Evidence-Based Treatment for Children with Autism

The CARD Model

Doreen Granpeesheh, Jonathan Tarbox, Adel C. Najdowski, Julie Kornack

• Editorial: Academic Press
• Año: 2014
• ISBN:
  9780124116184
• Categoría: Psicología
• Categoría: Psicología clínica

This manual is a user-friendly, comprehensive description of the Center for Autism and Related Disorders (CARD) model of autism treatment—the latest scientific information on what truly works in treating autism in an integrated, organized, consumable format. The book details effective early behavioral intervention, covering topics such as challenging behavior, visual modification, parental involvement, improving language, cognition, and social skills, and ends with a section that explains how all of the treatments can be put together in real-life service provision organizations. The CARD model is highly comprehensive and provides useful clinical information to form cutting-edge treatment programs.

• Describes in detail the world-renowned, state-of-the-art CARD model of treatment for children with autism spectrum disorders
• Provides practitioners critical guidance in how to combine the best components into comprehensive treatment programs for individuals with autism that are not only backed by research, but also the most effective, and the least intrusive
• Includes practical information, presented in a user-friendly, professionally-oriented format, with tables, figures, and flowcharts to help guide real-life clinical decision making

Chapter 1

Introduction

Doreen Granpeesheh

Abstract

This chapter provides a brief overview of the purpose of the book, what makes the Center for Autism and Related Disorders (CARD) Model unique, and what clinicians can expect to get out of reading the book. This chapter lays the foundation for the book by describing the “big picture,” including the overall purpose, goals, and format of comprehensive evidence-based treatment for children with autism.

Keywords

Center for Autism and Related Disorders (CARD)

autism

treatment

children

evidence-based

model

Welcome to Evidence-Based Treatment for Children with Autism: The CARD Model. Our goal in writing this book is to create the world’s most practical, user-friendly, and enjoyable-to-read manual for treating children with autism spectrum disorder (ASD). Our secondary goal is to describe the way we view the world: the Center for Autism and Related Disorders (CARD) Model of treatment for children with ASD. Hundreds of different treatments are available for children with ASD, most of which have little or no research support. The CARD Model is a successful approach to providing evidence-based treatment that is based on and incorporates the principles and procedures of applied behavior analysis (ABA). There are many different specializations within ABA treatment for children with ASD, including Pivotal Response Treatment, the Early Start Denver Model, Incidental Teaching, the Picture Exchange Communication System, the Verbal Behavioral Approach, to name a few. Many approaches to ABA treatment for children with ASD are distinguished by the fact that they emphasize one particular treatment procedure or another or one particular area of functioning (e.g., language). The CARD Model is an example of a comprehensive approach to the behavioral treatment of children with ASD. By comprehensive, we mean that the CARD Model emphasizes the need for the use of all empirically validated treatment procedures in a customized mix that meets the individual needs of each child at any given time. In addition, comprehensive means that every area of human functioning is addressed in proportions that match the degree of need. Although the CARD Model is, in some sense, a collection of treatment procedures, at a more fundamental level it is built upon a set of basic values and philosophical beliefs that are described in more detail in Chapter 2.

We do not claim that the CARD Model is more effective than any other model of comprehensive behavioral intervention for children with ASD. In fact, virtually no research has directly compared the effectiveness of different models of comprehensive ABA, so it is impossible to address this question with data at this time. However, great pains have been taken to modify and hone the CARD Model over the past 24 years, and the model continues to evolve and improve. Thus, we believe that the approach to comprehensive intervention described in this treatment manual is the best, and we sincerely hope that this book will assist clinicians who are treating individuals with ASD. Furthermore, in writing this book, we invite scientists to join us in defining other treatment modalities and detailing other unique blends of evidence-based treatment and clinical decision-making guidelines. Further articulation and manualization of the various approaches to intervention for children with ASD can only help decrease confusion, increase clarity, spur comparative research, and, ultimately, improve intervention for children on the spectrum.

Thorough program descriptions increase accessibility through replication. As more professionals are able to determine the needs and resources required to implement this model, providing CARD treatment becomes increasingly feasible. This, in turn, may increase accessibility to this effective treatment. Program descriptions remediate the limitations faced within the scientific literature regarding treatment research and efficacy. That is, treatment descriptions in research articles are limited by the space restrictions of scientific journals, and the articles focus, therefore, more on scientific methodology and treatment effects than on describing how to do treatment. It is one thing to know the results of treatment and another to understand how to implement it. Without practical expertise, there is a greater risk of poor implementation, lower quality, and inaccessibility due to lack of resources.

Introduction to Early Intensive Behavioral Intervention

The type of autism treatment that this manual describes is commonly referred to as Early Intensive Behavioral Intervention (EIBI). Other common acronyms from the research literature that mean the same thing are Early Intensive Behavioral Treatment (EIBT) and Intensive Behavioral Treatment (IBT). EIBI consists of intervention delivered in a one-to-one format, starting as young as possible (before the age of 3), done for 30 or more hours per week, and continued for 2 or more years (Granpeesheh, Tarbox, & Dixon, 2009). The general goal of EIBI is to remediate all skill deficits that a child with ASD presents, so she can be caught up to typical development, at least to the greatest degree possible. Behavioral intervention can also be delivered at lower intensities and for older children and produce substantial treatment effects. However, EIBI is the treatment approach for ASD that is supported by the largest amount of scientific research (see Chapter 27).

Format of This Book

This book is first and foremost a treatment manual. The primary purpose of this book is to help practitioners work with children with ASD. This book is not a review of published research, although the content of the book is derived from research. Thus, in order to save space and make the book more readable, we have intentionally included only the minimum of scholarly references. For a comprehensive scholarly handbook on treatment for young children with ASD, we recommend Handbook of Early Intervention for Autism Spectrum Disorders: Research, Policy, and Practice (Tarbox, Dixon, Sturmey, & Matson, 2014). The primary purpose of that handbook is to provide a scholarly review of research, and it consists of 29 chapters authored by the world’s leading autism researchers from prestigious universities and research institutes. The chapters in that book consist of reviews and critical analyses of research, not how-to instructions for helping children with ASD, the latter being the subject matter and purpose of this manual.

This manual is divided into five sections. Section I, Background, opens the book with a basic description of the book, describes the philosophical perspectives and mores upon which the CARD Model is built, and gives a description of the ASD diagnosis. Section II, Treatment Procedures, contains six chapters describing the procedural aspects of the CARD Model of treatment for children with ASD. In Section II, we focus on how to teach. Section III, Program Content, addresses what to teach. Nine chapters comprise this section. The first introduces the rationale and approach that CARD has taken to building the most comprehensive curriculum in the world for teaching skills to children with ASD. The next eight chapters address each major area of human functioning, giving practical advice on how to teach the myriad skills one may need to teach when implementing comprehensive intervention with children with ASD. Section IV, Treatment Oversight, is dedicated to describing practical and logistical details that are often omitted from treatment manuals. Useful tips are given regarding job descriptions, treatment settings, the clinical supervision process, and interdisciplinary collaboration. Section V, Looking Forward, concludes the book. This section includes chapters that address the burgeoning role of technology in autism treatment, global dissemination, how to maintain close contact with emerging research, and how to ensure that your treatment model revolves around research to ensure that children with ASD benefit from scientific findings that help improve the outcome of interventions.

History of the CARD Model

The Center for Autism and Related Disorders was founded by Dr. Doreen Granpeesheh after she completed her doctorate in psychology under the mentorship of Dr. O. Ivar Lovaas at the University of California, Los Angeles. After working as a researcher and clinician in Lovaas’s clinic, providing treatment to the children who were participants in the seminal 1987 paper by Lovaas, Dr. Granpeesheh founded CARD in 1990 with the goal of disseminating top-quality behavioral treatment to as many children as possible. From the beginning, Dr. Granpeesheh’s goals have always been to maintain the highest quality of treatment and to provide global accessibility to that treatment. Today at CARD, we continue to believe that sacrificing either of these two values is unacceptable. Children will not have the opportunity to fulfill their potential if treatment is not top quality, and millions of children will go without any treatment if more is not done to increase access to effective treatment throughout the United States and around the world. Across the 24 years that CARD has been in existence, we have always maintained a perspective that our treatment model is continuously evolving as we incorporate new research findings, update technology, and increase accessibility. Therefore, every aspect of the CARD Model has been analyzed, adjusted, and reworked countless times. The origins and foundations of the CARD Model came from Lovaas’s UCLA Young Autism Project, but the CARD Model has not been recognizable as “Lovaas therapy” for many years. The version of the CARD Model presented in this manual is, therefore, the most current version, and further refinements will surely continue to be made. Nevertheless, the overall combination of treatment procedures and the scope and detail of the curriculum have reached a level of comprehensiveness such that the CARD Model is more than ready for public consumption.

Tone of this Book

We intentionally wrote this manual using a commonsense, almost conversational tone. This approach is still somewhat uncommon in scientific writing because many fear that using everyday language may dilute the precision of what they are trying to say. While this can be true, we also believe that scientists often hide behind dry and boring language because it makes it easier to speak without having to actually say anything useful. The purpose of this book is to provide you with useful information, so we are going to “tell it like it is” – we can’t think of any reason not to talk to you in the way we would if we were standing right in front of you. Writing a treatment manual that is, on the one hand, intended for everyday use by a wide variety of practitioners and, on the other hand, based on scientific principles, procedures, and research, is always going to be a balancing act. Therefore, we often explain the same idea twice: once in commonsense terms and once in technical behavioral jargon. Perhaps teachers and clinicians will prefer the former, and scientists will prefer the latter. Our one goal throughout writing this manual, however, is to provide you with information that will be useful and interesting to read, and we sincerely hope that we have done that! We hope that you will enjoy reading this manual and that you will become part of the increasing voices that speak of the benefits of the CARD Model.

Reference

Granpeesheh D, Tarbox J, Dixon D. Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry. 2009;21:162–173.

Tarbox J, Dixon DR, Sturmey P, Matson JL, eds. Handbook of early intervention for autism spectrum disorders: Research, practice, and policy. New York: Springer; 2014.

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“To view the full reference list for the book, click here B978-0-12-411603-0.10000-X”

Chapter 2

Philosophy and Mores

Doreen Granpeesheh; Jonathan Tarbox

Abstract

All providers of autism treatment have values and basic philosophical assumptions that influence how they provide treatment, and these basic world views inform their mission and every aspect of how they do their jobs. The values that guide the Center for Autism and Related Disorders (CARD) Model of treatment are fearlessness, innovation, open-mindedness, insistence on highest quality, and the belief that every child with a disability has a right to evidence-based, maximally effective treatment. This chapter discusses these values in order to demonstrate how they can be integrated into the everyday activities of treating children with autism.

Keywords

autism treatment

philosophy

values

autism

children

evidence-based

All professionals working with indivi...