring that a high degree of motor-sound

practice (using prompts for accuracy of production)and generalization of these into novel syllables and

words within naturalistic activities are used withineach session

The inclusion of reciprocal interaction or choice-making, in all activities, in almost every turn.

Presentation of the same or similar activities over

time to provide a structure in which increasedmotor-language complexity and cognitive learningof events and sequences may be practiced.(Rogers et al., 2006)


16/46

PROMPT in use Initially, use play-based activities,

wait for child to initiate, and require

a sound production Then, use vocal modeling and manual

manipulation (of jaw, lips, or otherspeech mechanisms) while child

vocalizes Fade tactile prompts to visual prompts

(of hands moving)


17/46

The Denver Model v.

PROMPT Similarities

Developmentally-based

Focus on sharedattention and socialinteractions

Use naturalisticteaching methods

Match activities todevelopmentallevels

Initially, adult-structured

Differences

Organization ofevaluation data

How goals andobjectives are chosen

Organization of motorsystems towards tasks

Use of imitation v.tactual-kinesthetic

prompts

How tasks are taught

How programs aremodified


18/46

Present study Purpose

Develop the methods and tests of both

models for developing speech in non-verbal pre-schoolers with autism

Gather empirical support for bothapproaches

See if typical frequency of speechsessions with daily parent review wouldbe sufficient in producing speech


19/46

Participants

10 children (aged 20-65 months)

Recruited through clinic specializing intreatment of ASD & parent-groups

Criteria for participation:

Diagnosis of autism Spontaneous functional use of less than 5 words

per day

From parent reports and clinical observations

Developmental quotient of >30

No co-morbid conditions

NOTE: All participants received varyinglevels of outside therapies


20/46

Setting

2-room suite w/ one-way mirror

University of Colorado Autism andDevelopmental Disabilities ResearchLaboratory

All sessions videotaped


21/46

Design

ABA design (replicated 9 times) Pre- and post-treatment tests

Diagnostic, developmental, and speech-languageassessments

10-min. speech samples in baseline, treatment,

and maintenance phases


22/46

Procedure Pre-treatment assessments Autism Diagnostic Observation Scale (ADOS) Social Communication Questionnaire (SCQ)

Mullen Scales of Early Learning

Vineland Adaptive Behavior Scales

MacArthur Communicative Development Inventory(CDI)

Previous intervention history (through parentinterview)

Type of treatment, staff:student ratio, hours in therapy

Background information


23/46

Baseline Baseline speech probes (x3)

15-min.

Examiner put out a new toy every 5 min. andencouraged child to play with it

Play partner instructed not to initiate anyactivities

Made statements regarding childs play

Examiner asked for 1 request and 1 episode

of joint attention

Scored # of words and # of phrases emitted


24/46

Treatment Children randomly assigned to

Denver Model or PROMPT

Received 1 hr./ week therapy (12weeks)

Denver Model: parents present duringsession

Taught to implement one new skill in each of4 areas and had them practice

Asked to implement procedures for 45 min.per day


25/46

PROMPT

Parents observed sessions via video

Parents asked to practice new words orapproximations

Not required to manually prompt any responses

Asked to implement procedures for 30 min. perday

Family decided how to incorporate practice intodaily routines


26/46

Procedure (cont.) Speech samples

Each session was videotaped; a 10-min. samplewas randomly selected from each session

Data collection

# of novel words or approximations

# of novel phrases

Function of communication (I.e., joint attention,

social interaction) Spontaneous v. prompted

Summarized in graphs at end of the study


27/46

Post-treatment

3 weeks after completion

Same assessments as in pre-treatments

Three month follow-up

Used to score childs functional use ofspeech

Identical to speech probes in baseline


28/46

Treatment integrity 2 independent speech therapists trained up

to fidelity on both interventions

Likert scales developed for both

Developers of scales viewed videotapes regularly,visited quarterly, and supervised (by phone)monthly

Scored at 85% or better for 25% ofsessions


29/46

Results


30/46


31/46


32/46


33/46

Results (cont.) 8 of 10 participants engaged in functional

use of at least 5 novel words

Generalization probes showed less use Reasons? Not enough sessions (12)

Sessions not targeted for generalization andmaintenance

Generalization sessions looked at too many novelfeatures

Children not spontaneous enough


34/46

Results (cont.) Overall gains

Significant gains = score of 2 or 3 on ADOS inpre-treatment, score of 0 on post-treatment

Significant gains observed in both interventions

Denver Model: more in imitation skills

PROMPT: more in functional play skills

Generalization

9 of 10 participants used novel words at homeafter treatment

Based on parent report


35/46


36/46

Discussion Purpose was preliminary tests of

interventions

Experimenters urge more research More replication and extensions

8 participants generated some newspeech, 4 generated novel phrases,2 used phrases in generalizedmanners (novel statements in novelsettings)

Positive parent feedback


37/46

Limitations Children already in a developmental period

where language is observed to accelerate

Gains observed were still consideredlimited compared to typical children

Better gains observed for participants withhigher levels of parent involvement

Parents provided extra practice opportunities

than what was specified Implementation monitored by parent report


38/46

Limitations (cont.) Direct comparison of 2 interventions wasimpossible Too many similarities

Participants differed from one another (age,mental ages, expressive language capabilities)

Many components to each treatment

Limited generalization and maintenance data

Children were receiving outside therapies

concurrently No IOA


39/46

Future research Obtain similar participants

Control for effects of treatment

Component analysis of eachtreatment

Control for more extraneousvariables

I.e., outside therapies


40/46

Search parameters

JABA

PsycINFO

Google

First, attempted PROMPT Therapy 0 in JABA; mixed results in PsycINFO, 8060 on

Google

Link for www.promptinstitute.com

Tab for research; provides a research summary

No articles mentioned were peer-reviewed Out of 6 articles mentioned 2 unpublished research, 2 conference proceedings, 2 manuals

authored by Hayden

Other links to research were all presentations givenby Hayden or colleagues

1 study available (Rogers et al.)


41/46

PROMPT: Introduction to Technique: AManual (2006)

References section

Chumpelik--3 articles (2 unpublished, 1theoretical)

Hayden--11 articles (0 research studies)

Guides, manuals, assessments, etc.


42/46

Rogers et al. study (Hayden co-

authors)References section

Looked at all research containingPROMPT

5 references (all Chumpelik or Hayden) All unpublished, theoretical, or conference

proceedings

Google search for entire titles of all

possible research studiesNone available


43/46

ASAT online Research Summary: One small study indicatesthat an oral-motor therapy, PROMPT, may beefficacious in establishing early language skills innonverbal children with autism (Rogers et al., 2006).There have been no other peer-reviewed scientific

studies on Oral-Motor Training or Therapy forindividuals with autism spectrum disorders. (2008)

Recommendations: Researchers may wish toconduct studies with strong scientific designs toevaluate Oral-Motor Therapies. Professionals shouldpresent Oral-Motor Therapies as under-researched

and encourage families who are considering theseinterventions to evaluate them carefully. (2008)


44/46

Does PROMPT have enough

evidence to support its use? Gina Greens gold standards for evidencebased practice At least 3 between group designs demonstrating

efficacyNO

At least 3 single case designs demonstratingefficacyNO

At least 3 investigators needed for corroborationNO

Documentation of: How participants were obtainedYES

Continuous measurement of DVNO

Calibrated data collectionNO

Inter-observer agreementNO

Procedural integrityYES (25% of sessions)

Operationally defined baseline conditionYES

Treatment effectsNO


45/46

Conclusions?


46/46

References Rogers, S., Hayden, D., Hepburn, S., Charlifue-Smith, R., Hall,

T., & Hayes, A. (2006). Teaching young nonverbal children withautism useful speech: A pilot study of the Denver Model andPROMPT interventions. Journal of Autism and DevelopmentalDisorders, 36, 1007-1024.

Hayden, D. (2006). PROMPT: Introduction to Technique: AManual. Santa Fe, NM: The Prompt Institute.

Association for Science in Autism Treatment (2008). RetrievedJune 11, 2008, fromhttp://www.asatonline.org/resources/treatments/oral.htm

The Prompt Institute (2008). Retrieved June 11, 2008 fromhttp://www.promptinstitute.com

Green, G. (2008). Evaluating Evidence about Treatments forAutism. Presentation for Applied Behavior Analysis InternationalConference, San Diego, CA.

ps 572 prompt presentation lit rev

Documents