Planning a Comprehensive Program for Students with · PDF filePlanning a Comprehensive Program for Students with ASD ... Williams & Shellenberger, 1996 Taylor & Trott, 1991 Cognition

1

Planning a Comprehensive Program for Students with ASDUsing Evidenced-Based Practices in the

Classroom

Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. The Ziggurat Group

Brenda Myles, Ph.D. Ohio Center for Autism and Low Incidence

Workshop presented at the 10th International Conference on Cognitive Disabilities/Mental Retardation, Autism, & Other Developmental Disabilities

January 31, 2007

Overview of Day

Recent developments in autism research

Diagnostic criteria of autism spectrum disorders

Introduce the Ziggurat ModelHow to assess and address underlying characteristics

Five levels of intervention

Three points of intervention

Apply ZM to scenarios

Common evidenced-based intervention strategies

Pre-Test (1)

1. T F 1 in 166 people have an Autism Spectrum Disorder

2. T F Six to seventeen percent of individuals with ASDsdevelop catatonia

3. T F Most individuals with an autism spectrum disorder have a special talent.

4. T F If a child easily hugs others they probably do not have autism.

5. T F Visual supports such as schedules are a “crutch” andshould be discontinued as quickly as possible.

2

Pre-Test (2)

6. T F Asperger’s Disorder and High Functioning Autism are different words for the same disorder.

7. T F Signs of autism may be identified as early as one year of age.

8. T F Rett Syndrome may occur in boys or in girls.

9. T F One half of individuals with Asperger’s Disorder arenever diagnosed.

10. T F Asperger’s Disorder is a mild form of autism.

Asperger’s – Mild Autism?

“[Asperger’s Disorder] cannot be regarded as a mild disorder. Many examples exist to demonstrate that it can impose a heavy burden on the [person], the family and the wider community.”

Frith, 2004

Nikki Bacharach

Nikki “Committed suicide to escape the ravages to her brain brought on by Asperger's"

Copyright 2007 The Associated Press

3

Outcome

Findings of a 2002 U.S. study of 405 children and adults on the spectrum

(Seltzer and Krauss, 2002)

Of adults 22 and older, 73% lived with their parents

90% could not gain or keep employment

95% had difficulty making and keeping friends

The Myth of Developmental Milestones

Behaviors do not inherently change or develop as our children get older

Tolerance for their behaviors changesElementary: Time out

Middle/High School: School removal

Adulthood: Incarceration

Brenda Smith Myles

A Study in Contradictions

22% have IQs in the superior to superior range

12% are employed full-time**1% of this 2% are employed in an area in which they were trained/educated

**most did not have interventions at a young age

Brenda Smith Myles

4

Pervasive Developmental Disorders

Characterized by severe and pervasive impairments in the several areas of development

Reciprocal social interaction skills

Communication skills

Presence of stereotyped behavior, interests, and activities

Pervasive Developmental Disorders

Autism

Rett’s Disorder

Childhood Disintegrative Disorder

Asperger’s Disorder

Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

Autistic Disorder

Impairment in social interaction

Difficulty using nonverbal behaviors to regulate social interaction (e.g., eye-contact, physical proximity, etc.)Failure to develop age-appropriate peer relationshipsLittle sharing of pleasure, achievements, or interests with othersLack of social or emotional reciprocity

Restricted, repetitive behaviors, interests, or activities

Interests that are narrow in focus, overly intense, and/or unusualUnreasonable insistence on sameness and following familiar routinesRepetitive motor mannerismsPreoccupation with parts of objectsCommunication

Delay in or total lack of development of spoken languageDifficulty holding conversationsUnusual or repetitive languagePlay that is not appropriate for developmental level

5

Asperger’s Disorder

No clinically significant general delay in language and no significant delay in cognitive development

Impairment in social interaction

Difficulty using nonverbal behaviors to regulate social interaction (e.g., eye-contact, physical proximity, etc.)Failure to develop age-appropriate peer relationshipsLittle sharing of pleasure, achievements, or interests with othersLack of social or emotional reciprocity

Restricted, repetitive behaviors, interests, or activities

Interests that are narrow in focus, overly intense, and/or unusualUnreasonable insistence on sameness and following familiar routinesRepetitive motor mannerismsPreoccupation with parts of objects

Autism Characteristics Activity

Social Communication Restricted/Repetitive

Jessy

6

Male to Female Ratio

4.3 to 1

Greater difference at higher end of functioning

Adapted from Rosenn, D. (1997). Autism spectrum severity wedge.

“Classic” HFA/ASIncreasing Variability of Presentation

Differential Diagnosis

ADHD

OCD

Bipolar

MR

Early Speech Delays

Reactive Attachment Disorder

Schizophrenia

Visual Impairment

Sensory Integration Disorder

7

Catatonia in ASDs

Catatonia in Autism Spectrum Disorders

Characteristics of Catatonia in ASDs

1. Increased slowness effecting movement and verbal response

2. Difficulty initiating and completing action

3. Reliance on physical or verbal prompting

4. Increased passivity and lack of motivation

Wing and Shaw (2000). Catatonia in autism spectrum disorders. British Journal of Psychiatry. 176, 357-362.

Associated features of Catatonia in ASDs

1. Reversal of day and night

2. Parkinsonian features (e.g., tremor, eye rolling, stiff posture, freezing)

3. Excitement and agitation

4. Increase in repetitive and ritualistic behavior

Wing and Shaw (2000). Catatonia in autism spectrum disorders. British Journal of Psychiatry. 176, 357-362.

8

Interventions for Catatonia

Reduce stress

Provide verbal and physical prompts

Maintain routine and structure

Educate caregivers

Medication

ECT

Shah and Wing, (2006). Psychological approaches to chronic catatonia-like deterioration in autism spectrum disorders. In Catatonia in Autism Spectrum Disorders. D. Dhossche, L. Wing, M. Ohta, & K. Neumärker (Eds.).

Growth of Dendrites and Neural Circuitry: Arborization

Disproportional Corpus Callosum

Boger-Megiddo, et al. (2006). Corpus callosum morphometrics in young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36, 733-739.

9

Brain activation in response to faces

Courchesne and Pierce, (2005). Brain overgrowth in autism during a critical time in development: implications for frontal pyramidal neuron and interneuron development and connectivity. International Journal of Developmental Neuroscience 23 153-170.

Ziggurat n:(zig·gu·rat) from Assyrian ziqquratu, height, pinnacle

1. a temple having the form of a terraced pyramid of successively receding stories, erected by the ancient Assyrians and Babylonians

2. a framework for designing comprehensive interventions for individuals with autism spectrum disorders

Intervention ZigguratIntervention Ziggurat

Sensory Differences and Biological NeedsSensory Differences and Biological Needs

Skills to TeachSkills to Teach

Task DemandsTask Demands

Structure and Visual/Tactile SupportsStructure and Visual/Tactile Supports

ReinforcementReinforcement

© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.

10

Intervention ZigguratResponsive to Characteristics

Sensory and Biological Sensory and Biological NeedsNeeds

ReinforcementReinforcement

Structure and Structure and Visual/Tactile SupportsVisual/Tactile Supports

Task DemandsTask Demands

Skills to TeachSkills to Teach

The Ziggurat Model The Ziggurat Model

Components of the Ziggurat Model

Assessment ToolsUnderlying Characteristics Checklist (UCC)

ABC-Iceberg

Intervention Ziggurat (Ziggurat Worksheet)

Implement interventions at five levels and three points

Evaluate outcomes and adjust

11

Two pathways to intervention using the Ziggurat Model

General

Specific

General Intervention Plan

UCC

Intervention Ziggurat(Ziggurat Worksheet)


UCC


CAPS

12

Specific Behavior Plan

UCC

ABC-Iceberg



UCC

ABC-Iceberg


CAPS

Underlying Characteristics ChecklistUCC-HF and UCC-CL

Provides a “snapshot” of how autism is expressed for an individual

A descriptive instrument

Can be completed by multiple respondents

Provides a tool for assessing progress/change

13

UCC-HF for HFA and AS

UCC-CL for Autistic Disorder

- CL

ABC-Iceberg

Assesses patterns of behavior with an understanding of the characteristics of ASDs

Adapted from functional behavioral assessment and the iceberg metaphor

Prevents a “band aid” approach to intervention

Prevents punitive approaches

14

SpecificBehaviors

UnderlyingCharacteristics* #___ ____________________________

#___ ____________________________#___ ____________________________#___ ____________________________#___ ____________________________

Antecedent(s) Behavior Consequence(s)

© Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D.*As determined through the Underlying Characteristics Checklist

ABC-Iceberg

Antecedent(s)

• Recess• Low structure• After lunch

Behavior“Loner” on Playground

Consequence(s)

• Isolated from peers• Opportunity to

engage in stereotypicbehavior

Rick

Wandering the perimeterFlapping handsShaking sticks in front of eyesTalking to self

Interventions based on FBAReinforce Rick for 3 minutes without flapping hands

Remove sticks from Rick

Reward for playing with peers

Create a “play schedule” for Rick to structure his recess time

Hypothesized Function: Gain access to preferred activity

SpecificBehaviors

UnderlyingCharacteristics*

Antecedent(s)

• Recess• Low structure• After lunch

Behavior“Loner” on Playground

Consequence(s)

• Isolated from peers• Opportunity to

engage in stereotypicbehavior

*As determined through the Underlying Characteristics Checklist © Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D.

• [1] Mindblindness

• [7]Difficulty making friends

• [8] Difficulty joining an activity

• [10]Prefers solitary activities

• [13]Appears to be in “own world”

• [15] Strong need for routine or “sameness”

• [18] Preoccupied with sensory explorationof objects

• [36] Difficulty starting and joining conversation

• [73] Has athletic skills deficits

• [78] Easily stressed

ABC-Iceberg Rick

Wandering the perimeterFlapping handsShaking sticks in front of eyesTalking to self

15

Train and assign peer

buddy

Teach one or two

playground games

Difficulty making friends

Provide written script for

joining play and greetings

Reinforce for using

conversational skills

Difficulty starting conversations

Provide sensory dietPreoccupied with sensory exploration

InterventionUnderlying Characteristics

Interventions Based on Underlying Characteristics

FBA Compared to ABC-I

Reinforce Rick for 3minutes without flappinghands

Remove sticks from Rick

Reward for playing withpeers

Create a “play schedule” for Rick to structure his recesstime

Provide sensory diet

Provide written script for

joining play and greetings

Reinforce for using

conversational skills

Train and assign peer

buddy

Teach one or two

playground games

ABC-I InterventionsFBA Intervention

16

Sensory Differences and Biological Needs

“The last thing one knows in constructing a work is what to put first”

-Blaise Pascal


Provide a sensory diet

Monitor and address environmental stressors:

Sound, light, proximity/personal space, textures

Movement needs

Monitor and address:

Appetite/hunger

Arousal/activity level (e.g., fatigue, hyper)

Posture and movement

Medical needs

Sensory Issues in Asperger Syndrome

Brenda Smith Mylesand the co-authors of

Asperger Syndrome and Sensory Issues: Practical Solutions …Katie Cook, Nancy Miller, Louann Rinner, Lisa Robbins

www.asperger.net

17

Hans Aspergers (1944)

“… I will describe a particularly interesting and highly recognisable type of child. The children …all have in common a fundamental disturbance which manifests itself in their physical appearance, expressive functions, and, indeed, their whole behavior”.

Academic Learning

Daily Living

ActivitiesBehavior

Auditory Language

VisualSpatial

AttentionCenter

Eye-handCoordination

OcularMotor Control

PosturalAdjustment

Body Scheme

ReflexMaturity

Ability to Screen Input

PosturalSecurity

Awareness of Two Sides of the Body

MotorPlanning

Olfactory Visual Auditory Gustatory

Tactile Vestibular Proprioception

Central Nervous SystemTaylor & Trott, 1991Williams & Shellenberger, 1996

Cognition Intellect

PerceptualMotor

Development

SensoryMotor

Development

Sensory Systems

Sensory Systems

Tactile

Vestibular

Proprioceptive

Auditory

Visual

Gustatory

Olfactory

18

My Sensory Perceptions are Disordered!

Ordinary sights, sounds, smells, tastes and touches of everyday life that you may not even notice can be downright painful for me.I may appear withdrawn or belligerent to you, but I am really just trying to defend myself.

E. Notbohm, “Ten Things Every Child with Autism Wishes You Knew”(Miller & Robbins)


A simple trip to the grocery store may be hell for me.I am visually oriented, this may be my first sense to become over stimulated.



There’s glare from windows, moving fans on the ceiling, so many bodies in constant motion, too many items for me to be able to focus -- and I may compensate with tunnel vision.


19


All of this affects my vestibular system and now I can’t even tell where my body is in space. This may cause me to stumble, bump into things, or simply lye down to try to regroup.


Sensory Problems Most Often Seen in Children with Asperger Syndrome

Senseless

20

Tactile

Expresses distress during grooming

Bathing

Combing hair

Getting hair cut

Tooth brushing

Is sensitive to particular food textures/temperatures, fabrics

Tactile (cont)

Has difficulty standing in line or close to others

Expresses discomfort at dental work

Has rigid rituals in personal hygiene

Vestibular (Movement)

Seeks sedentary play options

Poor endurance/tires easily

Dislikes activities where head is upside down

Rocks unconsciously during activities

Becomes overly excited after a movement activity

21

Proprioception (Body Position)

Seems to have weak muscles

Tires easily especially when standing or hold a particular position

Has a weak grasp

Seeks opportunities to fall without regard for personal safety

Auditory

Is distracted or has trouble functioning in noise

Responds negatively to loud or unexpected noise

Appears not to hear what you say

Visual

Looks away from tasks to notice all actions

Has a hard time finding objects in competing backgrounds

Avoids eye contact

Expresses discomfort at bright lights

22

Taste & Smell

Avoids certain tastes/smells

Routinely smells objects

Shows preference for certain tastes

From Dunn, 1999; Dunn, Myles, & Orr, 2002; Rinner, 2000

Children with AS have more difficulties with modulation and emotional reactivity when compared to their counterparts with autism

Emotional Reactivity

Displays emotional outbursts when unsuccessful

Is stubborn or uncooperative

Often gets “stuck” in a situation

Is overly sensitive

Reacts overtly when sensory systems needs are not met

23

Sensory Diet Is ...

A planned and scheduled activity program designed to meet a child’s specific sensory needs (Yack et al., 1998)

Incorporates naturally occurring opportunities for children to get the sensory stimulation they need (Willbarger, 1995)

Miller & Robbins, 2005

How Long Does it Last?

Tactile: 1 to 1 1/2 hours

Vestibular: 4 to 8 hours

Proprioception: up to 1 1/2 hours

Auditory,Gustatory,

& Olfactory: transitory

Functional Sensory Diet Activities

Load/unload chairs

Deliver materials

Set up equipment for PE, assembly, etc …

Carry weighted book bag

Wear spandex clothing under clothes

Push grocery cart/ library cart

Rake, shovel, dig, vacuum

Pull wagon

Push wheelchair

Crush cans

Sharpen pencils

24

Functional Sensory Diet Activities

Work on floor, under table or stand on counter

Hold materials to fidget with while listening

Draw while listening

Take a snack break

Sensory Issues

Asperger Syndrome and Sensory Issues

Medical Interventions

Work with medical professional

Be patient – investigate options

Involve in planning/tracking medicine administration as developmentally appropriate

25


AntidepressantsSocial relations

Repetitive behaviors and movements

Aggression and tantrums

Depression and anxiety

All medications have potential serious side effects.


AntipsychoticsAggression

Impulsivity and hyperactivity

Repetitive behaviors

Communication



StimulantsImpulsivity and hyperactivity

Repetitive movements

Oppositional behaviors and tantrums


26

Coping Cards

Take 2 deep breathswith your eyes closed

Press hands together and count to 10 slowly

Amy Bixler, 2006

Signs That You Need to Revisit Sensory Differences and Biological Needs

Distress in response to sensory stimuli

Difficulty concentrating in noisy environments

Cries

Pain

Sudden change in behavior

Failure to attend to sensory stimuli (e.g., not responding to sounds)

Low energy level

Anxious and/or depressed

Irritable

Regression in behavior

Reinforcement

“If there is no reinforcer, there is no lesson”

-Andrew Bondy

27

Reinforcement Reminders

Reinforcement increases the likelihood of a behavior

“You may not have to look any further than your child’s special interest to find the perfect reward”

-Sakai, 2005, p. 52

Reinforcement Reminders

Involve students in the process of selecting reinforcersStart with high rate of reinforcement for new skillsUse variable rate of reinforcement for maintenanceReinforce practiceReinforce prompted behaviorReserve some reinforcers to maintain their effectiveness

Reinforcement Menu

Time to browse books in the school library

15 minutes to research on the internet on baseball/sports statistics/events

10 minutes of reviewing baseball statistics in personal magazines/books

My School Rewards

Amy Bixler, 2006

28

Home Reinforcement Menu

30 minutes of video games

Trip to local baseball card store

30 minutes of time to browse the web

My Home Rewards

Amy Bixler, 2006

Common Reinforcement Strategies

Giving more independence

Computer time

Token system

First-then chart

Permit self-selection of activity

Favorite peer guides to new places in building

Signs That You Need to Revisit Reinforcement

Failure to increase desired behavior

Failure to “buy in” to the behavior plan

Low self-esteem

High frustration level

Hopelessness

Failure to frequently earn reinforcers

Decrease in goal behaviors

Escape behaviors

29

Structure and Visual Supports

“And it is best if you know a good thing is going to happen, like an eclipse or getting a microscope…And it’s bad if you know a bad thing is going to happen like having a filling or going to France. But I think it is worst if you don’t know whether it is a good thing or bad thing which is going to happen.”

- From: The Curious Incident of the Dog in the Night Time, by Mark Haddon, 2003


“I like everything still. It gives you a full feeling. It gives you a full attention. With something quick, you don’t get the full idea of it. With something still, you take a look at it and you get to know the whole look and feeling”

-Warden from Rage for Order (BBC, 1996)

Common Misperceptions

If an individual can read then he/she does not need pictures or symbols

He’s in high school, he does not need an individualized schedule

I can stop using a visual schedule once my client learns the routine

If an individual has not looked at his/her schedule in three weeks he/she does not need it anymore

30

Visual Schedules

Highly structured environments – provide an opportunity for those with ASDs to succeed

Increased predictability and understanding results in:

Decreased problem behavior

Increased independence

Bopp, K., Brown, K., Mirenda, P. (2004). Speech-Language Pathologists’ Roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech-Language Pathology 13, 5-19.

Visual Schedules

Research on visual schedules shows that they are:

Effective across age ranges

Effective across settings

Visual Schedules

Schedules are effective in decreasing

off-task behaviors

disruptive behavior

noncompliance

aggression

tantrums

property destruction

31

Visual Schedules

Schedules depict:

Sequences Transitions between activities

Within activity steps

Rules for different individuals or routines

Bopp, K., Brown, K., Mirenda, P. (2004). Speech-Language Pathologists’ Roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech-Language Pathology 13, 5-19.

Morning Checklist

Pick reward from your menu

Take out journal

Turn in homework

Complete helper chart

Make lunch selection√

Put away backpack√ActivityCheck

Screaming

Outside voice

Talking voice

Soft voice/whisper

No talking

Rating Description Setting

Emergency only

Recess, ball game

Classroom, lunchroom

Library

When someone is talking to me, movies

Buron, K.D., & Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC.

32

Stress Thermometer

When my Lego toys fall apart

Most stressed ever

No stress

Ask for help

When I have hard homework

Putting stuff in my backpack after bus arrives

Call my mom for help

Pack before bus time

Video-Based Instructional Procedures

Video rehearsal – video segments of each skill step

Video rehearsal plus photo – video segments paired with photo of each step with written instruction

Video rehearsal plus video prompting during task engagement – video sequence viewed prior to and during task engagement

Van Laarhoven, T. & Van Laarhoven-Myers, T. (2006). Comparison of three fideo-based instructional procedurs for teaching daily living skills to persons with developmental disabilities. Education and Training in Developmental Disabilities, 41(4), 365-381.


Improve daily living skillsPromote generalizationSocially validated

Van Laarhoven, T. & Van Laarhoven-Myers, T. (2006). Comparison of three fideo-based instructional procedurs for teaching daily living skills to persons with developmental disabilities. Education and Training in Developmental Disabilities, 41(4), 365-381.

33


Video Modelingvideo of someone completing the taskwell validated behavioral intervention

Video Promptingvideo of each step (often from the perspective of the participant) with opportunity to complete each steprapid skill acquisition in daily living skill study

Canella-Malone, O’Reilly, de la Cruz, Edrisinha, Sigafoos, and Lancioni (2006). Comparing video prompting to video modeling for teaching daily living skills to six adults with developmental disabilities. Education and Training in Developmental Disabilities, 41(4) 344-356.

How to Make Popcorn

Open plastic bag

Unfold bag

How to Make Popcorn

Place in microwave and start time

Remove from microwave

Open carefully to eat

34

Cartooning

Combines words with simple drawings in order to explain a simple concept

Visual Thesaurus http://www.visualthesaurus.com

Who is in Charge

Dr. Carroll, Principal

Me

Ms. Jones(Homeroom)

Mr. Davidson(Art)

35

Exploring Feelings: Session Two

1. Review key points handout from previous session 2. Place relaxation pictures on a rope3. Heroes who get angry - write on butcher paper4. A time when I felt angry – write on butcher paper5. Emotional tool box to fix the feeling

picture of a hammer, picture of a paintbrush6. Review7. Reducing anger assignment

fill sheet 1 with own ideas fill sheet 2 with ideas of family and friends

8. Review – create handout of Session 2 key points

Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington,TX: Future Horizons.

Feeling Scale

Place relaxation pictures on rope-scale

Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington, Tx: Future Horizons.

Heroes Who Become Angry

Why was your hero angry?How did they cope?

Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington, TX: Future Horizons.

Screams and walks away

Takes deep breaths and

Asks Patrick for help

36

A Time When I Felt Angry…

Tell about a time you felt angryHow did it effect your body?


Cry, swear, yell, frown

Say, “I’m going to kill you

Fast breathing, felt hot

Sweaty palms

Emotional Toolbox

Physical toolsRelaxation tools


Reducing Anger

My Ideas to Relax Mom and Dad’s Ideas

Play video games

Watch Sponge Bob

Walk around the yardRub plastic wrap

Take deep breaths

Work in garden

Talk to someone

Work out

Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington, Tx: Future Horizons.

37

Common Structure and Visual Supports

Scheduled work system

Prepare for changes in schedule/routine

Visual timer

PECS

Checklist schedule located on desk

Individualized work station

Social stories TM (Gray, 1998)

Picture cards with activities

Picture schedule

Portable transition pictures

Gray, C.A. (1998). Social storiesTM and comic strip conversations with students with Asperger syndrome and high functioning autism. In E. Schopler, G.B. Mesibov, & L.J. Kunce (Eds.), Asperger syndrome or high functioning autism (pp. 167-198). New York: Plenum Press.

Signs That You Need to Revisit Structure and Visual Supports

Increased behavioral difficulties around periods of change (e.g., weather, substitute teacher)

Repetitive questioning

Increased anxiety

Increased behavioral difficulties during transition (e.g., from one activity to another, weekend to weekdays)

Failure to learn (e.g., skills, routines)

Increased anger and rages

Task Demands

“Just imagine your most stressful day that you’ve ever, ever had . . . your worst day is his best day”-Parent of child with Asperger’s

38

Task Demands

Easy Challenging/Emerging (possible with assistance)

Zone of Proximal Development

Leve

l of D

eman

d

Too demanding(independent skills-with or without modification and structural supports)


Task Demands – ThreeQuestions

1. Are you asking for performance of a skill that is too hard?

2. Are you asking for performance of a skill that has not been taught?

3. Are you asking for a task to be accomplished without the necessary supports?

Are you asking for performance of a skill that is too hard?

Prerequisite skills for playing with peers during recess

Tolerate sensory input of playground

Know how to seek assistance

Know how to follow unwritten and written rules

Know how to join or start activities and/or conversations

39

Are you asking for performance of a skill that has not been taught?

Component skills of a hug

Put your arms around someone

Squeeze gently

Count to three and let go

Are you asking for a task to be accomplished without the necessary

supports?

Supports in the lunchroom

List of conversation topics

Seating chart

Shortened lunch time

Coping cards

Peer buddy

Designated adult contact

Examples of Task Demand Interventions

Provide written instructions

Allow use of laptop to take notes

Give extra time for written work

Teach to use a Personal Digital Assistant (PDA)

Provide organizational skills support

E-mail assignments, reminders

40


Use coping cards

Create Circle of Friends

Provide narration

Provide high interest activities to encourage social interaction


Provide peer buddy/mentor

Give highlighted text

Provide monitoring teacher/contact

Provide “safe place”

Allow for breaks

Prepare for change

Minimize transitions

Finding our Way

Priming

Predicting

Countdown

Wrap-Up

Rewards

41

Common Task Demand Strategies

Scheduled work system

PECS

Modeling social/communication skills

Favorite peer guides to new places in building

Tactile teaching aides

Individualized work station

Verbal prompts

Social Stories TM (Gray, 1998); Thinking Stories TM

Repeated exposure to activities

Adult-directed play routines

Signs That You Need to Revisit Task Demands

Failure at a task

Quitting before the task is completed

Expressing feelings that the task is overwhelming

Meltdowns

Increased isolation

Rejection from peers

Skills to Teach

“The teacher who does not understand that it is necessary to teach autistic children seemingly obvious things will feel impatient and irritated”

-Hans Asperger

42

The Hidden Curriculum

Locker room rulesIf there are people taking showers or changing their clothes, do not stare at them or make comments about their bodiesIt is not appropriate to touch others in the restroom or showerChange into your P.E. clothes in the locker room, not the hallway.

Myles, Trautman, Schelvan, 2004, p.55

The Seemingly Obvious

What is it about the situation that comes naturally to everyone else but is missing for this person? Why is it that others do not show the same behavior?

What is it that has not occurred to me to teach?

That is the seemingly obvious. That is the thing to teach.

Skills to Teach

Social

Flexibility

Communication

Sensory

Cognitive

Motor

Emotional regulation/expression

43

Mind Reading

Afraid

www.do2learn.com

Surprised

www.do2learn.com

44

Cartoons

Video

Video modeling

Self

Peers

Identify emotional states in others

Predict reactions in others

Video with feedback

Common Skills to Teach Strategies

Social stories TM (Gray, 1998)

Adult directed play routines

PECS

Modeling social/communication skills

Scheduled work system to teach skills for independence

45

Signs That You Need to Revisit Skills to Teach

Lack of progress on goals

Lack of generalization of skills

Overdependence on assistance

Overdependence on modifications and accommodations

Failure to identify level of skill development and specific skill deficits

Baron-Cohen

http://www.nas.org.uk

Search: the transporters

Penny

46

UCC-HF or UCC-CL

Not a fine line. When in doubt, select the UCC-HF

UCC-HF or UCC-CL

UCC-CL

UCC-HF

HFA/AS“Classic” Autism

Average Skills

Complete the UCC

47

Two pathways to intervention using the Ziggurat Model

General

Specific


UCC


Designing a Global Intervention

Prioritize areas of concern

Select UCC items to address

Develop interventions for each level of the Ziggurat

Ensure that intervention is complete

48


UCC

ABC-Iceberg


The ABCs of Behavior

Antecedent

Behavior

Consequence

Antecedents

Written assignment Wanders room

Class discussion Insults peers

Transitions Loud verbalizations

Antecedent Resulting Behavior

49

Consequences

Wanders room

Insults peers

Loud verbalizations

Behavior Consequence

Finish work at recess

Private conversation with teacher

Attention

Common Functions for Behavior

Escape/avoidance

Adult/peer attention

Tangible items

Access to preferred activities

Sensory stimulation

Function of Penny’s behavior

Antecedent Behavior Consequence

Written assignment Wanders room Finish work at recess

Function Escape/Avoidance

50

Points of Intervention

Modify

Antecedent

Teach new

Behavior

Modify

Consequence

Written assignment Wanders room Finish work at recess

Teach coping& relaxation skills

Allow Penny to type Reward for startingand completing written work

Antecedent Behavior Consequence

Slim Starter

Before Intervention

A B C

Asked for order No answer No breakfast

51

After Intervention

A B C

Asked for order Touches nose Gets waffles

Three Points of Intervention

A B C

•Changed task demand

•Prompted

Taught alternativecommunicationsystem

Set up contingencies/reinforcers

*As determined through the Underlying Characteristics Checklist © Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D.

ABC-Iceberg Penny

BehaviorClass disruption

Says, “I don’t have to do this work”Insults peersDoes not complete writing tasks

Antecedent(s)

• Transitions (e.g., mornings,Mondays, vacations)

• Class discussions• Written assignments

Consequence(s)• Peer

rejection/isolation from peers

• Private conversation with teacher

•Loss of recess time•Delay of task•Attention/opportunity

to participate

#33. Gives false impression of understanding more than she does

# 1. Mindblindness

# 4. Lacks tact#16. Unmotivated by customary

rewards

SpecificBehaviors

UnderlyingCharacteristics* #63. Has difficulty understanding the

connection between behavior and consequences

#66. Resists handwriting#85. Low frustration tolerance#88. Difficulty understanding own

and others’ emotions#89. Difficulty managing stress and

anxiety # MBF Fatigue

#18. Difficulty with transition and change

52

Complete Intervention

Addresses all five levels of the Ziggurat

Several core underlying needs are addressed

Intervenes at all three points A-B-C

53

Intervention Ziggurat



Coping Cards

Repeat to myself 3 times, “Breathe in, hold, breathe out”

Ask for help

Amy Bixler, 2006

54


Reinforcement


Great Job! Ms. Simpson (teacher signature)

Notes: Penny wrote 4 sentences today!OtherScience lab assistantChew gumWatch ant farm

Take bug net to recessWear baseball cap at recessComputer game with peerInsect book break

Circle choice for this morning

What I want to work for:


Structure and Visual/Tactile Supports


55

Morning Checklist

Pick reward from your menu

Take out journal

Turn in homework

Complete helper chart

Make lunch selection√

Put away backpack√ActivityCheck


Task Demands


Rules for Class Discussion

No insults

Make on-topic remarks

Focus on speaker

Quiet mouth

Think about topic

Reinforce Penny for following cues on EITHER side of card

56


Skills to Teach


Kind words Rude words

Duh!YeahThat stinksAwesomeThat was dumbNice jobYou’re stupidGreat ideaSo whatGood job!

Develop a card with rules for class discussion [Skills to Teach]

Give Penny a card—one side green (with rules for appropriate class discussion) and the other side is red (with a list of appropriate listening). [Structure and Visual/Tactile Supports]

Interventions Address Multiple Levels –Red/Green Card

57

Turn the card to red if Penny makes an inappropriate contribution. Remove card at the end of class discussion. [Task Demands]

Reinforce Penny for following the rules for either side of the card. [Reinforcement]

Interventions Address Multiple Levels –Red/Green Card

Autism Intervention Challenge

• Autism Intervention Challenge Worksheet

• Penny’s UCC

Teasing - UCC

[1] Has difficulty recognizing the feelings and thoughts of others (mindblindness)

[7] Is naïve

[9] Has difficulty understanding others’nonverbal communication

58

Teasing - Interventions

1. Teach to recognize feelings of others based on facial expressions, voice tone, and gestures using video, pictures, and role-play. Reinforce for correctly identifying during practice.

2. Incorporate bully prevention program at school

3. Provide peer buddy during recess, lunch, and PE


Skills to Teach

Task Demands


Reinforcement

Train - UCC

[14] Has eccentric or intense preoccupations

[15] Asks repetitive questions

[18] Has problems handling transition and change

[19] Has strong need for closure or difficulty stopping a task before it is completed

[24] Interprets words or conversations literally

[80] Exhibits rage reactions or “meltdowns”

[85] Has low frustration tolerance

Train - Interventions

1. Prime (teach about train schedules – “we may be there and the train won’t be”). Make it visual –draw cartooning of sequence of events – discuss possible events (“you may or may not see a train”). Talk about how long you will stay, etc.


Skills to Teach

Task Demands


Reinforcement

59

One More time - UCC

[18] Has problems handling transition and change

[24] Interprets words or conversations literally

[38] Has difficulty understanding language with multiple meanings

[61] Displays very literal understanding of concepts

[80] Exhibits rage reactions or “meltdowns”

[85] Has low frustration tolerance

One More time - Interventions

1. Teach the concept of idioms and non-literal language. Keep a list of common expressions used in the classroom setting: For example “Just one minute,” “You’ve got to be kidding” and “Throw it in the trash”

2. Thoroughly prepare for new experiences (priming)


Skills to Teach

Task Demands


Reinforcement

Anna

60

Talking with Boys - UCC

[1] Has difficulty recognizing the feelings and thoughts of others [mindblindness]

[14] Has eccentric or intense preoccupations

[28] Has difficulty starting, joining, and or ending a conversation

Talking with Boys - Interventions

1. Teach Anna about interests of her peers – through video, narrating, and observing others (e.g., listen to peers talk in lunch, hallway, or classroom and write down topics)

2. Teach how to start conversations – use prepared scripts. Practice and role-play and reinforce

3. Teach Anna to “read” the responses of others to her behaviors and comments


Skills to Teach

Task Demands


Reinforcement

Learning to Walk - UCC

[1] Has difficulty recognizing the feelings and thoughts of others

[7] Is naïve

[68] Has poor motor coordination

61

Learning to Walk - Interventions

1. Train peer/Circle of Friends

2. Teach her to practice walking inside where others won’t make fun of her.

3. Consult with an occupational therapist to address motor coordination


Skills to Teach

Task Demands


Reinforcement

Evaluate Outcomes and Adjust Plan

Seek help/work together

Hang in there – sometimes things get worse before they get better

Re-visit assessmentsUCC

ABC-I

Strengths of the Ziggurat Model

1. Provides a process and framework for designing an intervention plan and is consistent with PBS/PBIS approach

“Make everything as simple as possible but not simpler”

- Albert Einstein

62


2. Addresses underlying characteristics of HFA/AS

Addresses surface needs

Tantrums when given writing task

Give computer orProvide adult

aide for dictationWrites without tantrum

Addresses surface and underlying needs


3. Emphasizes and enhances evidence-based strategies

63


4. Facilitates comprehensive intervention design


5. Incorporates assessment

Underlying Characteristics ChecklistABC Iceberg


6. Emphasizes positive approach/reinforcement

64


7. Facilitates the design of proactive interventions

8. Facilitates interdisciplinary interventions


9. Consistent with Positive Behavioral Interventions and Supports (PBIS) approach

IndividualizedEvidenced based strategiesComprehensive Functional assessment

Skill developmentImproves environmentTeam building

Contact Information

Ruth Aspy, Ph.D. The Ziggurat Group

[email protected]

214-227-7741

Barry G. Grossman, Ph.D.The Ziggurat Group

[email protected]

214-227-7741

www.texasautism.com

Brenda Myles, Ph.D.

Ohio Center for Autism and Low [email protected]

Documents

Planning a Comprehensive Program for Students with · PDF filePlanning a Comprehensive Program for Students with ASD ... Williams & Shellenberger, 1996 Taylor & Trott, 1991 Cognition