Presentation is loading. Please wait.

Presentation is loading. Please wait.

Solution Focused Interventions for Children with Autism

Similar presentations


Presentation on theme: "Solution Focused Interventions for Children with Autism"— Presentation transcript:

1 Solution Focused Interventions for Children with Autism
Rose Iovannone, Ph.D., BCBA-D University of South Florida

2 Objectives Participants will:
Describe the standards for establishing an intervention as “evidence-based” Use guiding questions to determine the level of evidence held by various interventions Describe the features of several interventions with established efficacy for young students and explain how to implement them in their environments

3 Agenda What is evidence? Examples of strategies with evidence
Resources

4 “If you’ve seen one child with Asperger’s Syndrome or autism, you have seen one child with Asperger’s Syndrome or autism.” Brenda Smith Myles November 14, 2000

5 Evidence-Based What is it?

6 Evidenced-Based Practice
An instructional strategy that: Has a base of high quality research over a range of different students, in a range of places, and over a range of behavior Has been shown to result in measurable educational, social, or behavioral benefit

7 Identifying Evidence-Based Interventions
“Reliance on sources such as expert opinion is contrary to evidence-based practice approach because such alternatives have many sources of potential bias.” Gambrell, 2003 (page 13)

8 Identifying Interventions
Internet as a source is overwhelming: Example: term “autism cure” Google search 2 time points (Feb Feb. 2006) Change in number of web pages—528,000 to 5,290,000 (Long, 2006) Many not evaluated nor provide reliable information about their claims (or outcomes) Training programs (for practitioners) do not consistently disseminate evidence-based practices

9 Identifying Interventions
No single research method can answer all questions Experimental: Manipulating variables systematically—quantitative Descriptive: Description of naturally occurring relations between 2 or more variables—qualitative Experimental provides the answer about an intervention’s impact on behaviors Descriptive provides directions for research; does not demonstrate causal relationships

10 Two Methods of Establishing Evidence
Threshold (restrictive) Number of randomized clinical trials (standard = 2) Hierarchy of Evidence (more inclusive) Continuum (4-5 points) of evidence Example: Well established to no supporting evidence Evaluating evidence Randomized control trials = gold standard Well designed quasi-experimental studies = acceptable but weak Single-participant—not clear

11 Identifying Interventions
Currently, there is no reliable database for validated autism interventions Alternative—construct interventions that contain principles of behavior—Formative E.g., antecedent control, positive reinforcement, shaping, fading

12 Implementing the Intervention
Match to sample Training of intervention agents Characteristics of students Environmental context Training and fidelity issues

13 Evaluating the Intervention
Measuring progress should occur frequently and systematically Two questions: Is the behavior changing? At what rate is behavior changing?

14 Guidelines for Consumers (Detrich, 2008)
Decisions about interventions should be based on the best available experimental evidence In the absence of clear evidence-based information, interventions should be developed that use strategies from the established principles of behavior When modifying an intervention, base it on the established principles of behavior Select interventions that were tested situations similar to those of the specific student Direct training should be provided to practitioners Fidelity measures should be collected regularly Systematic evaluation of progress should be conducted

15 What are Evidence-Based Practices?

16 Guides National Research Council (2001)
National Standards Report (2009) Iovannone et al., (2008, 2003)

17 National Research Council
Practices recommended: Curriculum focus on social interaction, play and communication Specialized services—speech/language & occupational therapy Family involvement Consistent and ongoing communication between team members Capacity to address behavioral challenges Specialized and ongoing training and support to staff

18

19 NSP Evidence-Based Interventions
2009 Report is the first. Future reports will expand focus of criteria for inclusion -Looked only at educational and behavioral interventions (excluded biomedical with exception of curative diets) -Looked at only two classes of research design (group and single-subject) -Limited scope to strict diagnostic criteria What is the National Autism Center? The NAC advocates for and identifies evidence-based treatment approaches shares practical information with families Conducts applied research Develops training and service models for practitioners Works to shape public policy concerning ASD and its treatment through the development & dissemination of national standards practice Professional Advisory Board Alice C. Carter, Marjorie H. Charlop, Carl J. Dunst, Jennifer Gillis, Gina Green, Sandra L. Harris, Debra M. Kamps, Lynn Kern Koegel, Robert L. Koegel, Catherine E. Lord, O. Ivar Lovaas, Stephen C. Luce, Ph.D., Gail G. McGee, Raymond G. Romanczyk, Leslie Rubin, Helen Tager-Flusberg Expert Panelists Susan M. Wilczynski, (Chair), Jane I. Carlson, Edward G. Carr, Marjorie H. Charlop, Glen Dunlap, Gina Green, Alan E. Harchik, Robert H. Horner, Ronald Huff, Lynn Kern Koegel, Robert L. Koegel, Ethan S. Long, Stephen C. Luce, James K. Luiselli, Samuel L. Odom, Cathy L. Pratt, Robert F. Putnam, Joseph N. Ricciardi, Raymond G. Romanczyk, Ilene S. Schwartz, Tristram H. Smith, Phillip S. Strain, Bridget A. Taylor, Susan F. Thibadeau, Tania M. Treml

20 NSP Strength of evidence
Strength of Evidence Classification System used by National Standards Project Established Emerging Unestablished Ineffective/Harmful ◖ Established. Sufficient evidence is available to confidently determine that a treatment produces favorable outcomes for individuals on the autism spectrum. That is, these treatments are established as effective. ◖ Emerging. Although one or more studies suggest that a treatment produces favorable outcomes for individuals with ASD, additional high quality studies must consistently show this outcome before we can draw firm conclusions about treatment effectiveness. ◖ Unestablished. There is little or no evidence to allow us to draw firm conclusions about treatment effectiveness with individuals with ASD. Additional research may show the treatment to be effective, ineffective, or harmful. ◖ Ineffective/Harmful. Sufficient evidence is available to determine that a treatment is ineffective or harmful for individuals on the autism spectrum.

21

22 Established interventions
1. Antecedent Package 2. Behavioral Package 3. Comprehensive Behavioral Treatment for Young Children 4. Joint Attention Intervention 11 Treatments were identified as established/effective. 1. Antecedent Package (99 studies) Includes but not restricted to: behavior chain interruption; behavioral momentum; choice; contriving motivational operations; cueing and prompting/prompt fading procedures; environmental enrichment; environmental modification of task demands, social comments, adult presence, intertrial interval, seating, familiarity with stimuli; errorless learning; errorless compliance; habit reversal; incorporating echolalia, special interests, thematic activities, or ritualistic/obsessional activities into tasks; maintenance interspersal; noncontingent access; noncontingent reinforcement; priming; stimulus variation; and time delay. 2. Behavioral Package (231 studies) Includes but not restricted to: behavioral sleep package; behavioral toilet training/dry bed training; chaining; contingency contracting; contingency mapping; delayed contingencies; differential reinforcement strategies; discrete trial teaching; functional communication training; generalization training; mand training; noncontingent escape with instructional fading; progressive relaxation; reinforcement; scheduled awakenings; shaping; stimulus pairing with reinforcement; successive approximation; task analysis; and token economy. 3. Comprehensive Behavioral Treatment for Young Children (22 studies) Discrete trial, incidental teaching, etc.) which are delivered to young children (generally under the age of 8). May also be referred to as ABA programs or behavioral inclusive program and early intensive behavioral intervention. 4. Joint Attention Intervention (6 studies) Examples include pointing to objects, showing items/activities to another person, and following eye gaze.

23 Established interventions
5. Modeling 6. Naturalistic Teaching Strategies 7. Peer Training package 8. Pivotal Response Treatment 5. Modeling (50 studies) Examples include live modeling and video modeling. 6. Naturalistic Teaching Strategies (32 studies) Includes focused stimulation, incidental teaching, milieu teaching, embedded teaching, and responsive education and prelinguistic milieu teaching. 7. Peer Training Package (33 studies) Common names for intervention strategies include peer networks, circle of friends, buddy skills package, Integrated Play Groups™, peer initiation training, and peer-mediated social interactions. 8. Pivotal Response Treatment(14 studies) PRT is an expansion of Natural Language Paradigm which is also included in this category.

24 Established interventions
9. Schedules 10. Self-management 11. Story-based Intervention Package 9. Schedules (12 studies) Can take several forms including written words, pictures or photographs, or work stations. 10. Self-management (21 studies) Examples include the checklists (using checks, smiley/frowning faces), wrist counters, visual prompts, and tokens. 11. Story-based Intervention Package (21 studies) Social Stories™ are the most well-known story-based interventions.

25 Unestablished interventions
Academic Interventions Auditory Integration Training Facilitated Communication Gluten-and-Casein-Free Diet Sensory Integrative Package 5 treatments were identified as “unestablished”. There is no reason to assume these treatments are effective. Further, there is no way to rule out the possibility these treatments are ineffective or harmful. There are likely many more treatments that fall into this category. 1. Academic Interventions These interventions involve the use of traditional teaching methods to improve academic performance. Examples include but are not restricted to: “personal instruction”; paired associate; picture-to-text matching; The Expression Connection; answering pre-reading questions; completing cloze sentences; resolving anaphora; sentence combining; “special education;” speech output and orthographic feedback; and handwriting training. 2. Auditory Integration Training 3. Facilitated Communication This intervention involves having a facilitator support the hand or arm of an individual with limited communication skills, helping the individual express words, sentences, or complete thoughts by using a keyboard of words or pictures or typing device. The National Standards Project followed strict inclusionary/exclusionary criteria. As a result, we eliminated a large number of studies on the treatment of Facilitated Communication that {a} involved adults 22 years of age or older, {b} involved individuals with infrequently occurring co-morbid conditions, and {c} focused on the adult facilitators (as opposed to the individuals with ASD). Although our results indicate Facilitated Communication is an “Unestablished Treatment,” we believe it is necessary to make readers aware that a number of professional organizations have adopted resolutions advising against the use of facilitated communication. These resolutions are often related to concerns regarding “immediate threats to the individual civil and human rights of the person with autism…” (American Psychological Association, 1994). 4. Gluten-and-Casein-Free Diet These interventions involve elimination of an individual’s intake of naturally occurring proteins gluten and casein. Early studies suggested that the Gluten- and Casein-Free diet may produce favorable outcomes but did not have strong scientific designs. Better controlled research published since 2006 suggests there may be no educational or behavioral benefits for these diets. Further, potential medically harmful effects have begun to be reported in the literature. We recommend reading the following studies before considering this option: 1. Arnold, G. L., Hyman, S. L., Mooney, R. A., & Kirby, R. S. (2003). Plasma amino acids profiles in children with autism: Potential risk of nutritional deficiencies. Journal of Autism and Developmental Disabilities, 33, 2. Heiger, M. L., England, L. J., Molloy, C. A., Yu, K. F., Manning-Courtney, P., & Mills, J. L. (2008). Reduced bone cortical thickness in boys with autism or autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 5. Sensory Integrative Package These treatments involve establishing an environment that stimulates or challenges the individual to effectively use all of their senses as a means of addressing overstimulation or understimulation from the environment.

26 Effective Educational Strategies (Dunlap, Iovannone, & Kincaid, 2008; Iovannone, Dunlap, Huber, & Kincaid, 2003) Individualized Supports and Services Systematic Instruction Comprehensible/Structured Learning Environments Specific Curriculum Content Functional Approach to Problem Behavior Active Family Involvement

27 Evaluative Questions for Interventions
Will the intervention impair or detract? cause frustration or regression? What happens if method proves ineffective? Is method balanced with other components? Is the intervention developmentally appropriate? Questions to guide selection & use of controversial methods (Simpson & Myles) Controversial intervention be evaluated primarily using robust, objective scientific methods & undocumented treatments be closely monitored until they are fully understood and objectively evaluated. Have deeply ingrained respect & reverence for personal choice & individual freedom--sometimes it outweighs need for empirical validation.

28 Evaluative Questions for Interventions
Has the intervention been validated scientifically? How will the intervention be integrated into the individual’s current program? Have appropriate outcomes and assessment methods been identified? Does it lead to increased independence? What is impact on quality of life?

29 Examples of evidence-based strategies
Activity Matrices Prompting Hierarchy Data FUNN Positive Behavior Support

30 Characteristics of Critical Skills
Broad classes of behaviors Variety of contexts Required to complete part or all of activity Not THE activity Not sweeping, taking out trash, washing dishes Instead—communicating need for materials, using both hands together to complete task, initiate social interactions Repeated use throughout all daily activities and routines Activity-based goals may limit opportunities for student to practice skill throughout day (e.g., sweeping) Examples—expressing concerns, bilateral coordination, response to social interactions

31 Identifying What to Teach: Critical Skills
Broad classes of behaviors Variety of contexts Required to complete part or all of activity Not THE activity Not sweeping, taking out trash, washing dishes Instead—communicating need for materials, using both hands together to complete task, initiate social interactions Repeated use throughout all daily activities and routines

32 Use an Activity Matrix to:
Plan for specialized instruction Assess individual needs in classroom setting Plan when data collection will occur Plan activities and materials necessary for incidental teaching or embedded instruction

33 Activity-Based Intervention Matrix
11/1/02 Activity-Based Intervention Matrix adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

34

35 Classroom Activity Matrix
CHILDREN ACTIVITIES Child 1 Child 2 Child 3 Free Play -App. Play (intro new toys and independent play with bins) -Matching (pic to pic) -Ask for preferred toy (PECS) -App. Play (new play activities) -Ask for preferred toy or material -Point to pic in book (rec. ID) -Independent play -Asking/Answering questions -Sharing and trading (new) Clean-up/transition -Simple dir (stand-up, give me) -Put toys away -Move chair to circle Independent toileting (initiating) -Simple dir (stand-up) -Follow multi-step directions Circle -Simple dir (clap hands, stand-up) -Imitation (gross motor, oral motor) -Simple dir (stomp feet, sit down, stand up) -Imitation (gross/fine motor) -Asking questions -Advanced imitation Outside -Imitation (gross motor) -App. Play (intro new activity, initiate new activity) -Independent play (new activities) Snack -Request desired food items (PECS) -Proximity to peers -Request snack items (PECS) -Asking questions (What, Who, Where) Structured Activity -Request materials (PECS) -Matching -Matching (colors) -Matching pic and obj (gen) -Peer imitation -Pronoun/gen (my, your, his,her) -Advanced conversations

36 Time/ Routines Skills Snack time 3:00-3:15 Outside time 4:00-4:30
Play with sister (Interactive play) Ask for items without being told (initiate communicative requests) Paying attention to what mom attends to (joint attention) Play with toys (Imitate motor movements) Make choices between 2 Imitate sounds Snack time 3:00-3:15 Essential item missing or in closed container; child needs to request Point to favorite item—”look”; give when child follows point Choose sequence of eating Imitate child’s vocalizations Outside time 4:00-4:30 Roll ball back & forth to sister Time delay—push child on swing & stop; wait for “more” Pause before responding in established routine—praise for anticipation Car/doll—demonstrate functional act for imitation Choose activity Imitate child’s actions and make minor change Bathing 7:00-7:30 Float toy back & forth to sister Essential item in sight but out of reach Splash hand in water—”look” Toy chosen by child—demonstrate functional act Choose toy to take to bath

37

38 Activity-Based Intervention Matrix A
11/1/02 DAILY SCHEDULE OF ACTIVITIES IEP Objective #1:Making Choices (Level E, P) Center Time Block center or housekeeping? Classroom Chores Water plants or feed fish? Snack/Cooking Activity Pudding or milkshakes? Small Group-Art Which art materials to use? Going to Park with Parents Slide or swing? # Opportunities: 5 adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

39 Activity-Based Intervention Matrix B
11/1/02 HOME - SCHEDULE IEP Objective #1:Making Choices (Level E, P) Breakfast Block center or housekeeping? Laundry w Mom Water plants or feed fish? Lunchtime Preparation Pudding or milkshakes? Reading Time Which art materials to use? Playing with my Brother Slide or swing? # Opportunities: 5 adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

40 Activity-Based Intervention Matrix C
11/1/02 DAILY SCHEDULE OF ACTIVITIES IEP Objective #2:Reach and Grasp (Level M, E) Center Time Build tower w/ blocks Classroom Chores Reach for/grasp attendance slip – place on desk in office Snack/Cooking Activity Reach for/grasp cooking utensils Small Group-Art Reach for/grasp built-up paintbrush handle Going to Park with Parents Reach/grasp to hold onto swing/side of slide # Opportunities: 5 adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

41 Activity-Based Intervention Matrix D
11/1/02 HOME SCHEDULE IEP Objective #2:Reach and Grasp (Level M, E) Breakfast Build tower w/ blocks Laundry w Mom Reach for/grasp attendance slip – place on desk in office Holiday Baking w Mom Reach for/grasp cooking utensils Gluing Stuff w Mom Reach for/grasp built-up paintbrush handle Play Games with my Brother Reach/grasp to hold onto swing/side of slide # Opportunities: 5 adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

42 Activity-Based Intervention Matrix E
11/1/02 DAILY SCHEDULE OF ACTIVITIES IEP Objective #3: Initiate Social Interaction (Level P, I) Center Time Greet other children – vocalize or eye contact` Classroom Chores Initiate contact with office personnel Snack/Cooking Activity Eye contact w/ peers – their turn to stir Small Group-Art Initiate interaction w/ adult – ask for assistance Going to Park with Parents Eye contact/vocalize – to let know what she wants to be pushed # Opportunities: 5 adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

43 Activity-Based Intervention Matrix F
11/1/02 DAILY SCHEDULE OF ACTIVITIES IEP Objective #4: Cause/Effect (Use of Switch) (Level E,P or I) Classroom Chores Use switch to turn on toy (dump blocks center ‘building site’) Snack/Cooking Activity Switch to activate blender etc Small Group-Art Going to Park with Parents Switch to turn on music box # Opportunities: 3 adapted from Grisham-Brown & Hemmeter, 1998 adapted from Grisham-Brown and Hemmeter, 1998 West Central Ohio SERRC Presentation- Project DIRECT

44

45

46

47

48

49 Activity Matrix Time/ Routines Skills Circle time 9:00-9:20 Recess
Socially interact with peer Ask for items without being told (initiate communicative requests) Paying attention to what adult attends to (joint attention) Play with toys (Imitate motor movements) Make choices between 2 Ask for help Circle time 9:00-9:20 Have greeter role: Hand out materials and greet each peer Point to favorite item—”look”; give when child follows point Choose order of greting Recess 10:20-10:45 Roll ball back and forth to one peer Withhold favorite toy item (ball); provide opportunity for student to request the ball Car/doll—demonstrate functional act for imitation Choose peer for playing Reading 1:00 – 1:45 Essential item in sight but out of reach Choose book to read for group read

50 Prompting Hierarchy LEAST TO MOST MOST TO LEAST Full Physical
Natural Cue Gesture Do task analysis—decide before hand whether to do least-to most or most to least. Decide on criterion for moving from prompts in hierarchy. Definition—any teacher behaviors that cause childs to know how to do behavior correctly. Increases probability of correct responding. Natural stimulus—no additional prompting from teacher needed (hunger, dirty table needing bussed, etc.) Gestures—hand motions, pointing, head nodding, or other nonverbals. Head nod toward dirty table example. Verbals—use of specific verbal statement that tells child what to do and how to do it. (not suggestion or simply telling). E.g., playing checkers, person right next to child would say “When my piece next to yours like that, you need to jump it. Go ahead and jump my piece now.” Let’s play checkers is a suggestion or direction but not verbal prompt (not specific to performance of behavior and more general). Wolery: 5 types of verbal prompts: 1) tell how to do behavior; (2) tell how to do part of behavior; (3) give rule to follow; (4) give a hint; (5) provide options. Visual/Picture—2 dimensional (words, symbols, signs etc.). E.g., provide picture or drawing of clock ith clock hands arranged to indicate particular time with picture showing individuals engaging in certain activity appropriate for time, e.g., relaxing at break. Model: demonstrating behavior (putting on coat). Prerequisite: attending and imitating. If imitation deficient, may need to combine with other prompts. Partial/full physical—full places hand over other hand, guide hand to do action (getting glass of water). Most intrusive and controlling. Should be used only when child will not respond to less direct methods of prompting. Partial—touch may be nudge, tap, guidance partially through movement or contact on part of arm. Always pair physicals with less intrusive (verbal and gestures). Verbal LEAST TO MOST Visual/Picture MOST TO LEAST Model Physical (partial, full) Full Physical

51 Making Data FUMM (FACETS)
Functional Include as part of activity Useful Child responses accomplish routine outcome Meaningful Varied formats to ‘show’ progress Measurable Obvious, quick, countable

52 Making Data-Collection Teacher and Family Friendly
Locate close to area where intervention most likely to occur E.g., Clipboard, wall near teaching location, tape recorder on kitchen counter—snack routines; tape data form to mirror in bathroom for bathing/toileting routines; index card in diaper bag Data collection should serve as visual prompt for data to be collected E.g., add symbols/pictures to illustrate key steps or targets Easy and quick to use E.g., Fill-in-the-blank, checklist, circle-response format Space for comments/notes

53 Amy’s Difficulties Week of: ___
Monday Tuesday Wednesday Thursday Friday Arrival Circle Nap Clean-up Other: Bus ride Average Score 3.0 2.2 1.4 .8 0=no problems, 1 = whining, resisting; 2= screaming, falling on floor; 3=screaming, hitting, other aggression

54 Ben’s Playtime 3=Cooperated, stayed briefly
2=Fussed, took several turns 1= Cried, refused to play 4=Laughing, stayed Monday Tuesday Wednesday Thursday Friday Saturday 4 3 2 1

55 Always Never 3-7 3-10 3-13 3-8 3-9 3-14 3-15 3-16 3-17 Engaged Call-outs Kicking Key: Engaged—5=completed tasks in both routines, no prompts; 3=completes task with 1-3 prompts; 1=did not complete tasks, needed >5 prompts or removal. Call-outs—5=10 or more; 3=4-6; 1=0. Kicking—5=>5 kicks in group work time; 3=3 kicks; 1=0 kicks

56 Dusty’s Signs During Routines
MEAL TIME DIAPER CHANGE Dirty Stinky Stand up Lay down Wait Eat Drink More Hot Cookie Fork Cracker Hungry Thirsty All done Spoon Diaper Clean Throw away All done Body parts Peek-a-boo

57 Jimmy’s Problem Behavior During Feeding
1 2 3 Monday No problems Some problems Lots of problems Tuesday Wednesday Thursday Friday

58 Jimmy’s Problem Behavior During Feeding

59 “More isn’t better if the data aren’t accurate.”

60 Got ABA Principles?

61 Applied Behavior Analysis (ABA)
“ABA is not a specific program, procedure, or a technique; it involves methods and principles that are applied in diverse ways.” Dunlap, 1999

62 Intervention Approaches Using ABA Principles
Discrete Trial PECS Verbal Behavior Incidental Teaching Time Delay Pivotal Response Training Positive Behavior Support Functional Behavior Assessment

63 Incidental Teaching Procedure
Environment arranged to promote teaching episodes Child initiates episode by expressing interest Adult follows child lead and establishes joint attention Adult models behavior, then looks expectantly at child

64 Incidental Teaching Procedure (continued)
If child does not respond, adult provides mand (request) If child does not respond to mand, adult provides physical prompt Adult provides natural reinforcement

65 Example: Incidental Teaching Procedure
Environment arranged to promote teaching episodes – Arrange water table with variety of preferred objects Child initiates episode by expressing interest – Child moves to table or gazes at table Adult follows child lead and establishes joint attention – “Playing in water is fun. Look at the boats!” Adult models behavior, then looks expectantly at child – “I found a boat! Can you find a boat?”

66 Example: Incidental Teaching Procedure
If child does not respond, adult provides mand (request) – “Pick up a boat.” If child does not respond to mand, adult provides physical prompt – “I’ll help you, boat!” Adult provides natural reinforcement – “It’s fun to find the boats!”

67 How do you Know When to Follow Child’s Lead?
Look for: Gaze shift/look at item (tracking) Reach Grab Verbalization (can be a whine or a cry toward item) Label Request (in various forms)

68 Important Part: Reinforcers!
New skills: Select powerful reinforcer(s) Reinforce each time! Reinforce IMMEDIATELY after desired behavior Change reinforcers (avoid satiation) Pair with verbal praise Be specific

69 What is Prevent-Teach-Reinforce (PTR)?
Research project funded by U.S. Department of Education University of South Florida & University of Colorado, Denver Purpose: Investigate effectiveness of PTR process vs. “business as usual” Comparing treatment and wait-list compariosn groups Making process prescriptive, yet simple Intervention “Package” ONE ‘P’revent; ONE ‘T’each; ONE ‘R’einforce Based on ABA principles and individual Positive Behavior Support 69

70

71 PTR Model Based on principles of behavior and values of positive behavior support Five step process Teaming Setting Goals Functional Behavior Assessment Interventions Training, coaching, and fidelity measurements Evaluation and monitoring

72

73 Step 1: Team Building Team Development
Include relevant stakeholders Team Collaboration—enhancers and inhibitors Tools Work style survey Teacher and Teacher Assistant Teaming survey

74 Step 2: Goal Setting Purpose: Targeted Areas:
Identify behaviors of greatest concern to the team and possible replacement behaviors (teach) Prioritize and operationalize behaviors Develop teacher friendly baseline data collection system Targeted Areas: Problem behaviors Social skills Academic behaviors

75 Case Study- Mike: Behavior Rating Scale
Screaming 9+ times 7-8 times 5-6 times 3-4 times 0-2 times 5 4 3 2 1 Hitting 8+ times 6-7 times 4-5 times 2-3 times 0-1 times Expressing Frustration 40%+ 30-40% 20-30% 10-20% 0-10% Transition to Non-preferred Whimper or squeal Louder than indoor voice Outdoor play voice Louder than outdoor play Ear penetrating Date

76 Step 3: PTR Assessment (FBA)
Each team member independently answers a series of questions related to: Observed antecedents/triggers of problem behaviors Functions of the problem behaviors Consequences ordinarily associated with the problem behaviors PTR facilitator summarizes input and develops draft hypothesis Team reaches consensus

77 Step 3: Case Study – Mike Hypotheses
When…. he will As a result… Mike is asked to complete non-preferred tasks (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher is attending to other students scream and hit Mike is able to gain attention and delay the transition/activity Mike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher attending to other students express his frustrations appropriately complete the assigned task Mike is able to delay the transition/activity Mike is able to gain attention Inappropriate Appropriate

78 Step 4: Behavior Intervention Plan
Team selects interventions from each component (P-T-R) Detailed behavior plan developed Consultant provides training and on-site assistance with plan implementation Implementation fidelity evaluated

79 Step 4: Case Study – Mike’s BIP
Prevent Strategies Specific Strategy steps Environmental Support A wait card will be placed on Mike’s desk to assist him in remembering to wait his turn. 1. Prior to group work, tell Mike, “Remember, when it is someone else’s turn, you sit quietly and wait,” while pointing to his card. 2. If Mike calls out, point to his visual to remind him what to do. 3. Use a verbal prompt if the point prompt does not work.

80 Mike’s Intervention Plan
Prevent Strategies Specific Strategy steps Environmental Support Mike’s visual schedule will be modified to detail the number of and type of activities he is to complete during non-preferred activities. For example, if math involves listening to a lesson, doing a hands-on activity, and completing a worksheet, his visual schedule will list each activity under math using either a picture of the type of activity or using numbers that correspond to a number on the worksheet. 1. Prior to the start of the activity, Mike should review the visual schedule. 2. As Mike completes an activity, he should X off the activity.

81 Mike’s Intervention Plan
Prevent Strategies Specific Strategy steps Curricular Modification Mike will be given an easy, independent activity, such as a worksheet, to complete upon transitioning to a non-preferred activity or an activity that requires him to wait, such as group activities

82 Specific Strategy Steps
Teach Strategies Specific Strategy Steps Replacement Behavior Mike will be taught to use his voice output device to express his need to calm down. Steps: Mike’s device will be programmed to say “I need to calm down.” Prior to transitioning to a non-preferred activity or at the end of a preferred activity, say “If you start to get mad, you can choose to calm down.” As soon as Mike starts to get upset, prompt him to use his device (hierarchy—hand-over-hand, gesture, verbal). Once Mike communicates “I need to calm down”, present him with the choice board of calming strategies and ask him, “What do you want?” As soon as he is calm, praise him (e.g., “You made a good choice.”. Allow Mike to engage in his choice until he is calm for 1-minute. If Mike does not want to leave his choice, then start becoming animated with students in the non-preferred activity.

83 Specific Strategy Steps
Teach Strategies Specific Strategy Steps Self-Management Mike will be taught to independently use his calming strategies. 1. A tracking sheet with smiley faces and sad faces will be given to Mike at the start of each day. 2. Role-play with Mike about when he needs to make the choice to calm down. 3. Practice completing the tracking sheet. 4. Set and review the daily goal for using the calming strategies. 5. Prompt Mike to complete the tracking sheet if needed

84 Specific Strategy Steps
Reinforce Strategies Specific Strategy Steps Replacement Behavior Anytime Mike “says” “I need to calm down”, his choice board should be given. Praise Mike for communicating (“thank you for telling me what you need.”) Provide his choice board. Allow him to calm for 1 minute Praise him as soon as he is quiet Praise him for returning to the group Self-Management Anytime Mike scores his behavior, attention should be given. When Mike marks his tracking sheet, praise him for doing so. At the end of the day, review the sheet with Mike. Talk about the sad faces. Provide his reward if his goal is met. Waiting Mike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule.

85 Specific Strategy Steps
Reinforce Strategies Specific Strategy Steps Transition Mike will earn stars during Reading Centers if he transitions and completes his work without screaming. A social story will be reviewed prior to Reading Centers to remind Mike that he can earn a star if he comes to centers and works. At the end of each reading center, an adult will review Mike’s behavior with him and ask him if he earned his stars. Provide his stars if earned. During the teacher’s group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group. Allow Mike to participate in his chosen activity if he earned his stars.

86 Step 5: Evaluation Is it working?
Daily ratings of behavior Continuous progress monitoring BRS Other data collection forms Is it being implemented consistently and accurately? Fidelity ratings Do we need more data? Does the plan need to be modified or expanded? Plan for generalization and maintenance

87 Step 5: Mike Evaluation

88 Step 5: Evaluation

89 Step 5: Evaluation

90 Step 5: Evaluation

91 News and Noteworthy Manual will be published by Brookes (November 2009) Two journal articles in press (both provided) Journal of Positive Behavior Interventions—Case study Journal of Emotional Behavioral Disorders—Preliminary outcomes Next steps: Facilitating schools to scale up Training key school staff and team members to do process

92

93 Resources

94

95

96

97

98

99

100

101

102

103

104

105 For Copies of PowerPoint:

106 Questions????


Download ppt "Solution Focused Interventions for Children with Autism"

Similar presentations


Ads by Google