Autism Facts 1 in 110 children diagnosed with autism Four times more likely to occur in boys than in girls ASDs can sometimes be detected at 18 months or younger By age 2, a diagnosis by an experienced professional can be considered very reliable - Recent studies have estimated that the lifetime cost to care for an individual with an ASD is $3.2 million http://www.cdc.gov/ncbddd/autism/facts.html
What Causes Autism? Definite causes are unknown Genetic risk factors Children who have a sibling or parent with an ASD are at a higher risk of also having an ASD. Comorbid with other medical conditions: seizure disorder, chromosomal disorders, autoimmune disorders, etc. Once common belief that poor parenting practices (refrigerator mothers) cause ASDs is not true.
What is Autism? Neurological disorder that involves 3 domains: * Language delay/impairments * Impairments in social skills * Repetitive, restricted, stereotyped behaviors Begins at birth or within first three years of life Spectrum disorder
What are the Treatments? Individualized: everyone is affected differently 2009 National Standards Report (over 700 research studies) to determine the most effective treatments. 11 established treatments, most of which include behavioral methodology 20+ emerging treatments Symptoms are treated, not disorder
Applied Behavior Analysis Multi-method strategy that consists of: 1. Observing behavior 2. Identifying target behavior 3. Identifying possible causes for behavior 4. Selection of behavior treatments 5. Implementation of treatments and treatment evaluations - Goal: to decrease undesirable behavior while increasing desirable behavior
Applied Important to change Socially relevant Age appropriate Prerequisites met
Behavior Anything a person does that can be described in observable and measurable terms Not observable or measurable Observable and measurable Tantrum Dropping to the floor and crying Happiness Smiling, laughing Aggression Hitting, kicking, biting therapist or peer
Analysis -Observation and measurement of behavior to determine function -Development of behavior change procedure -Analysis of the effects of behavior change procedures
The ABCs of ABA -Antecedent: events that precede an act -Behavior: anything a person does -Consequence: events that follow the behavior, the results of a behavior
The ABCs of ABA AntecedentBehaviorConsequence See cracker Say "cracker" Get cracker Thirsty Say "juice" Get juice See iron Touch iron Get burned Peer takes toy Hit peer Peer gives toy back
Reinforcement The Basis of Behavioral Intervention
Reinforcement -Used to increase desired behaviors -Reinforcer is anything that increases a behavior -Increases the future probability of the behavior
Rules of Reinforcement Rule Number 1: Catch the student being good!
Rules of Reinforcement Rule Number 2: Vary your reinforcement
Rules of Reinforcement Rule Number 3: Reinforcement must be contingent on behavior
Rules of Reinforcement Rule Number 4: Reinforcement must be delivered immediately after the desired behavior
Rules of Reinforcement Rule Number 5: The size or amount of reinforcement must be appropriate * The Matching Law
Rules of Reinforcement Rule Number 6: The reinforcement must be motivating for the student (satiation, deprivation)
Rules of Reinforcement Rule Number 7: The value of a reinforcer depends on competing reinforcers that are available for other behaviors.
Negative Reinforcement - Increase in behavior by removing something from the environment
Punishment - Decreases behavior - Type I: Something is added to the environment to decrease behavior - Type II: Something is taken away from the environment - Temporary fix - Last resort!!
Extinction -To extinguish or decrease undesirable behaviors -Reinforcement is no longer delivered after the behavior -Extinction burst: The behavior may get worse before it gets better. * vending machine example
Differential Reinforcement -Commonly used with extinction -Goal is to increase one behavior while decreasing another
The Difference Between Reinforcement and Bribery - Reinforcement is proactive. - Reinforcement is initially presented before a behavior occurs.
Function -Every behavior has a function -Function must be determined to appropriately replace behavior -ABC data can often show patterns in behavior -Four basic functions: attention, escape, tangible, automatic -Rule out possible physiological causes
What is the Function? AntecedentBehaviorConsequence Teacher is talking to another teacher Student comes up to teacher and bites Teacher says "don't do that!" Student is playing with peer Student bites peer Teacher comes over and reprimands student Student is playing at recess Student bites peer A teacher gasps "oh my!"
What is the Function? AntecedentBehaviorConsequence Student is asked to come sit down for calendar. Student bites teacher Teacher sends student to hallway for time out Student is doing a worksheet Student bites teacher Teacher replaces the worksheet with an easier one Student is told to get a pencil out for math Student bites peer Teacher puts student on time out
What is the Function? AntecedentBehaviorConsequence Teacher is reading a story to the class Student comes over and bites teacher Student is reprimanded but then given a snack. Student is playing with peer Student bites peer Peer gives student the ball Class is eating snack. Student finishes snack and bites teacher Student is given book to look at
What is the Function? AntecedentBehaviorConsequence Student is playing in the sandbox Student bites his own hands Student continues to play Class sitting at snack Student bites his juice cup Teacher says, "don't do that!" Teacher calls student over for calendar time Student bites his shirt but complies Teacher ignores
Choosing an Intervention - After function is determined, an appropriate intervention can be put in place - Two types of approaches: proactive and reactive
Proactive Approach - Manipulating antecedent events (the environment) to make behavior less likely to occur.
Proactive Approach -For attention seeking behaviors: -Catch the student being good! -Provide reinforcement for desirable behavior
Proactive Approach -For escape behaviors: -Make tasks more fun to decrease motivation to escape -Teach appropriate language to ask for a break -Schedule in regular breaks -First/Then chart or picture schedule
Proactive Approach -For behavior that functions to access tangibles: -Provide access to tangible reinforcement for desirable behaviors -Use a first/then chart
Proactive Approach -For behaviors that serve a self-stimulatory function: -Make sure the student is constantly engaged in activities -Sensory diet
Reactive Approach -For attention seeking behaviors: -Provide NO attention -Turn away -Neutral expression -Monotone voice -Replace with appropriate language if possible
Reactive Approach -For escape behaviors: -Behavioral momentum -Never allow a student to get out of it by exhibiting behavior
Reactive Approach -For behaviors that function as access to tangibles: -Do NOT provide tangible items after the inappropriate behavior -Use behavioral momentum -Replace with appropriate language
Reactive Approach -For behaviors that serve a self-stimulatory function: -Replace the behavior with something more appropriate -Redirect to a different, appropriate activity
Tips for Working Through Behavior Behavior cannot be expected to simply stop. It needs to be replaced.
Replacement Behaviors Replace...With... Throwing a book Turning the pages or throwing a ball Repetitive language Appropriate conversation initiation Biting sibling Biting chew tube or asking for a snack Yelling for attention ??
Tips for Working Through Behavior Do not reprimand the student. Tell them what to do instead.
Tips for Working Through Behavior Remember the importance of a proactive approach. Catch the student being good!
Simulations What does it feel like to have an Autism Spectrum Disorder?