5 Implmt. The Ziggurat Model. 5 Steps to Designing a Comprehensive Intervention Plan. Overview of Presentation

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The Ziggurat Model Designing Comprehensive Behavior Interventions for Students with ASD Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA Overview of Presentation Review Levels of the Intervention Ziggurat Pt.

com Idaho Webinar Day 2 The Ziggurat Model Despite an enormous increase in knowhow, the autistic way of looking at autism has resulted in too little knowwhy.

1 The Ziggurat Model Designing Comprehensive Behavior Interventions for Students with ASD Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA Overview of Presentation Review Levels of the Intervention Ziggurat Pt. 1 Sensory and Biological Reinforcement Structure and Visual/Tactile Support Case study Q&A Idaho Webinar Day 2 The Ziggurat Model Despite an enormous increase in knowhow, the autistic way of looking at autism has resulted in too little knowwhy. We have protocols for diagnostics and various methods of treatment, but the core of autism is sometimes missed, due to a tendency to focus too much on the behavior of people with autism (often even details of that behavior) without sufficiently taking into account the context of what is taking place in the mind of people with autism. - Peter Vermeulen Characteristics Social Communication Repetitive Patterns Associated Features Sensory Motor Cognitive Emotional Vulnerability Medical and Biological Factors Interventions 5 Steps to Designing a Comprehensive Intervention Plan Characteristics Design 5 Implmt. 1

UCC ISSI Global Guide Evalua4on Data Provides a snapshot of

priori4es Ziggurat Worksheet Special Educa4on Supports,

Plan Present Levels of Func4onal Performance IEP Team

Centered Planning CAPS 1 Opera4onalized IEP: Student

Supports Underlying Characteristics Checklist Helps you to

expressed for an individual A descriptive instrument Can be

change Ensures development of a comprehensive plan Ensures

Strengths and Skills Inventory 2 Social Behavior,

Motor Emotional Biological Designing a Global Intervention

constructing a work is what to put first -Blaise Pascal

2 UCC ISSI Global Guide Evalua4on Data Provides a snapshot of ASD Iden4fies strengths and skills Iden4fies meaningful priori4es Ziggurat Worksheet Special Educa4on Supports, Related Services/Accommoda4ons and Behavior Interven4on Plan Present Levels of Func4onal Performance IEP Team Considera4ons: Parent Concerns, Transi4on, and Person- Centered Planning CAPS 1 Opera4onalized IEP: Student Schedule with Embedded Benchmarks/Short- term Objec4ves and Supports Underlying Characteristics Checklist Helps you to see the autism Provides a snapshot of how autism is expressed for an individual A descriptive instrument Can be completed by a team Provides a tool for assessing progress/ change Ensures development of a comprehensive plan Ensures implementa4on of the comprehensive plan Individual Strengths and Skills Inventory 2 Social Behavior, Interests, and Activities Communication Sensory Cognitive Motor Emotional Biological Designing a Global Intervention Plan 3 Task Demands The last thing one knows in constructing a work is what to put first -Blaise Pascal Structure and Visual /Tactile Supports Reinforcement Sensory Differences and Biological Needs Sensory Differences and Biological Needs 2

Sensory Differences and Biological Needs Provide a sensory diet Monitor and address environmental stressors: Sound, light, proximity/ personal space, textures Movement needs Monitor and address:

3 Sensory Differences and Biological Needs 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 Addressing Sensory Issues Smell Taste Touch Visual Input Auditory Vestibular (balance) Proprioception (body awareness) Sensory Issues 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 Brenda Smith Myles 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) Sensory Area Visual Calming and Alerting Sensory Activities Calming Activities Work in dim light or with lights turned off Block distractions by using a screen, room divider, or study carrel Wear sunglasses Provide visual materials such as a glitter wand, oil and water toys, fish tank Work at distraction-free desk Alerting Activities Work in bright lights Use brightly colored paper Use a highlighter to underline important text Use a slant board to place materials at an angle Miller & Robbins, 2005 Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 19 3

Sensory Area Auditory Calming and Alerting Sensory Activities Calming Activities Cover ears when a loud or unexpected noise happens Work in a quiet environment Use headphones to shield from noise

Simple Strategies that Work. AAPC p. 19 How Long Does it Last?

4 Sensory Area Auditory Calming and Alerting Sensory Activities Calming Activities Cover ears when a loud or unexpected noise happens Work in a quiet environment Use headphones to shield from noise Alerting Activities Prepare in advance for loud/strange noises Listen to music with varied pitch, sound loudness or uneven/ fast beat Sample Sensory/Motor Interventions Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 19 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, Transitory & Olfactory: Sensory - Key Points Sensory dysfunction influences all aspects of an individual s life. There are seven types of sensory dysfunction Interventions need to occur in ALL of the individual s environments. Assessments must be completed and interventions must be supervised by a trained occupational therapist. Brenda Smith Myles Coping Cards Take 2 deep breaths with your eyes closed Press hands together and count to 10 slowly Amy Bixler, 2006 If you do not have good reinforcers and are not working to establish them, you might as well just go home -Leaf & McEachin Reinforcement 4

5 Reinforcement Reminders Reinforcement increases the likelihood of a behavior The way positive reinforcement is carried out is more important than the amount -B.F. Skinner Reinforcement Stinginess Disorder (RSD) Adult Onset (A) Qualitative impairment in reinforcement delivery behaviors, as manifested by at least two of the following: marked impairment in the use of praise and positive feedback in response to demonstrations of new skills failure to reinforce behaviors that were prompted or modeled Reinforcement Stinginess Disorder (RSD) Adult Onset a lack of spontaneous seeking to encourage the achievements of others (e.g., by a lack of giving, or delivering a reinforcer following a goal behavior) delay in, or total lack of, the development of compassion for those who are reinforced by non-traditional reinforcers or who achieve skills at a rate different from their typically developing peers Reinforcement Stinginess Disorder (RSD) Adult Onset in individuals with adequate speech, marked impairment in the ability to distinguish fair from equal stereotyped and repetitive use of ineffective strategies such as delivering punishment in order to change behaviors related to a neurological disorder lack of varied, spontaneous approaches to maintaining meaningful reinforcers for all learners Reinforcement Stinginess Disorder (RSD) Adult Onset (B) Onset post 21 years of age (C) The disturbance is not better accounted for by lack of common sense or the belief that you can punish the ASD out of someone. Rate of Disciplinary Measures Special Education (Per 100) 56 In School Suspensions 25 Out of School Suspensions General Education (Per 100) 33 In School Suspensions 12 Out of School Suspensions Based on Texas Department of Education Records Heasley, S. (2010). Disability Scoop. 5

Reinforcement Reminders Involve students/clients in the process of selecting reinforcers Start with high rate of reinforcement for new skills Use variable rate of reinforcement for maintenance

available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique need and prepare them for further education, employment, and

52 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.

6 Reinforcement Reminders Involve students/clients in the process of selecting reinforcers Start with high rate of reinforcement for new skills Use variable rate of reinforcement for maintenance Reinforce practice Reinforce prompted behavior Reserve some reinforcers to maintain their effectiveness The Purpose of Special Education (IDEA) To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique need and prepare them for further education, employment, and independent living (emphasis added) Reinforcement Reminders You may not have to look any further than your child s special interest to find the perfect reward -Sakai, 2005, p. 52 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 People with autism do not cope well with vagueness and ambiguity. In practice, things not being very clear is the number-one challenge for people with autism; they are confused. And that confusion often results in cognitive and emotional breakdowns, p.108 Structure and Visual/Tactile Supports Vermeulen, Autism as Context Blindness 6

7 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) Structure and Visual/Tactile Supports 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 Raise Your Hand Structure 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, 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 7

Research-Based Literacy Strategies Edited by Christina Carnahan, Ed.D.

Williamson (2010). Quality Literacy Instruction for Students with ASD.

8 Research-Based Literacy Strategies Edited by Christina Carnahan, Ed.D., And Pamela Williamson, Ph.D. AAPC Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 10 Work System for Reading Group Choices at Handwriting Station Carnaham, Williamson (2010). Quality Literacy Instruction for Students with ASD. AAPC. Carnaham, Williamson (2010). Quality Literacy Instruction for Students with ASD. AAPC. Choice Board Bathroom Task Strip 8

Morning Checklist Rating Description Setting Screaming Emergency only Check Put away backpack Activity Outside voice Recess, ball

voice/whisper Library Pick reward from your menu No talking When someone is talking to me, movies Buron, K.D., & Curtis, M. (2003).

Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009) Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)

9 Morning Checklist Rating Description Setting Screaming Emergency only Check Put away backpack Activity Outside voice Recess, ball game Make lunch selection Complete helper chart Talking voice Classroom, lunchroom Turn in homework Take out journal Soft voice/whisper Library Pick reward from your menu No talking When someone is talking to me, movies Buron, K.D., & Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC. Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009) Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009) Things That Can Run Out Problem Solving Chart Stickers Chocolate milk Time Glue Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing. 9

Problem Solving Chart Video-Based Instructional Procedures Video Modeling video of someone completing the task well validated behavioral intervention Video Prompting video

Reilly, de la Cruz, Edrisinha, Sigafoos, and Lancioni (2006).

Education and Training in Developmental Disabilities, 41(4) 344-356. Mataya, K., & Owens, P. (2012).

How to Make Popcorn Open plastic bag Unfold bag Power Card - Adolescent 12 th grade adolescent with Asperger s Served in general education Received social skills training

when people did not understand his sense of humor or special interests Lonely Preoccupied with Yu-Gi-Oh Hero was Kazuki Takahashi Davis, Boon, Cihak, & Fore. (2010).

10 Problem Solving Chart Video-Based Instructional Procedures Video Modeling video of someone completing the task well validated behavioral intervention Video Prompting video of each step (often from the perspective of the participant) with opportunity to complete each step rapid 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) Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing. How to Make Popcorn Open plastic bag Unfold bag Power Card - Adolescent 12 th grade adolescent with Asperger s Served in general education Received social skills training to address: Difficulty with eye contact Understanding humor Relating to peers in age-appropriate manner Talked about cartoon characters as if they were real Became upset when people did not understand his sense of humor or special interests Lonely Preoccupied with Yu-Gi-Oh Hero was Kazuki Takahashi Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25, Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25, Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25,

11 Percentage of Time Engaged in Others-Focused Conversation Generalization Generalization Pre Post Sessions Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25, Social Behavior Mapping Participating in Class Discussions Expected Behaviors Make comments and ask questions related to the topic being discussed Share your thoughts and opinions in a way that isn t offensive to others. How They Make Others Feel Interested Calm Relaxed Involved Consequences You Experience The teacher knows you are paying attention to the topic. Students know you are thinking about the discussion and listening to them when they talk. Garcia Winner (2007). Social Behavior Mapping. Think Social Publishing, Inc. pp How you Feel about Yourself Part of the group Proud Relaxed Successful Social Behavior Mapping Participating in Class Discussions Cartooning Unexpected Behaviors Add thoughts/ask questions that aren t related to the discussion Turn your body and eyes away from the group. Dominate the conversation How They Make Others Feel Confused Irritated Annoyed Hostile Consequences You Experience Others may tell you to be quiet. The teacher won t include you in the discussion. Others may not want you to be in the group. How you Feel about Yourself Embarrassed Frustrated Left out Anxious Sad Combines words with simple drawings in order to explain a simple concept Garcia Winner (2007). Social Behavior Mapping. Think Social Publishing, Inc. pp Chad Case Study Chad 11

12 Chad Diagnosed with Asperger s Disorder Obsessive interest with trains Displays meltdowns when routine is changed Leaving train yard before routine is complete Hokey Pokey misunderstanding. Thought that song would be sung one more time it was one more time for each student in class Chad s Selected UCC Items [9] Difficulty understanding others nonverbal communication [14] Has eccentric or intense preoccupations [18] Has Problems handling transition and change [19] Has strong need for closure [24] Interprets words literally [52] Displays poor problemsolving skills [80] Exhibits meltdowns [85] Has low frustration tolerance [87] Difficulty identifying and expressing emotions [89] Difficulty managing stress and/or anxiety Intervention Ziggurat Quiet Corner Sensory Differences and Biological Needs Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. UCC Items Addressed [80] Exhibits meltdowns [85] Has low frustration tolerance [89] Difficulty managing stress and/ or anxiety Intervention Ziggurat Reinforcement Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. 12

13 Books about Trains UCC Items Addressed [14] Has eccentric or intense preoccupations [80] Exhibits meltdowns [85] Has low frustration tolerance [89] Difficulty managing stress and/ or anxiety Intervention Ziggurat Hokey Pokey Get in circle Structure and Visual/Tactile Supports Follow the words to the music Sing one verse for each student Sit on square Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Chad s Selected UCC Items [18] Has Problems handling transition and change [19] Has strong need for closure Intervention Ziggurat Task Demands [24] Interprets words literally [80] Exhibits meltdowns Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. 13

First First-Then Then Chad s Selected UCC Items [18] Has Problems handling transition and change [19] Has strong need for closure [24] Interprets words literally [80]

change Just a minute Button your lips Lunch is at 11:00 In a little while No talking Around 11:00 [19] Has strong need for closure [24] Interprets words literally [80]

When Thomas is anxious, his face turns red and he does not look at others. His mouth turns down in a frown.

14 First First-Then Then Chad s Selected UCC Items [18] Has Problems handling transition and change [19] Has strong need for closure [24] Interprets words literally [80] Exhibits meltdowns Prime - Words and Their Meaning Chad s Selected UCC Items Word One more time Meaning Everyone gets one more turn [18] Has Problems handling transition and change Just a minute Button your lips Lunch is at 11:00 In a little while No talking Around 11:00 [19] Has strong need for closure [24] Interprets words literally [80] Exhibits meltdowns Intervention Ziggurat Skills to Teach Feeling Anxious Sometimes our bodies help us to know when we are stressed and need a break. When Thomas is anxious, his face turns red and he does not look at others. His mouth turns down in a frown. Sometimes, when you think that something is wrong, your body shows signs too. You clinch your fists, stiffen your body, and frown. Your face turns red. When you feel your body do this, it is a sign that you are anxious and need a break. Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. 14

Chad s Selected UCC Items [52] Displays poor problem-solving skills [80] Exhibits meltdowns [85] Has low frustration tolerance [87] Difficulty identifying and expressing emotions [89]

15 Chad s Selected UCC Items [52] Displays poor problem-solving skills [80] Exhibits meltdowns [85] Has low frustration tolerance [87] Difficulty identifying and expressing emotions [89] Difficulty managing stress and/or anxiety Contact Information Ruth Aspy, Ph.D. aspy@texasautism.com Barry G. Grossman, Ph.D. grossman@texasautism.com

The Ziggurat Model. Ziggurat n: Comprehensive Intervention Planning in the Schools Using The Ziggurat Model. Why was the Ziggurat Model Developed?

The Ziggurat Model. Ziggurat n: Comprehensive Intervention Planning in the Schools Using The Ziggurat Model. Why was the Ziggurat Model Developed? Comprehensive Intervention Planning in the Schools Using The Ziggurat Model The Ziggurat Model Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA www.texasautism.com Presented at the