2What is Autism ?Autism is a neurobiological disorder with no singular known cause, however much speculation exists as to causal factors related to exposure of expectant mother’s to environmental hazards, toxins, and the role of genetics
4Autism PrevalenceCurrently 1 in 88 children are diagnosed with Autism, though a recent finding…In a telephone survey of 100,000 parents of children aged 6 to 17, the Centers for Disease Control and Prevention found a 1 in 50 prevalence rate. The report indicates the nation's prevalence rate may be higher than the official 1 in 88 rate, but does not replace that finding.
5Autism Spectrum Disorders Up until this year there were five disorders which fell beneath this category. These include:AutismAsperger’s DisorderChildhood Disintegrative Disorder (rare 2 children per 100,000)Rett’s Disorder (affects females 1/10-15,000)Pervasive Developmental DisorderNot Otherwise Specified (PDD/NOS)
6DSM-V ClassificationThe new diagnostic label is Autism Spectrum Disorders (ASD)Persistent deficits in social communication and social interaction across contexts not accounted for by general developmental delays, and manifest by all of the following:Deficits in social/emotional reciprocityDeficits in non-verbal communicative behaviors used for social interaction
7DSM-V ClassificationRestricted repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:Stereotyped or repetitive speech, motor movements, or use of objectsExpressive adherence to routines, ritualized patterns of verbal or non- verbal behavior, or excessive resistance to changeRestricted or fixated interestsHyper-or-hypo reaction to sensory input or unusual interest in sensory aspects of the environmentSymptoms must be present in early childhood but may not become fully manifest until social demands exceed limited capacities.Symptoms together limit and impair daily functioning.
8Characteristics of ASD It is characterized by severe and pervasive impairments in the areas of social communication skills including reciprocal social interactions and the presence of stereotypical behavior and interestsSevere language delays including:A lack of babbling or purposeful gestures by age 1.The absence of single words by 16 months.The absence of combining two words by age 2.The loss of language or social communication skills.
9Characteristics of ASD Autism ranges from mild to severe and impacts the degree to which a person’s development is impaired.Those individuals who are higher functioning on the autism spectrum may display only minimal impairments in their intellectual processes, they may experience some motor difficulties, often an obsession with a particular area of interest, difficulty with understanding and communicating feelings such as humor or empathy, an inability to discern subtle cues, difficulties with pragmatic or functional language, and a hypersensitivity to certain noises, light, smells, and textures found in clothes or food.Individuals with more severe forms of autism can have intellectual impairments, significant language delays, or even non-verbal and often engage in stereotypical behavior such as hand flapping, pacing, rocking, and engage in aggressive behavior towards themselves or others.
10Co-Occurring Conditions Many children with autism spectrum disorders suffer from some degree of mental retardation (approximately 75% of children identified with ASD).Auditory processing difficulties-Typically children with ASD have a keen sense of visual perception and difficulty in processing auditory stimuli.Seizure Disorders-Usually 1 in 4 children with ASD develop seizure disorders between their early childhood and or adolescent years.
11Etiology Etiology is concerned with causation of a condition. Early theories were that Autism was caused by psychological factors, these myths “refrigerator mom’s” were expounded on by professionals such as Bruno Bettleheim.
12EtiologyNeurological differences in persons with Autism are pronounced, confounding variables for understanding these complexities are the heterogeneity of the population.These studies are generated from the post-mortem analysis of the brains of persons with ASD, or through neuro-imaging while still alive, and through the use of animal models to note neurological differences.
15Biological Basis of ASD Postmortem and MRI studies have shown that many major brain structures are implicated in autism. This includes the cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem.Recent neuroimaging studies have shown that a contributing cause for autism may be abnormal brain development beginning in the infant’s first months. This“growth dysregulation hypothesis” holds that the anatomical abnormalities seen in autism are caused by genetic defects in brain growth factors. It is possible that sudden, rapid head growth in an infant may be an early warning signal that will lead to early diagnosis and effective biological intervention or possible prevention of autism (NIMH, 2008).
16Environmental Toxins and ASD Exposure to environmental toxins e.g., heavy metals, mercury etc… and their relationship to autismThe MMR debate?Thimerosal?See Article Handout
21Positive Behavior Supports Child behaviorWhat child DOES nowChallenging behavior – Excessive behavior – too much, too oftenSkill deficitWrong behavior at the wrong timeWhat we would like child to do insteadConcrete, skills abilitiesBehavior happens for a reason or reasonsPositiveSkill building, teaching,Initial learning, Skillful use, When & Where to do certain behaviors, Independence, InnovationPositive methodsSupportsteachers, peers, parents, siblingsNot single interventionVarious changes in environment to help child learn & use positive behaviorsPre-vention, not just intervention
22Behavior Child behavior Behavior happens for a reason or reasons What child DOES nowChallenging behavior – Excessive behavior – too much, too oftenSkill deficitWrong behavior at the wrong timeWhat we would like child to do insteadConcrete, skills abilitiesBehavior happens for a reason or reasonsChallenging behaviorsPositive behaviorsReasons = “Functions”
23Positive Skill building, teaching, Initial learning, Skillful use, When & Where to do certain behaviors, Independence, InnovationPositive methods
24Supports teachers, peers, parents, siblings Not a single intervention Assistants, bus drivers, kitchen staffClassmates, friends, siblings, cousins, etcParents, grandparents, uncles, aunts, etcNot a single interventionVarious changes in environment to help child learn & use positive behaviorsPre-vention, not just intervention
25What is a behavior challenge that you are experiencing with a child with ASD? Write it downDescribe itActions toward Persons or ObjectsExamples, specific instancesPositive behaviorWhat should child DO instead?
27Behavior DefinitionExample ActionObject/PersonQualifierChallenging BehaviorBites --Mouth or teeth on another childAttempt to bitepeersTakes toysGrabbing, pulling toyFrom peersWithout askingForcefullyPositive ReplacementSays or signs “stop”To peerWhen peer enters his space (arms distance)Asks for toyFrom PeerExchanges toyWith peer
28Behavior Definition PRACTICE ActionObject/PersonQualifierChallenging BehaviorPositive Replacement
29Behavior Reasons Behavior in context “Reasons” Antecedent Behavior ConsequenceSituation – who, where, when“Reasons”FunctionsWhat supports behavior now?What consequences does it produce now?Behavior’s “purpose” – caution!!!!!!!TriggersWhat immediately provokes the behavior, sets it off?What situations (people, places, things, prior interactions or events) make it more likely
30Basic Functional Assessment Questions What is/are the specific behaviors of concern?Challenging behaviors; Skills/Replacement BehaviorsWhen, where, & with whom does the behavior happen?Challenging; Skill/ReplacementWhen, where, & with whom does the behavior not happen?Challenging; ReplacementWhat are the typical responses to the behavior?“I usually…., then I….”; “Sometimes I….”“He avoids/escapes….”; “She gets….”What are the other (unintended) consequences of the behavior?“It sometimes gets her….”; “It sometimes allows him to get….”“The one thing I could do to make the behavior happen right nowChallenging; ReplacementHow do others see this behavior (in terms of the above questions)?See it the same as or different than I
31Basic Functional Assessment Methods & Procedures Indirect methodsGetting impressions, perceptions, recollections from others who know the child –asking one person about another’s behaviorTeachers, assistants, other staff, family, the child, etcRich, varied source of informationAccuracy? Disagreements? Different actual “functions” with different people?Direct MethodsDirectly observing & recording what the child doesMore accurate? More intensive?Combined with indirect information – triangulate or zoom in on probable situations, triggers, consequences that “cause the behavior
32FBA Methods Indirect Direct Records review Incident logs Psychological, developmental tests, etcInterviewsWith othersWith childBehavior Situation Rating scalesDirectScatterplotObservations of child by trained observerSpecialist, teacher, assistant, other staff, peer/sibling, parent, etcABC, behavior counts, estimates, behavior “products”Environmental manipulationChanging situation, trigger, consequences, etc, to see if and how behavior is affected
33Basic Functional Assessment Methods InterviewsIdentify behavior concernsBegin definitionWhat are the PERCEIVED situations, triggers, consequences?Behavior Situation Rating ScalesRate how likely specific behavior is in different situations, triggers, consequencesScatterplotSimple observation recording of time of day or activities when behavior happens, doesn’t happenAt least 2 weeksObservationsDirect observation of behaviorGuided by interviews, rating scales, scatterplotSituations, antecedent triggers, consequences/outcomesBehavior count, durationPre-intervention baseline for evaluating interventionAt least 3 – 5 daysFocused, specializedEnvironmental manipulationTrying out different changes in situation, triggers, consequencesDo these things really affect the behavior?Preview of intervention effectiveness
34Basic Functional Assessment Interview Questions What is/are the specific behaviors of concern?Challenging behaviors; Skills/Replacement BehaviorsWhen, where, & with whom does the behavior happen?Challenging; Skill/ReplacementWhen, where, & with whom does the behavior not happen?Challenging; ReplacementWhat are the typical responses to the behavior?“I usually…., then I….”; “Sometimes I….”“He avoids/escapes….”; “She gets….”What are the other (unintended) consequences of the behavior?“It sometimes gets her….”; “It sometimes allows him to get….”“The one thing I could do to make the behavior happen right nowChallenging; ReplacementHow do others see this behavior (in terms of the above questions)?See it the same as or different than I
35Behavior Situation Rating Scales Motivation Assessment Scale (Durand & Crimmins, 1992)Modified for Early Childhood by McEvoy & ReichleRating scale: “0” (never) to “6” (Always)Rate a specific behavior (e.g., hits peers) in specific situation (e.g., during circle time)
3616 questions: (examples) Would the behavior occur continuously over and over if this child were left alone for long periods of time?Does the behavior occur after you ask the child to do something difficult?Does the behavior occur when you are talking to other adults or children in the room?Does the behavior ever occur to get a toy, food, or activity that this child has been told he or she can’t have?ScoredAverage total score/relative ranking for each of:Sensory, escape, attention, tangible consequenceOthers include : Problem Behavior Questionnaire (PBQ), Questions About Behavior Function (QABF)
39Environmental Manipulation Challenging BehaviorWhen child’ favorite toy is on a shelf out of reach, he cries until teacher or assistant asks him what he wants several timesWhen he finally points in direction of the toy, teacher/assistant gives him the toy & crying stopsPut toy out of reach Mon, Weds, FriPut toy within reach Tues, ThursCrying is higher on Mon, Weds, Fri, than on Tues or ThursPositive Behavior with SupportsBEFORE crying starts, with toy out of reach, ASK child what he wantsIf he points, give him the toyIf he doesn’t point but looks at toy, help him point, then give him the toy
40Return to your behavior challenge What consequences or outcomes does the behavior usually get?What seems to trigger the behaviorIf you wanted me to see the behavior right now what is the one thing you would do to make it happen?What situations:When, where, with whom does the behavior happenWhen, where with whom does the behavior not happen
42Functional Assessment Example SituationsTriggersBehaviorConsequencesChallenging BehaviorTransitions, lines, play timeLater morningAfter napPeer within arm’s distance of TommyBites peersPeer cries, moves away, teacher says “We don’t bite our friends”Center time, playground, Adults not near byPeer plays with toys David likes, near himGrabs, pulls toys from peerPeer cries & pulls back, teacher: “We don’t take things from friends; “That was Jana’s toy”Positive ReplacementPeer within arm’sSign or Say “Stop”Have peer move away; Teacher says, “Good to use your words Tommy”Center time, playground, Adults watchingPeer plays with preferred toy near DavidDavid asks for toy; gives peer another preferred toyDavid plays with preferred toy; Teacher: Thanks for sharing” both boys
43Functional Assessment PRACTICE SituationsTriggersBehaviorConsequencesChallenging BehaviorPositive Replacement
44Positive Behavior Supports Not just one intervention, not just individual interventionsPreventionPrimary prevention or Universal levelpositive supports for all childrenPositive behaviors that your program values for all childrenE.g., sharing, cooperation, helping, etc.A system or program-wide approach (PWPBS)A system to encourage children to develop these behaviorsSecondary preventionPrevent behavior challenges from getting worseInterventions for certain types of behaviorBehaviors shown by several or more children in a class or program“typical” behavior issues that seem not to be improving or getting worsePrimary level by itself is not enough for these children’s behaviorsPrimary intervention continues but add Secondary intervention
45SWPBS is preventativeA three-tiered approach (Lewis & Sugai, 1999; Sugai et al., 2000; Walker et al., 1996)
46Primary Universal Level Broad categories of behaviorSharing, cooperating, helping, etcAll program staff, parents, etcIdentify specific instances of these behaviors in various activities of the dayDefine clearlyTeach the behaviors directlyRole play, skits, practice:Pictures, Posters, VideosPeriodic review
47Document behavior incidents AcknowledgePraise, description, positive consequences“Catch the kids being good”Document behavior incidentsWhere, when, with whom – to analyze & modify environment to improve positive replacement behaviors & target behaviors of Primary levelReductions in incident reports to evaluate primary level
48Secondary Level of Intervention Those children for whom behavior challenges aren’t sufficiently reduced by Primary level, Program-wide supportsIncorporate behaviors from primary levelFurther specify per particular student challengesInappropriate vs Lack of interactionCommunicating vs TantrumsEvidence-based interventionsSelf monitoring, “Say – Do – Say”Social Skills TrainingSocial Stories with Picture stories, booksVideo ModelingPicture SchedulesMore child specific progress data to evaluate progress & intervention
49Group Behavior Interventions Several students within same classroom or activity with similar behavior issues (following directions, or playing cooperativelyGroup contingencyGood Behavior GameAnchor the BoatBoat & anchor pictureChildren earn links in the chain to connect & anchor the boatSpecial activity , game, party when the chain connects the boat & anchorPom Pom Jar or Wrist BandsDuring free time, centers, etc.,acknowledge good behavior with object (pom pom ball or wrist band),deposited at end of activity in jar,special activity when jar is filled
50Tertiary or Intensive Individualized Interventions Functional Behavior AssessmentIntervention based in part on the function of the challenging behaviorSelecting an alternative behavior that can serve the same function but in a more appropriate way
51Functional Assessment Example SituationsTriggersBehaviorConsequencesChallenging BehaviorTransitions, lines, play timeLater morningAfter napPeer within arm’s distance of TommyBites peersPeer cries, moves away, teacher says “We don’t bite our friends”Center time, playground, Adults not near byPeer plays with toys David likes, near himGrabs, pulls toys from peerPeer cries & pulls back, teacher: “We don’t take things from friends; “That was Jana’s toy”Positive ReplacementPeer within arm’sSign or Say “Stop”Have peer move away; Teacher says, “Good to use your words Tommy”Center time, playground, Adults watchingPeer plays with preferred toy near DavidDavid asks for toy; gives peer another preferred toyDavid plays with preferred toy; Teacher: Thanks for sharing” both boys
53Collaborating & Partnering with Parents PBS provides multiple opportunities & ways to collaborate with ParentsPBS seeks to change or enhance school/program culture, atmospherePositive emphasisPWPBS – primary levelParent input into target behaviors for PWPBSSchool/Program leadership teamHelp providing materials, personal support for acknowledgement activitiesHelp with teaching behaviors – skits, videos, etcHelp with data monitoring, inputting
54Secondary intervention level Positive “notes” home – focus on positive behavior & improvementPhysical notes, electronic notes ( , text)Observe in classroom, teaching staff model positive approaches, functional approachAssistance in class with positive interventionsAdapt behaviors, interventions for use in homePromote generalization & maintenance of child behavior change
55Tertiary or Intensive Individual Behavior Intervention level Parents participate in identifying behavior functionInterviewing parents & other family membersCompleting behavior –situation rating scalesScatterplot of behavior at home in the morning before & traveling to school – setting events for behavior at schoolIdentifying appropriate, acceptable replacement behaviorsIdentifying appropriate, preferred, acceptable consequences to support behavior changeIdentify communication & social skills abilities, deficits“Notes” home on behavior improvementAdapt intervention to home useHome observation
56Survey parents, family members about acceptability & success of: PWPBS interventionSecondary interventionIndividual behavior planRecruitment of other parents to assist in & support PBS activities
59Survey To help the Center of Excellence in Early Childhood plan needed ASD technical assistanceneeded by 1st District EC providers, programs, & familiesVOLUNTARY – ok not to fill it outInformationSome demographic information about youQuick description of what YOU feel is needed in ASD11 checklist or short answer questions15 min max., then to lunchInclude contact informationOnly if you want to do soIf you want follow up information
62Assessment of Autism Spectrum Disorders The PEP~3John J. Wheeler, Ph.D.
63Assessment Outcomes Derived from the Assessment Process Confirmation of the diagnosisCurrent levels of functioning across developmental domainsDevelopment of goals and objectives leading to the IEPExample:
64Psychoeducational Profile Third Edition Originated from Division TEACCH (Treatment and Education of Autistic and related Communication handicapped Children (TEACCH) at the University of North Carolina-Chapel Hill.Authors include: Eric Schopler, Margaret D. Lansing, Robert J. Reichler, & Lee M. Marcus
65Description of the PEP~3 Designed to assist educators in planning educational programming and in diagnosing ASD.Composed of two parts.Has 10 subtests, 6 that measure developmental abilities and 4 that measure maladaptive behaviors.The subtests yield three composites: Communication, Motor and Maladaptive Behaviors.
66Purposes of the PEP~3Assist in educational planning and diagnosis of ASD for children ages 2-12 years.Determine individual strengths and challengesCollect performance data to assist in confirming the diagnosisEstablishes developmental and adaptive levelsAssists as a research tool in outcome-based research and learning.
68Performance Part of the PEP~3 Developmental Subtests Include:1. Cognitive Verbal/Preverbal- 34 items designed to focus on cognition and verbal memory. These items measure problem-solving, verbal naming, sequencing, and visual- motor integration. Item examples include: puzzles, finding hidden objects, repeating numbers and sentences.
69Performance Subtests cont’d 2. Expressive Language-25 items aimed at measuring a child’s ability to express him/herself by using language or gestures. Example items include: requesting items, food or drink, saying plural nouns, reading words or sentences aloud, naming sizes/shapes “big” and “little”.3. Receptive Language-Includes 19 items designed to assess a child’s ability to understand spoken language. Examples include pointing to body parts and colors, and identifying letters.
71Performance Subtests cont’d 4. Fine Motor-20 items designed to assess the child’s fine motor skills. Examples include blowing bubbles, pincer or scissor grasp and other developmentally appropriate tasks.5. Gross Motor-15 items aimed at evaluating the child’s coordination and gross motor skills such as climbing stairs, drinking from a cup, transferring objects.
72Performance Subtests cont’d 6. Visual-Motor Imitation-Consisting of 10 items aimed at assessing a child’s ability to imitate visual and motor tasks. This is an important relationship given the relationship between imitation and language. Learning words requires one to imitate.
74Maladaptive Behavior Subtests 7. Affective Expression-This subtests consists of 11- items designed to measure the degree to which a child displays appropriate affective responses such as facial expressions & body postures to display feelings/emotions, other examples include demonstrating fear and or responding to tickling during the testing session.8. Social Reciprocity-12 items aimed at measuring the social interactions between the child and others including initiating social interactions, joint attention, cooperating with the examiner during testing.
75Subtests cont’d9. Characteristic Motor Behaviors- This subtest is 15- otems and is designed to measure tactile and sensory behaviors that are most commonly found in children with ASD. Example items examine how children interact with testing materials and react to sounds.10. Characteristic Verbal Behaviors-11-items that are designed to measure the child’s expressive language abilities in the absence of babbling and or echolalia. High scores indicate an absence of these behaviors whereas low scores indicate the presence of these behaviors.
76CompositesCommunication Composite-measures a child’s ability to speak, listen, read and write. The Cognitive Verbal/Preverbal, Expressive and Receptive Language subtests contribute to the composite score.Motor Composite-assesses motor competence including eye-hand coordination and gm skills. Fine Motor, Gross Motor, and Visual-Motor Imitation contribute to this composite score.
77Composites cont’dMaladaptive Behavior Composite-measures a child’s inappropriate behaviors in social interactions, idiosyncratic language, and stereotypy. The Affective Expression, Social Reciprocity, Characteristic Motor Behaviors and Characteristic Verbal Behaviors subtests account for this composite. This composite score will be primarily used to make an accurate diagnosis of autism or other PDD in the child.
78Caregiver ReportParents and or caregivers complete the Caregiver Report based on their daily interactions and observations of the child.The parent/caregiver estimates (a) the child’s current developmental level in several areas and (b) the degree of problems in different diagnostic categories.Three subtests comprise the Caregiver report: (a) Problem Behaviors, (b) Personal Self-Care, (c) Adaptive Behavior.
80Assessment is Designed to Ask Relevant Questions!
81Segment II PEP~3 Section 1 Identifying Information Child’s name, gender, date of testing, date of birth, and age, the parents name; and examiner’s name.Exact age is determined by: subtracting his/her birth date from the date tested. In some instances, subtracting the child’s dob from the testing date is simple, in other cases more confusing see example:
83PEP~3 Sections 2-4Record of Subtest Scores-The subtest scores including the raw scores, developmental ages, percentile ranks, and developmental/adaptive levels are recorded in Section 2.Record of Composite Scores-The developmental/adaptive level and developmental age are recorded in Section 3.Performance Subtest Scoring-pages 2-9 of the Examiner Scoring and Summary Booklet, the examiner records the score for each Performance Item.
84PEP~3 Sections 5-8Caregiver Report Subtest Scoring (Problem Behaviors, Personal Self-Care, and Adaptive Behavior).Profile of Developmental Ages-plot the results from the seven developmental subtests in this section.Interpretation and RecommendationsScoring for Items 85,86 and 93 through 95.
86Design of Interventions Evidence-based PracticesIndividualized Interventions for Children with ASD
87Evidence-Based Practice in the Treatment of Autism Spectrum Disorders: Implications for Children, Families and ProfessionalsJohn J. Wheeler, Ph.D.
88What is Evidence – Based Practice? Refers to a body of scientific evidence that supports practice
89Origins of Evidence – Based Practice Evidence – based practice originated in the field of medicine where scientific literature was used to inform treatment (Odom et al., 2005).This research to practice paradigm is the central focus of medical education.
90Challenges in the Implementation of EBP in Special Education Sadly, we have witnessed irregularities in the ability of special education to adopt such a model and consequently we witness a broad range of practices across educational settings serving children with ASD, many of which may not be evidence – based practice.
91The National Autism Center has just published specific guidelines for specifying types and levels of evidence needed to identify a practice as evidence – based.
92The Importance of Merging EBP into Practice Research findings paired with professional judgement, data-based decision making, family input, and the capacity to implement interventions are all factors to consider (NAC, 2009).
93A Synthesis of Where We Are in the Identification and Treatment of ASD The field has made major strides in the refinement of early identification and assessment of ASD in young children.
94Efforts to promote greater awareness in instructional materials have been developed to support physicians in understanding the early signs of autism.
95The prevalence rates as we know have reached significant levels i. e The prevalence rates as we know have reached significant levels i.e., 1 – 88 children (Centers for Disease Control, 2012).
96Educational research has brought advances into furthering our understanding of how to facilitate learning in children with ASD.
97The caveat that remains is our ability to generalize learning over time, places, setting and people given the limitations found within the service delivery systems.
98RecommendationsWe need to synthesize and critically evaluate our research efforts to date and build programs of research around those “gaps” in the literature to further our understanding of ASD at all levels be it basic or applied research.
99P – 16 initiatives between public schools and colleges and universities are vital to the success of linking training programs, practitioners, children, and families together in an effort to establish model program development.
100Colleges and universities need to strive for improved and more uniformed training programs aimed at developing professionals in the area of ASD in “state- of-the-art” skills.
101ConclusionConsolidation and coordination of effort needs to occur as a means of better utilizing resources, minimizing overlap and program duplication and as a more efficacious and efficient way of serving children and families affected by autism.
102Positive Behavior Support: Assessment (FBA) – Intervention (BIP) Link Functional Perspective:Behavior happens for a reason or reasonsReason = Function (outcome or “purpose” of behviorFunctionsAccess something: attention, activity, tangible, a feeling (sensory consequence)Escape something: attention, activity, tangible, a feeling (sensory consequenceDual or multiple function (e.g., getting teacher’s attention to access a preferred toy; escaping circle time & accessing preferred play materials)Choose or develop an intervention based at least in part on the assessed FUNCTION of the behavior
103Functional-based Intervention 1 SituationsTriggersBehaviorConsequencesChallenging BehaviorTransitions, lines, play timeLater morningAfter napPeer within arm’s distance of TommyBites peersPeer cries, moves away, teacher says “We don’t bite our friends”Positive ReplacementPeer within arm’sSign or Say “Stop”Have peer move away; Teacher says, “Good to use your words Tommy”
104Function-based Intervention 1 Alternatives What else could be done to address biting in terms of the function?What changes in situation?What Changes in trigger?What changes in behavior?What changes in consequence?What might be some interventions NOT indicated by function?
105Function-based Intervention 2 SituationTriggerBehaviorConsequneceChallenging BehaviorCenter time, playground, Adults not near byPeer plays with toys David likes, near himGrabs, pulls toys from peerPeer cries & pulls back, teacher: “We don’t take things from friends; “That was Jana’s toy”Replacement BehaviorCenter time, playground, Adults watchingPeer plays with preferred toy near DavidDavid asks for toy; gives peer another preferred toyDavid plays with preferred toy; Teacher: Thanks for sharing” both boys
106What might be some interventions NOT indicated by the function? What else could be done to address Grabbing Toys from Others in terms of the function?What changes in situation?What Changes in trigger?What changes in behavior?What changes in consequence?What might be some interventions NOT indicated by the function?
107Function-based Intervention 3 SituationsTriggersBehaviorConsequencesChallenging BehaviorPlay time outside, Centers, teacher, assistant, 10 childrenPeers and toys near CarlaCarla makes frequent initiations to adults or plays aloneTeacher & Assistants talk to Carla, tell her to initiate to peersLittle or no interaction with peersPositive Replacement
108Functional Assessment & Intervention for Carla What might be the function of Carla’s behavior?What would be possible replacement behaviors for Carla?What might be one or more function-based interventions for Carla to encourage the target replacement behavior(s)?
109Individualized Interventions for Children with ASD John J. Wheeler, Ph.D..
110ConsiderationsGoals and objectives should be based on social relevance, what is important to the child and family.Built around the child’s strengths.Teaching methods structured and with visual clarity based on the child’s primary input mode.Consistently applied.
111Analyzing Performance vs. Skill Problems A skill problem is present: Use shaping, chaining, task analysis, systematic instruction, etc.A performance problem is present: Increase motivation through positive reinforcement, increased relevance (e.g., functional skills, incorporating interests and strengths), peer supports, etc.
112The Stages of Learning Acquisition (development of new skills) Accuracy can vary from 0 – 70%Fluency (doing it faster and better)Accuracy usually above 60%Generalization (performance in different contexts)Varied situations, people, materials, environmentsMaintenance (generalization over time)Regular use of skills in relevant contexts
113Specific Strategies Learner Profile What are the strengths that promote learning?What are the challenges that inhibit learning?Is there a skill or performance deficit (or both)?What is the current stage of learning?Successful input modes (teaching formats)Successful output modes (response formats)Desired objects / activities / social reinforcersAre there specific cues, prompts, or materials that have in the past been used successfully?
114Specific Strategies Task Design Make tasks socially valid & functionally relevant.Match tasks to ability.Build in choice.Determine the appropriate length of activities.Vary the schedule of activities.Use individualized & classroom schedules.
117VIII. Specific Strategies Task PresentationSystematic instructionClear & consistent cuesEmbedded cues within the taskInterspersed requestingNaturally-occurring reinforcers
118VIII. Specific Strategies Example: Embedded Cues
119VIII. Specific Strategies Example: Instructional Cues
120Specific Strategies Applied Example Daniel 6 years old Diagnosed with autism at age 2 ½Previously in an activity-based preschool program that practiced consequence-based classroom managementTransition to a kindergarten programNeeded assistance in the area of task engagement
121VIII. Specific Strategies Target behavior selected: Independent task engagementIndependently locate task materialsCompleting tasksPutting materials away upon completionSelf-monitoring using a photo activity schedule
122VIII. Specific Strategies Development of intervention:Increased levels of structure & consistency by using a daily classroom scheduleIndividualized activity scheduleDesign & delivery of developmentally- appropriate tasks incorporating visual cuesEnvironmental modifications including designated areas for leisure and group activities
123VIII. Specific Strategies Results:Daniel averaged 29% on task engagement in BaselineHis performance increased to 87% during interventionOver the course of follow-up (4 months) his mean performance was 86% during probe conditions.
127What are Social Skills?A group of discrete or individual and separate skills used daily in our interactions with others.Examples:Greeting othersSaying thank you, excuse me, or asking for help
128What does Social Competence refer to? Social competence is an integration of these discrete skills such as:The ability to discern subtle non-verbal social cuesEmotion recognition to achieve one’s social goals(Chasson, Timpano, Greenberg, Shaw, Singer, & Wilhelm (2011)
129ASD and Social SkillsFor children with ASD we see a marked difference in their development with respect to the formation of social emotional skills and subsequently they experience difficulty in the areas of communication and in the performance of social skills.Social emotional development for children who are typically developing.
130Social Competence in Daily Life Persons with ASD experience difficulties in their social interactions with others. Evidence of this often includes difficulties with such skills as:Social Reciprocity or turn-taking when conversing with othersAttending to subtle social cuesAvoiding eye contactUnderstanding non-verbal behaviorsA lack of interest in peer interactionA lack of enjoyment from social opportunitiesRepetitive and stereotypical behaviorsInsistence on routinesSpecific example- fast food restaurantEarly research literature- aloof, withdrawn, internalized- describe atypical social behaviorAutism translated from ancient Greek “authos” means self. First used in research literature by Swiss Psychiatrist, Eugen Bleuler as early as 1910.
131Importance of Social Competency These social limitations greatly impact on the ability of individuals with ASD to establish friendships and often pose limitations on the quality of their experiences while in school and can often pose challenges to successful employment and community living.
132Challenges faced by individuals with ASD Children and adolescents report having fewer friends, experienced bullying while in school and adults with ASD who are high functioning are less likely than typically developing peers to live and work independently.
133Understanding Social Skill Difficulties in Persons with ASD Theoretical Perspectives to better understand social and communication difficulties:Brain-Based PerspectiveCognitive TheoryBehavioral Perspective
134Neurodevelopmental Perspective Recent research has identified the executive functioning or “high order” cognitive processes associated with the prefrontal cortex of the brain which controls and regulates behavior (Pellicano, 2012) as being underdeveloped and a potential explanation for the social skill deficits experienced by persons with ASD.Magnetic resonance imaging (MRI) has revealed that there was impaired connectivity not only in the “social brain”, but also in the regions of the brain associated in affective aspects of social processing.
135Cognitive Perspective “Theory of Mind” (ToM) proposes that individuals with ASD have an inability to understand the feelings of others, or as Baron-Cohen (2009) described it they lack the ability “to put oneself into someone else’s shoes (p.68).” (Baron-Cohen, Leslie, & Frith, 1985)Mind-BlindnessEmpathizing-Systemizing Theory- supports the need for systematically teaching affective skills such as empathy within the context of a structure or system. This teaching style accommodates the the needs and learning styles of children with ASD.
136Behavioral Perspective Designs treatment programs to improve the social skills of individuals with ASD through the use of applied behavior analysis.These interventions have been largely successful in helping learners with ASD develop discrete social skills.GreetingsMaking eye contactHolding the door for another personSaying “thank you”, “please” and “excuse me”Persons with ASD have difficulty with generalizing these skills across settings and maintaining them over time.
137Evidence-Based Practices in the Development of Social Skills The most frequently used intervention types were applied behavior analysis (ABA), largely within the school setting and involved the use of peer training and video modeling .
138Evidence-Based Practice Methods to Teach Social Skills Interventions that have been demonstrated to be effective and that qualify as evidence-based intervention:Social skills training groupsVideo modelingSocial narrativesSelf-managementNaturalistic intervention
139Parent PartnershipsFor interventions to be truly effective they are reliant on the input and collaboration of all concerned with the well being of the learner and at the top of this list are the learner’s parents.Parent-assisted interventions:Increase the likelihood of generalizationReinforce the learner’s acquisition and fluency of new skillsProvides a comfortable setting for learning and hopefully reduces anxiety.
140Peer-Mediated Instruction Enables typically developing peers the opportunity to model and reinforce appropriate social interactions for students with ASD.Promotes the interaction of learners with ASD with typically developing peers and/or siblings within the context of natural environments (Zhang & Wheeler, 2011).Can incorporate video modeling using peersHas been demonstrated to be even more effective when using siblings as peer models.
141Peer-Mediated Instruction (continued) Steps in implementation in the classroom:Selection of peersTraining of peersImplementation of the peer-mediated instructionPromoting generalization(Sperry, Neitzel, & Wells (2010)It is important to help children understand the commonalities they share rather than focusing on the differences, but it is important for the classroom teacher to help them delight in individual differences.
142Peer-Mediated Instruction (continued) It is important to select peers who exhibit good social skills, who are well liked by peers, and who respond favorably to supervision from the teacher.It is important to help children better understand the commonalities rather than focusing on the differences, but to also help them delight in individual differencesProvide peers with strategies for implementation and allow peers to exchange their ideas(Sperry et al., 2010).
143Peer-Mediated Instruction (continued) With younger children it is important to teach basic play behaviors such as:Selecting a play activitySharing with othersThe teacher will introduce and provide support to the peers as well as the child or children with ASD with needed prompts when appropriate.The sessions should be scheduled consistently within a quiet area of the classroom.Carefully consider the materials selected for the activity and limit the number.Loosely structured times serve as great opportunities to introduce peer-mediated social skills instruction.
144Social Skills Training Groups Teaching format most often used:Modeling of the skill to be taught by the teacherRehearsal on the part of the learner with feedbackPractice by the learnerFeedback and reinforcement by the teacherThe skills taught within these sessions will vary with the age of the participants.Opportunities should be provided to practice the skill in actual environments.Be consistent. Repetition, intensity, and direct instruction have been demonstrated to be most effective in teaching social skills to students with ASD (Kroeger, Schultz, & Newsom, 2007).Role playing and video modeling have also been effective in promoting skill development in learners with ASD.
147Video ModelingVisual input has traditionally been a very effective method for promoting learning for individuals with ASD.Video modeling consists of a student watching a videotape of a person performing the target behavior, followed by the child imitating the performance.Video self-monitoring (VSM) allows the learner to imitate and perform a behavior and then review the videotape as a form of feedback.Temple Grandin- Thinks in pictures
148Video Modeling (continued) Merits of video modeling:It may be more effective than live modelingProvides a visually cued model thus building on the visual learning styles most commonly associated with students with ASD.Void of irrelevant stimuli, minimizes distractionMinimizes the amount of human interaction thus reducing anxiety for the child with ASD.Video modeling is more effective if the person in the video is similar in age or the learner views himself.
149Video Modeling (continued) Implementation considerationsDetermine type of video to be viewedTarget behavior that is of social value to the learnerTarget behavior should be observable and measurableAssess the ability of the learner to perform the behavior and determine the level of proficiency for baseline data.Note strengths and areas of needEstablish a training scheduleHave student watch video and practiceRecord data, use instructional prompting, feedback, and praiseReduce number of sessions as the learner reaches fluency and check for generalization in other environments.Social validity checklist
150Application Sample Apps VideoTote- a video modeling application that allows users to easily create, organize, and view training and task videos…aimed at increasing employment opportunities for individuals with Autism.My Pictures Talk- helps you catalog, share, remember, and can teach skills to those with autism or developmental delays. My Pictures Talk is the first app that allows you to create your own social stories using your own personal videos.Social Skill Builder- video scenarios of real interactions in preschool, elementary school, middle & high school and community settings.Model Me Kids- videos for modeling social skills (free)
151Social StoriesA story or narrative describing a social situation with cues and desired responses in that social situationBreaks down social situations into manageable steps for individuals with ASDThey can be read by the student or to the student or delivered on a computer or tablet deviceExample: Stories2Learn- preloaded with 6 social narratives on two different developmental levels. Parents or educators can add their own audio and write dialogue that corresponds to the photos. Photos and text can be added to help organize the day.iPad apps- technology seems to enhance this
152Social Stories (continued) Implementation considerationsTarget the social skill and context to be addressedThe skill should be a socially valid goal for the learnerDefine and break it down into its’ components so it is observable and measureableCollect baseline performance levelsSelect the story being sure it coincides with the target behavior and is age and developmentally appropriateDetermine performance criteria you seek to develop and when you consider the skill masteredProvide prompting and feedbackWork toward generalization
153Self-ManagementInterventions aimed at teaching self-regulation to learnersSelf-monitoring/self-recording- students monitor the occurrence and performance of their behavior and usually self-record.Identify and operationally define the skillDetermine how the student will record their progress and how you will teach them to do the recordingTeach appropriate response through direct instructionPractice the skillObserve the student to help evaluate their performance and have the student self-recordSelf monitoring/recording- checklists on desk or wall, tabletsPicture scheduleiGet…My Schedules at School Social Skills StoriesStoryMaker for Social Stories
154Self-Management (continued) Interventions (continued)Self-instruction- learners are taught a set of instructions for performing a social skill with emphasis placed on cues that the learner can recall.Cues become self-instructional verbalizations the learner uses to assist him/her in performing the skill.Model the skill along with verbalizationsThe learner rehearses while reciting the steps aloud, gradually becoming less obvious and ultimately without the need of the verbalizations
155Naturalistic Interventions Aimed at enhancing the social-communication skills of children with ASDA broad and encompassing set of child-centered interventions that focus on implementation in natural settingsPivotal Response Training (PRT)- naturalistic interventions are within the context of daily routines and allow for child- directed activities aimed at building communication
156Activities to Extend Your Learning Build a resource file of games and activities that you can adapt for teaching social skills across play, school, home, and community domains to learners with ASD and also in a peer support setting with typical same-age peers.Visit a social skills training group for adolescents and young adults with ASD. Try contacting your local and/or regional state autism society.Experiment with downloadable apps for portable devices for teaching social skills through video modeling.
157Resources to Consult Social Skills (highly recommended)******Working with Parents and FamiliesNational Professional Development Center on Autism Spectrum Disorders
158All the best on your journey…John, Karen and Scout
159IX. Summary & Conclusions A lack of learning in any particularsituation should first be interpreted as aresult of inappropriate or insufficient useof teaching strategy, rather than aninability on the part of the learner.(Gold, 1980)
161Documenting, Monitoring & Evaluating Evidence-based Practices for Children with ASD in the Classroom
162Documenting Evidenced-based Practices & Student Progress TeacherShow Use of Evidence-based practicesEvaluate InterventionStudentEstablish ObjectivesEvaluate Student ProgressEvaluate Modify Intervention or ObjectivesRe-evaluate ProgressPlan & Evaluate Generalization & Maintenance
163Teacher Intervention Checklist Listing of components of interventionComplete checklist dailyAt end of instructional activity or at end of dayCheck off each component teacher didCalculate % of total components completedOR Tally the number of times teacher engages in intervention componentCompleted by Teacher or by 3rd party observer
164Intervention Step Done Not done Tommy’s Sharing Intervention ChecklistDate Person completing checklistIntervention StepDoneNot doneArranged for play area to contain preferred & non-preferred toysArranged for 1 or more peers to be within reach of TommyPre-arranged peer playing with Tommy’s most preferred toyTommy has at least one other toy in his hand or in his reachWhen Tommy looks toward peer or preferred toy & BEFORE he grabs toy, verbally prompt him to ask peer for preferred toy (e.g., “Tommy, tell Peter, ‘Toy’? (or sign toy)Give a silent count of 3 and then see if Peter gives Tommy the toy. If not verbally or physically prompt him to do so.When Peter gives Tommy the preferred toy, then prompt Tommy to give Peter the other toy.When the boys share toys, make a positive acknowledgement (“Boy, look at how you guys are sharing!”)Allow the boys to play with the toys for a few minutes.Repeat this sequence 2 – 3 more times during this or other play periods__________
165Intervention Step Done Not done Intervention Checklist ___ PRACTICEDate Person completing checklistIntervention StepDoneNot done__________
166Progress Checks of Student Behavior Quick, efficient, accurateFrequency tallyMomentary Time SamplePermanent ProductFrequency of checksdaily, weekly, etc.Probe assessments
167Quick Methods Frequency tally Permanent Products/Work Samples tally each challenging behaviorshort duration, low to moderate frequencyPermanent Products/Work Samplese.g., number of assignments completedMomentary Time Samplingseries of short time intervals (e.g., ea.min.)mark behavior “Yes” or “NO” at end of each intervalbehaviors of different length, durations
168Frequency & Permanent Product Examples assignments completed5 written assignments each dayDay 1: 2 completed; Day 2: 4 completed; Day 3: 3 completedAnalysis2/5, 4/5, 3/540%, 80%, 60%FREQUENCYVerbal refusalat recess 10: :00Tally IIII I refusalsAnalysisDay 1:6 refusals in 30 min.6/30 = 0.02 rpmDay 2:6 refusals in 15 min.6/15=0.04 rpm
170Frequency Count PRACTICE Child: Observer: Date:Behavior: (Action – Object)Beginning time:Count (each time behavior occurs, make a tally mark)Ending Time:Total behavior frequency:Total time observed (Ending time –Beginning time)Rate of behavior: (Total frequency/Total time)
171Momentary Time Sample Child: Observer: Date: Activity: Behavior: MinuteBehavior OccurredBehavior Not Occurred1 min2 min3 min4 min5 minTotal Intervals:Total Intervals with BehaviorTotal Intervals without BehaviorTotal Intervals with Behavior/Total Intervals:
172Permanent Product Child: Nannette Observer: MS White Date: 7/25/13 Activity: Coloring Behavior: Breaking CrayonsBeginning time: 10:15 Ending Time: 10:25Number of products counted: 6Beginning time – Ending Time: 10 minNumber of products/Total Time: 6/10 = .6 per min.
173Permanent Product PRACTICE Child: Observer: Date:Activity: Behavior:Beginning time: Ending Time:Number of products counted:Beginning time – Ending Time:Number of products/Total Time:
174Probes (Observation) Definition Procedure behavior sample or “snap shots” in activitybrief, focused observations during activityrepeated over several daysongoing assessment of student behaviorProcedureexample: min. observation of student during independent seatwork2-3 min. at beginning, middle, & end ORrandomly throughout activity
176Evaluating Progress Simple Line Graph of Progress Check Data Quick, Easy to UnderstandBehavior progress over timeIncreasing, Decreasing, Staying the SameRelated to Behavioral ObjectiveShow AimRelationship to Behavior InterventionLabel Baseline & Intervention
177Momentary Time Sample Probe of Peer & Adult Interaction
181Peer Comparison Compare student’s behavior to peers Procedure directly observe target studentdo same type of observation withall other students in class ORsample of students (random; best; average) ORstudents in classroom to which learner will transitionlocal, regional, national norms“Round Robin”alternate observing target & peer students during same activity
182Peer Comparison Example -- “On-Task” Fred = target child, Tom & Harry = Comparison Peers
186What behaviorUnder what conditionsWhoHowmuchbywhatdate
187Modifying Intervention Trend in behavior during interventionTrend Line AnalysisBehavior increasing, decreasing, no changeWill Reach Aimcontinue interventionNot reach Aimmodify intervention or use new interventionchange criterion (amount of behavior)change date to achieve criterion
188Will Reach Aim On Time or Before Continue Intervention
192Planning for Generalization & Maintenance Increasing Independent FunctioningGeneralizationgetting behavior to occur in other situationsMaintenancegetting behavior to last as intervention removedDeliberate Plan Implementedmultiple teaching examplesself-management skillsbehavior dependent fading of intervention