Quality of Life Issue

Using the Ziggarut Model as a Guide for assessment and intervention planning, Ruth Aspy, Ph.D and Barry Grossman, Ph.D.

Evidence-Based Practice originated in the medical field, where thousands of controlled research studies have been conducted. Disciplines such as psychology and education have embraced the evidence-based practice movement to build and qualify interventions through accountability and fidelity.

      (See Autism Spectrum Disorders, Guide to Evidence Based Practice Interventions, MO Guidelines Initiative, 2012).

We don’t have a wealth of time to make the most impact on the child with autism’s quality of life.

We would like to avoid law suits by using haphazzard teaching methods and instructional techniques that are hit and miss.

We like to see the progression of progress and advancement of skills.

We like to build confidence with parents and other professionals.

We do it as a TEAM~!!

        Fewer Behavior Problems More Instructional Time Increased Compliance with Law Increased Engagement Time Faster IEP Development Better IEPs More positive/collaborative relationship with parents Improved collaboration with staff

Structured TEAACH, STAR (starautismsupport.com and SCERTS ( www.barryprizant.com

) and ( www.SCERTS.com

the philosophy of using visual supports, structuring the skills and functional routines. They all follow good ) are all evidence-based intervention models that focus on the strengths of the child and with addressing the Autism in a comprehensive, systematic way. These programs also follow student’s environment, helping them regulate their sensory and biological needs and teaching communication, social behavioral principals such as ABA-Applied Behavior Analysis and the ABC’s of teaching new skills. However, the vocabulary and focus of the Ziggarut Model relates more closely to our public school model and language. Additional forms for Ziggarut Model may be downloaded from their website: texasautism.org.

Remember……Good educational programming for students with autism is a win-win for the classroom. Students who have learning disabilities, ADHD, language impairment, emotional disturbance benefit from any or all of the instructional strategies we will discuss.

     50% of all children with autism are nonverbal.

If children do not have an efficient way (either verbal and/or nonverbal) to communicate their wants and needs they WILL communicate through behaviors.

90% of all communication is nonverbal (and children with autism are not good at this).

Children with Autism have difficulty with perspective-taking (Mindblindness) and central cohesion due to language deficits and with Executive Functioning. They are Visual Learners in an Auditory World!

          Parents Student General Education Teacher Special Education Teacher Para-professional Speech Language Pathologist Occupational Therapist School Psychologist Administrator Social Worker Others as needed.

Problems in the following areas of functioning have the most impact on a student with autism’s academic performance…..

   Communication Social Restrictive Patterns of Behavior, Interests and Activities (preoccupation with video games, has to have their personal items organized in a certain manner, etc.)

     Sensory-either under aroused or over aroused.

Motor-fine and/or gross motor delays, awkwardness, clumsy.

Cognitive-delays in both processing and with adaptive skills.

Emotional Vulnerability-Emotional Regulation, more susceptible to stress and anxiety and later depression.

Medical and Biological Factors-difficulty sleeping, digestive problems.

    

Underlying Characteristics Checklist-HF Underlying Characteristics Checklist Classic The Individual Strengths and Skills Inventory The Intervention Worksheet The Ziggarut Worksheet

 Remember, you do not have to use formal tests to do a thorough assessment, as a matter of fact informal observations during functional routines and parent interview gives you the best information.

    Remember, joint attention is a pre-requisite to communication so until you have it, you won’t get communication with any modality.

Autism is the ultimate communication disorder so this is the biggest component of the assessment and intervention plan. Social and communication skills are so inter-related and inter-dependent, they can be assessed together. A child’s ability to self-regulate his emotions, control impulsivity (execute functioning) impacts their communication skills. If a child cannot communicate efficiently or is provided a means to supplement skills not developed, unwanted behaviors will be seen.

      Autism is the ultimate communication disorder. Observe communication skills in a variety of settings and during functional routines. Parent interview of how the child communicates at home.

What modalities of communication do they have if they are nonverbal, ie: gestures, signs, pointing to items they want or need, pictures, device?

Consider what people they communicate with.

Consider their level of comprehension and ability to use all the functions of language, ie: requesting, labeling, receptive skills (identifying objects from pictures.

See Ziggarut Model’s Underlying Characteristics Checklist for High-Functioning (HF) and Classic Autism.

  Remember accommodations, assistive technology sections in the IEP when considering communication needs. Students with limited communication or who use AAC need extra time to respond and/or formulate their ideas and thoughts using AAC.

Structure your classroom so that the student has lots of opportunity to practice requesting, labeling, commenting, asking, answering, joining into conversations.

  Model, use phonemic cues, sentence completion cues, semantic cues, encourage circumlocution (talking around the word to help with word-retrieval problems).

Keep directions simple if a student has receptive language deficits.

    Verbal behaviors, requesting, answering questions, asking questions, commenting, labeling.

Receptive vocabulary-object and picture identification, object-picture matching, picture-picture matching, picture-line drawing, object function, sorting, categorization skills, classification by feature.

Expressive skills: expanding utterances, picture descriptions, story retell.

Play skills, how objects are used.

  AAC stands for alternative and/or augmentative communication. Alternative if the child is never expected to communicate verbally and augmentative if the child has some functional speech. If by age 2, a child does not verbalize any words, it might be time to start teaching signs and gestures to communicate basic wants and needs.

    Sign language DOES NOT deter a child from developing speech/language skills.

Sign language is a form of unaided communication because the child’s hands are always available.

Pictures and communication devices-voice output devices are aided forms of communication.

Selection of vocabulary should be team approach with parent involvement.

  A student’s cognitive level and level of receptive language will drive the type of pictures you use with AAC or PECS. Real objects may have to be used if a student has very poor picture discrimination skills.

A student’s cognitive level and level of receptive language will drive selection of vocabulary, size of picture and number of pictures that should be on each page.

 Show examples of AAC pictures…… www.speakingofspeech.com

; dotolearn.com

     Know the modalities of communication your student uses (from plep in IEP), ie: signs gestures, pictures, device. Aided vs. Unaided.

Involve parents when at all possible communication book between home and school.

Create as many opportunities as possible for student to communicate with as many different people in as many different environments to request, comment, ask, answer, refuse.

Choose motivating engaging activities to elicit functional communication.

View AAC as a second language incorporated into your classroom 

     It is not that children with autism do not want to socialize. It is not uncommon to hear these children or adults express the desire to have friends. They are often uncomfortable in social settings and tend to have difficulty making friends and joining in conversations and groups of peers.

Unwritten social codes, readily understood by others, often seem indecipherable to them.

They come across many times as spoiled or rude.

They have significant difficulty understanding humor, slang, figurative language. Often misunderstand, overreact, think they are being bullied. Often they are the victim of bullying due to their social and/or motor differences.

  The more impaired the child’s functional communication skills are with requesting, answering, commenting, asking, refusing, the more impaired their social skills will be. Communication is the avenue by which social skills develop.

The child with autism’s social skills are further impacted by his/her own unique restricted patterns of behavior, interests and activities.

  Environments: Classroom is different from playground, P.E., cafeteria, waiting for bus.

Look at the Ziggarut Underlying Characteristics Checklist-Social: HF and Classic.

  Teaching social skills is a common intervention with children with autism, but remember, teaching itself is very social and involves reciprocity and interpersonal activity.

Social skills must be taught in naturalistic settings, during functional routines in order to facilitate generalization. Social skills are the most difficult for a student with autism to generalize.

       Sharing Turn-taking Joint attention Initiating Asking for help Joining in an activity Can be impacted greatly by difficulty with transition and/or behaviors.

    Quality social stories requires thorough observation of the student in the environment with careful attention to the language used, details of the learner’s behavior and specifics of the situation to be addressed. They are comprised of the following sentence types.

Can be used for teaching a variety of skills and behaviors, ie: picking nose, good manners, yelling, perspective taking.

Are comprised of the following sentence types (good for language development): descriptive, directive, perspective, affirmative, control, cooperative.

Can use photographs, pictures or just text depending on the age of the child, reading ability, cognitive level.

   Can be written on the fly!

Can be written for any social communication opportunity.

Here is a quick one….

◦ What to say if a teacher asks for your homework and you don’t have it.

         Teacher-”….Do you have your homework?” Student-”No, I don’t teacher” Teacher-”Why don’t you have your homework?” Student-”Because I left it at home”.

Teacher-”Well, bring it tomorrow, but remember, you won’t get full credit”.

Student-”I will and I remember I’ll get 10 points taken off for it being late”.

Teacher-”Is there some strategy you can use to remember to bring your homework back so you will get full credit in the future?” Student-”Maybe putting it in my backpack the night before?” Teacher-”Great idea”

   Social Autopsies were discussed in Richard Lavoie’s book “It’s So Much Work to be Your Friend”.

The basic logic about doing a social autopsy is it is done in the moment-immediately following a social error-ie: student insulting; using negative tone of voice, yelling, belching.

The student and instructor sit down and identify the incorrect behavior or social response. The student identifies how that response or behavior made other’s feel (use what ever visuals you need to here  . The student identifies and practices a replacement skill in multiple environments.

   Mind blindness is one of the most significant problems for students with autism in social situations. Their difficulties with perspective taking usually persist into adulthood. This is also compounded by their own difficulties monitoring what they say (metalinguistic skills).

Cartooning, you know the kind, where one character says something and the other has a little thinking bubble over their head.

See article in your book on The Critical Importance of Declarative Language Input for Children with ASD.

       Expresses strong need for routine or “sameness”, especially with younger children with autism.

Expresses desire for repetition.

Has eccentric or intense preoccupation/absorption in own unique interests.

Asks repetitive questions.

Seems to be unmotivated by customary rewards.

Has problems handling transition and change.

Has strong need for closure or difficulty stopping a task before it is finished.

  Teachers may get the impression the child with autism is lazy, defiant. Many reasons for behaviors of concern. Let’s talk about some……..

   A-ntecedent Events (what happened immediately before a behavior occurred).

B-ehavior C-onsequence (reinforcement)

     Behavior serves as a function.

Behavior is related to antecedents and consequences.

Behavior may be impacted by factors outside of immediate antecedents and consequences.

Behavior may result from biological factors.

Behavior may result from skills deficits (ie: communication, social, academic)

  When you are getting undesirable behaviors instead of the new ones you are teaching, you need to revisit the intervention plan.

Are the student’s biological and medical needs being met? If a child has had a change of meds or has other medical, biological and/or sensory needs, address those before even beginning work. ◦ ◦ Are we being stingy with reinforcement? Is it the right kind of reinforcement? Look at the backward chaining video.

   Are task demands too high? If so, consider a peer model, visual supports, within-task visual schedule?

Are we teaching the right skills? Are the skills we are teaching most closely directed toward improving quality of life, communication, self-help skills to gain independence?

Look at what occurred immediately before the behavior-Antecedent Events…..

         Time of day-mornings with transition or after lunch.

Presence of specific peers.

Specific classroom subject-skills deficit?

Transition from more preferred to less preferred activity (ie: video game to homework). Timer works well for this.

Change in routine-visual schedule eliminates the unknown.

Request to STOP the behavior…… Medication changes…… Family circumstances…….

Environmental changes or dietary changes.

    You heard it correctly, you need to assess what reinforces the student or motivates him/her to work, communicate, interact socially.

We are motivated by material things, so is the child with autism.

Don’t be stingy with it. Decide how often it is going to be delivered and when to reduce it.

  ◦ ◦ ◦ Are task demands too high? Is the activity engaging? Have we used priming and enough modeling?

Do we need a peer model?

What do we mean by errorless teaching? That means providing such a highly structured learning experience, that the students literally do not have the opportunity to make mistakes. Using the visual tools, you show them what the next step is and you prompt them if necessary to follow that step.

  Routine Strips dotolearn.com has some already generated.

Can be drawings, photographs or Boardmaker picture symbols. Predictability/Independence Sequencing/Memory

    ABA-Applied Behavioral Analysis: Includes good teaching principals and is not just discreet trials. Provides positive behavior supports throughout the student’s day. Teaches functional routines.

Pivotal Response Training: done in naturalistic settings, teaches language and play skills; creates teachable moments in context; follows ABA format.

Backward Chaining Functional Routine Instruction

      Help students with Autism see the Big Picture.

Remember they see details and not the whole picture.

Other students also have difficulty with central cohesion and executive functioning are students with ADHD, ED, ID.

Provide practice identifying relevant vs. irrelevant information.

Categorizing activities, sorting, give answers and have them generate the question.

Identify main ideas in stories.

    Break up into two groups-mix it up Hermann and Fulton  Read about Robbie.

Complete the activity. This is open book and open discussion. No wrong or right answers.

 Once you have developed an intervention plan by identifying sensory differences, biological and/or medical concerns, reinforcements to be used and when, what visual and/or tactile supports are needed, what the task demands are, look at quality of life again. Will the objectives you have selected and interventions have the most impact on quality of life?