Transcript Behavior Interventions*HELP!!

Evidence Based Instruction for
Students with ASD and Other
Developmental Disabilities
Penny Williams, M.Ed., BCBA
[email protected]
The Labels
ASD
CDD
Asperger
Syndrome
PDD
PDD-NOS
DSM-V changes for ASD
• No Asperger or PDD NOS diagnosis
(subsumed under the ASD category)
• Two Domains: persistent social
communication and social interactions (socialemotional reciprocity, nonverbal
communication, developing and maintaining
relationship); restricted and repetitive
patterns of behavior (stereotypy, excessive
adherence to routines, highly fixated interests,
hyper/hypo reactive to sensory input)
Social Communication Disorder
• (SCD) is an impairment of pragmatics and is
diagnosed based on difficulty in the social uses
of verbal and nonverbal communication in
naturalistic contexts, which affects the
development of social relationships and
discourse comprehension and cannot be
explained by low abilities in the domains of
word structure and grammar or general
cognitive ability.
What do we know about ASD?
Majority have other
neurological
differences
Many children make
remarkable gains with
intensive intervention
1 in 88
There is no one right
way to teach a student
with ASD
Outcome must be
supported by data
Causes of Autism: What we know
and don’t know
Also an environmental
component (but we don’t
know what it is yet)
Clearly a genetic
component
1 in 88
5 times more common in
males
No known cure
Social Deficits: What You Might See
Behavior challenges may be related to
the lack of interest of social praise/
consequences
More interactive with adults
(vs. peers)
Inappropriate interest
in others
Lack of understanding
of nonverbal
information (gestures,
facial expressions)
Wants
friends, but
not successful
May have low interest
in others
Communication: What You Might See
Behavior problems because of
limited language
Nonverbal or low verbal
Children with very
good language, but
odd uses: pronoun
reversals, strange
uses of words.
Children with very
good language, but
odd uses: pronoun
reversals, strange
uses of words.
“scripting”
Repetitive,
unimaginative play
or no play
Stereotypy: What You Might See
Behavior problems around
obsessions
Tantrums and other behavior
problems around routine changes
Hand flapping,
vocalizing,
spinning,
Obsessions with
trains, maps,
letters, etc
Lack of interest
in “normal”
childhood
activities
Self-injurious
behavior
Other Challenges
Obsessions can be challenging to
overcome
Often misinterpret information
Non
Compliance
Emotion
Regulation
Odd verbal behaviors
(prosody, inflection)
10
What about Executive Functions?
Executive Functions help with
•
•
•
•
•
•
Thinking
Acting
Solving Problems
Learning new info
Remembering
Retrieving info
Looks like….
Pay attention to minor details, but
fail to see big picture
Difficulty Maintaining
Attention
Impulse Control
Challenges
Difficulty Organizing
Thoughts
Difficulty with Self
Regulation
Why is school so challenging for
children with ASD?
• Groups
• Sometimes
inconsistent
Classrooms
Environments
• Fast moving
• Always
Changing
• Social
• Verbal
Activities
Classroom Challenges
• Insistence on sameness/difficulty with
changes in routines
• Difficulty learning in large groups
• Poor organization skills
• Poor writing skills
• Poor concentration
• Vocab usually good, comprehension poor
Classroom Challenges
• Inability to make friends
• Difficulty with reciprocal language
• Low frustration tolerance
• Poor coping strategies
• Emotional vulnerability
• Problem solving abilities tend to be poor
What can you do about the possible
mismatches?
Think of Behavior as
communication
Do not work on
everything at once!
Children with ASD are
children first
Adjust Environment To:
Make communication easier
Meet a need
Add a preference
Remove some distracters
The Environment
• What is the purpose of environmental arrangement?
Foster
Independence
Greater Staff
Efficiency
Decrease
Challenging
Behavior
Facilitate
Social
Interactions
Increase
Predictability
The Environment: Ideas
Do instructional areas have clear visual boundaries?
• Bookshelves used to define reading areas
• Tables for small groups
• Areas for individual instruction (if needed)
Are materials organized and easily accessible?
• Materials labeled
• Shelves not overstocked
Are rules posted
• For children
• For staff
• Words and pictures
Reinforcement
Token Systems
Visual
Supports
Instruction
Teaching
Tools
What is it that
motivates a student to
try when something is
hard?
What is the schedule
of reinforcement—or
how often do they
need to be motivated?
It begins and ends
with motivation
How to keep it as
natural as possible.
Fading and Delaying
Reinforcement
What is Reinforcement?
Something that immediately follows a
behavior and increases the likelihood
that that behavior will happen again.
23
Reinforcement is not a bribe!
A reinforcer is a stimulus that
increases likelihood of behavior
occurring again, and is presented
AFTER behavior occurs
A bribe does not guarantee the
increase of behavior and is presented
DURING a behavior or as a “carrot”
24
Choosing Reinforcers
•Reinforcers are
individual
•Use natural reinforcers
whenever you can
Get out of Homework Pass
Name____________
Date____________
Good for one subject on any day.
15 Minute Free Time Card
Name_________________
Date__________________
Good for one use only. When time is up, I will go back to work.
Schedules of Reinforcement
Goal:
Natural
Less
available
over time
Thick to
Thin
Reinforcement
Token Systems
Visual
Supports
Instruction
Teaching
Tools
Prompting—What is it?
Something that occurs before a
response and increases the
likelihood of a correct response
Prompting before a response
minimizes errors
Types of Prompts
Verbal
Model
Pictorial
Gestural
Environmental
Physical
Breaks a skill into very
small parts
Provides concentrated
teaching
Discrete
Trial Training
Response is initiated
by teacher
A response by the
child is required
General Instructional
Considerations
• Never assume the student CAN do a
task/activity—is there a skill deficit?
• Have you given enough processing time?
• Have you broken down the skill enough for
the student to understand?
• Are you providing enough practice?
33
Reinforcement Token
Systems
Visual
Supports
Instruction
Teaching
Tools
A strategy that really works….
Verbal
info
Visual
Supports
Schedules may………..
Provide the
following
info:
Help:
• Change in activities or new
activities
• When events will happen
• When it is time to move to next
activity
• Establish concept of being finished
• Set expectations
• Decrease “surprises”- reduce
anxiety
• Establish routines
How was my day?
Great
Okay
Will work on it
(2 points)
(1 point)
(no points)
Followed directions
Completed Work
Kept it together
Total Points:____________
First Then Scheduler
Visual Schedule Planner
Student: Alexander
1. Get pencil
2. Get folder
3. Open folder
4. Take out worksheet 1
5. Complete worksheet 1
6. Take out worksheet 2
7. Complete worksheet 2
8. Put worksheets in folder
9. Close folder
10. Put folder away
Date: September 14th
Visual Timer
timetimer.com
Regulating Arousal States
48
49
Recess Schedule
1.
2.
3.
4.
5.
6.
Choose one friend to play
Ask friend to play
Choose a game
Play for 10 minutes
Thank friend for playing
Make a choice
50
51
52
How to Look Like a Student at My Desk
Sit at my desk with my mouth and feet quiet.
If I need to I can sit on my feet
or stand at my desk.
My hands can be doing school work by writing or reading.
I can do my writing with my pencil and
I can read the books in my desk.
I can ask for help if I need to.
I will follow my teachers’ directions.
When my teachers ask me to do something
I will listen and follow their direction.
If something is hard I need to try,
but I can ask for help.
I am working on
I am working on: keeping my hands to myself (not touching others)
Did I do it?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
5
No
No
No
No
No
No
No
I am earning: 15 minutes on computer
I am working on: keeping my hands to myself (not touching others)
Did I do it?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
5
I am earning: 15 minutes on computer
No
No
No
No
Challenging Behavior
Self Injury or injury to
others
Damage to the
environment
Challenging
Behavior
Interferes with
learning
Interferes with
socializing
What is
Positive Behavior Support?
Assumes all challenging behaviors have a
function
Emphasizes:
• Prevention
• Instruction of appropriate alternative behaviors
Improves quality of life for student and
family
Understanding the function of behavior:
Behavior is lawful
When we understand why a student is
demonstrating a behavior, we say that we
understand the function of that behavior
What does the “function” of
the behavior mean?
Obtain
• Attention
• Tangible
• Sensory
Escape
• Attention
• Tangible
• Sensory
Stress and ASD
• As many as 84% have an anxiety disorder
• Levels of endorphins significantly higher in ASD
than typicals
• Anxiety leads to social withdrawal, repetitive
movements, difficulty with attention and cognitive
function, easy to arouse/anger, impaired memory,
poor decision making, difficulty to calm
Accommodations for Work Output
Clear Expectations
• Concise Language (keep it simple)
• Pictures/Symbols/Written as much as possible
Modifications
• Highlight, circle, shorten, break down
• Fidgets, seating modifications
Check Ins/Monitoring
• May need help to get started
• May need assistance to keep going
Writing
• “having to engage in handwriting is the most
significant and serious impediment to
academic participation for students with
autism spectrum disorders in schools in North
America today. (Dr. Richard Simpson, 2007)
• multiple tasks (printing and thinking) leads to
“a system wide resource constraint”—blood
and oxygen for each component task are
reduced and coordination of brain decreases
Hand Writing Accommodations
• Permit student to verbally express
information and tape record it
• Allowing the student to state information to
a scribe
• Modify assignments/tests to incorporate
multiple-choice, fill-in-the-blank, matching,
and/or short-answer questions
• Computer, laptop use
• Allow student to underline or highlight answers
to questions in reading passage
• Supply student with a teacher-made outline of
main ideas and key points from readings and/or
presentations
“Home Base”
A place the student can go to…
• Plan/review daily events
• Escape stress of a current environment
• Regain control if needed (meldown, tantrum)
Important that student recognizes home base
as:
• A predictable and positive place
• Not presented used as a time out
Amount of time in home base:
• Some students may need more time initially
• Some activities may be scheduled daily (social
skills)
Key Concepts
•Twice as much
“Asperger time half as much
Time”
done
Manage
Anxiety
•Changes……
•Setting Events
General Considerations…
Work and Directions
• Tasks and skills broken down? Task lists?
• Amount of work? Hand writing
accommodations?
Directions
• Have you given enough processing time?
• Avoid overloading student with too much verbal
information—can you use gestures/visuals?
Reinforcement and Visuals
• Is motivation considered? Lots of Praise
• Schedules, social scripts, behavior cues?
What Else?
Consider Sensory needs
• Built in schedule of sensory activities
• Accommodations (seating, group work, etc.)
Physical and Health needs
• Food intake, bathroom habits, fatigue
• Temperature, clothing, odors, etc.
Any scheduling changes?
• Too tired in the am?
• Crowded environments
More…..
Collaboration
• Work together to uncover/discover,
teach and prevent
• Planned meetings/check ins with team
members
Social Skills and Behaviors
• Functions
• Instruction (skill development and
bullying/teasing info)
Some Important Resources
• Autism Society of America
• Aspergersyndrome.org
• do2learn.com, speakingofspeech.com
• polyxo.com, abaresources.com
Some Key Skills To Target
Communication
• Make requests
• Protest appropriately
• Conversation skills
Emotions and
Arousal States
• Identify emotions in self and others
• Identify arousal states in self
• Learn how to self-regulate emotional states
Problem
Solving/Beginning
Perspective Taking
• Develop strategies to cope with emotions
• Problem solving skills with peers and adults
• Perspective taking and inferences
Basic Skills: Teach……..
Appropriate
Requests
Appropriate
Protests
Provide
structure
Other beginning skills to consider….
Tolerate new
demands/tasks
Following
directions
Delay
reinforcement
Wait
Accept
interruptions
Accept
endings/transitions
Stay on task
Intermediate Skills: Teach……
Identify
emotions
Identify
arousal
states
Identify and
implement
coping
strategies
Other emotion regulation skill
examples
Dealing with
mistakes
Understanding
impact of
unkind behavior
Accepting no as
a consequence
Asking for help
Using nice
words
Compromising
Reading body
language
Beginning Conversation Skills
Responding to
Greetings and
Closures
General responding
(what?, okay, oh
really)
Initiating Greetings
and Closures
Comments (look, I
did it, that’s fun)
Mands (move, let
go, give me___)
Sentence Stems (I
see, I have, It’s a)
Yes/No
Intermediate Conversation Skills
Social Questions
(name, age, where
you live)
Subjective Questions
(favorite food, movie,
etc.)
Asking Questions
Statement/Statement
Statement/Question
Talking to My Friends
When I am playing with my friends I
need to talk to them.
I will ask _______ questions.
I will make ______ comments.
Additional Instructional Activities
Conversation Topics
Conversation Topics:
Alex can choose a topic to
talk about. Teacher will
support him with
coming up with details
about the topic (i.e.
Beach: sand, water,
digging, fun)
Alex may need to choose a
topic from a list
Topic:______________________________
Details:
1.____________________________________________
2.____________________________________________
3.____________________________________________
4.____________________________________________
5.____________________________________________
Advanced Conversation Skills
Nonverbal
Language
(proximity, voice
volume, gestures)
Shifting Topics
Listening Skills
Maintaining
Conversations
Appropriate
interruptions
Initiating
Conversations
Idioms, humor,
private/public
topics