Starting Strong 2015 Understanding Autism Spectrum Disorders and An Introduction to Applied Behavior Analysis

Transcription

1 Starting Strong 2015 Understanding Autism Spectrum Disorders and An Introduction to Applied Behavior Analysis Robin Talley, M.Ed., BCBA UW Autism Center

2 Presentation Overview Overview of Autism Spectrum Disorders (ASD) and How Symptoms Manifest Diagnostic Criteria of Autism Spectrum Disorders Introduction to Applied Behavior Analysis Components of a Teaching Loop

3 AUTISM SPECTRUM DISORDERS

4 Autism Spectrum Disorder (ASD) ASD is a neurodevelopmental disorder 1 The collection of symptoms vary from individual to individual 2 Prevalence: 1 in 68; 1 in 42 boys to 1 in 189 girls Prevalence ranges from 1 in 175 in Alabama to 1 in 45 in New Jersey Infants with an older sibling with a diagnosis of ASD, are at an elevated risk for ASD and ASD symptoms 1 DSM-V, 2013; 2 Siegel,

5 Qualitative Impairment in Social Interaction DSM-IV to DSM-5 Core Areas of Impairment Qualitative Impairments in Communication Restricted, Repetitive and Stereotyped Patterns of Behavior Persistent Deficits in Social Communication and Social Interaction Restricted, Repetitive Patterns of Behavior

6 Social Communication/Social Interaction Deficits in social-emotional reciprocity Atypical social approach Difficulty in back-and-forth conversation Reduced sharing of interests, emotions or affect Difficulty initiating or responding to social interactions Deficits in nonverbal communicative behaviors Poorly integrated verbal and non-verbal communication Differences in eye contact and body language Deficits in understanding and use of gestures Lack of or reduced facial expressions and nonverbal communication DSM-V, 2013

7 Social Communication/Social Interaction Deficits in developing, maintaining and understanding relationships Difficulties adjusting behavior to suit various social contexts Difficulties in making friends Reduced interest in peers DSM-V, 2013

8 Restricted/Repetitive Patterns of Behavior Stereotyped or repetitive motor movements, use of objects or speech Repetitive motor movements Lining up toys or flipping objects Echolalia Scripted words or phrases Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior Extreme distress at small changes Difficulties with transitions Rigid thinking patterns Greeting rituals Need to take same route or eat same food every day DSM-V, 2013

9 Restricted/Repetitive Patterns of Behavior Highly restricted, fixated interests that are abnormal in intensity or focus Strong attachment to or preoccupation with unusual objects Unusual interests or interests of extreme intensity Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment Apparent indifference to pain/temperature Adverse response to specific sounds or textures Excessive smelling or touching of objects Visual fascination with lights or movement DSM-V, 2013

10 Understanding Individuals with ASD Behaviors Observed Symptoms of ASD Adapted from Division TEACCH; University of North Carolina at Chapel Hill

11 Understanding Individuals with ASD Behaviors Observed Does not engage in typical play with peers Ignores others when greeted Looks away when someone is talking to him Stands too close to others in line Symptoms of ASD Reduced sharing of interests, emotions or affect Difficulty initiating or responding to social interactions Differences in eye contact and body language Deficits in understanding and use of non-verbal communication Adapted from Division TEACCH; University of North Carolina at Chapel Hill

12 Understanding Individuals with ASD Behaviors Observed Speaks too loud at inappropriate times Has a meltdown when mom drives to school a different way than usual Does not want to move from one activity to the next, resulting in challenging behaviors Symptoms of ASD Difficulties adjusting behavior to suit various social contexts Extreme distress at small changes Difficulties with transitions Adapted from Division TEACCH; University of North Carolina at Chapel Hill

13 1. Group Activity: How does autism impact participation? Consider how the characteristics of ASD impact an individual's participation in one of the following activities and how this behavior could be misinterpreted 1. Making a choice in the lunch line 2. Riding on the bus with peers 3. Hangin on the playground 4. A situation that you are experiencing with your student/son/daughter Be prepared to share

14 DIAGNOSIS OF ASD

15 What is important about an ASD diagnostic evaluation? Clarify individual s behavioral and developmental difficulties Psycho-education about Autism Spectrum Disorders (ASD) Access to services Information about next steps (e.g., treatment recommendations)

16 Who can diagnose ASD in Washington State? board eligible neurologists (M.D.), board eligible psychiatrists (M.D.), licensed psychologists (Ph.D., Psy.D.), board certified developmental and behavioral pediatricians (M.D.) Medical diagnosis of ASD Special education eligibility as a student with autism

17 Screening vs. Diagnosis Screener Tools: Modified Checklist for Autism in Toddlers (M-CHAT-R) Screening Tool for Autism (STAT) Where and when are they given? When is a referral for a full evaluation needed? A positive screener does NOT guarantee an ASD diagnosis!

18 An ASD evaluation does NOT automatically = ASD diagnosis

19 Interdisciplinary vs. Multi-Disciplinary vs. Single Discipline ASD Evaluations Single Discipline one type of professional conducts the diagnostic evaluation Multi-Disciplinary more than one type of professional doing evaluations, not necessarily contributing to one diagnostic formulation Inter-disciplinary more than one type of professional (for example, Psychologist, Neurologist, Speech Language Pathologist) involved in the diagnostic process

20 UWAC Clinic Diagnostic Evaluation Four sessions Intake interview Two assessment sessions Feedback session Model Use of multiple respondents, standardized assessments, observational data, and review of school and medical records Final written report and follow-up call to review results and next steps

21 INTERVENTIONS FOR ASD

22 Overview of Interventions Autism Speaks 100 Day Toolkit Description of treatment for ASD docs/treatment.pdf

23 Evidence-Based Practices National Standards Project, Phase 2 (2015) Evidence-based practices for individuals with autism across the lifespan that include ABA-based intervention strategies (ages years) Behavioral interventions: ages years Comprehensive Behavioral Treatment for Young Children: ages 0-9 years

24 APPLIED BEHAVIOR ANALYSIS

25 Applied Behavior Analysis (ABA) The science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change

26 What is Applied Behavior Analysis? Scientific approach to understanding behavior and how it is affected by the environment The use of behavior analytic methods and research findings to change socially important behaviors in meaningful ways Consumer confusion Cooper, J. O., Heron, T. E., and Heward, W. L. (2006). Applied behavior analysis (2 nd ed.)

27 The Umbrella of ABA Discrete Trial Training Incidental Teaching Reciprocal Imitation Training Early Start Denver Model Pivotal Response Training

28 A-B-C Model of Behavior A Antecedent B Behavior C Consequence Events that occur immediately BEFORE the behavior Can be altered to increase or decrease the occurrence of the behavior Response to the things and events around us at any given time. Events that occur immediately AFTER the behavior Can increase or decrease the likelihood that the person will display the behavior again *Wolery, M., Bailey, D.B., & Sugai, G.M. (1988). Effective teaching: Principles and procedures of applied behavior analysis with exceptional students. Boston, MA: Allyn and Bacon, Inc.

29 ABA Program Features A-B-C model of behavior Comprehensive or specific programs Blend of teaching strategies (DTT and naturalistic) Individualized Intensive Repeated practice Embedded learning opportunities Quality of learning trials Data-driven decisions Builds on the child's interests and actively engages the child Teaches tasks as a series of simple steps Use of reinforcement to teach new behaviors Generalization of skills targeted National Research Council (2001). Educating Children with Autism.

30 Increase desirable behaviors Teach new skills Basic ABA Outcomes Promote generalization of skills Decrease undesirable behaviors

31 TEACHING LOOP

32 Teaching Loop Cue Behavior Prompt (if necessary) A B Prompt (if necessary) Feedback C

33 Teaching Loop Target Behavior Cue Prompt Request bubbles by giving paired with eye contact Bubbles with lid closed tightly None Behavior Feedback Give bubbles paired with eye contact Blow bubbles

34 Incorrect Teaching Loop Target Behavior Cue Prompt Receptive color identification Can you give me red? Gesture (tap card) Response Feedback Shakes head no and picks up orange card None, continues to give cue

35 Teaching Loop: Cue Cue Also called instruction, antecedent, or S D Behavior Prompt (if necessary) Lets the child know when to respond (question, command, presence of a peer, bell ringing) Remember it s not always a verbal instruction Feedback

36 Cue: Things to Remember Must be clear and concise Consistent instructions should be used across team members Avoid repeating instructions Follow through with every cue given modifying is okay Use cue/instruction that is familiar to the child Be sure that the child is interested in the materials being used

37 Teaching Loop: Prompt Cue Behavior Prompt (if necessary) Something that occurs before the response and increases the likelihood of a correct response Prompt prior to a response minimizes errors Feedback

38 Types of Prompts Physical (Full and Partial): When teaching clapping, adult brings the child's hands together and claps or brings them close together and lets the child complete the action Verbal: When teaching expressive label cup Adult asks what is it? cup, c Gestural: When teaching functions of objects what do you drink with?, Adult holds his/her hand to his/her mouth shaping it like a cup Model: Adult models the whole/partial action of clapping while teaching the receptive instruction clap hands Visual: When teaching receptive instruction clap hands, picture of someone clapping is shown in addition to the auditory direction

39 To reward child To minimize errors Frequent errors: Why Prompt? Tend to be repeated Decrease opportunities for praise or positive feedback May impact motivation Lead to challenging behaviors

40 Prompt Fading Target Behavior Asking a social question *Any prompt added must be faded

41 Target Behavior Request swing by putting planet in Dad s hand Trial #1 Gesture (hand) = PROBE SKILL Prompt Fading Trial #2 Trial #3 Trial #4 Trial #5 Full physical (sit) Full physical (give) Gesture (hand) Full physical (sit) Partial physical (give) Gesture (hand) Full physical (sit) Proximity/Environm ental (give) Gesture (hand) Environmental

42 Prompt: Things to Remember Plan ahead for how prompts will be used Use the least amount of prompting necessary to ensure a correct response Goldilocks Rule Only give an instruction if you know you can prompt the child to complete the task A prompt is only considered effective if it results in the child s correct response

43 Teaching Loop: Behavior Cue Prompt (if necessary) Demonstrated by the child Result of given cue Behavior Allow time for the student to respond Feedback

44 Teaching Loop: Feedback Cue Also called consequence Prompt (if necessary) Follows any response given by the child Behavior Provides feedback to the child regarding the response Feedback

45 Types of Feedback Correct response = reinforcement Positive reinforcement Negative reinforcement Incorrect response = corrective feedback Try again I didn t hear you No

46 Feedback: Things to Remember Reinforce frequently when first teaching a skill Follow the Goldilocks rule to determine the right amount of reinforcement to give following a behavior Reinforcers should be paired with social praise Use behavior specific praise, let the child know what they did correctly If you can t identify a reinforcer there should be NO instruction

47 Questions?? Robin Talley: