1. Increasing Learning Opportunities for Young Children with Autism Spectrum Disorders during Play and Daily Routines
Jamie Owen-DeSchryver, Ph.D. & Amy Matthews, Ph.D.
Grand Valley State University

2. Introductions & Agenda
Foundations
Brief introduction to the START project
Brief introduction to core characteristics of young children with ASD
Primary Content
Increasing learning opportunities and engagement during daily routines and play activities
Increasing communication opportunities during daily routines and play activities
Increasing imitation skills during daily routines and play activities

3. START Project

4. Thinking Different about Autism Spectrum Disorders, Professional Development, and Statewide Support

5. Purpose of START
START serves as a coordinating and supporting entity for schools and regional networks across the state of Michigan to increase access to local training and resources for students with autism spectrum disorder.

6. START Primary Components

7. START Early Intervention Intensive Training
Targets preschool age, ECSE classrooms supporting children with ASD
Strategies:
Are good for children with a variety of developmental disabilities
Will benefit children 0-3
Were developed based on review of Evidence-Based practices

8. Autism Spectrum Disorders

9. Michigan Students with an ASD Eligibility Label

10. Autism Spectrum Disorders
Numbers of students with ASD are increasing
1 in 150 (CDC)
1 in 91 (Health Resources & Services Administration)
Age of diagnosis is earlier
This leads to more and more students with ASD served in birth-3 and preschool-age programs

11. Autism Spectrum Disorders
Fastest-growing developmental disability
$90 billion annual cost
90% of current costs are in adult services
Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention
Autism Society of America, 2006

12. DSM-IV Definition Core Deficits of Autism
Differences in socialization
Differences in behavior
Differences in communication

13. Triad of ASD

14. Joint Attention
The core symptoms of autism are represented in the triad of impairments. Yet the earliest sign of autism is often manifested as a deficit in joint attention, which has a significant and pervasive impact on all developmental domains.

15. Intervention for Young Children with ASD
The Foundations

16. 16 hours of total intervention
A Model Program for Children with ASD age 0-3 Boulware, et al. (2006): Project DATA for Toddlers
Integrated playgroup (5 typical peers, 2 children with ASD, 3 children with other disabilities)
3 hours per week (2, 1.5 hour sessions)
Individualized instruction (1:1)
6 hours per week (2 hours 3x/wk)
Family support in home or community
2 hours per week by Project DATA staff, 5 by family
16 hours of total intervention

17. Barriers to Implementing this Model?
Financial
Personnel
Philosophical
Status quo
Other??
Given these issues, what CAN we do?

18. Learning Opportunities
We can increase
Learning Opportunities
Active Engagement
We can provide supported opportunities for learning that lead to better outcomes for children

19. 19

20. What does a Learning Opportunity Look Like?
1. Instruction/activity/ situation is presented to the child
2. Child has an opportunity to respond
3. Child is given feedback
Acknowledgement that response was correct or situation went well
Correction/prompt to help the child give a correct response or improve the situation

21. Engaged Time
It may not be possible to provide learning opportunities all the time, but we can increase time engaged.
Engaged time: Active involvement in productive activities that lead to learning. Provide pre-teaching, interesting materials, and adult and peer support

22. Reaching Our Ultimate Goals
Why do we work so hard to increase learning opportunities?
Independence
Socialization
Preparation for typical school experiences
Quality of life

23. Increasing Learning Opportunities & Engagement during Daily Routines and Play Activities

24. Increasing Learning Opportunities & Engagement during Daily Routines & Play Activities
Strategies for Daily Routines & Play Activities:
Goal Cards (CAMPS)
Teach Play Skills- 3 Rs; goal cards
Incorporate Child Interests
Use Visual Supports (play schedule books, sequencing cards, visual schedule, computer book)
Strategies for the Playground or Backyard
Preteach Skills
Use Visual Supports (schedule, first-then)
Interrupt & Redirect

25. Strategies to Increase Learning Opportunities & Engagement: Goal Cards
Preschool Age:
C – Communication goals
L – Literacy goals (letters, pre-reading)
A – Academic goals (numbers, shapes, colors)
M – Motor goals (gross, fine)
S – Social goals
Birth – 3:
C – Communication (verbal, PECS or sign language; choice-making, yes/no)
A – Academic/pre-academic (colors, pre-numeracy skills)
M – Motor (gross, fine)
P – Play (basic toy play skills, e.g., building, imitation, simple pretend play)
S – Social (turn-taking; fill-ins, joint attention)

26. Goal Card for Bath Time C: Communication goal
Requests water “on/off”, “duck”, “pour”, “yes/no”
A: Academic/Preacademic goal
Counts or sorts bath toys/objects, Fills in words in songs: “this is the way we wash our _____ tummy”, points to body parts
M: Motor goal
Scoops and pours water
P: Play goal
Washes a baby doll
S: Social goal
Plays peek-a-boo with caregiver using the washcloth; fills in or participates in game “ready, set, ___(go)” (then pours water out of a cup or drops a toy in the water to make a splash)

27. Goal Card for Riding in the Car
C: Communication goal
Verbalizes or signs for seatbelt “on/off”, music “on/off”, window “up/down”, signs “all done” before having seat belt removed
A: Academic/Preacademic goal
Labels or points to objects in the environment (red car, yellow house, big truck, moon, etc.); points to picture that indicates destination
M: Motor goal
Claps hands “yeah, we’re here”, uses pointer finger to touch colorforms/window decals on window
P: Play goal
Sings songs with caregiver, “if you’re happy…”; looks at book/listens to book on tape; moves or plays with window decals
S: Social goal
Waving to people or objects (“wave bye-bye to the truck”)

28. Goal Card for Putting Shoes On
C: Communication goal
Labels “shoes,’ “socks”, requests “help me”, signs “all done” when finished putting shoes on
A: Academic/Preacademic goal
Labels or points to colors (where’s the red shoe?); counts “how many shoes do you have?”; finds item, “where’s the BIG shoe”
M: Motor goal
Pushes foot into shoe; straps velcro; pulls on socks using two hands
P: Play goal
“Yay, you have your shoes on, let’s pretend we’re ice-skating”, “let’s hop like a bunny”, “let’s tiptoe”
S: Social goal
Responds to absurdities: e.g., caregiver putting shoe on her head; fills in words: “all ____ (done)” time to ___(go)”

29. Goal Card for Breakfast
C: Communication goal
Chooses items (food, bowl, etc.,) either verbally or by pointing
A: Academic/Preacademic goal
Sits in a chair for the meal, labels or points to colors/pictures on placemat
M: Motor goal
Holds and uses spoon, uses a cup, drinks from straw
P: Play goal
Pretends to feed stuffed animal/animal figurine; feeds baby doll
S: Social goal
Shares food (hands food to caregiver/sibling when requested); takes turns (“my turn/your turn”);

30. Strategies to Increase Learning Opportunities & Engagement: Identify and Teach Appropriate Play Skills
Children with ASD often:
Have play skill deficits
Have a small play repertoire
Engage in stereotyped behavior when given the opportunity to play

31. Identify and Teach Age-Appropriate Play Activities (Examples for children ages 2-3)

32. Basic Play Skill Targets
Domain
Example Play Activities
Early toy play
Put together/take apart
Put in/ take out
Play with blocks and manipulatives
Builds/connects
Makes pretend objects
Play with vehicles
One action play with vehicles
Plays in a scene with vehicles
Play with figures or stuffed animals
One action play with figures
Plays in a scene with figures
Pretend Play
Pretends with one object
Pretends without props

33. For More Information on Basic Play Skill Targets
Teach 2 Play
Smith, M. (2001). Teaching playskills to children with ASD
The Assessment of Basic Language and Learning Skills (ABLLS)

34. Blanc et al., 2005
The effects of adult guidance during play were beneficial for children with ASD, children with CI and for typical children, but more particularly for children with autism.
Children with autism showed more complex, and higher developmental levels of play when they were supported/ prompted by adults.

35. An Applied Behavior Analysis (ABA) Approach to Presenting Instruction
3 Rs
Request
(Stimulus)
Response
Reaction
(Consequence)
One to one teaching trial
At lunch
Walking to speech
Video 191, 194, supernanny calling 35

36. The 3 Rs are the same as a “Learning Opportunity”36

37. Using the 3 Rs 100% Success is expected
A child will be assisted until he is successful
Failure is not an option
Don’t make a request unless you are going to follow through 37

38. What Does this Look Like with Play Targets?
REQUEST: Make the request
“Put the cups together”
“Stack the blocks”
“Make a train”
“Fly the airplane”
“Feed the baby”
RESPONSE: If the child doesn’t respond, or responds incorrectly, prompt the correct response
REACTION: Praise and reward the child for the correct response

39. Incorporating an ABA Approach within Classroom Activities
McBride & Schwartz (2003)- embedded instructional episodes (“Learning Opportunities” or “Request, Response, Reaction sequences”) into ongoing classroom routines and activities
Teachers identified individualized IEP/IFSP goals
Addressed the target goals during classroom activities using an ABA approach

40. Goal cards can also focus on play: Building with Blocks
C: Communication goal
Requests block; says “uh-oh” when blocks fall
A: Academic/pre-academic goal
Touch counts blocks (with help); labels colors of blocks
M: Motor goal
Coordinates motor movements to build tower
P: Play goal
Crashes tower with toy car; imitates tower or model made by caregiver; figurine “jumps” off of tower
S: Social goal
Hands block to caregiver; plays peek-a-boo behind the tower

41. and developmental approaches
Strategies to Increase Learning Opportunities & Engagement: Incorporate Child Interests
Braiding the ABA
and developmental approaches

42. Developmental Practices
DAP Position Statement (NAEYC.org)
Pivotal Response Treatment (Koegel et al., 2003)
Naturalistic Instruction
Capitalizes on children’s interests; natural consequences
Targets functional skills

43. Developmentally Appropriate Practice National Association for the Education of Young Children, 2009 (naeyc.org)
Teaching to enhance development and learning
“Developmentally appropriate teaching practices provide an optimal balance of adult-guided and child-guided experiences… child-guided experience proceeds primarily along the lines of children’s interests and actions, with strategic teacher support” (p. 17).

44. Incorporate Child Interests
If you’re working with a child who likes Thomas the Tank Engine, how can you teach important skills using Thomas?
Communication - requests Thomas
Academic – sorts engines by color; completes a Thomas puzzle with help
Motor - jumps over Thomas
Play - re-enacts a scene from a Thomas video
Social – tolerates turn-taking with Thomas

45. Strategies to Increase Learning Opportunities & Engagement: Use Visual Supports
Visual supports can be used to teach early play skills
Early learners may not understand symbolic representations in pictures
Initially, these students may require additional repetition, prompting and feedback (the 3 Rs) to use the visual supports effectively

46. Visual Supports: Play Schedule Book
Identify specific functional play targets for the student; use pictures to cue the activities

47. Play Schedule Book: Where are you going with it?

48. Play Schedule Book: Where are you going with it?

49. Visual Supports Play Sequences
Create picture schedules of play scenarios with sequenced steps
3-Step Sequencing Cards:
Cooking

50. Visual Supports Emerging Dramatic Play

51. Visual Supports: Emerging Dramatic Play
Going Fishing
Put on boots
Put on hat
Get bucket and fishing pole
Catch a fish

52. Emerging Dramatic Play
Computer Book for “Going on a Picnic”
It’s Time for a Picnic!

53. Strategies to Increase Learning Opportunities & Engagement: Preteach Skills
Preteach play skills that are useful during outdoor play

54. Using Visual Supports on the Playground/ in the Backyard
Create appropriate routines; expose the child to new activities; incorporate social opportunities

55. Visual Supports
First: Sandbox
Then: Swing

56. Interrupting and Redirecting
Get in the way!
Make the path to the desired item or equipment through you
Prompt and reinforce the child for appropriate play

57. SUMMARY Increasing Learning Opportunities & Engagement during Daily Routines & Play Activities
Strategies for Daily Routines & Play Activities:
Goal Cards (CAMPS)
Teach Play Skills- 3 Rs; goal cards
Incorporate Child Interests
Use Visual Supports (play schedule books, sequencing cards, visual schedule, computer book)
Strategies for the Playground or Backyard
Preteach Skills
Use Visual Supports (schedule, first-then)
Interrupt & Redirect

58. Increasing Communication Opportunities during Daily Routines & Play Activities

59. Increasing Communication Opportunities during Daily Routines & Play Activities
Identify and teach a Functional Communication system
Increase motivation for communication (natural and contrived events)
Plan for and create communication opportunities (e.g., MITS approach, multiple domains)
Prompt and fade support

60. Communication
Communication needs to be taught throughout the day, every day, by all adults in all environments
Communication should be a TOP priority of 0-3 programming
Decreases problem behaviors
Associated with better prognosis

61. Each Child should have a Functional Communication System
The ability to request:
Desired items (e.g., “Want train”)
Necessary items (e.g., “I need a fork”)
Assistance (e.g., “Help please”)
Attention (e.g., “Watch me!”)
Actions (e.g., “Swing me”)
Information (e.g., “What is it?”)
Negative reinforcement – removing something unwanted (e.g., “Go away”, “Take a break”)

62. What is the “Right” Communication System?
1. Individualized
2. Total communication
3. What’s better, signing or pictures?
4. Should we use alternative systems or just focus on language development?

63. Using Natural Events to Increase Motivation for Communication
When is a child most likely to be hungry? Thirsty?
If the child is thirsty, what has become more valuable?
What behaviors might the child show?
Good communication behaviors: opening cabinet, going to sink, getting a cup
Poor communication behaviors: screaming, crying
This scenario provides us with opportunities to teach requesting (e.g., cup, open cabinet, pour juice, etc.)

64. Using Contrived Events to Increase Motivation for Communication
Create a situation that makes something more valuable
Give the child his yogurt without a spoon
Give the child only a small amount of her drink
Before recess, provide the child with only one of his boots
Hand the child a preferred item that’s been placed in a clear box that she can’t open on her own

65. Other Strategies to Increase Motivation for Communication
In sight, but out of reach
Begin favorite activity, then pause for communication
Missing materials
Offer choices
Display pictures of preferred items and activities throughout the environment
Expectant look
Show an interesting but unfamiliar item, prompt the child to ask questions (e.g., “What is it?”)
Place preferred item in child’s sight, but out of reach (e.g., on a shelf)
Begin a favorite activity and then pause (e.g., push the child in a swing, then facing the child grab the swing to stop it and wait until the child says “swing,” “push me,” etc.).
Provide only some of the materials required for an activity (e.g., paint but no brush).
Present the child with choices (e.g., “Do you want juice or water?”).
Display pictures of preferred items and activities (e.g., picture of trains)
Glance at materials and then look at the child expectantly (e.g., put an unopened juice box on the table during snack then look questioningly at the child).
Show an interesting but unfamiliar item, have the child ask questions (e.g., “What is it?”)

66. MITS: Creating Learning Opportunities for Communication
Multiple Incidental Teaching Sessions (MITS) (Charlop-Christy & Carpenter, 2000)
Child initiates request by using adult as tool (child grabs adult’s arm and attempts to reach to the upper shelf for the cars)
Adult verbally models “I want cars” and hands child one car
Adult immediately implements two more trials of requesting: adult verbally models “I want cars” and provides more cars to the child after each appropriate request

67. Increasing Communication Skills
Plan for and create communication opportunities
Focus on initiation of communication--requesting is more important than labeling
Identify motivating items from multiple domains (not just food)
Supernanny communication

68. Communication Targets from Multiple Domains
Foods/Drinks/Snacks:
Chips
Pretzels
Juice
Water
Toys with Multiple Pieces:
Puzzles
Play-doh
Train tracks
Cars
Interactive/Motor Activities:
Tickles
Swinging
Trampoline
“blanket slide”
Bouncing on therapy ball
Toys Requiring Help:
Bubbles
Balloons
Spinning tops, toys

69. How to Teach Requesting Using Sign Language
Begin with the preferred item present
First opportunity: Provide a freebie while verbally labeling the item, “bubbles”!
Next opportunity:
Model the sign while verbally labeling the item, “bubbles”
Then physically prompt the student to sign for the item; label it again, “bubbles”
Provide the item and label it again, “bubbles”

70. Teaching Verbal Requesting
Again, the first opportunity is a freebie
The label is provided, “tickle”
Child receives item/activity immediately upon approximating the word

71. SUMMARY: Increasing Communication Opportunities during Daily Routines & Play Activities
Identify and teach a Functional Communication system
Increase motivation for communication (natural and contrived events)
Plan for and create communication opportunities (e.g., MITS approach, multiple domains)
Prompt and fade support

72. Increasing Imitation Skills during Daily Routines and Play Activities

73. Increasing Imitation Skills during Daily Routines and Play Activities
Strategies to Increase Imitation
Reciprocal imitation
Teach imitation using the 3 Rs
Observational play with matched toy sets
Observational play through video modeling

74. Imitation
Due to impairments in joint attention & possibly, due to differences in a region of the brain that holds “mirror neurons” children with ASD often show deficits in imitation
Like other early learner skills, imitation may need to be systematically taught

75. For Children who Show Limited Awareness of Others: Use Reciprocal Imitation
Reciprocal imitation involves the adult (or a peer) imitating the actions of the child using matched or similar toys (appropriate play actions, not inappropriate behaviors)

76. Teach Imitation Using the 3Rs
Adult: Says “Do this” and pushes a bus
Child: (no response)
Adult: physically assists child to push the bus and says “This is pushing the bus”

77. Learning through Observation
Learning observationally, or learning from the environment
Watching peers and/or adults and imitating their behaviors

78. SUMMARY: Increasing Imitation Skills during Daily Routines and Play Activities
Strategies to Increase Imitation
Reciprocal imitation
Teach imitation using the 3 Rs
Observational play with matched toy sets
Observational play through video modeling

79. THANKS!! Please complete an evaluation form
Our Contact Information:
Jamie Owen-DeSchryver, Ph.D.
Amy Matthews, Ph.D.
Souls

80. Selected References
Blanc, R., Adrien, J., Roux, S., Barthelemy, C. (2005). Dysregulation of pretend play and communication development in children with autism. Autism, 9,
Boulware, G., Schwartz, I., Sandall, S & McBride, B. (2006). Project DATA for toddlers: An inclusive approach to very young children with Autism Spectrum Disorder. Topics in Early Childhood Special Education, 26,
McBride, B.J. & Schwartz, I.S. (2003). Effects of teaching early interventionists to use discrete trials during ongoing classroom activities. Topics in Early Childhood Special Education, 23, 5-17
National Association for the Education of the Young Children (NAEYC, 2009). Developmentally Appropriate Practice in early childhood programs serving children from birth to age 8. Draft Position Statement, adopted 2009.