Verhaltens- und fertigkeitenbasierte Frühinterventionen bei Kindern mit Autismus

Einleitung: Zu den autistischen Syndromen werden der frühkindliche Autismus (Kanner-Syndrom), das Asperger-Syndrom und atypische Autismusformen oder nicht-spezifizierte tiefgreifende Entwicklungsstörungen gezählt. Bei den autistischen Syndromen liegen Beeinträchtigungen (1) der Kommunikation und (2) der sozialen Interaktion vor. Weiterhin weisen (3) die Kinder in unterschiedlichem Maß stereotypes, repetitives Verhalten auf und haben bestimmte Sonderinteressen. Verhaltensbasierte Frühinterventionen bei Kindern mit Autismus basieren auf lerntheoretischen und verhaltenstherapeutischen Konzepten. Sie berücksichtigen die besonderen vorliegenden Beeinträchtigungen in der Wahrnehmung, der emotionalen Reaktionen, der sozialen Interaktionen sowie der Kommunikationsmuster. Die systematische Anwendung und Evaluation solcher Modelle in Deutschland ist aber bisher eher die Ausnahme. Fragestellungen: - Wie sind die gesundheitliche Effektivität und Sicherheit von verhaltens- oder fertigkeitenbasierten Frühinterventionen bei autistischen Syndromen untereinander und verglichen mit einer Standardbehandlung? - Gibt es Hinweise auf besondere Wirkfaktoren für die Effektivität? - Wie ist die Kosten-Effektivität? - Wie hoch sind die Kosten der verschiedenen Interventionen? - Lassen sich aus ethischen und rechtlichen Überlegungen Schlüsse für die Anwendung der betrachteten Interventionen bei Betroffenen mit autistischem Syndrom in der Praxis ziehen? Methoden: Basierend auf einer systematischen Literaturrecherche werden ab 2000 in deutscher oder englischer Sprache veröffentlichte kontrollierte Studien zu verhaltens- oder fertigkeitenbasierten Frühinterventionen bei Kindern mit Autismus im Alter von bis zu zwölf Jahren eingeschlossen und bewertet. Die Mindestzahl an Studienteilnehmern muss zehn pro Interventionsgruppe betragen. Ergebnisse: Insgesamt 15 Veröffentlichungen klinischer Primärstudien, acht systematische Reviews und eine ökonomische Veröffentlichung erfüllen die Einschlusskriterien. Die meisten Studien evaluieren intensive Frühinterventionen, die sich an das Modell von Lovaas (Early intensive behavioural treatment (EIBT), Applied behavioural analysis (ABA)) anlehnen. Einige Studien evaluieren andere Interventionen, die teilweise pragmatisch waren und teilweise einem bestimmten Modell folgen (spezifisches Elterntraining, Responsive education and prelinguistic milieu teaching (RPMT), Joint attention (JA) und symbolisches Spielen (SP), Picture exchange communication system (PECS)). Verhaltensanalytische Interventionen basierend auf dem Lovaas-Modell können weiterhin als die am besten empirisch abgesicherten Frühinterventionen angesehen werden. Vorschulkinder mit Autismus können durch verhaltensbasierte Interventionen mit einer Mindestintensität von 20 Stunden pro Woche Verbesserungen in kognitiven und funktionalen Bereichen (expressive Sprache, Sprachverständnis und Kommunikation) erreichen. Es bleibt jedoch unklar, welche Mindestintensität notwendig ist, und welche Wirkkomponenten für die Ergebnisse verantwortlich sind. Für andere umfassende Frühinterventionen bei Kindern mit Autismus liegt keine hochwertige Evidenz vor. Die für den ökonomischen Teilbereich identifizierte und einbezogene Publikation ist methodisch und thematisch nicht dazu geeignet, die Fragen nach der Kosten-Effektivität oder den Kostenwirkungen von Frühinterventionen beim Autismus auch nur ansatzweise zu beantworten. Publikationen zu rechtlichen, ethischen oder sozialen Aspekten werden nicht identifiziert. Die finanzielle Lage der Betroffenen und der Familien wird durch das Pflege-Weiterentwicklungsgesetz (Pf-WG) verbessert. Weitere rechtliche Belange betreffen die Betreuung und die Deliktfähigkeit der Menschen mit Autismus. Auch die gleichheitliche Betreuung und Versorgung sind insbesondere vor dem Hintergrund der Pflege im häuslichen Umfeld eine wichtige Frage. Diskussion: Es gibt nur wenige methodisch angemessene Studien zur Beurteilung der Wirksamkeit von Frühinterventionen bei Kindern mit Autismus. Die meisten Studien sind vergleichsweise kurz und haben teilsweise kein verblindetes Ergebnis-Rating. Der Mangel an hochwertigen vergleichenden Studien lässt keine solide Antwort auf die Frage zu, welche Frühintervention bei welchen Kindern mit Autismus am wirksamsten ist. Programme nach dem Lovaas-Modell scheinen am wirkungsvollsten zu sein. Dies gilt vor allem, wenn sie klinikbasiert durchgeführt werden. Zu einzelnen Wirkfaktoren von Frühinterventionen nach dem ABA-Modell konnte allerdings keine solide Evidenz gefunden werden. Es zeigte sich, dass ein Elterntraining hinsichtlich der Verbesserung der Kommunikation besser ist als eine Routinebehandlung, in der eine Mischung von Theapieelementen angewendet wird. Sowohl für die klinischen als auch die gesundheitsökonomischen Studien besteht das Problem unzureichender Verallgemeinerbarkeit der Studienergebnisse in den deutschen Versorgungskontext. Die ökonomischen Studien sind methodisch und thematisch nicht dazu geeignet die aufgeworfenen Fragestellungen zu beantworten. Schlussfolgerung: Basierend auf der derzeitigen Studienlage liegt für keine der untersuchten verhaltensbasierten Frühinterventionen bei Kindern mit Autismus ausreichende Evidenz vor. Die in diesem Bericht ausgewerteten Studien und Reviews legen nahe, dass Vorschulkinder mit Autismus durch verhaltensbasierte Interventionen mit einer Mindestintensität von 20 Stunden pro Woche Verbesserungen in kognitiven und funktionalen Bereichen erreichen können. Es gibt bisher keine Hinweise, dass bei einem substantiellen Anteil der Kinder eine vollständige Normalisierung der Entwicklung erreicht werden kann. Die meiste Evidenz liegt für die ABA vor. Ein Minimum an erforderlicher oder sinnvoller Behandlungsintensität kann jedoch nicht angegeben werden. Eine professionelle Umsetzung eines verhaltensbasierten Frühinterventionsprogrammes in engem und ausführlichem Kontakt mit den Kindern und unter Einbeziehung der Eltern erscheint sinnvoll. Zur Kosten-Effektivität von intensiven Frühinterventionen bei Kindern mit Autismus können keine validen Angaben gemacht werden. Effektive Frühinterventionen könnten jedoch die Gesamtkosten des Autismus langfristig reduzieren, indem die anfallenden hohen Aufwendungen durch eine spätere bessere soziale Anpassung überkompensiert werden.

PUBLIC-PRIVATE PARTNERSHIP FOR RESPONSIVE EXTENSION EDUCATION: THE CASE OF SAFE AND UCC IN GHANA

Developing nations in Africa are not shielded from the pressures of a globalized competitive agricultural marketplace. With an appreciable bulk of her people deriving livelihoods from diverse agricultural enterprises, these nations must respond to important contemporary issues shaping global agriculture. Farmers from such nations, including Ghana, will be able to improve their participation in the competitive local, regional and global agricultural marketplace if the appropriate agricultural technologies and extension information support are available. To achieve this, a new breed of agricultural extension graduates who can respond to current and emerging challenges in agriculture and interface effectively with farmers must be produced through responsive extension education and training. While extension education can produce effective extensionists to hasten agricultural development, budgetary constraints make it difficult for most African governments to successfully and sustainably implement such educational programs. However, public-private partnership (PPP) initiatives offer a way out of this financial dilemma. Beginning in 1993, the Sasakawa Africa Fund for Extension Education (SAFE) worked with the University of Cape Coast (UCC) in Ghana to develop an innovative extension education program through a public private partnership. The program, comprising a BSc. and Diploma components, was designed to respond to the myriad of challenges facing higher agricultural extension education in Ghana. A key practical feature of the curricula is the “Supervised Enterprise Projects” (SEPS), which enable students to work with relevant stakeholders to identify and tackle agricultural problems in farming communities through experiential extension approaches and action research. The SAFE-UCC initiative fulfils important education goals such as: expanding and improving access; ensuring quality and relevance; ensuring funding and mobilizing resources for sustainability; building partnerships and linkages; and promoting international co-operation. The paper discusses the underlying conditions for a successful public private partnership in agricultural and extension education and sheds light on the impacts, lessons learned and challenges.

Aligning school reform and teacher education reform in the middle years: An Australian case study

This paper discusses the development of a new Bachelor of Education (Middle Years of Schooling) at The University of Queensland. The middle years of schooling have increasingly been the focus of education reform initiatives in Australia, but this has not been accompanied by significant increases in the number of teacher education institutions offering specialised middle schooling-level teacher preparation programmes. Considering the rapidly changing social and economic context and the emergent state of middle schooling in Australia, the programme represented a conceptual and practical opportunity and challenge for The University of Queensland team. Working collaboratively, the team sought to design a teacher education preservice programme that was both responsive and generative: that is, responsive to local school contexts and to current educational research and reform at national and international levels; and generative of cutting-edge theories and practices associated with middle schooling, teachers' work, and teacher education. This paper focuses on one component of the Middle Years of Schooling Teacher Education programme at The University of Queensland; namely, the practicum. We first present the underlying principles of the practicum programme and then examine "dilemmas" that emerged early in the practicum. These issues and tensions were associated with the ideals of "middle years" philosophy and the pragmatics of school reform associated with that new approach. In this paper, and within this context, we explore what it means to be both responsive and generative, and describe how we as teacher educators negotiated between the extremes these terms implied.

New challenges in mathematics for the european higher education

In this paper we will talk about a math project submitted to the Lifelong Learning Programme. European higher education needs a reform in order to play its full role in the Europe of Knowledge. Modernisation of higher education is necessary in the areas of curricula (Bologna process), funding and governance so that higher education institutions can face the challenges posed by globalisation and contribute more effectively to the training and retraining of the European workforce. On the other hand Mathematics is an essential component of all educational systems. Mathematical literacy is being scrutinized in assessment efforts such as the OCDE Programme for International Student Assessment (PISA). This showed a low level in Europe. Due to the Bologna Process, which brought several didactical implications for Higher Education (HE) institutions, there is the need of lifelong learning. This evolution is in conflict with the earlier mentioned lack of competencies on basic sciences, such as Mathematics. Forced by this duality, efforts are combined to share expertise in the Math field and the integration of pedagogical methodologies becomes a necessity. Thus, several European countries have proposed an International Project to the Lifelong Learning Programme, Action ERASMUS Modernisation of Higher Education, to make institutions more attractive and more responsive to the needs of the labour market, citizens and society at large. One of the main goals of the project is to attract students to math through high-quality instructional units in an understandable, exciting and attractive way.

Aboriginal women in education : Honouring our experiences a vision of access to and success within the university

This thesis explores Aboriginal women's access to and success within universities through an examination of Aboriginal women's educational narratives, along with input from key service providers from both the Aboriginal and non-Aboriginal community. Implemented through the Wildfire Research Method, participants engaged in a consensusbased vision of accessible education that honours the spiritual, emotional, intellectual, and physical elements necessary for the success of Aboriginal women in university. This study positions Aboriginal women as agents of social change by allowing them to define their own needs and offer viable solutions to those needs. Further, it connects service providers from the many disconnected sectors that implicate Aboriginal women's education access. The realities of Aboriginal women are contextualized through historical, sociocultural, and political analyses, revealing the need for a decolonizing educational approach. This fosters a shift away from a deficit model toward a cultural and linguistic assets based approach that emphasizes the need for strong cultural identity formation. Participants revealed academic, cultural, and linguistic barriers and offered clear educational specifications for responsive and culturally relevant programming that will assist Aboriginal women in developing and maintaining strong cultural identities. Findings reveal the need for curriculum that focuses on decolonizing and reclaiming Aboriginal women's identities, and program outcomes that encourage balance between two worldviews-traditional and academic-through the application of cultural traditions to modern contexts, along with programming that responds to the immediate needs of Aboriginal women such as childcare, housing, and funding, and provide an opportunity for universities and educators to engage in responsive and culturally grounded educational approaches.

Governmentality in higher education : a critical analysis of the National Survey of Student Engagement (NSSE)

In this dissertation, the National Survey of Student Engagement (NSSE) serves as a nodal point through which to examine the power relations shaping the direction and practices of higher education in the twenty-first century. Theoretically, my analysis is informed by Foucault’s concept of governmentality, briefly defined as a technology of power that influences or shapes behavior from a distance. This form of governance operates through apparatuses of security, which include higher education. Foucault identified three essential characteristics of an apparatus—the market, the milieu, and the processes of normalization—through which administrative mechanisms and practices operate and govern populations. In this project, my primary focus is on the governance of faculty and administrators, as a population, at residential colleges and universities. I argue that the existing milieu of accountability is one dominated by the neoliberal assumption that all activity—including higher education—works best when governed by market forces alone, reducing higher education to a market-mediated private good. Under these conditions, what many in the academy believe is an essential purpose of higher education—to educate students broadly, to contribute knowledge for the public good, and to serve as society’s critic and social conscience (Washburn 227)—is being eroded. Although NSSE emerged as a form of resistance to commercial college rankings, it did not challenge the forces that empowered the rankings in the first place. Indeed, NSSE data are now being used to make institutions even more responsive to market forces. Furthermore, NSSE’s use has a normalizing effect that tends to homogenize classroom practices and erode the autonomy of faculty in the educational process. It also positions students as part of the system of surveillance. In the end, if aspects of higher education that are essential to maintaining a civil society are left to be defined solely in market terms, the result may be a less vibrant and, ultimately, a less just society.

New Thinking for Intervention: Towards a Culturally Responsive Model of Understanding Indigenous Suicide

Thesis (Ed.D.)--University of Washington, 2016-06

The Development of Novice Teachers' Culturally Responsive Classroom Management Practice

Thesis (Ph.D.)--University of Washington, 2016-06

'Worldmarks': Web guidelines for socially and culturally responsive assessment in university classrooms

In the early 21st century, we need to prepare university students to navigate local and global cultures effectively and sensitively. These future professionals must develop comprehensive intercultural communication skills and understanding. Yet university assessment in Australia is often based on a western template of knowledge, which automatically places International, Indigenous, as well as certain groups of local students at a study disadvantage. It also ensures that Australian students from dominant groups are not given the opportunity to develop these vital intercultural skills. This paper explores the issues embedded in themes 1 and 4 of this conference and provides details of an innovative website developed at Queensland University of Technology in Brisbane, Australia, which encourages academic staff to investigate the hidden assumptions that can underpin their assessment practices. The website also suggests strategies academics can use to ensure that their assessment becomes more socially and culturally responsive.

Juliane Lamprecht: Rekonstruktiv-responsive Evaluation in der Praxis, Neue Perspektiven dokumentarischer Evaluationsforschung. Wiesbaden: VS Verlag für Sozialwissenschaften 2012 [Rezension]

Rezension von: Juliane Lamprecht: Rekonstruktiv-responsive Evaluation in der Praxis, Neue Perspektiven dokumentarischer Evaluationsforschung, Wiesbaden: VS Verlag für Sozialwissenschaften 2012 (305 S.; ISBN 978-3-5311-7985-8)

Developmental TVET rhetoric in-action: the White Paper for post-school education and training in South Africa

This paper explores the extent to which latest developments in the Technical and Vocational Education and Training System in South Africa respond to key principles espoused for a developmental, democratic and inclusionary ideal. The White Paper for post school education and training approved by Cabinet in November, 2013 is referred to by the Minister as the “definitive statement of the governments vision for the post school system” and as such represents a crucial strategy document intended to chart the TVET direction to 2030. Using key theoretical constructs from development theory, this paper provides an assessment of the TVET strategy contained is the paper and explores the extent to which it does respond to the agenda defined by the promise. It is argued that the challenges outlined are not yet able to provide the blueprint for a TVET transformative vision. It is concluded that while the development rhetoric contained in the paper is plausible, the creative tinkering of the system is unlikely to lead to the radical revisioning necessary for a truly transformative TVET system. The underlying assumptions regarding purpose, impact and outcome will need to be carefully reconsidered if the system is to be responsive to the promises of the democratic developmental ideal to which the government is committed. (DIPF/Orig.)

In Search of Social Justice: Current Developments in Higher Education and the Labour Market in Bulgaria

The discussions about social justice date from ancient times, but despite the enduring interest in the topic and the progress made, we are still witnessing injustices throughout the world. Thus, the search for social justice, under some form, is an inseparable part of our lives. In general, social justice may be considered as a critical idea that challenges us to reform our institutions and practices in the name of greater fairness (Miller 1999, p. x). In political and policy debates, social justice is often related to fair access (Brown, 2013) but at the same time its meanings seem to vary when we consider different definitions, perspectives and social theories (Zajda, Majhanovich, & Rust, 2006). When seen in the context of higher education, social justice appears in relevant literature as a buzzword (Patton, Shahjahan, Riyad, & Osei-Kofi, 2010). Within the recent studies of higher education and public debates related to the development of higher education, more emphasis is placed on the link between higher education and the economic growth and how higher education could be more responsive to the labour market demands, and little emphasis has been put on social justice. Given this, the present study attempts to at least partially fill the gap with regard to this apparently very topical issue, especially in the context of the unprecedented worldwide expansion of higher education in the last century (Schofer & Meyer, 2005), an expansion that is expected to continue in the next decades. More specifically, the expansion of higher education intensified in the second part of the 20th century, especially after World War II. It was seen as a result of the intertwined dynamics related to demographic, economic and political pressures (Goastellec, 2008a). This trend undoubtedly contributed to the increase of the size of the student body. To illustrate this trend, we may point out that in the period between 2000 and 2007, the number of tertiary students in the world increased from 98,303,539 to 150,656,459 (UNESCO, 2009, p. 205). This growth occurred in all regions of the world, including Central and Eastern Europe, North America and Western Europe, and contributed to raising the number of tertiary graduates. Thus, in the period between 2000 and 2008, the total number of tertiary graduates in the European Union (EU) 27 increased by a total of 35 percent (or 4.5 percent per year). However, this growth was very uneven, ranging from 21.1 percent in Romania to 0.7 percent in Hungary (European Commission working staff document, 2011). The increase of the number of students and graduates was seen as enhancing the social justice in higher education, since it is assumed that expansion “extends a valued good to a broader spectrum of the population” (Arum, Gamoran, & Shavit, 2007, p. 29). However, concerns for a deep contradiction for 21st-century higher education also emerged with regard to its expansion.