Transcript Slide 1

You Got to Have Friends!
Developing Appropriate Social Skills in
Students with Learning and Behavior
problems
Bob Babcock, Ph.D., BCBA
Coordinator of Psychological and Outreach
Services, The Learning Tree, Inc.
Private Practice
Why is this so hard???
Humans don’t come with a schematic diagram
….. Although we are getting much better
information about functional neurophysiology
every day
 People are really complicated …. (Self-evident on
Valentine’s Day)
 The old saw about how: “Everything I needed to
know in life I learned in (perhaps before)
Kindergarten” seems loosely correct.
 Unfortunately, we usually have the most trouble
with folks who are don’t have good social skills
long after the age of 6.
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Kids and adults with autism
spectrum disorders as a model for
extreme difficulties with social skills
(sung to the tune of “New York, New York, if I can make it there
I can make it anywhere, ”)
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Diagnostic criteria:
– Qualitative deficits in social functioning
– Impairments in language
– Restrictions in the range of interests
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Increasingly identified
Including Asperger’s Syndrome the prevalence of people
on “the spectrum” may be much higher than the 1/150
recently announced by CDC
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Current findings in the neurobiology of
autism:
Both the medial temporal lobe (MTL), including
the amygdala, as well as the cerebellum, have
been found to be abnormal in several studies
(Akshoomoff, Pierce & Courchesne, 2002;
Dawson et al., 2002).
 A striking recent finding is increased brain
volume when children with autism are young,
although not at birth or later in life (Aylward,
Minshew, Field, Sparks, & Singh, 2002), leading
to a theory of brain growth dysregulation
underlying autism (Courchesne et al., 2002).
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Abnormal processing of
Information in facial recognition
tasks with adults
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fMRI study of
differences B.O.L.D.
between S’s with ASD
and comparison S’s.
Slides presenting facial
discrimination tasks to
subjects
S’s are asked to identify
as same or different
Schultz, Gauthier, Klin, Fulbright, Anderson, Volkmar, Skudlarski, Lacadie, Cohen,
& Gore (2000)
Fusiform gyrus hypoactivity in facial
information processing tasks
Replicated across labs – hence reliable
 Conceptually important as it relates directly to
the development of
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Shared attention,
Joint eye contact,
Recognition of emotional states of others,
Social intuition.
Combined with decreased time ASD subjects
spend looking in the eyes of faces of others
suggests persons with ASDs are compensating in
social tasks for a specific neurological weakness
Evidence of partial impact of
normal social experience in
remediation
Children with autism show the now classic
pattern of fusiform hypoactivation first seen by
Schultz and others to faces of strangers
 They show normal patterns of fusiform
activation to facial expressions of the mothers
and siblings
However…..
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Beneath fusiform gyrus hypoactivity lies
fear….
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Dalton et al (2005) used neuroimaging
procedures from Shultz, et. al (2000) and others
and examined correlation between diminished
eye gaze in facial recognition tasks and BOLD
level measures of activation in medial temporal
lobe.
– Decreased eye contact correlated with hypoactivation
in fusiform gyrus
– Decreased eye contact correlated with
HYPERACTIVATION in areas of amygdala associated
with negative emotion!
Autism Severity correlates with Functional
Abnormalities In Temporal Lobe
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Meresse, et al (2005) Studied blood flow at rest in 45
CWA, average age 7.9 years, using whole brain
covariance analysis to assess the relationship between
clinical profile on the ADI-R and blood flow
– A significant negative correlation was found between rCBF
in the left superior temporal gyrus and ADI-R scores.
– The more severe the autistic syndrome, the lower rCBF is
in this region -- suggesting left superior temporal
hypoperfusion is related to the severity of autistic behavior.
– In the dominant hemisphere the superior temporal lobe is
involved in language and has been implicated in social
perception of biological movement, including movements
of the eyes, mouth, hands, and body.
Ann Neurol 2005;58:466–469
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Kids with ASDs in residential
schools are kids with huge deficits
in social skills
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Typically get to residential schools by exhibiting
severe problems with aggression, elopement, selfinjurious behavior, deficits in communication skills,
etc.
Criteria for placement – Community schools can’t
provide FAPE because of the severity of maladaptive
behavior patterns
Usually, school and home environments of these
kids are so far from what they need that anything
less restrictive than placement would be too risky
[email protected]
The Learning Tree, Inc. – A residential
school-based program in Alabama
Begun as a private, non-profit school for kids with
intellectual challenges, communication difficulties and
challenging behaviors
 Educational program licensed/funded by the Alabama
SDE
 Home-life component certified/funded by the Alabama
DMHMR.
 Begun as a non-profit organization in the Mobile County
in1983 by three parents of multiply-handicapped children
to establish an environment to nurture, challenge, and
provide individualized instruction.
 The goal was to provide their children with a quality
education focusing on strengths and using those
strengths to develop skills.
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[email protected]
Strong organizational commitment to only offering
empirically validated treatment
(i.e., applied behavior analysis and conservative empirical
psychopharmacology for treatment )
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In 23 years of service, the school has grown from four
students and two staff persons at one school in Mobile;
to over 80 students and over 350 full- and part-time staff
at 3 residential campuses.
Currently 17 full-time BCBA-level staff are administrative,
clinical, and teaching roles across all programs
Currently training 14 master’s level graduate students at
Auburn University providing BCBA practicum supervision,
and training 5 undergraduate BCABA-level students at
JSU
Outstanding university-affiliated psychiatric and
neurological services (Roy Sanders, MD-Marcus, Manuel
Cepeda, MD-Univ. South Alabama, UAB neurology)
We don’t permit SI, AI, diet, or other “alternative”
autism interventions at any of our schools
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Instructional services
Residential programs have, at most, 3 children in a
group-home setting staffed by educationally-oriented
direct-care (ISPs are developed using CALS)
 TLT school environments are staffed between 1:1 and
1:3 (IEPs are developed using the ABLLS and CALS)
 Behavior analysis procedures are implemented across
both school and home environments
 FBAs are all direct, typically descriptive, and use brief
FAs when clear and consistent hypotheses do not
emerge from FAI and structured observations
 All treatment evaluation is data-driven with ongoing, but
not always adequate, monitoring of IOA and treatment
integrity
 Placing students in our local community schools is an
increasingly common outcome for our kids – most of
whom are long-term (until 18 or 21)
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[email protected]
Costs of Residential Education
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$95,000 to $232,000
 source: Lexington public schools
Projected median cost for student entering residential at 11 years of
age.
– $163,500 per year
Costs probably average well above the median for programs
providing appropriate services
Once residential placement occurs, coming home may not be an
easy thing to do…..
– When schools place a child and costs are picked up by the state,
few rush to welcome these kids back
– When parents experience that they can’t keep a child at home
and go through the separation of putting him/her in residential
home placements may not longer be realistic
– When kids are “fixed” in a residential placement, this does
nothing to educate the community school and home to prepare
for return
[email protected]
Costs of Placement in a Residential School for ASD
(if placed from 10-22 years, $1,962,000)
Residential Educational Placements
median cost
$3,500,000
$3,000,000
$2,500,000
$2,000,000
$1,500,000
$1,000,000
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$500,000
$0
From data posted
by Lexington MA Public
School System
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number of years in residential
Program Development Efforts
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We serve approximately 35 children across over a dozen
school systems throughout Alabama seeking to prevent
residential placements
– Most referrals come through attorneys wanting to settle cases
they would otherwise fight at the school’s and child’s expense
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We serve 8 children (2.5 yrs-5yrs) with autism in an
intensive ABA and inclusion-based preschool affiliated
with Auburn University (The Little Tree Learning Center)
We provide training for personnel in community schools
at our preschool for personnel through the ACORN
program (see a theme here?)
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The Little Tree Learning Center
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Preschool program for CWA and typical kids
Incidental teaching, peer modeling, and peer tutoring
supplemented with discrete trial training if needed
CWA included in regular classrooms except when 1:1 is
needed for types of instruction we can’t provide with
typical peers
Data driven intensive ABA intervention with a minimum
of 150 learning opportunities per hour and progress on
all programs within 2 weeks required
ABLLS used as primary but not exclusive curriculum
All procedures selected for the individual child justified
by published ABA literature
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Promoting Social Behavior
Language development occurs in play
interactions
 Peer interactions are expected from the
earliest of ages – not deferred until the
child is “ready.”
 Peer tutoring is explicitly used to develop
social behavior
 We are pushing for earlier rather than
later admission to services.
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Monthly Levels of Change for Children at The Little Tree
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The ACORN Project
 Assisting
 Children
to
 Overcome with
 Research findings &
 Nurturance
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How it Works -Training is available throughout the year
We begin with an initial assessment of children selected
by the school using the ABLLS.
 Personnel and parents participating in the program come
to the Little Tree Learning Center in Auburn, an inclusive
model preschool program, for training in basic ABA
procedures for implementation in their local settings.
 We the train adults by emersing them in our preschool
as interventionists in a 2-5 day experience with children
and programs selected to develop their use of improved
early intervention skills back home.
 After the training we provide on site consultation to
begin programs and supervise the use of newly learned
skills.
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[email protected]
At The Little Tree
Participants receive competency-based training
in selected core-skill areas that are essential
components of behavioral instruction for children
in a preschool environment.
 Examples of these skills include:
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Incidental teaching of language and social skills
Attend and ignore (behavior management)
Maintaining functional engagement
Finding and using reinforcement effectively
Effective prompting strategies
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Comprehensive Behavioral
Support Program
(aka School Consultation)
Ages of Students Served
18
16
Median
age ~11.5
14
YEARS
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10
8
6
4
2
0
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3
[email protected]
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Diagnoses of Students Served
12
NUMBER
10
8
6
4
2
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VI
OD
D
AS
D
AU
TIS
M
SS
IO
N
DE
P
RE
'S
ER
GE
R
AS
P
AD
HD
0
Services Provided
0
5
DIAG
3
ABLLS
3
10
15
20
24
STAFF EDUCATION
17
FBA
15
PBS
9
DRO
10
DRA
2
TE
RESP COST
1
4
class wide PBS
4
NETO
TO RM
1
SELF-MGT
1
3
FLUENCY
PEER MENTORING
1
PECS
1
TRANSITION PLANNING
1
2
ACORN
PARENT EDUCATION
1
OBM
1
[email protected]
25
30
Severity of Behavioral Issues
Presented by Students
diagnosis only
ivb, nc only
ivb,nc, (MI/Risk hx)
ato, atp, sib
0
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5
10
15
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Functional Behavioral Assessment
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Descriptive
– Interview
– Observation
– Ecological Data Analysis
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Analogue
– Brief FAI
– Extended FAI
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Demonstrating Functional Relations in
Treatment
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Plus an FBA and a Behavior Support Plan we often…
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Review the IEP for how well the students social, motivational,
communication, life skill, and academic deficits are addressed
Conduct the CALS and other assessments depending on the
situation
Select new IEP goals that can result
– Functionally equivalent replacement skills (better
communication, social and negotiation skills)
– Self-management skills
Train teachers in specific instructional techniques needed by
challenging students
Set up OBM systems to involve the school’s administration in
reinforcing (with attention and praise) the implementation of
positive behavioral support plans
Set up videotape or other monitoring systems to permit consultant
to monitor, evaluate, and provide feedback to teachers and others
on correct and incorrect use of teaching and behavior support
program techniques
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Tools:
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Consent to share information with school and parents on
an equal footing
CALS
FAI, NSA
Eco-Behavioral Assessment System
Standardized format for managing individual data
spreadsheets
Email with password protected files as attachments
Competency-based training, using video modeling and
video feedback
Videotape monitoring of teaching skills, Engagement, and
Program implementation
Celeration charts for fluency-based training
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A Typical Positive Behavioral Support Program
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Functional Behavioral Assessment – Interview and
Observations
Hypothesis about Function and Skills to be Developed
Data Collection Method
Current Behavioral Levels
Behaviors to Strengthen
Behaviors to Weaken/Eliminate
Objectives
Reinforcement Procedures
Responding to Problem Behaviors
Procedures for Data Review
Parental Consent
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Social Skills Training Embedded in
Positive Behavior Support Plans
Quite Hands (personal space)
 Polite Voice
 Listening to the teacher
 Sharing things with other students
 Participating in group activities
 “Stop-Freeze”
 Accuracy in reporting rule following
 Making mistakes without melting down
over them
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Techniques teachers can use to promote
appropriate social behavior in schools
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Direct instruction in role play activities (giving teachers scripts to use to
coach specific skills)
Self management training – reviewing positive classroom rules and
reinforcing both behaviors consistent with positive rules and do-say
correspondence (giving teachers cues to use to provide reinforcement for
appropriate behavior)
Pivot praise – prompting by reinforcement of peers for appropriate social
behavior combined with differential reinforcement (giving teachers a
method for responding to problem behaviors without directly reacting to
them)
Positive scanning (Prompting teachers to see and reinforce god behavior)
Beat the timer – providing teachers with both flexibility and structure
(giving teachers a system to prompt use of ALT-R techniques while
ensuring the rate of reinforcement remains adequate)
NETO – providing a stimulus as a prosthetic response and cue to children
about contingencies (giving teachers a way to manage extinction, time-out,
and negative reinforcement of good behavior without inadvertently
reinforcing problem behaviors)
Peer mentoring groups and adult mentoring of acceptance of one’s
limitations for kids with ADHA, etc.
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Typical Examples of Outcomes…
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1 5th grade child re-entered school after 16 months at home
2 high-school students successfully moved to regular education
2 high-school students received reasonable accommodations and needed
nothing else (not kids with autism)
1 5th grader removed from a single inclusion class by parent during
baseline
2 children with autism fully included in regular Kindergarten with
behavioral intervention instead of being in a segregated “preschool.”
2 First-grade students included in regular education with pullouts, instead
of being in self-contained with dramatically decreased aggression and sib
2 students with Asperger’s provided with support in regular education – 1
needing a BSP, the other being assisted with teacher training
1 High-school student provided with a completely revised IEP
4 students maintained in current setting with behavior support plans
decreasing aggression, SIB, etc.
[email protected]
Behavioral Coaching Adolescents
and Adults
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Social deficits are more responsible for unemployment
that a lack of technical job skills
Interviewing for a job can be harder than doing one
Stress in work and social situations can result in
avoidance behavior patterns
Unskilled interactions with law enforcement personnel
can be hazardous
Intimate relationships must be built upon both
competent judgment and information about
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Biology
Emotional attachments
Legal issues
What our Momma would think about it if she knew what you two
were up to…
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Strategies
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Addressing functional but counterproductive ASD specific patterns of social
behavior with a conceptual FA
Identifying natural contingencies and educating the person about what to
expect
Instructing new behavior patterns through coaching (Risley’s macro level of
intervention)
Instructing self-management skills such as relaxation
Arranging short-term goals and short term contingencies to help individuals
experience success and eventually meet longer-term goals
Teaching parents and other support providers to use positive scanning to
reinforce progress in social functioning.
Developing self-managements plans negotiated with significant others
Helping people that provide support to persons with challenges become
objective consultants, rather than providers of consequences
Helping people identify their limitations and to explain how a reasonable
accommodation would permit them to be successful at work and in social
settings
Helping people building a philosophy of rules in specific areas (e.g., dating)
from experience (using the EAB findings on rule-governed behavior and
persistence)
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Bottom lines
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People manipulate their social environments – those who cannot live with
“learned helplessness.”
There isn’t anything wrong with being in control of your environment
There are good behaviors and bad behaviors – but labeling them so and
punishing bad behaviors doesn’t teach good behaviors
People who lack social skills can learn to not behave through punishment –
but learning a new skill requires effective prompting and reinforcement
We know much more about how to shape and mold new behaviors than we
are willing to apply when we believe that social failures reflect motivational
problems
Being raised right only works (when it does) for kids who don’t need much
more than reasonable adult models.
Most adults deal with kids the way they were dealt with as children
An enormous number of kids need a lot more instruction than we realize
when they screw up on issues that are social in nature.
You don’t resolve a “can’t do” problem with a strategy focused on
motivational issues, errors, and failures. All you teach that way is that
adults “Don’t get it.”
If you assume the problem is a skill deficit then there is, after all something
you have to teach a child other than that they are a failure.
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