Autism Care for Toddlers (ACT) Clinic

Therese L. Mathews, Laura L. Needelman, Melissa L. King, Ashley M. Lugo, Leny D. Velasquez & Kiley J. Bliss
UNMC Department of Psychology, Munroe-Meyer Institute

Mission
To provide services to uninsured toddlers ages 18 to 36 months with autism and their families, train service providers in evidence-based early intervention procedures, and to conduct research.

Services Preliminary Findings:

 The ACT clinic is a free-of-charge early intervention program for underinsured toddlers (ages 18-36 12-18-month
months) with a diagnosis of an Autism Spectrum Disorder (ASD) in the Omaha area. The clinic seeks to
combine clinical service and research with interdisciplinary education to improve social communication, Evaluation Results

a
play, and adaptive skills through the use of techniques based on Applied Behavior Analysis (ABA).
VB-MAPP

 The ACT Clinic opened its doors in September 2013 to three children with moderate to severe ASD three 160

VB-MAPP
mornings per week (i.e., 10.5 direct contact hours). Since then, we have expanded our services to serve 140
Baseline

a total of 27 children, and clinic services are provided 4 full days per week. 6-month
1-year
 All participants had improved VB-MAPP scores in each
120 18-month
of the assessment periods.

Assessment/Outcome Measures Early Intervention Services  The mean baseline score = 25, 6 months = 62, 12
100

Several assessments are conducted with every child, prior to enrollment
in the clinic and every 6-months thereafter.
Cognitive assessment (i.e., Mullen Scales of Early Learning; Cognitive
Adaptive Test/Clinical Linguistic and Auditory Milestone Scale)
Total Score
80 months=71, and 18 months = 82. (Higher score desired)
The ACT clinic provides early intervention services to target social 60
ADOS-2
communication, language, play skills, and maladaptive behavior. The 40
 The mean scores for ADOS-2 at baseline =19, 6 months
Verbal Behavior (VB) approach to early intervention is used to guide
= 13, 12 months =15, and 18 months =19. (Lower score
individualized assessment and intervention to facilitate language 20

desired)
acquisition in early learners. 0

Functional assessment and/or analysis of challenging behavior 1 2 3 4 5 6 7 8 9

Participant
10 11 12 13 14 15 16 17

ABAS-2
Direct clinic services include:
Autism Diagnostic Observation Schedule, 2nd Edition. The
1:1 discrete trial teaching targeting expressive and receptive  No substantial differences were noted during the
ADOS-2 is a semi-structured standardized observation tool used to ADOS-2

language, imitation, social play, compliance, and preschool readiness assessment period.
measure autism symptoms in social relatedness, communication, play, 30

and repetitive behaviors. A higher total score indicates a higher skills COGNITIVE (Mullen & CAT/CLAMS)
Natural environment training to capture and contrive motivation to
Baseline

likelihood of autism
 No significant differences were noted between
6-month
25 12-month

Adaptive Behavior Assessment System, 2nd Edition. The ABAS-II mand under natural contingencies and to promote generalization of 18-month

assessment periods.
is a rating form used to assess adaptive behavior in various domains, acquired skills 20

including: Communication, Community Use, Functional Academics, Functional assessment and/or analysis of problem behavior (e.g., self-

Autism Severity Score

Discussion
Home Living, Health and Safety, Leisure, Self-Care, Self-Direction, injurious behavior, aggression, tantrums) 15

Social and Work (optional subscale).

Parent Training
The Verbal Behavior-Milestones Assessment and Placement 10

Program. The VB-MAPP is an assessment tool and curriculum guide LIMITATIONS

used to assess and target early language and learning skills. As part of standard clinic services, collaboration between clinic staff and
5

 Parent report may be biased on the ABAS-2 scores.

parents is ongoing. Additionally, in order to show improvement in adaptive
Student Training Opportunities
0

Parents are encouraged to meet on-site with their child’s case scores, the toddlers would be expected to make gains at a
1 2 3 4 5 6 7 8 9
Participant 10 11 12 13 14 15 16 17

supervisor for 30-minutes every other week to discuss child’s progress faster rate than their peers.
and practice skills taught in their child’s individualized program.  There was a change in ADOS-2 module from toddler to
Students are taught the basics of applied behavior analysis in order to Module 1 because of age change. Further, repetitive
In addition, parents attend one 1.5 hour group session per month ABAS-2
behaviors and restricted interests may emerge as the child
perform duties as behavior therapists. Multiple opportunities for growth 100

during which they are taught about general behavior principles and ages.
as future service providers are available, including: 90

techniques through the use of behavioral skills training  There were different examiners for testing across
 Training to become a Registered Behavior Technician 80 baseline
assessment tools and assessment periods.
Assessing preference and pairing 6-month
12-month

 Learning to collect data and make data based decisions 70

Understanding behavior (e.g., the ABC’s & functions of behavior) CONSUMER SATISFACTION
 Developing and implementing individualized interventions 60

Using positive reinforcement

Standard Score

 Conducting applied research Overall, high levels of satisfaction are reported.

50

Teaching new skills (e.g., discrete trial teaching, how to use 40  “The impact that this program has had on our family is
Additionally, Licensed Psychologists and/or Board Certified Behavior effective prompting) immeasurable and we will reap benefits of the time that has
Analysts: 30

been invested in our son for his entire lifetime and beyond.”
Using differential attention
 Oversee practicum opportunities for students in the field of applied –parent of a participant
20

Parents collect data on their in-home implementation of specific

behavior analysis and related fields 10

strategies and then meet individually with a parent training coordinator

 Provide ongoing staff training and direct supervision between group sessions
0
GAC Conceptual
Composite
Social Practical

Current behavior therapist's have been recruited from local universities Individual follow-up meetings are provided with parents to review
(i.e., Creighton, College of St. Mary, University of Nebraska, AmeriCorps homework from the parent training program
at UNMC; St. Cloud State)