ABOUT: WHAT WE DO
A Letter from Our Founder
Doreen Granpeesheh, PhD, BCBA-D
CARD Founder and Executive Director
In 1978, I met a young boy with autism named Corey. His gentle nature, exceptional memory and desire to interact touched my heart. The positive impact of the therapy he received inspired me to start the Center for Autism and Related Disorders, Inc. (CARD) in 1990. At CARD, we truly believe that recovery is possible and we develop our programs with that in mind.
The CARD I and CARD II programs include comprehensive and cutting-edge curricula that can be tailored to the specific needs of individuals from birth to 21 years of age. These programs help children learn to communicate, develop friendships, and lead happy, healthy lives.
CARD Specialized Outpatient Services (SOS) provides assistance with specific areas of concern for a family and develops and implements strategies to diminish problem behaviors and teach necessary skills.
None of these life-changing programs would be what they are without the work of our exceptional staff which includes PhDs, licensed psychologists, speech and language pathologists, masters-level supervisors, social workers, Board Certified Behavior Analysts, and marriage and family therapists. They are truly committed to helping all of our children achieve their fullest potential.
I hope this publication will answer some of your questions about CARD and in doing so give you optimism that success and recovery are possible.
ABOUT: THE CARD APPROACH
Focused on Measurable Results Since 1990
Applied Behavior Analysis
Behavior Analysis is the science of behavior. Applied behavior analysis ( ABA ) is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree (Baer, Wolf & Risley, 1968/1987; Sulzer-Azaroff & Mayer, 1991). Specifically, ABA refers to a systematic approach to the assessment and evaluation of behavior and the application of interventions that alter behavior. Over the past 30 years, several thousand published research studies have documented the effectiveness of ABA across a wide range of:
Populations (children and adults with mental illness, developmental disabilities, and learning disorders)
Interventionists (parents, teachers, and staff)
Settings (schools, homes, institutions, group homes, hospitals, and business offices), and
Behaviors (language; social, academic, leisure, and functional life skills,self-injury, and stereotyped behaviors)
Reliable Measurements — Objective Evaluation
ABA is an objective discipline focused on the reliable measurement and objective evaluation of observable behavior. Programs based upon ABA methodologies are grounded in the well-established principles of learning and operant conditioning, as influenced by the works of researchers, such as Edward L. Thorndike and B.F. Skinner. The use of single case experimental design to evaluate the effectiveness of individualized interventions is an essential component of ABA programs. This process includes the following components which outline a reliable and accountable approach to behavior change (Sulzer-Azaroff & Mayer, 1991):
Selection of interfering behavior or behavioral skill deficit
Identification of goals and objectives
Establishment of a method of measuring target behaviors
Evaluation of the current levels of performance (baseline)
Design and implementation of the interventions that teach new skills and/or reduce interfering behaviors;
Continuous measurement of target behaviors to determine the effectiveness of the intervention, and
Ongoing evaluation of the effectiveness of the intervention, with modifications made as necessary to maintain and/or increase both the effectiveness and the efficiency of the intervention
ABA generally focuses on the process of behavior change with respect to the development of adaptive, prosocial behavior and the reduction of maladaptive behavior. Specific "socially significant behaviors" include academics, communication, social skills and adaptive living skills. For example, ABA methods can be used to:
Teach new skills (e.g. the socially significant behaviors listed above)
Generalize or transfer behavior from one situation to another (e.g., from communicating with caregivers in the home, to interacting with classmates at school)
Modify conditions under which interfering behaviors occur (e.g., changing the learning environment so as to foster attention to the instructor)
Reduce inappropriate behaviors (e.g., self injury or stereotypy)
Treatment approaches grounded in ABA are now considered to be at the forefront of therapeutic and educational interventions for children with autism. In general, this behavioral framework utilizes manipulation of antecedents and consequences of behavior to teach new skills and eliminate maladaptive and excessive behaviors. The Discrete Trial is a particular ABA teaching strategy which enables the learner to acquire complex skills and behaviors by first mastering the subcomponents of the targeted skill. For example, if one wishes to teach a child to request a desired interaction, as in "I want to play," one might first teach subcomponents of this skill, such as the individual sounds comprising each word of the request or labeling enjoyable leisure activities as "play." By utilizing teaching techniques based on the principles of behavior analysis, the learner is gradually able to complete all subcomponent skills independently. Once the individual components are acquired, they are linked together to enable mastery of the targeted complex and functional skill. This methodology is highly effective in teaching basic communication, play, motor, and daily living skills.
Discrete Trial Teaching (DTT)
Initially, ABA programs for children with autism utilized only Discrete Trial Teaching (DTT) and the curriculum focused on teaching basic skills as noted above. However, ABA programs, such as the program implemented at CARD, continue to evolve, placing greater emphasis on the generalization and spontaneity of skills learned. As patients progress and develop more complex social skills, the strict DTT approach gives way to treatments that include other components. Specifically, there are a number of weaknesses with DTT, including the fact the DTT is primarily teacher initiated, that typically the reinforcers used to increase appropriate behavior are typically unrelated to the target response, and rote responding can often occur. Moreover, deficits in areas, such as"emotional understanding," "perspective taking," and other executive functions, such as problem-solving skills, must also be addressed, and the DTT approach is not the most efficient means to do so. Although the DTT methodology is an integral part of ABA-based programs, other teaching strategies based on the principles of behavior analysis, such as Natural Environment Training (NET), may be used to address these more complex skills. NET specifically addresses the above-mentioned weaknesses of DTT in that all skills are taught in a more natural environment in a more "playful manner." Moreover, the reinforcers used to increase appropriate responding are always directly related to the task (e.g., a child is taught to say the word for a preferred item such as a "car" and as a reinforcer is given access to the car contingent on making the correct response). NET is just one example of the different teaching strategies used in a comprehensive ABA-based program. Other approaches that are not typically included in strict DTT include errorless teaching procedures and Fluency-Based Instruction. At CARD, all appropriate teaching approaches based on the well-grounded principles of applied behavior analysis are utilized.
Introducing Skills®, the new, invaluable web tool for treating autism!
Providers of ABA-based services must consider many factors in order to provide effective intervention programs. Skills offers professionals everything they need to design and manage a customized treatment program for every child. Fully comprehensive assessment and curricula (including lessons targeting complex behavior, such as perspective taking or Theory of Mind) are combined with detailed data-tracking capabilities and other features to enable ABA professionals to maximize treatment effectiveness and provide services to more children while saving time and money.
References Baer, D., Wolf, M., & Risley, R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis , 1, 91 - 97.
Baer, D., Wolf, M., & Risley, R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis , 20, 313 - 327.
Sulzer-Azaroff, B. & Mayer, R. (1991). Behavior analysis for lasting change . Fort Worth, TX : Holt, Reinhart & Winston, Inc.
ABOUT: OUR HISTORY
The Center for Autism & Related Disorders was established in 1990 by Dr. Doreen Granpeesheh.
Dr. Doreen studied autism treatment for 12 years under the direction of renowned autism treatment scientist Dr. Ivar Lovaas at the University of California, Los Angeles. Dr. Lovaas discovered that intensive early intervention using applied behavior analysis treatment yielded a 47 percent recovery rate among children with autism who participated in his study.
Building off these findings, Dr. Doreen and her associates authored a treatment curriculum for children diagnosed with autism now known as the CARD Treatment Approach and opened the first CARD office in Los Angeles, California, in 1990. Dr. Doreen continued to train hundreds of therapists and supervisors on this methodology and has successfully treated and recovered tens of thousands of children. Today, CARD has 19 offices in the United States, one office in Sydney, Australia and one office in Auckland, New Zealand. In addition, CARD provides parent/therapist training and consultation worldwide through its workshop-model services.
CARD is committed to remaining at the forefront of research on ABA-based methods of autism assessment and treatment. In August 2009, CARD researchers published the first-ever study to document recovery in a large group of children with autism. "Retrospective Analysis of Clinical Records in 38 Cases of Recovery from Autism," published in the Annals of Clinical Psychiatry, earned CARD's Executive Director, Doreen Granpeesheh, PhD, BCBA-D, the prestigious American Academy of Clinical Psychiatrists 2011 George Winokur Research Award.
CARD is equally committed to developing technology to make autism recovery available to professionals and families around the world. Based on over 30 years of research on child development and autism, CARD's breakthrough Web-based tool, Skills®, provides comprehensive skill assessment, individualized curriculum design, and the ability to track treatment progress with automatically-generated graphs and clinical timeline charts. Skills™ is designed to teach over 4,000 age-appropriate skills to children with autism, making it the most in-depth, multidisciplinary system of its kind in the world.
With a staff of nearly 1,000 worldwide, CARD strives for success and even recovery for every individual it treats.
ABOUT: OUR FOUNDER
Dr. Granpeesheh has dedicated thirty years to helping individuals with autism lead healthy, productive lives.
Dr. Doreen Granpeesheh is a world-renowned clinical psychologist and expert in the field of autism research and therapy. Dr. Doreen has worked with a wide range of patients – from high-functioning children with autism to the most challenging individuals whose families have been told to give up hope. Dr. Doreen has an unparalleled recovery rate, enabling children with autism to lead independent lives. With a PhD in Psychology from UCLA, Dr. Doreen is licensed by the medical boards of California, Texas, Virginia, Arizona and is a Board-Certified Behavior Analyst. She is the 2011 recipient of the American Academy of Clinical Psychiatrists' prestigious Winokur Award.
Dr. Doreen founded the Center for Autism and Related Disorders, Inc., (CARD) in 1990, the world's largest and most experienced organization effectively treating children with autism. CARD develops individualized treatment plans utilizing the principles of applied behavior analysis (ABA), a behavioral treatment approach which the scientific community has empirically validated. Under Dr. Doreen's leadership, CARD has seen success with every child over the past 20 years.
Dr. Doreen is also the founder and president of ACT Today! (Autism Care and Treatment Today!), a national nonprofit organization that grants funding for resources and treatments to disadvantaged families.
Current and Prior Science, Advisory and Executive Board Positions
Autism Society of America
Autism Care and Treatment Today
US Autism and Asperger Association
4-A Healing Foundation
The Autism File Magazine
Autism 360 / Medigenesis
SEARCH Family Autism Resource Center
Autism Human Rights and Discrimination Initiative
American Academy of Clinical Psychiatrists Winokur Award (2011)
Autism Society of America, Wendy F. Miller Professional of the Year Award (2007)
Parenting Arizona, Raising the Bar Award (2007)
FOX News, "Vaccines and Autism," January 08, 2011
Dr. Phil Talk Show, "Coping with Autism," March 08, 2008
The Doctors Talk Show, "Autism and Latest Treatments," April, 23, 2010
Time.com, "Can Children Recover from Autism," December 01, 2010
Medical News Today, "Study Reveals Children Recover from Autism," October 12, 2010
The Capitol Times, "Study Reveals Children Recover from Autism," October 12, 2010
The Arizona Republic, "Study Reveals Children Recover from Autism," October 12, 2010
KPNX –TV, "Study Reveals Children Recover from Autism," October 11, 2010
KCBS 2, "Study Reveals Children Recover from Autism," October 11, 2010
Canada Television (CTV), "Latest Treatments for Children with Autism," October 22, 2010
KCAL 9 / CBS Channel 2, "CARD's 20th Anniversary Gala," September 25, 2010
FOX's Good Day LA, "Celebrating 20 Years of Autism Innovation," September 22, 2010
ABC News.com, “Autism Recovery,” December 09, 2009
KTLA - Los Angeles, "Can Marijuana Cure Autism?," November 09, 2009
ETV - South Africa, "Challenging Behavior," August 01, 2009
SAFM - South Africa, "Autism and Challenging Behaviors," August 01, 2009
PBS – KOCE, "Effective Autism Treatments," February 13, 2009
Recovered: Journeys Through the Autism Spectrum and Back (2008)
Best Documentary 2008, Director's Chair Film Festival in Staten Island, New York
Official Selection in the 2008 Victoria Independent Film Festival in Sebastopol, Australia
2009 ReelHeART International Film Festival in Toronto, Canada
Recovery from autism is still a controversial topic and many in the autism field are still afraid to discuss it. We at CARD have seen recovery for decades and we make it happen for some of the children that we treat. We are not the only ones. Treatment providers all over the country who have been doing top-quality ABA treatment for children with autism, for a minimum of 30 hours per week, for two or more years, have been recovering children for years. Let me explain exactly what we at CARD mean when we say a child has recovered from autism. We mean that the child no longer displays clinically significant impairments related to autism. In other words, there is nothing left to treat, the child is doing just fine. But it’s not good enough to just take our word for it, so here is how we measure it.
There are three main pieces to how we measure recovery from autism: 1) the child scores in the average range or higher on valid standardized tests of intelligence, language, socialization, and daily living skills, 2) the child is earning passing grades in a regular education classroom, with no specialized supports, whatsoever, and 3) the child is evaluated by a medical doctor or psychologist who is an expert in diagnosing autism, and the clinician’s conclusion is that the child no longer qualifies for any diagnosis on the autism spectrum.
You may have noticed that we use the word recovery in some of the marketing and public relations materials for CARD and SKILLS and you might be wondering if we are saying that CARD services or SKILLS are going to recover your child. We are not saying that, and there is currently no guarantee that any treatment in the world can recover your child from autism. SKILLS is the best quality multidisciplinary system in the world for designing and tracking progress in ABA programs. Top-quality early intensive ABA treatment is what brings about recovery in some portion of children with autism, so if your team is using SKILLS and your team is doing professional-quality ABA treatment, starting before the age of 4, with 30 or more hours per week of therapy, continuing for 2 or more years, your child may have a chance at recovery.
Any scientists reading this might be wondering about the research. Every single published study on the outcomes of behavioral intervention for children with autism, that included a control group, that started treatment before the age of 5, implemented more than 25 hours per week of treatment, and that continued treatment for 2 or more years, reported that at least some of their participants achieved functioning in the average range on at least some of their outcome measures. In most of these studies, some percentage of the children achieved average functioning on all of the outcomes. More scientifically rigorous research is still needed on recovery from autism, and it is currently underway here at CARD and at a few other centers, but the evidence currently available already strongly supports recovery.
Some people acknowledge that children with autism may be able to achieve completely non-impaired functioning but they must still have autism. But if the child no longer qualifies for the diagnosis and does not have any challenges left for us to treat (other than any other typically developing child might), then why do we still need to burden him with the label? There may well be something still amiss biologically or physiologically, but if there is no longer any clinically significant impairment in language, socialization, and stereotyped behavior, then the child no longer has autism, they have some sort of impaired physiology.
Another issue that needs to be discussed is that, by recovering someone from autism, we are not removing their unique perspectives on life or their unique personality. We are simply teaching skills, we are giving tools, we are opening up options. It is then the child’s choice as to whether or not he wants to take them. We are not trying to make anyone “normal,” we don’t even believe in normal. We believe in learning skills that make you stronger and more independent.
Unfortunately right now, the research has not been done yet to allow us to predict exactly who will recover and who won’t. As long as we are able to start intensive treatment, and by intensive we mean 30 or more hours per week, before the age of 5 or so, we are shooting for recovery with every child. We know we won’t achieve it in every case, but the worst possible outcome is that the child learns lots of useful life skills. The fact that most children will still not recover from autism doesn’t mean they don’t deserve a shot at getting the best treatment possible and learning the most they can.
Butter, E. M., Mulick, J. A., Metz, B., et al. (2006). Eight case reports of learning recovery in children with pervasive developmental disorders after early intervention. Behavioral Interventions, 21, 227-243.
Fein, D., Barton, M., Eigsti, I., Kelley,E., Naigles, L., Schultz, R., Stevens, M., Helt, M., Orinstein, A., Rosenthal, M., Troyb, E., &, Tyson, K. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, DOI: 10.1111/jcpp.12037.
Granpeesheh, D. (2008). Recovery from autism: Learning why and how to make it happen more. Autism Advocate, 50, 54-58.
Granpeesheh, D., Tarbox, J., Dixon, D., Carr, E., & Herbert, H. (2009). Retrospective Analysis of Clinical Records in 38 Cases of Recovery from Autism. Annals of Clinical Psychiatry, 21, 195-204.
Helt, M., Kelley, E., Kinsbourne, M., et al. (2008). Can children with autism recover? If so, how? Neuropsychology Review, 18, 339-366.
Kelley, E., Naigles, L., & Fein, D. (2010). An in-depth examination of optimal outcome children with a history of autism spectrum disorders. Research in Autism Spectrum Disorders, 4, 526–538.