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Autism Spectrum Disorders

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Presentation on theme: "Autism Spectrum Disorders"— Presentation transcript:

1 Autism Spectrum Disorders
John J. Wheeler, Ph.D.

2 What 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

3 History of Autism

4 Autism Prevalence Currently 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.

5 Autism Spectrum Disorders
Up until this year there were five disorders which fell beneath this category. These include: Autism Asperger’s Disorder Childhood Disintegrative Disorder (rare 2 children per 100,000) Rett’s Disorder (affects females 1/10-15,000) Pervasive Developmental Disorder Not Otherwise Specified (PDD/NOS)

6 DSM-V Classification The 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 reciprocity Deficits in non-verbal communicative behaviors used for social interaction

7 DSM-V Classification Restricted 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 objects Expressive adherence to routines, ritualized patterns of verbal or non- verbal behavior, or excessive resistance to change Restricted or fixated interests Hyper-or-hypo reaction to sensory input or unusual interest in sensory aspects of the environment Symptoms 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.

8 Characteristics 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 interests Severe 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.

9 Characteristics 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.

10 Co-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.

11 Etiology 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.

12 Etiology Neurological 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.

13 Biological Basis of ASD

14 Learning Can Be Fun!

15 Biological 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).

16 Environmental Toxins and ASD
Exposure to environmental toxins e.g., heavy metals, mercury etc… and their relationship to autism The MMR debate? Thimerosal? See Article Handout

17 Interaction Between Environmental Toxins and Genetic Susceptibility
© Wheeler, Mayton, Carter (In-press)

18 Take Each Child and Family Where They Are!

19 Break! 9:45 -10:00

20 Positive Behavior Supports & Autism

21 Positive Behavior Supports
Child behavior What child DOES now Challenging behavior – Excessive behavior – too much, too often Skill deficit Wrong behavior at the wrong time What we would like child to do instead Concrete, skills abilities Behavior happens for a reason or reasons Positive Skill building, teaching, Initial learning, Skillful use, When & Where to do certain behaviors, Independence, Innovation Positive methods Supports teachers, peers, parents, siblings Not single intervention Various changes in environment to help child learn & use positive behaviors Pre-vention, not just intervention

22 Behavior Child behavior Behavior happens for a reason or reasons
What child DOES now Challenging behavior – Excessive behavior – too much, too often Skill deficit Wrong behavior at the wrong time What we would like child to do instead Concrete, skills abilities Behavior happens for a reason or reasons Challenging behaviors Positive behaviors Reasons = “Functions”

23 Positive Skill building, teaching,
Initial learning, Skillful use, When & Where to do certain behaviors, Independence, Innovation Positive methods

24 Supports teachers, peers, parents, siblings Not a single intervention
Assistants, bus drivers, kitchen staff Classmates, friends, siblings, cousins, etc Parents, grandparents, uncles, aunts, etc Not a single intervention Various changes in environment to help child learn & use positive behaviors Pre-vention, not just intervention

25 What is a behavior challenge that you are experiencing with a child with ASD?
Write it down Describe it Actions toward Persons or Objects Examples, specific instances Positive behavior What should child DO instead?

26 Behavior Definition Action Object/Person Qualifier
Challenging Behavior Positive Replacement

27 Behavior DefinitionExample
Action Object/Person Qualifier Challenging Behavior Bites --Mouth or teeth on another child Attempt to bite peers Takes toys Grabbing, pulling toy From peers Without asking Forcefully Positive Replacement Says or signs “stop” To peer When peer enters his space (arms distance) Asks for toy From Peer Exchanges toy With peer

28 Behavior Definition PRACTICE
Action Object/Person Qualifier Challenging Behavior Positive Replacement

29 Behavior Reasons Behavior in context “Reasons”
Antecedent Behavior Consequence Situation – who, where, when “Reasons” Functions What supports behavior now? What consequences does it produce now? Behavior’s “purpose” – caution!!!!!!! Triggers What immediately provokes the behavior, sets it off? What situations (people, places, things, prior interactions or events) make it more likely

30 Basic Functional Assessment Questions
What is/are the specific behaviors of concern? Challenging behaviors; Skills/Replacement Behaviors When, where, & with whom does the behavior happen? Challenging; Skill/Replacement When, where, & with whom does the behavior not happen? Challenging; Replacement What 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 now Challenging; Replacement How do others see this behavior (in terms of the above questions)? See it the same as or different than I

31 Basic Functional Assessment Methods & Procedures
Indirect methods Getting impressions, perceptions, recollections from others who know the child –asking one person about another’s behavior Teachers, assistants, other staff, family, the child, etc Rich, varied source of information Accuracy? Disagreements? Different actual “functions” with different people? Direct Methods Directly observing & recording what the child does More accurate? More intensive? Combined with indirect information – triangulate or zoom in on probable situations, triggers, consequences that “cause the behavior

32 FBA Methods Indirect Direct Records review Incident logs
Psychological, developmental tests, etc Interviews With others With child Behavior Situation Rating scales Direct Scatterplot Observations of child by trained observer Specialist, teacher, assistant, other staff, peer/sibling, parent, etc ABC, behavior counts, estimates, behavior “products” Environmental manipulation Changing situation, trigger, consequences, etc, to see if and how behavior is affected

33 Basic Functional Assessment Methods
Interviews Identify behavior concerns Begin definition What are the PERCEIVED situations, triggers, consequences? Behavior Situation Rating Scales Rate how likely specific behavior is in different situations, triggers, consequences Scatterplot Simple observation recording of time of day or activities when behavior happens, doesn’t happen At least 2 weeks Observations Direct observation of behavior Guided by interviews, rating scales, scatterplot Situations, antecedent triggers, consequences/outcomes Behavior count, duration Pre-intervention baseline for evaluating intervention At least 3 – 5 days Focused, specialized Environmental manipulation Trying out different changes in situation, triggers, consequences Do these things really affect the behavior? Preview of intervention effectiveness

34 Basic Functional Assessment Interview Questions
What is/are the specific behaviors of concern? Challenging behaviors; Skills/Replacement Behaviors When, where, & with whom does the behavior happen? Challenging; Skill/Replacement When, where, & with whom does the behavior not happen? Challenging; Replacement What 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 now Challenging; Replacement How do others see this behavior (in terms of the above questions)? See it the same as or different than I

35 Behavior Situation Rating Scales
Motivation Assessment Scale (Durand & Crimmins, 1992) Modified for Early Childhood by McEvoy & Reichle Rating scale: “0” (never) to “6” (Always) Rate a specific behavior (e.g., hits peers) in specific situation (e.g., during circle time)

36 16 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? Scored Average total score/relative ranking for each of: Sensory, escape, attention, tangible consequence Others include : Problem Behavior Questionnaire (PBQ), Questions About Behavior Function (QABF)

37 Scatterplot


39 Environmental Manipulation
Challenging Behavior When child’ favorite toy is on a shelf out of reach, he cries until teacher or assistant asks him what he wants several times When he finally points in direction of the toy, teacher/assistant gives him the toy & crying stops Put toy out of reach Mon, Weds, Fri Put toy within reach Tues, Thurs Crying is higher on Mon, Weds, Fri, than on Tues or Thurs Positive Behavior with Supports BEFORE crying starts, with toy out of reach, ASK child what he wants If he points, give him the toy If he doesn’t point but looks at toy, help him point, then give him the toy

40 Return to your behavior challenge
What consequences or outcomes does the behavior usually get? What seems to trigger the behavior If 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 happen When, where with whom does the behavior not happen

41 Functional Assessment
Situations Triggers Behavior Consequences Challenging Behavior Positive Replacement

42 Functional Assessment Example
Situations Triggers Behavior Consequences Challenging Behavior Transitions, lines, play time Later morning After nap Peer within arm’s distance of Tommy Bites peers Peer cries, moves away, teacher says “We don’t bite our friends” Center time, playground, Adults not near by Peer plays with toys David likes, near him Grabs, pulls toys from peer Peer cries & pulls back, teacher: “We don’t take things from friends; “That was Jana’s toy” Positive Replacement Peer within arm’s Sign or Say “Stop” Have peer move away; Teacher says, “Good to use your words Tommy” Center time, playground, Adults watching Peer plays with preferred toy near David David asks for toy; gives peer another preferred toy David plays with preferred toy; Teacher: Thanks for sharing” both boys

43 Functional Assessment PRACTICE
Situations Triggers Behavior Consequences Challenging Behavior Positive Replacement

44 Positive Behavior Supports
Not just one intervention, not just individual interventions Prevention Primary prevention or Universal level positive supports for all children Positive behaviors that your program values for all children E.g., sharing, cooperation, helping, etc. A system or program-wide approach (PWPBS) A system to encourage children to develop these behaviors Secondary prevention Prevent behavior challenges from getting worse Interventions for certain types of behavior Behaviors shown by several or more children in a class or program “typical” behavior issues that seem not to be improving or getting worse Primary level by itself is not enough for these children’s behaviors Primary intervention continues but add Secondary intervention

45 SWPBS is preventative A three-tiered approach (Lewis & Sugai, 1999; Sugai et al., 2000; Walker et al., 1996)

46 Primary Universal Level
Broad categories of behavior Sharing, cooperating, helping, etc All program staff, parents, etc Identify specific instances of these behaviors in various activities of the day Define clearly Teach the behaviors directly Role play, skits, practice :Pictures, Posters, Videos Periodic review

47 Document behavior incidents
Acknowledge Praise, description, positive consequences “Catch the kids being good” Document behavior incidents Where, when, with whom – to analyze & modify environment to improve positive replacement behaviors & target behaviors of Primary level Reductions in incident reports to evaluate primary level

48 Secondary Level of Intervention
Those children for whom behavior challenges aren’t sufficiently reduced by Primary level, Program-wide supports Incorporate behaviors from primary level Further specify per particular student challenges Inappropriate vs Lack of interaction Communicating vs Tantrums Evidence-based interventions Self monitoring, “Say – Do – Say” Social Skills Training Social Stories with Picture stories, books Video Modeling Picture Schedules More child specific progress data to evaluate progress & intervention

49 Group Behavior Interventions
Several students within same classroom or activity with similar behavior issues (following directions, or playing cooperatively Group contingency Good Behavior Game Anchor the Boat Boat & anchor picture Children earn links in the chain to connect & anchor the boat Special activity , game, party when the chain connects the boat & anchor Pom Pom Jar or Wrist Bands During 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

50 Tertiary or Intensive Individualized Interventions
Functional Behavior Assessment Intervention based in part on the function of the challenging behavior Selecting an alternative behavior that can serve the same function but in a more appropriate way

51 Functional Assessment Example
Situations Triggers Behavior Consequences Challenging Behavior Transitions, lines, play time Later morning After nap Peer within arm’s distance of Tommy Bites peers Peer cries, moves away, teacher says “We don’t bite our friends” Center time, playground, Adults not near by Peer plays with toys David likes, near him Grabs, pulls toys from peer Peer cries & pulls back, teacher: “We don’t take things from friends; “That was Jana’s toy” Positive Replacement Peer within arm’s Sign or Say “Stop” Have peer move away; Teacher says, “Good to use your words Tommy” Center time, playground, Adults watching Peer plays with preferred toy near David David asks for toy; gives peer another preferred toy David plays with preferred toy; Teacher: Thanks for sharing” both boys

52 Collaborating & Partnering with Parents

53 Collaborating & Partnering with Parents
PBS provides multiple opportunities & ways to collaborate with Parents PBS seeks to change or enhance school/program culture, atmosphere Positive emphasis PWPBS – primary level Parent input into target behaviors for PWPBS School/Program leadership team Help providing materials, personal support for acknowledgement activities Help with teaching behaviors – skits, videos, etc Help with data monitoring, inputting

54 Secondary intervention level
Positive “notes” home – focus on positive behavior & improvement Physical notes, electronic notes ( , text) Observe in classroom, teaching staff model positive approaches, functional approach Assistance in class with positive interventions Adapt behaviors, interventions for use in home Promote generalization & maintenance of child behavior change

55 Tertiary or Intensive Individual Behavior Intervention level
Parents participate in identifying behavior function Interviewing parents & other family members Completing behavior –situation rating scales Scatterplot of behavior at home in the morning before & traveling to school – setting events for behavior at school Identifying appropriate, acceptable replacement behaviors Identifying appropriate, preferred, acceptable consequences to support behavior change Identify communication & social skills abilities, deficits “Notes” home on behavior improvement Adapt intervention to home use Home observation

56 Survey parents, family members about acceptability & success of:
PWPBS intervention Secondary intervention Individual behavior plan Recruitment of other parents to assist in & support PBS activities

57 Break 11:00 – 11:15

58 Technical Assistance Survey

59 Survey To help the Center of Excellence in Early Childhood
plan needed ASD technical assistance needed by 1st District EC providers, programs, & families VOLUNTARY – ok not to fill it out Information Some demographic information about you Quick description of what YOU feel is needed in ASD 11 checklist or short answer questions 15 min max., then to lunch Include contact information Only if you want to do so If you want follow up information

60 Administer Survey

61 LUNCH! 12:00 – 1:30 Start Again 1:30 Sharp!

62 Assessment of Autism Spectrum Disorders
The PEP~3 John J. Wheeler, Ph.D.

63 Assessment Outcomes Derived from the Assessment Process
Confirmation of the diagnosis Current levels of functioning across developmental domains Development of goals and objectives leading to the IEP Example:

64 Psychoeducational 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

65 Description 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.

66 Purposes of the PEP~3 Assist in educational planning and diagnosis of ASD for children ages 2-12 years. Determine individual strengths and challenges Collect performance data to assist in confirming the diagnosis Establishes developmental and adaptive levels Assists as a research tool in outcome-based research and learning.

67 Understanding Autism with the PEP~3

68 Performance 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.

69 Performance 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.

70 Understanding the Idiosyncrasies of ASD

71 Performance 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.

72 Performance 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.

73 Characteristics of ASD

74 Maladaptive 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.

75 Subtests cont’d 9. 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.

76 Composites Communication 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.

77 Composites cont’d Maladaptive 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.

78 Caregiver Report Parents 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.

79 End of Segment 1 on the PEP~3

80 Assessment is Designed to Ask Relevant Questions!

81 Segment 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:

82 http://theemergencesite. com/Tech/TechIssues-Autism-OCD-Aspergers-ADD

83 PEP~3 Sections 2-4 Record 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.

84 PEP~3 Sections 5-8 Caregiver 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 Recommendations Scoring for Items 85,86 and 93 through 95.

85 Break! 2:00 – 2:15

86 Design of Interventions
Evidence-based Practices Individualized Interventions for Children with ASD

87 Evidence-Based Practice in the Treatment of Autism Spectrum Disorders: Implications for Children, Families and Professionals John J. Wheeler, Ph.D.

88 What is Evidence – Based Practice?
Refers to a body of scientific evidence that supports practice

89 Origins 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.

90 Challenges 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.

91 The National Autism Center has just published specific guidelines for specifying types and levels of evidence needed to identify a practice as evidence – based.

92 The 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).

93 A 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.

94 Efforts to promote greater awareness in instructional materials have been developed to support physicians in understanding the early signs of autism.

95 The 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).

96 Educational research has brought advances into furthering our understanding of how to facilitate learning in children with ASD.

97 The caveat that remains is our ability to generalize learning over time, places, setting and people given the limitations found within the service delivery systems.

98 Recommendations We 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.

99 P – 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.

100 Colleges 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.

101 Conclusion Consolidation 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.

102 Positive Behavior Support: Assessment (FBA) – Intervention (BIP) Link
Functional Perspective: Behavior happens for a reason or reasons Reason = Function (outcome or “purpose” of behvior Functions Access something: attention, activity, tangible, a feeling (sensory consequence) Escape something: attention, activity, tangible, a feeling (sensory consequence Dual 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

103 Functional-based Intervention 1
Situations Triggers Behavior Consequences Challenging Behavior Transitions, lines, play time Later morning After nap Peer within arm’s distance of Tommy Bites peers Peer cries, moves away, teacher says “We don’t bite our friends” Positive Replacement Peer within arm’s Sign or Say “Stop” Have peer move away; Teacher says, “Good to use your words Tommy”

104 Function-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?

105 Function-based Intervention 2
Situation Trigger Behavior Consequnece Challenging Behavior Center time, playground, Adults not near by Peer plays with toys David likes, near him Grabs, pulls toys from peer Peer cries & pulls back, teacher: “We don’t take things from friends; “That was Jana’s toy” Replacement Behavior Center time, playground, Adults watching Peer plays with preferred toy near David David asks for toy; gives peer another preferred toy David plays with preferred toy; Teacher: Thanks for sharing” both boys

106 What 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?

107 Function-based Intervention 3
Situations Triggers Behavior Consequences Challenging Behavior Play time outside, Centers, teacher, assistant, 10 children Peers and toys near Carla Carla makes frequent initiations to adults or plays alone Teacher & Assistants talk to Carla, tell her to initiate to peers Little or no interaction with peers Positive Replacement

108 Functional 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)?

109 Individualized Interventions for Children with ASD
John J. Wheeler, Ph.D. .

110 Considerations Goals 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.

111 Analyzing 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.

112 The 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, environments Maintenance (generalization over time) Regular use of skills in relevant contexts

113 Specific 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 reinforcers Are there specific cues, prompts, or materials that have in the past been used successfully?

114 Specific 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.

115 Specific Strategies Example: Choice

116 Specific Strategies Example: Schedule

117 VIII. Specific Strategies
Task Presentation Systematic instruction Clear & consistent cues Embedded cues within the task Interspersed requesting Naturally-occurring reinforcers

118 VIII. Specific Strategies
Example: Embedded Cues

119 VIII. Specific Strategies
Example: Instructional Cues

120 Specific Strategies Applied Example Daniel 6 years old
Diagnosed with autism at age 2 ½ Previously in an activity-based preschool program that practiced consequence-based classroom management Transition to a kindergarten program Needed assistance in the area of task engagement

121 VIII. Specific Strategies
Target behavior selected: Independent task engagement Independently locate task materials Completing tasks Putting materials away upon completion Self-monitoring using a photo activity schedule

122 VIII. Specific Strategies
Development of intervention: Increased levels of structure & consistency by using a daily classroom schedule Individualized activity schedule Design & delivery of developmentally- appropriate tasks incorporating visual cues Environmental modifications including designated areas for leisure and group activities

123 VIII. Specific Strategies
Results: Daniel averaged 29% on task engagement in Baseline His performance increased to 87% during intervention Over the course of follow-up (4 months) his mean performance was 86% during probe conditions.

124 Specific Strategies

125 John J. Wheeler, Ph.D. & Karen Dotson Wheeler, M.A.
Social Skill Interventions for Children with ASD: Applying the Evidence to Practice John J. Wheeler, Ph.D. & Karen Dotson Wheeler, M.A.

126 Supports

127 What are Social Skills? A group of discrete or individual and separate skills used daily in our interactions with others. Examples: Greeting others Saying thank you, excuse me, or asking for help

128 What does Social Competence refer to?
Social competence is an integration of these discrete skills such as: The ability to discern subtle non-verbal social cues Emotion recognition to achieve one’s social goals (Chasson, Timpano, Greenberg, Shaw, Singer, & Wilhelm (2011)

129 ASD and Social Skills For 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.

130 Social 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 others Attending to subtle social cues Avoiding eye contact Understanding non-verbal behaviors A lack of interest in peer interaction A lack of enjoyment from social opportunities Repetitive and stereotypical behaviors Insistence on routines Specific example- fast food restaurant Early research literature- aloof, withdrawn, internalized- describe atypical social behavior Autism translated from ancient Greek “authos” means self. First used in research literature by Swiss Psychiatrist, Eugen Bleuler as early as 1910.

131 Importance 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.

132 Challenges 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.

133 Understanding Social Skill Difficulties in Persons with ASD
Theoretical Perspectives to better understand social and communication difficulties: Brain-Based Perspective Cognitive Theory Behavioral Perspective

134 Neurodevelopmental 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.

135 Cognitive 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-Blindness Empathizing-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.

136 Behavioral 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. Greetings Making eye contact Holding the door for another person Saying “thank you”, “please” and “excuse me” Persons with ASD have difficulty with generalizing these skills across settings and maintaining them over time.

137 Evidence-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 .

138 Evidence-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 groups Video modeling Social narratives Self-management Naturalistic intervention

139 Parent Partnerships For 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 generalization Reinforce the learner’s acquisition and fluency of new skills Provides a comfortable setting for learning and hopefully reduces anxiety .

140 Peer-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 peers Has been demonstrated to be even more effective when using siblings as peer models.

141 Peer-Mediated Instruction (continued)
Steps in implementation in the classroom: Selection of peers Training of peers Implementation of the peer-mediated instruction Promoting 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.

142 Peer-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 differences Provide peers with strategies for implementation and allow peers to exchange their ideas (Sperry et al., 2010).

143 Peer-Mediated Instruction (continued)
With younger children it is important to teach basic play behaviors such as: Selecting a play activity Sharing with others The 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.

144 Social Skills Training Groups
Teaching format most often used: Modeling of the skill to be taught by the teacher Rehearsal on the part of the learner with feedback Practice by the learner Feedback and reinforcement by the teacher The 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.

145 Video Modeling

146 Apps

147 Video Modeling Visual 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

148 Video Modeling (continued)
Merits of video modeling: It may be more effective than live modeling Provides a visually cued model thus building on the visual learning styles most commonly associated with students with ASD. Void of irrelevant stimuli, minimizes distraction Minimizes 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.

149 Video Modeling (continued)
Implementation considerations Determine type of video to be viewed Target behavior that is of social value to the learner Target behavior should be observable and measurable Assess the ability of the learner to perform the behavior and determine the level of proficiency for baseline data. Note strengths and areas of need Establish a training schedule Have student watch video and practice Record data, use instructional prompting, feedback, and praise Reduce number of sessions as the learner reaches fluency and check for generalization in other environments. Social validity checklist

150 Application 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)

151 Social Stories A story or narrative describing a social situation with cues and desired responses in that social situation Breaks down social situations into manageable steps for individuals with ASD They can be read by the student or to the student or delivered on a computer or tablet device Example: 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

152 Social Stories (continued)
Implementation considerations Target the social skill and context to be addressed The skill should be a socially valid goal for the learner Define and break it down into its’ components so it is observable and measureable Collect baseline performance levels Select the story being sure it coincides with the target behavior and is age and developmentally appropriate Determine performance criteria you seek to develop and when you consider the skill mastered Provide prompting and feedback Work toward generalization

153 Self-Management Interventions aimed at teaching self-regulation to learners Self-monitoring/self-recording- students monitor the occurrence and performance of their behavior and usually self-record. Identify and operationally define the skill Determine how the student will record their progress and how you will teach them to do the recording Teach appropriate response through direct instruction Practice the skill Observe the student to help evaluate their performance and have the student self-record Self monitoring/recording- checklists on desk or wall, tablets Picture schedule iGet…My Schedules at School Social Skills Stories StoryMaker for Social Stories

154 Self-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 verbalizations The learner rehearses while reciting the steps aloud, gradually becoming less obvious and ultimately without the need of the verbalizations

155 Naturalistic Interventions
Aimed at enhancing the social-communication skills of children with ASD A broad and encompassing set of child-centered interventions that focus on implementation in natural settings Pivotal Response Training (PRT)- naturalistic interventions are within the context of daily routines and allow for child- directed activities aimed at building communication

156 Activities 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.

157 Resources to Consult Social Skills
(highly recommended)****** Working with Parents and Families National Professional Development Center on Autism Spectrum Disorders

158 All the best on your journey…John, Karen and Scout

159 IX. Summary & Conclusions
A lack of learning in any particular situation should first be interpreted as a result of inappropriate or insufficient use of teaching strategy, rather than an inability on the part of the learner. (Gold, 1980)


161 Documenting, Monitoring & Evaluating Evidence-based Practices for Children with ASD in the Classroom

162 Documenting Evidenced-based Practices & Student Progress
Teacher Show Use of Evidence-based practices Evaluate Intervention Student Establish Objectives Evaluate Student Progress Evaluate Modify Intervention or Objectives Re-evaluate Progress Plan & Evaluate Generalization & Maintenance

163 Teacher Intervention Checklist
Listing of components of intervention Complete checklist daily At end of instructional activity or at end of day Check off each component teacher did Calculate % of total components completed OR Tally the number of times teacher engages in intervention component Completed by Teacher or by 3rd party observer

164 Intervention Step Done Not done
Tommy’s Sharing Intervention Checklist Date Person completing checklist Intervention Step Done Not done Arranged for play area to contain preferred & non-preferred toys Arranged for 1 or more peers to be within reach of Tommy Pre-arranged peer playing with Tommy’s most preferred toy Tommy has at least one other toy in his hand or in his reach When 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 __________

165 Intervention Step Done Not done
Intervention Checklist ___ PRACTICE Date Person completing checklist Intervention Step Done Not done __________

166 Progress Checks of Student Behavior
Quick, efficient, accurate Frequency tally Momentary Time Sample Permanent Product Frequency of checks daily, weekly, etc. Probe assessments

167 Quick Methods Frequency tally Permanent Products/Work Samples
tally each challenging behavior short duration, low to moderate frequency Permanent Products/Work Samples e.g., number of assignments completed Momentary Time Sampling series of short time intervals (e.g., ea.min.) mark behavior “Yes” or “NO” at end of each interval behaviors of different length, durations

168 Frequency & Permanent Product Examples
assignments completed 5 written assignments each day Day 1: 2 completed; Day 2: 4 completed; Day 3: 3 completed Analysis 2/5, 4/5, 3/5 40%, 80%, 60% FREQUENCY Verbal refusal at recess 10: :00 Tally IIII I refusals Analysis Day 1: 6 refusals in 30 min. 6/30 = 0.02 rpm Day 2: 6 refusals in 15 min. 6/15=0.04 rpm

169 Momentary Time Sampling

170 Frequency 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)

171 Momentary Time Sample Child: Observer: Date: Activity: Behavior:
Minute Behavior Occurred Behavior Not Occurred 1 min 2 min 3 min 4 min 5 min Total Intervals: Total Intervals with Behavior Total Intervals without Behavior Total Intervals with Behavior/Total Intervals:

172 Permanent Product Child: Nannette Observer: MS White Date: 7/25/13
Activity: Coloring Behavior: Breaking Crayons Beginning time: 10:15 Ending Time: 10:25 Number of products counted: 6 Beginning time – Ending Time: 10 min Number of products/Total Time: 6/10 = .6 per min.

173 Permanent Product PRACTICE
Child: Observer: Date: Activity: Behavior: Beginning time: Ending Time: Number of products counted: Beginning time – Ending Time: Number of products/Total Time:

174 Probes (Observation) Definition Procedure
behavior sample or “snap shots” in activity brief, focused observations during activity repeated over several days ongoing assessment of student behavior Procedure example: min. observation of student during independent seatwork 2-3 min. at beginning, middle, & end OR randomly throughout activity

175 Break! 3:15 – 3:30

176 Evaluating Progress Simple Line Graph of Progress Check Data
Quick, Easy to Understand Behavior progress over time Increasing, Decreasing, Staying the Same Related to Behavioral Objective Show Aim Relationship to Behavior Intervention Label Baseline & Intervention

177 Momentary Time Sample Probe of Peer & Adult Interaction

178 Social Interaction Probe

179 Social Interaction Probe

180 Social Interaction Probe Results

181 Peer Comparison Compare student’s behavior to peers Procedure
directly observe target student do same type of observation with all other students in class OR sample of students (random; best; average) OR students in classroom to which learner will transition local, regional, national norms “Round Robin” alternate observing target & peer students during same activity

182 Peer Comparison Example -- “On-Task”
Fred = target child, Tom & Harry = Comparison Peers

183 Ginger & Comparison Peers’ Interaction Percentages
Day Percentage of Time Ginger’s Peer Interaction Comparison Peers’ Interactions Aim 1 10 % 2 15 % 30 % 3 5 % 4 45 % 5 6 5 % 35 % 40 %

184 Comparison Peers Aim Ginger

185 Ginger & Comparison Peers’ Interaction Percentages
Day Percentage of Time Ginger’s Peer Interaction Comparison Peers’ Interactions Aim 1 10 % 2 15 % 30 % 3 5 % 4 45 % 5 6 5 % 35 % 40 % Social Skills Training 7 12 % 8 20 % 9 25 % 10

186 What behavior Under what conditions Who How much by what date

187 Modifying Intervention
Trend in behavior during intervention Trend Line Analysis Behavior increasing, decreasing, no change Will Reach Aim continue intervention Not reach Aim modify intervention or use new intervention change criterion (amount of behavior) change date to achieve criterion

188 Will Reach Aim On Time or Before
Continue Intervention


190 Improving But Won’t Reach Aim
Modify Intervention? Change Objective Level? Change Date?


192 Planning for Generalization & Maintenance
Increasing Independent Functioning Generalization getting behavior to occur in other situations Maintenance getting behavior to last as intervention removed Deliberate Plan Implemented multiple teaching examples self-management skills behavior dependent fading of intervention


194 Final Questions, Comments

195 Contact Information Dr. John Wheeler Director Dr. James Fox Research Director Center of Excellence in Early Childhood Learning & Development (office) (FAX) Box ETSU Johnson City, TN 37614

196 ETSU Positive Behavior Support Initiative
Assistance in developing positive behavior support programs, training in effective teaching & behavior support methods, training & supporting functional behavior assessment – behavior intervention teams Dr. Leia Blevins, Associate Director

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