1. Overview of Self-Management Strategies and their Effective use for Individuals with Autism Spectrum Disorders in School, Employment, and Community Settings Keith Storey Touro University, Graduate School of Education Keith.Storey@tu.edu Michal Post Touro University, Graduate School of Education Michal.Post@tu.edu

2. 3 Key Points of Self-Management 1. Gives power to the person 2. Increases generalization Behaviors. Times. People. Settings. 3.Very flexible

3. What is Self-Management? Giving the person more control over their own life Control is given through teaching the person skills Giving the person specific strategies to control or modify their own behavior The terms self-regulation and self-control are often used interchangeably with self- management.

4. Self-management ideally involves: Recognizing one’s own problem Translating problems into behaviors to be changed Finding natural contingencies or contriving them to support change Arranging the contingencies for change to occur

5. Published Cases of Successful Self- Modification (From Watson & Tharp, 2007) Increasing creative productivity (Herren, 1989). Improving study habits (Richards, 1976) Controlling weight (Mahoney, Moura, &Wade, 1973) Handling anxiety in social situations (Rehm & Marston, 1968) Controlling nervous habits such as scratching, nail biting, and hair pulling (Perkins & Perkins, 1976; Watson, Tharp, & Krisberg, 1972) Overcoming depression (Hamilton & Waldman, 1983; Tharp, Watson, & Kaya, 1974) Eliminating teeth grinding (Pawlicki & Galotti, 1978) Speaking up in class (Barrera & Glasgow, 1976) Exercising (Kau & Fisher, 1974)

6. Advantages to Self-Management Involve the person in their own behavior change Instead of always doing something to somebody you are helping them to do something independently and thus working with them For people with disabilities often the choices of what to do, where to go, who to be friends with is taken away – This gives back the control

7. Advantages to Self-Management Generalization of the behavior change can be enhanced – likely to use self management strategy in multi settings Example – Cleaning dining tables using a checking-off job tasks list can use same strategy for cleaning the kitchen area Avoid Learned Helplessness Less dependant on job coaches or other support providers

8. Advantages of Self-Management Disadvantages of externally controlled procedures may be reduced such as: Performing behavior only in presence of those who administer consequences Teachers and others often miss a great deal of behavior when applying reinforcement or punishment

9. Advantages of Self-Management Self-management procedures are effective with people with all types of disabilities People with very severe disabilities can learn to use self-management procedures effectively (Browder & Shapiro, 1985) Self-management procedures can and should be adapted to meet the individual needs of the person – not based on disability type

10. Disadvantages to Self-Management Could be stigmatizing to the person using the procedure May be time consuming up front teaching the self-management skills

11. Components of Self-Management Self-management broadly refers to all processes used by an individual to influence her or her behavior (Browder & Shapiro, 1985) Self management techniques Antecedent cue regulation devices Self-monitoring Self-determined consequences Self-punishment Combination of techniques Usually is part of an instructional package – not isolated

12. Self Management Techniques Antecedent cue regulation devices: Use of prompts and operations that lead the user to the correct response ACR can be used to lead a person to perform every stop within a task analysis To perform an entire task To perform a series of tasks in the correct order over a longer period of time Checklists – arranged in order of task Modified clock face – task symbol in place of time Auditory prompts - Micro cassette tape or MP3 players

13. Self Monitoring Cards

15. Antecedent cue regulation

17. Self-management techniques Self-monitoring Involves procedures that help a person to identify a specific response Detects whether the response in question has occurred Make some record of the response Charts and checklists – tasks over a number of times Manual counters – golf beads Timers – time spent on tasks

18. Self-management techniques Self-monitoring ( continued) the use of a cell phone, personal digital assistant (PDA) or other electronic device in which cues are programmed (such as a cell phone being programmed to give a signal and say “time to go to lunch” at noon and then signal and say “time to get back to work” at 12:30).

19. MONDAYPUT PLUS MARK WHEN CHECKED 1. Look in mirror after eating lunch. 1. Check face, mustache, shirt, and tie for food. 1. If there is food on face or mustache, wet washcloth. 1. Use wet washcloth to wash all food off face and/or mustache. 1. Brush any crumbs off short and tie.

20. When the timer sounds, place a + beside the number if you were on-task and a 0 beside the number if you were not on-task. MondayTuesdayWednesdayThursdayFriday 11111 22222 33333 44444 55555 66666 77777 88888 99999 1010101010

21. Self Monitoring Cards

24. Self-management techniques Self-determined consequences Self-Delivery of coins or tokens – take tokens upon completion of task and exchange for an item or activity that the person values Analysis of performance records – learn to view the data in light of reinforcing value Self-recruited feedback – submit self- monitored record to supervisor

25. Self-punishment Rarely used because reinforcement techniques are usually viable alternatives Less likely to evoke undesirable side effects Rubber band on wrist Response cost

26. General Self-Management Steps (Koegel, Koegel, & Park, 1992) Getting Ready Teaching Self-Management Creating Independence

27. General Self-Management Steps (Koegel, Koegel, & Park, 1992) Getting Ready Define behaviors Measure behaviors Choose a reinforcer Select an initial goal Teaching Self-Management Get materials Identify the behavior Record the behavior Reinforce self-management

28. General Self-Management Steps (Koegel, Koegel, & Park, 1992) Creating independence Increase amount of time your student self- manages behavior Fade your student’s reliance on prompts Increase the number of responses necessary for a reward Fade the presence of the treatment provider

29. Implications for Instruction Include a self-management from the start if warranted Instituted after fading of instructional procedures Environment must be considered – Device (e.g.,checklist, ipod, picture board etc.) should not draw undue negative attention Looking at what devices are currently being used for person’s without disabilities and modify as needed

30. Using “Auditory Prompts” as a Support System in Work and Community Environments from Post & Storey (2002) What are “auditory prompts”? Auditory prompts consist of verbal commands using single word or multiple word phrases to encourage and guide an individual to complete a task.

31. Using “Auditory Prompts” as a Support System in Work and Community Environments from Post & Storey (2002) How are recorded auditory prompts used? Recorded auditory prompt systems can be used to transfer instruction onto a portable electronic device (MP3, cell phone, ipod, ipad, iphone, etc.) and used as a teaching tool to: support the teaching of a new skill, provide on going reinforcement to make the learned skill permanent maintain focus on task and filter out some auditory distractions provide independence from constant direct supervision

32. Using “Auditory Prompts” as a Support System in Work and Community Environments from Post & Storey (2002) How is a recorded auditory prompt system used? Auditory prompts are recorded on an electronic device and listened to through attached headphones: The recording device should be portable enough to be easily worn without interfering with the work task The spacing and delivery of prompts are tailored to the work pace, skill level, and specific support needs of the individual

33. Using “Auditory Prompts” as a Support System in Work and Community Environments from Post & Storey (2002) What kinds of prompts are used in an auditory prompt system? An auditory prompt system may involve: the recording of step by step instructions for completing a specific task a recording of phrases that compliment performance and /or encourage continuation of work a recording of questions directing self-evaluation of work performance a recording of selected music embedded with intermittent prompts that deliver positive reinforcement or instructional guidance An audio recording paired with picture prompts a recording using a combination of the above

35. Visual paired with audio task analysis for handheld device. (Davies et al.)

36. HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructions from Post & Storey (2002) Create a Task Analysis for the targeted task. This analysis involves breaking down the targeted task into small incremental teachable steps. Using understandable language, write these steps in script form for recording. For the script reading, choose a familiar voice known to produce a positive response from the student, or experiment with various voices for clarity and positive effect Record the step-by-step instructional prompts. Insert necessary wait time needed to perform the task. The spacing of prompts can be determined by observing the student’s work pace. Spacing may need to be adjusted once the student becomes comfortable with the system.

37. HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructions from Post & Storey (2002) One option is to insert prompts of encouragement, praise, or evaluation within the “wait time” between instructional prompts. Such prompts used might be “You are doing a fine job” or “Keep up the good work”. An example of an evaluation prompt for teaching the use of a clothes dryer might be “Are all the clothes in the dryer?” A second or additional option is to embed recorded music between instructional prompts. Studies using music had the students select their favorite recordings or used classical music or recordings that produced a calming effect. Once the recording is ready, introduce the recorded auditory prompt system by first demonstrating how to physically operate the device with the headsets. After the above modeling, have the student’s practice putting on the equipment.

38. HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructions from Post & Storey (2002) Determine that the students can operate the on/off controls. For this step, a recording containing the student’s favorite music could be used. If needed, make modifications to the operation icons/controls, etc. Making only the on/off controls available for pressing may be necessary for some students. Modifications may include: Removing any fast forward controls to prevent inadvertent pressing, Adding a drop of whiteout to the volume control to allow supervisor to visually monitor volume, Color-coding the on and off control for easier reference, Using a remote switch carried in the participant’s pocket that contained only an on/off option.

39. HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructions Taken from Post & Storey (2002) Once the student has demonstrated competence in the use of the system, allow the student to independently use the auditory prompt system. Closely monitoring the student using the system may be necessary initially. However, fading personal assistance can be managed according to the support needs of the student. Many studies showed student being able to learn the targeted task and no longer needing to use the prompt system once the specific skill was learned. The prompt system was then only reintroduced if the skill was to be performed in a different setting. A few studies indicated the need for continuous use of the auditory prompt system to maintain the improved performance.

40. HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructions from Post & Storey (2002) Once the student has mastered the on/off operation, have the students practice removing the equipment. Now instruct the students to independently put on the recording device and headset. Introduce the recorded script containing the task analysis. Have the students press the on control, listen to the first step, then turn off the device and perform the step. If the student has difficulty performing the task, ask the student to repeat the recorded instructions out loud, then perform the step. If there is still confusion, model the performance of the step for the student, or give enough assistance necessary to enable the student to perform the step. Continue in this way until the student demonstrates accuracy in performing the step.

41. Troubleshooting Tree from Post, Montgomery, & Storey (2009) Client Not Performing Job Task Follows direction But forgets Steps of Task Develop task analysis Record step by step instructions Follows instructions and completes task but poor accuracy and quality Record selected music and insert self evaluation prompts Follows and remembers directions but becomes distracted easily and often Recorded selected music and embed with prompts of encouragement Does not follow directions and does not respond to oral prompts of reminders or encouragement appears disoriented Explore Other Options

42. Study 1 Facilitating Task Acquisition Through The Use of a Self-Operated Auditory Prompting System Paul A. Alberto, Georgia State University William R. Sharpton, University of New Orleans Anita Briggs and Mary Helen Stright, Georgia State University

43. Facilitating Task Acquisition Through the Use of a Self-Operated Auditory Prompting System Who were the participants? Four adolescents (12, 14, 15, and 16 years old) with moderate to severe developmental disabilities. What was the problem? Participants were required to perform the tasks of: using a clothes washing machine, preparing a cup of soup, and preparing a peanut butter sandwich without the presence of a personal assistant guiding them with verbal and/or physical assistance. Prior to the introduction of the auditory prompt system, none of the adolescents successfully completed any of the tasks.

44. Facilitating Task Acquisition Through the Use of a Self-Operated Auditory Prompting System Before introducing the tape recorded script of prompts, the teacher guided the participants with verbal and physical prompts by reading the script with the step-by-step instructions for correctly completing each task. Colored-coding was used for the on/off controls. Step by step instructions used with length of pause between instruction tailored to each participant. Self-evaluation prompts were used. A question was heard on the tape asking the participant if they had completed all the steps. If there was a problem, the teacher was called to demonstrate how the step should be completed. Prompt for contacting the teacher was eventually eliminated.. When 90% correct performance for three consecutive sessions was attained, the participants then performed the task with only a beginning cue (“Wash these clothes in the machine” and “make a cup of soup”) and without the use of the recording.

45. Facilitating Task Acquisition Through the Use of a Self-Operated Auditory Prompting System What were the results? The participants learned the task quickly, accurately and were able to perform task 8 months later without the use of the prompt system.

46. Study II Generalized Use of a Self-Operated Audio Prompt System Anita Briggs and Paul Alberto, Georgia State University William Sharpton, University of New Orleans Karen Berlin and Carolyn Mc Kinley, Dekalb County Schools Chris Ritts, Fulton County Schools

47. Generalized Use of a Self-Operated Audio Prompt System Who were the participants? Four students (14 to 19 years old) with moderate and severe disabilities. What was the problem? Students were required to correctly use a coin operated washer and dryer without the personal assistance of a support person. Prior to intervention, teacher and parents reported that students were unskilled on these tasks.

48. Generalized Use of a Self-Operated Audio Prompt System How was the tape-recorded auditory prompt system used as a support? The participants were given the materials they needed to use a washing machine and dryer. Listened to the step-by-step instructions embedded with a bell tone signaling them when to turn off the device and perform the task. Self-evaluation questions were given after each step. Such questions were: “Are the clothes in the washer?’ and “Are all the coin slots filled with quarters?’ When the participant completed the task with 80% accuracy for three consecutive sessions, the participant was trained to perform the same task in a second setting.

49. Generalized Use of a Self-Operated Audio Prompt System What were the results? Successful use of the washer and dryer in the school setting with the help of the recorded prompting system Students were able to generalize the use of the prompt system to transfer the skill to successfully use a washer and dryer in a community setting.

50. Study III The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental Retardation Carol Ann DavisMichael P. Brady Robert E. WilliamsMichele Burta University of Houston

51. The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental Retardation Who were the participants? Three high school students (16, 16, and 20 years old) with severe mental retardation working in a food preparation facility. What was the problem? Students needed to increase the work pace Correctly fill salt and pepper shakers, drying serving trays, and lining trays with paper liners. Prior to the study were able to perform the tasks but needed to increase fluency.

52. The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental Retardation How was the tape-recorded auditory prompt system used as a support? After four to seven days of performing the task, participants were given an electronic device for listening to music while performing the task. The fast forward control was eliminated to avoid inadvertent fast forwarding.. All sessions began with the teacher’s cue. After six days of listening to a tape of music, an auditory prompt system consisting of music with verbal prompts interspersed throughout was implemented. The delivery of prompts was individually determined according to the time needed for each student. The timing for delivery of cues was varied averaging 30, 18, 10, or 7 seconds between cues. Cue’s consisted of phrases as, “Keep working” or “Don’t stop working until the alarm rings.” The student’s name was also spoken.

53. The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental Retardation What were the results? The use of the auditory prompt system led to increased work fluency for all three participants. Prior to the study, one student filled salt and pepper shakers averaging.4 per minute. After intervention with the audio prompt system the average increased to 2.8 salt and pepper shakers filled per minute. A second student increased her average from 2.0 shakers filled per minute to an average of 4.4 per minute An increase in trays dried and lined went from an average of 1.8 trays per minute to 3.1 trays per minute

54. Study IV Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills. Sandra A. Trask-TylerTheresa A. Grossi William L. Heward

55. Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills Who were the participants? Three young adults (17, 20, and 21 years old) with moderate developmental disabilities and visual impairments preparing food recipes in apartment kitchens in a school setting. What was the problem? Participants were required to prepare edible food by accurately following the steps in a recipe. Prior to the intervention of the tape-recorded recipes, none of the students prepared an edible item. Recipes used in the study were microwave french fries, microwave pizza, microwave popcorn, automatic drip coffee, automatic drip tea, instant pudding, instant cheesecake, microwave brownies, and microwave cake.

56. Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills How was the tape recorded auditory prompt system used as a support? After instruction in the use of the audio prompt system, students were instructed to use the system to prepare a specified recipe they had previously been unsuccessful at preparing. Participants were told to turn the recording device off when they heard a “beep” sound, perform the food preparation step and then turn on the device for the next instruction. A remote switch containing only an on/off button was carried in the participant’s pocket. If a student incorrectly began a step, the experimenter gave a verbal prompt, and then a verbal prompt paired with physical guidance if further help was needed. If participant did not respond to prompts, hand-over-hand manipulation and verbal prompts were used. After two successful recipe preparations were completed, students were asked to prepare a new recipe with the pre-recorded recipe instructions.

57. Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills What were the results? Students prepared edible food by correctly following the step by step recipe instructions Students prepared more complex and unfamiliar recipes without pre-training by staff.

58. Unpublished study The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training Joyce Montgomery, Keith Storey, Michal Post, and Jacky Lemley Touro University – California and Vallejo City Unified School District

59. The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training Who were the participants? Two students (17 years old) with autism and mental retardation What was the problem? Students were participants in an employment training program sponsored by a school district program. Student worked at two local restaurants participating as part of the restaurant prep crew. Students washed tables and chairs as well as set the tables for the day service. The students had received instruction on their tasks and were able to perform the tasks however; they required constant verbal and physical prompts to complete the tasks in a timely manner otherwise, they may spend much of the training session on one table.

60. The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training How was the tape-recorded auditory prompt system used as a support? Students received their assignment and materials for their assigned tasks. With assistance as needed, students turned on their recording device and put on their headphones. Their favorite music was embedded with prompts of encouragement and self evaluation to continue working and maintain the productivity and quality of their work. Students would listen to the music with prompts while competing their tasks Support staff continued to provide verbal and physical prompts as needed

61. The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training What were the results? Students were able to complete their assigned tasks within the allocated amount of time with minimal prompting from support staff During the reversal phase of the study, students again required verbal and physical prompting from the support staff to complete their assignments When the tape recorder was reintroduced, the students performance again increased and the prompts decreased

62. The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training

64. Software Apps- Pictello http://www.assistiveware.com/pictello.php Easy to use and requires no literacy skills to locate and read stories. Pictello offers an easy visual story creation wizard. An advanced editor gives full control of the editing capabilities. USES Social stories to teach skills or to recall events. Talking books. Teaching narrative skills as part of a literacy or language skills curriculum. Schedules, Task instructions, etc. Includes voices which can be swapped at no costs for British voices that can be downloaded through WiFi by Pictello. Pictello does not require an active Internet connection for story creation or playback. A universal version that will also support the iPad is in development as are localized versions in other languages. These will be free upgrades.

65. Each page in a Pictello can contain a picture, up to five lines of text, and a recorded sound or text-to-speech using high-quality voices. Stories can be shared using iTunes File Sharing or via WiFi with other Pictello users through a free account on the Pictello Sharing Server.

66. Proloquo Software AAC device www. http://www.proloquo2go.com Create stories, messages, and edit text.http://www.proloquo2go.com

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69. Tollison, P. K., Synatschk, K. O., & Logan, G. (2011). Self-regulation for kids K- 12: Strategies for calming minds and behavior. Austin, TX: Pro-Ed. Trask-Tyler, S. A., Grossi, T. A., & Heward, W. L. (1994). Teaching young adults with developmental disabilities and visual impairments to use tape-recorded recipes: Acquisition, generalization, and maintenance of cooking skills. Journal of Behavioral Education, 4, 283–311. Vohs, K. D., & Baumeister, R. F. (2010). Handbook of self-regulation: Research, theory, and applications (2nd ed.). New York: Guilford Press. Watson, D. L., & Tharp, R. G. (2007). Self-directed behavior: Self-modification for Personal adjustment (9th ed.). Belmont, CA: Wadsworth/Thomson Learning. Workman, E. A., & Katz, A. M. (1995). Teaching behavioral self-control to students. Austin, TX: Pro-Ed.