Therapy for the 21st Century

Jul 25 • Newsroom • 2598 Views • Comments Off on Therapy for the 21st Century

Cutting edge research is being conducted on how those with autism learn, with well-studied interventions that have a new technological twist. A Portland-based behavior analyst is getting extraordinary results with a video modeling intervention method that has proven results called Discrete Video Modeling (DVM).

“Think of it as high tech video flashcards—or for more advanced learners—think of it as a live action social story,” says Dr. Maria Wynne, a researcher and behavior analyst who recently relocated to Portland from Los Angeles. “I have used this method with many individuals on the autism spectrum and the outcomes have been the best I have ever seen compared to any other language intervention.”

DVM, is a method of demonstrating desired behaviors through video (as opposed to a “live” model). It is also a form of observational learning that has been proven to teach a wide variety of skills. DVM adds to that teaching power by stripping away all non-essential information. Words and concepts are taught on white screens to give clean and easy-to-process information.

The end goal is for the patient to be able to confidently model behaviors across settings. Applied Behavior Analysis (ABA) studies show this method can lead to increased language, social skills and the ability to socially regulate. This method has also been certified as evidence-based, according to the National Professional Development Center on Autism Spectrum Disorders, and the addition of video-based learning has been shown to
be more effective than ABA alone.

“The individual with autism can learn in a way through video that does not require as much of the social filtering skills that are needed for live, face-to-face interactions,” says Wynne. “I am pushing the boundaries to see how much our kids can actually learn. It’s more than most thought possible.”

Video therapy is most effective for language and skill building, she adds. “There always must be a live, human face for the individual to talk to and interact with once the language and skills have been acquired through the video modeling.”

With the new tools Dr. Wynne is using, the video therapy sessions she creates can be sent home over the Internet. Parents, teachers and therapists are then able to collaborate and use the same methods and terminology when working with a student.

Studies are also showing that once a skill is learned through video modeling, it is maintained over time and generalized across settings. Parents, teachers and therapists are also able to collaborate and use the same methods and terminology when working with a student, helpful to many on the spectrum who are incredibly literal.

Using teletherapy with online video modeling can also provide access to those in rural settings that otherwise would be unable to physically see a provider.

“Teletherapy simply addresses the access issue many families contend with today, especially with the rising numbers in need and lack of access to high quality therapy, or any therapy services at all,” Wynne says. At age 12, John* (*not his real name) had behavior so erratic that he was breaking dishes, electronics and had pulled a knife on his nanny. Diagnosed with High Functioning Autism and ADHD, John’s family began work with Dr. Wynne in a desperate attempt to help complement their work with a local psychologist and psychiatrist near their Los Angeles home.

Because of their high public profile status, the family declined to be named for this article.

“We knew we needed different help then we were getting,” says John’s mother. “We had no idea about telehealth services for what we needed, and at first we didn’t think it was possible for Dr. Wynne to assess our son unless she was physically in our home to see what was happening.”

After spending several face-to-face sessions with the family, Dr. Wynne wrote up the most “spot-on” assessment the family had seen from any professional, his mother says. Because of the family’s extensive travel and work schedules, teletherapy, and the ability to connect remotely from anywhere in the world, was essential.

“We knew Dr. Wynne was the perfect set-up for this,” she says.

During a 30-day assessment, the family and Dr. Wynne worked together in person (sometimes daily), created a crisis intervention plan, helped the family effectively respond to John’s erratic and destructive behaviors to ensure everyone’s safety. A phone tree of local supports, including crisis intervention response, and a flow chart of response choices to various behavioral outbursts was put into place.

Teletherapy then began twice a week via Skype, as well as videos the family would take of John’s day-to-day life.

John’s mother reports that his behaviors subsided immediately, and with continued support two years later, and continued sessions three times a month remotely, the family has learned invaluable information. The couple identified what they were doing to reinforce John’s behavior, how to problem-solve more collaboratively, as well as the importance of consistency.

“We can go out in public and not have to worry about the paparazzi catching our son having an outburst,” John’s mother reports. “It is like a completely different life and we owe so much to Dr. Wynne.”

Implementing a treatment plan using video modeling should first begin with targeting a specific behavior. Practitioners clearly define the goals within the plan so accurate data can be collected throughout the process to track and monitor effectiveness.

Equipment set-up for teletherapy is pretty straight-forward: a computer with a high-speed internet connection, an email account and a video camera. Working from a script or detailed plan, therapists can break down complex skills into a sequential set of tasks or behaviors by modeling them to the patient. Patients can watch and perform the therapy sessions live, or view recorded sessions before performing a certain task, such as making lunch or going to the grocery store.

Spokane, Wash.-based Gemiini has been a pioneer in the video modeling arena, creating a system of videos and online software that has been implemented in university and public school settings internationally.

Founders Laura and Brian Kasbar draw on personal experience, with three of their seven children on the autism spectrum. The website has quickly grown to feature more than 12,000 videos accessible with an annual or monthly membership, and scholarships are available so no child is turned away for an inability to pay.

“A child can never have enough in-vivo (face-to-face) therapy,” Brian Kasbar says. “But we all know the realities: therapy is scarce and it’s expensive. We need to make those golden hours of face-to-face therapy as productive and efficient as possible.”

The DVM can work best as “therapy homework,” Brian Kasbar says. Parents like the system because it is a clinician-designed intervention used in addition to the hours of in-person therapy that is completely customized to each child.

“We should let computers do what they do best (repetitive tasks and teaching) and let humans do what they do best—which is to use all of their technical skills to bring out the wonderful, communicative and loving children that are inside each of our kids.”

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