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.

Preliminary Findings:
12-18-month
Evaluation

Services

VB-MAPP

The ACT Clinic opened its doors in September 2013 to three children with moderate to severe ASD three
mornings per week (i.e., 10.5 direct contact hours). Since then, we have expanded our services to serve
a total of 27 children, and clinic services are provided 4 full days per week.

160

VB-MAPP
140

Baseline

1-year

Functional assessment and/or analysis of challenging behavior

Autism Diagnostic Observation Schedule, 2nd Edition. The
ADOS-2 is a semi-structured standardized observation tool used to
measure autism symptoms in social relatedness, communication, play,
and repetitive behaviors. A higher total score indicates a higher
likelihood of autism
Adaptive Behavior Assessment System, 2nd Edition. The ABAS-II
is a rating form used to assess adaptive behavior in various domains,
including: Communication, Community Use, Functional Academics,
Home Living, Health and Safety, Leisure, Self-Care, Self-Direction,
Social and Work (optional subscale).
The Verbal Behavior-Milestones Assessment and Placement
Program. The VB-MAPP is an assessment tool and curriculum guide
used to assess and target early language and learning skills.

Student Training Opportunities

Students are taught the basics of applied behavior analysis in order to
perform duties as behavior therapists. Multiple opportunities for growth
as future service providers are available, including:
Training to become a Registered Behavior Technician
Learning to collect data and make data based decisions
Developing and implementing individualized interventions
Conducting applied research
Additionally, Licensed Psychologists and/or Board Certified Behavior
Analysts:
Oversee practicum opportunities for students in the field of applied
behavior analysis and related fields
Provide ongoing staff training and direct supervision
Current behavior therapist's have been recruited from local universities
(i.e., Creighton, College of St. Mary, University of Nebraska, AmeriCorps
at UNMC; St. Cloud State)

The mean baseline score = 25, 6 months = 62, 12

months=71, and 18 months = 82. (Higher score desired)

Total Score

80

ADOS-2

60

The mean scores for ADOS-2 at baseline =19, 6 months

= 13, 12 months =15, and 18 months =19. (Lower score
desired)

40

20

0
1

Direct clinic services include:

1:1 discrete trial teaching targeting expressive and receptive
language, imitation, social play, compliance, and preschool readiness
skills
Natural environment training to capture and contrive motivation to
mand under natural contingencies and to promote generalization of
acquired skills
Functional assessment and/or analysis of problem behavior (e.g., selfinjurious behavior, aggression, tantrums)

Parent Training
As part of standard clinic services, collaboration between clinic staff and
parents is ongoing.
Parents are encouraged to meet on-site with their childs case
supervisor for 30-minutes every other week to discuss childs progress
and practice skills taught in their childs individualized program.

10

11

12

13

14

15

16

17

Participant

ABAS-2
No substantial differences were noted during the
assessment period.

ADOS-2

30

COGNITIVE (Mullen & CAT/CLAMS)

Baseline

No significant differences were noted between

assessment periods.

6-month
25

12-month
18-month

20

Autism Severity Score

Cognitive assessment (i.e., Mullen Scales of Early Learning; Cognitive

Adaptive Test/Clinical Linguistic and Auditory Milestone Scale)

The ACT clinic provides early intervention services to target social

communication, language, play skills, and maladaptive behavior. The
Verbal Behavior (VB) approach to early intervention is used to guide
individualized assessment and intervention to facilitate language
acquisition in early learners.

18-month

100

Discussion

15

10

LIMITATIONS
5

0
1

In addition, parents attend one 1.5 hour group session per month
during which they are taught about general behavior principles and
techniques through the use of behavioral skills training

9
Participant

10

11

12

13

14

15

ABAS-2
100

90

baseline

80

Assessing preference and pairing

6-month

16

17

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

Additionally, in order to show improvement in adaptive
scores, the toddlers would be expected to make gains at a
faster rate than their peers.
There was a change in ADOS-2 module from toddler to
Module 1 because of age change. Further, repetitive
behaviors and restricted interests may emerge as the child
ages.
There were different examiners for testing across
assessment tools and assessment periods.

12-month
70

Understanding behavior (e.g., the ABCs & functions of behavior)

CONSUMER SATISFACTION

60

Using positive reinforcement

Teaching new skills (e.g., discrete trial teaching, how to use
effective prompting)

Standard Score

Several assessments are conducted with every child, prior to enrollment

in the clinic and every 6-months thereafter.

Early Intervention Services

All participants had improved VB-MAPP scores in each

of the assessment periods.

6-month
120

Assessment/Outcome Measures

Results

The ACT clinic is a free-of-charge early intervention program for underinsured toddlers (ages 18-36
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,
play, and adaptive skills through the use of techniques based on Applied Behavior Analysis (ABA).

Overall, high levels of satisfaction are reported.

The impact that this program has had on our family is
immeasurable and we will reap benefits of the time that has
been invested in our son for his entire lifetime and beyond.
parent of a participant

50

40

30

Using differential attention

Parents collect data on their in-home implementation of specific
strategies and then meet individually with a parent training coordinator
between group sessions
Individual follow-up meetings are provided with parents to review
homework from the parent training program

20

10

0
GAC

Conceptual

Social

Composite

Practical