Transcript Determining appropriate treatment goals for children with

Using Neurotypical Peers to
Determine Social Skills Goals
to children with ASD
Kelly McKinnon, MA, BCBA
Kelly McKinnon & Associates, Inc.
www.kellymckinnonassociates.com
Kelly McKinnon & Associates, Inc.
Module 1: Joint attention
DSM IV: Qualitative Social Impairment
Impairment with nonverbal behaviors: eye gaze, facial expression, body posture, gestures

Joint attention is considered by many researchers to be pivotal to deficits in language,
play and social development (in the autism population), (Mundy, 1995)

Researchers have noted the importance of joint attention deficits in the development of
children with autism (Kasari C., 2004, Whalen, C., Schreibman, L., 2003

Mundy (1995) theorized that joint attention deficits in children with ASD by distort
systems that motivate children to attend & engage in their social world

All babies use eye contact to inspect; Pauline Filipeck, 2008
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Neurotypical development Module 1: Level 1: Referencing/joint attention
12-18 months
18-24 months
24-36 months
4 years old
5 years old
Attends to music or
signing
Imitates other
children
Watches the face of
others for clues to
their emotions or
feelings
Points to up to four
items in pictures
Interested in new
experiences
Likes to sing, dance,
act, performing before
others
Maintains attention to
speaker
Shows toys or
actions to others
Watches others
children in play and
may join in
Participates in simple
group activities, such
as singing clapping or
dancing
Can sit and participate
in small group
activities
Looks at person saying
child’s name
Looks when parents
are looking
Points to events or
toys of interest
Sits for stories up to 20
minutes
Looks at familiar
objects and people
when named
Smiles when others
are smiling; may
cry when other
babies cry
Looks between events
and people to share
interest
Gains attention with
gestures, or
declarations, “Look”
Points to objects to
indicate awareness
Imitates
interactions shows
interest with other
children
7-12 months
References others to
check if mood or
emotion; should
continue activity
Performs for attention
Extends arm to show
object
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Module 1: Joint Attention/Imitation
Student:
Module 1 Joint Attention/Attending
1:1 setting
Basic rapport building/instructional control
(can tolerate simple 2-3 motor step directions minimum)
Establishes basic eye contact to objects & people in anticipation
Looks/reaches for desired item in close proximity
Turns and orients toward person when making requests
Looks when called/comes when called/responds to name
Follows eye gaze, point or gesture by others
Beginning imitation 1-3 step motor tasks
Looks/orients when listening to others (shifts body/gaze every few sec.)
Follows simple commands
Respond/imitate to basic gestures
Sits and attends to simple tasks (10 min)
1:1 Reciprocal actions- ball/toy/action activities
Shift gaze (during activities) to new people/items in space
Sit quietly in circle/small group/look, sit, attend 10 minutes
Imitates hand movements in circle to music & rhythm & group imitation
Reciprocal activities in a small group
Recognize/know your place in space
Following group auditory & nonverbal instructions
Imitates & recognizes voice & body activities (level, vocal actions)
Calls out in unison
Waiting turn to talk (1:1, in a group, and gaining attention)
Sharing and being a leader-check & orient toKelly
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Basic checking and reading non-verbal social cues & your place
Group setting
Natural Setting
Neurotypical data points
joint attention & referencing
Video of: 4 year old boy & 3 year old girl playing:
Data for 4 year old boy:
Looked when he spoke: 100%
Looked when listening to peer: 57%
Held up object to showed: 3 times, in 3 min.
Referenced adult in room: 4 times in 3 min
Looked to watch: 2 times in 3 min
Looked when called: 100% (1/1)
Imitated actions in play: 0
Called peers name in conversation: 2 times
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Neurotypical data points
joint attention & referencing
Data for 3 year old girl:
Looked when he spoke: 100%
Looked when listening to peer: 67%
Held up object to showed: 2 times, in 3 min.
Referenced adult in room: 4 in 3 min
Looked to watch: 5 times
Looked when called: 100% (2/2)
Imitated actions in play: 1
Called peers name in conversation: 1 time
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Skill
Boy-4 Boy-4 Girl-6 Girl-6
Look to watch
Show others
Imitate
Look-talking
Look-answer
5
2
3
60%
100%
3
4
2
63%
40%
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3
1
3
90%
100%
5
1
0
100%
80%
Listening to a story
Listening to a story on the floor
Partial Interval sample data collection
Criteria: Reference story at least every 30 seconds
 3 year old: Reference 100%; Duration Ave: 1 min.
 4 year old: Reference 100%, Duration Ave: 1.37 min.
 5.5 year old: Reference 100%, Duration Ave: 2.5 min.
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Listening to story
Montessori classroom Kindergarten, 1st and 2nd
5 minute sample; 2 girls, 3 boys
Partial Interval sample data collection
Criteria: Reference story at least every 30 seconds
Girls: 100% (looked once per 30 seconds for 5 minutes)
Fatigue? No> 100% after 7 minutes
Boys: 2 boys, 100% criteria, 1 boy, 80% (looked 1x per 5)
Fatigue?>Not really, boy at 80%, stayed there
Other two boys at 92%
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Additional referencing skills
Using a point to choose:
25%, 100%, 100% Ave of 3: 75% of time
Referencing for approval/Information:
100%, Responding to Yes/No: 100%
Hearing a noise: Knock on door
Look to noise: all three looked both times
Comment to noise: 1 of 3 boys comment “What’s that”
Comment on person entering room (purpose of knock) 2 of 3 boys
commented
Need larger sample!
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Looking for a reason & imitating
Stopping and starting to music
(Criteria: stopping in 1-2 seconds)
3 year old boy: 60%
4 year old boys (2): 100%
Stopping and starting, based on Yes/No head nods
(Criteria: stopping in 1-2 seconds)
3 year old boy 80% (possibly momentum from previous experience
4 year old boy (2) 100%
Imitation of others’ “different” behavior
3 year old boy: looked at peers: 2 times, copied change 2 times (100%)
4 year old boy: looked at peers 4 times, copied change 3 times (75%)
4 year old boy: looked at peers 2 times, coped 1 time * Leader*
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Programming considerations

Teach social referencing: looking, to see if others are
listening, if you are doing something correctly

Teach imitation of peers: watch peers, copy peers;
especially if you don’t know what to do

Teach joint attention: show others items you have! Look
when you talk!

Teach sitting quietly in a group: a school must!
Use data provided as your criteria aims for mastery
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Sample Goals:
 Kelly will orient toward others when speaking, at least 1 time
per statement, checking if listener was listening and heard
his statement.
 Kelly will follow others points toward an object (at a distance
of a minimum of 25 feet), reference back to pointer for
approval, obtain the item and/or comment on the object,
completing 3-4 steps of the sequence, independently
 Kelly will orient to a speaker when listening both in a group
and 1:1, orienting and glancing at least 1 time every 30-40
seconds, (to watch in anticipation of and action or a
movement), for a duration of 5 minutes
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Module 3: Play skills
DSM-IV -Autism
Lack of varied, spontaneous, social imitative play,
preoccupation with parts of objects
Failure to develop peer relationships at
developmental level
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Play Skills
 In 2001 the book Educating Children with Autism
ranked social skills and the teaching of developmentally appropriate
play, “among the eight types of goals that should have priority in the
design of effective educational programs for children with ASD”
 “Children with autism often gravitate to repetitive play activity, to
pursuing obsessive and narrowly focused interests. Without specific
guidance, they are less likely to engage in functionally appropriate play
with objects” (Wolfberg, 1999)
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Module 3: Level 1: Social Play- Developmental Milestones
7-12 months
12-18 months**
18-24 months
24-36 months
4 years old
5 years old
Imitates familiar
actions with caretaker
Demonstrates
functional use of
objects
Uses vocalizations and
words during pretend
play
Uses most toys
appropriately
Associative Play
common (engaged in
same play, interacting,
yet going own way)
Acts out characters
Plays pat a cake
Shows symbolic use of
objects
Uses two toys together
in pretend play
Demonstrate parallel
play
Follows rules in simple
games without being
reminded
More likely to agree with
others on rules- more
cooperative play
Participates in games
with adults
Plays with a toy in a
different way
Stacks and assembles
toys and objects
Performs longer
sequences of play
activities
Plays “Mom” or “Dad”
Sometimes demanding,
sometimes cooperative with
friends
Explores environment
with curiosity
Imitates simple actions
of others in play
Engages in pretend and
symbolic play~
performs several steps
(such as feeding doll,
cover with blanket)
Pretends to perform
caregivers routines
Emerging Cooperative
play with other children
(working together
toward common goal)
My visit friends
independently
Plays ball with adults
Uses one object to
represent many objects
Has plan when building
with items- using models
Stories/narration have
sequences of actions, no
central character or theme
Imitates interactions
shows interest with
other children
Emerging Associative
Play
Organizes doll furniture
& use imaginatively
Will build a block
tower- up to 9 blocks
Silly in play, may do
things wrong on purpose
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Likes to dress up and act
out characters
Module 3: Social Play
Play can be simple, or very intricate
 Some common play scenarios:
 Play with closed ended toys (stacking cups)
 Open ended purposeful play (block building)
 Independent play
 Parallel play
 Symbolic/Pretend play
 Dramatic play
 Basic cooperative play
 Team play
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Neurotypical data points
Independent play:
Children play alone, short or long periods of time, and using a
variety of toys! They explore & access toys
INDEPENDENTLY, playing FUNCTIONALLY
Boy, age 2: played trains, 4 min. before looking bored &
referencing adult; built, used trains, built some more; quiet,
references to adult often, then plays again
Girl, age 2: played kitchen, babies & house together, 13+
minutes; some play narration, reference to adult when name
called
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Independent play
Boy age 4: Picks a theme (power rangers), moves
around, incorporating many toys into play; narrates
play, shifts play, nearly constantly; durations
Boy age 6: Narrates play, explores objects, then finds
one, has a plan when you ask, duration up to 20
minutes at a time!
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Associative Play
Associative play~ involves sharing same play materials, showing others own
activities, commenting; both engage entire duration allotted (5 minutes)
Boy, age 4 (in yellow)
Look/watch other boy: 7 times
Imitated peers actions: 4 times
Make sounds/actions: 3 times
Shows others~ gains attention of others
“I...” or shows object : 3 times
Narrates play (note directed at anyone in particular): 3 times
Coordinates idea (“Lets....”): 2 times
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Boy, age 4 (in red)
Look/watch other boy: 3 times (more of a leader)
Imitated peers actions: 2 times
Make sounds/actions: 3 times
Shows others~ gains attention of others
(“I...” or shows object): 3 times
Narrates play (note directed at anyone in particular): 4 times
Coordinates idea (“Lets....”: 3 times
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Play data points
Boy, age 6
Look/watch other boy:
Imitated peers actions:
Make sounds/actions: 3 times
Shows others~ gains attention of others
(“I...” or shows object): 3 times
Narrates play (note directed at anyone in
particular): 4 times
Coordinates idea (“Lets....”: 3 times
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More data points
Boy, age 6
Look/watch other boy: 3 times (more of a leader)
Imitated peers actions: 2 times
Make sounds/actions: 3 times
Shows others~ gains attention of others
(“I...” or shows object): 3 times
Narrates play (note directed at anyone in particular):
4 times
Coordinates idea (“Lets....”: 3 times)
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Programming considerations




Teach: Independent play: access & play with toys on
your own, functionally; give mom a break!
Teach: Imitation in play: watching, copying & responding
to others actions
Teach: Initiating play ideas: generate new ideas in play
Teach: Pretend play; acting out scenarios, characters
Use data provided as your criteria aims for mastery
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Sample Goals
 Kelly will expand her play-skill repertoire, to include the
ability to build several items (at least three different objects)
with three different types of building toys (blocks, K’nex,
Lincoln logs), independently
 Kelly will expand her play-skill repertoire, to include the
ability to use objects for pretend play actions including
several items (army men, cars, transformers) initiating at
least a 10-action play scheme with each play item,
independently
 Kelly will engage in functional, independent play, using 1-3
toy items, sustaining play for at least 10 minutes
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Sample Goals
 Kelly will demonstrate emerging parallel play
skills by playing in the same area and sharing
play materials with a peer, for at least 5 minutes,
or until the activity is over
 Kelly will expand dramatic/pretend play skills with
peers, by initiating at least 5 new pretend play
ideas, and observe and imitate at least 3 play
actions, in a 10 minute play period
 Kelly will join into play of others, sustaining and
participating in the activity at least 10 minutes, or
until activity is over.
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Social Language & Communication
DSM-IV –Autism
Qualitative Impairment in Communication
Delay or lack of spoken language
Delay in ability to initiate or sustain conversations
Stereotyped and repetitive use of language
 Children with autism exhibit a range of problems associated with
communication and language (Schopler & Mesibov, 1985).
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Module 5: Level 1: Social Language (see speech chart for complete speech & language information)
7-12 months
12-18 months
18-24 months**
24-36 months
4 years old
5 years old
Vocalizes during games
Responds to other
children’s vocalizations
Uses words to interact
with others
Uses 3-word phrases
frequently
Uses attention getting
words, “Look”, “Hey”
Speaks in five to six
words
Speaks in sentences of
more then 5 words
Sings along familiar
songs
Uses words to protest
Understands meaning
of action wordsanswers to “What
doing?”
Uses action words
consistently- uses “is” &
contractions (he is
running, he’s running)
Follows three-part
commands
Uses future tense,
irregular tense
Uses one-two words
spontaneously
Shakes head No
Uses two-three word
phrases spontaneously
Talks more in play with
children
Recalls parts of a story
Tells longer stories
Uses a word/sound to
call out to someone
Asks to have needs met
Uses 50 different words
Follows 3-step unrelated
commands
Tells beginning stories
Responds verbally to
friends favorably
Imitates three animal
sounds
Understands commands
to sit down, come here
Identifies parts of an
object and function of
objects
Mastered some grammar
Sings independently
Identifies body parts
and clothing items
Responds to
questions- “Who, What,
Where” (in, on, under)
Correctly tells two events
in order of sequence
Responds to give me
commands
Chooses five familiar
objects on request
Answers Yes/No
questions correctly
Fills in the
blank/intraverbals
Asks what’s that
Follows a two-step
related command
Establishes likes and
dislikes
Uses fillers to
acknowledge others
Identifies objects by
categories
Takes turns during
conversations
Engages in conversations
from past ideas, own
items
Uses language for
fantasy, jokes
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Social Language & Communication
Mark Sundberg, CALABA 2006
“Children with ASD often present extensive tacting repertoires & receptive
repertoires >absent or low rates of mand & intraverbal repertoires”
Creates a scenario of language solely under SD’s
These are the children that have hundreds of words, only when prompted!
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What we need to teach
Module 5: Social Language
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Types of social language
Most social language of young children involves:
 Showing others what you have to gain attention
“Look”, “Watch this”
 Sharing information
“I have”, “I like”, “I went”
 Making contingent statements
“Me too”, “I have that too”
 Asking questions
“Where did you get that”
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Neurotypical data points
Boy age 4
Makes sounds & actions 7 times (in 5 min)
Shows others items: 4 times (in 5 min.)
Shares information or idea: 6 times (in 5 min.)
Asked questions: 2
Narrates own play (no intended listener) 4 times
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Boy age 4
Makes sounds & actions 3 times (in 5 min)
Shows others items: 3 times (in 5 min.)
Shares information or idea: 3 times (in 5 min.)
Asked questions: 1
Narrates own play (no intended listener) 4 times
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Kindergarten Lunch data:
3 boys, 3 girls at lunch table (5 minute sample)
Ave. comments by boys: 7
Ave. comments by girls: 8
Types of comments:
“Can I have that?” (6 times) “I have M&M’s”
“I have a fruit roll up” “I love those”
“I have two chips” “Look at this. Everyone wants this”
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Neurotypical data points
 Children eating, don’t talk that much!
“Lunch bunches” or “snack & talks” should not be primary social
skill teaching
 Children ages 2.5-7 all knew at least 1 thing:
-favorite foods
-new toy items
-things they like & don’t like
-places they like to go
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Neurotypical data points
Children rely on similar constructs to talk





They talk about what they are doing
They show each other what they are doing
They make statements about what they have, what
they are doing
They comment back when others make these
statements
They ask some questions to gain information, however
this is not the pre-dominant method of conversation
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Language Programming
considerations

Teach showing others, and calling for attention

Teach sounds paired with actions

Teach talking about your play actions or idea

Teach narration of play> so others will know what you are doing!

Teach knowing information> what child likes, toys they have, places
they have been
Use data provided as your criteria aims for mastery
Kelly McKinnon & Associates, Inc.
Sample Goals
 Kelly will comment to others/mand for attention about her
play activities (“Look, I build a robot” or “Watch me”!) at
least five times in a five minute play period
 Kelly will make basic contingent statements, when peers
make statements, (such as, “I like, I have too”) at least
70% of instances, in a 5 minute activity
 Kelly will approach others with an opening starter
statement (“I statement”) or with a related question, to
appropriately engage a peer in conversation (vs. blurting
out a statement or making and inappropriate statement)
80% of opportunities.
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Thank you
Social Skills Solutions, A hands on manual for teaching children with autism;
Kelly McKinnon, www.difflearn.com
Sources: for developmental milestones:
Hawaii Early Learning Profile Checklist, 1984, The Rosetti Infant-Toddler Language Scale, ages Brith-3 (1990), The Developmental Assessment of
Young Children: Adaptive Behavior, Communication, Social-Emotional and Cognitive sub-tests, Inventory of Early Development II (2004) and
Developmental Profile (1984) and Speech & Language Development chart, Addy Gard, Leslea Gilman, Jim Gorman, Desired Results Developmental
Profile, California Dept. of Education; Theory of Mind Development Chart, DeCurtis, Schryver-Stahly & Ferrer, CSHA Magazine, Fall 2003;
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