Young Children with Autism Spectrum Disorders. Amy Matthews, Ph.D. Grand Valley State University

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1 Young Children with Autism Spectrum Disorders Amy Matthews, Ph.D. Grand Valley State University

2 Purpose of START START serves as a coordinating and supporting entity for regional sites across the state of Michigan to increase access to local resources, training and support for students with autism spectrum disorder.

3 Primary Components

4 Why Are we Here?

5 Michigan Students with ASD Eligibility , Number of students ,

6 # of MI Students with ASD by Age * Based on 2010 MDE, OSE-EIS Eligibility Count Age

7 Latest CDC Report 1 in 110 children have an autism spectrum disorder Autism is no longer a low incidence disorder

8 We need to change our approach to educating young children with ASD

9 Intervening Early with Effective Programming

10 Effective Practices Wrightslaw: All available research strongly suggests that intensive early intervention makes a critical difference to children with autistic spectrum disorders. Without early identification and diagnosis, children with autism are unlikely to learn the skills they need to benefit from education.

11 Big Ideas for Early Intervention Identify and intervene early Use evidence based practices Increase learning opportunities (i.e. opportunities to respond with feedback) and student engagement Focus on meaningful, functional goals and tasks (independence and socialization) Use effective instructional delivery (3 Rs- Request, Response, Reaction)

12 Big Ideas for Early Intervention Establish positive patterns of behavior early on Many problem behaviors are preventable with planned supports Provide lots of meaningful integration opportunities Use data to confirm that what you are doing is working Carefully plan for transition Work as a team with families

13 Where do we get information about effective practices? National Research Council Report Educating Children with Autism (download for free at the National Academy Press) National Autism Center National Standards Project ( NPDC ( Michigan is one of 12 states that is a collaborative partner OCALI AIM website (

14 Early Childhood Assessment Tool Statewide Autism Resources and Training (START) Effective Practices Assessment Tool for Young Children with Autism Spectrum Disorders Team: District: Date: AREA 1: Critical Program Components Current Status/Progress Not in Place Partially In Place In Place Priority Level 1 5 1=low, 5=high CRITICAL COMPONENTS 1. Students are actively engaged with many learning opportunities throughout the day CRITICAL COMPONENTS 2. Programming is individualized to meet student needs 1 Students each receive less than 5 learning opportunities (including entire request, response, reaction sequence) per hour on average. Students are actively engaged in productive activities less than 50% of the time. 1 Students receive traditional preschool instruction with minimal adjustments for individual needs. 2 3 Students each receive approximately 10 learning opportunities (including entire request, response, reaction sequence) per hour on average. Students are actively engaged in productive activities more than 80% of the time. 2 3 Programming is individualized for some students, some of the time, but not consistently enough to make rapid progress toward IEP goals. 4 5 Students each receive more than 20 learning opportunities (including entire request, response, reaction sequence) per hour on average. Students are actively engaged in productive activities more than 80% of the time. 4 5 Instructional goals, methods, prompts and response requirements are individualized to meet the student s abilities, needs, and developmental level. Priority Priority

15 Autism Spectrum Disorders

16 DSM-IV Definition of Autism (MI definition) Impairment in Socialization Restricted & Repetitive Behavior Impairment in Communication

17 DSM-V Proposed Change Impairment in Social- Communication Restricted & Repetitive Behavior

18 Joint Attention The core symptoms of autism are represented in the triad (dyad) of impairments. Yet the earliest sign of autism is often manifested as a deficit in joint attention, which has a significant and pervasive impact on all developmental domains.

19 Shared/Joint Attention

20 What are the two biggest problems we hear with regard to teaching young children with ASD? 1. Behaviors 2. Learning/ Skill Development

21 What can we do? Create as many structured learning opportunities as possible, individualized for students within engaging activities This will eliminate many of the issues with problem behaviors

22 Supported, structured opportunities for learning lead to better outcomes

23 Neurotypical Child Child with Autism 1,000 learning opportunities a day Few learning opportunities a day Learn from their environment Poor observational learners Specific instruction not needed Specific instruction necessary Strong speaking skills Weak speaking skills Strong listening skills Weak listening skills *A child with autism has to learn at a faster rate than typical peers just to catch up.

24 What does a learning opportunity look like? 1. Instruction/activity/ situation is presented to the child 2. Child has an opportunity to respond 3. Child is given feedback a) Acknowledgement that response was correct b) Correction/prompt to help the child give a correct response

25 Engaged Time It may not be possible to provide learning opportunities all the time, but we can increase time engaged. Engaged time: Active involvement in productive activities that lead to learning. How we organize activities will determine engagement

26 Counting Learning Opportunities and Time Engaged Let s count learning opportunities and watch for engaged time Example 1 Example 2 Watch the student. When you see a learning opportunity mark it down. If you have a timer, start it when the child is engaged and stop it when the child is not engaged.

27 Learning Opportunities & Engagement

28 Learning Opportunities & Engagement

29 Reaching Our Ultimate Goals Why do we work so hard to increase learning opportunities? Independence Socialization Preparation for typical school experiences Quality of life

30 Increasing Learning Opportunities & Engagement Strategies for Teaching: Goal Cards (CAMPS) Teach using the 3 Rs Teaching Imitation Comprehensive Programs

31 Goal Cards

32 Increasing Learning across Activities: Goal Cards Preschool Age: C Communication L Literacy A Academic M Motor S Social Birth 3: C Communication A Academic/pre-academic M Motor P Play S Social

33 Increasing Learning across Activities: Goal Cards Birth 3: C A M P S Communication (verbal, PECS or sign language; choice-making, yes/no) Academic/pre-academic (colors, prenumeracy skills) Motor (gross, fine) Play (basic toy play skills, e.g., building, imitation, simple pretend play) Social (turn-taking; fill-ins, joint attention)

34 Goal Card for Bath Time C: Communication goal Requests water on/off; asks for duck or pour; responds to yes/no A: Academic/Pre-academic goal Counts or sorts bath toys/objects; fills in words in songs: this is the way we wash our (body part) ; points to body parts M: Motor goal Scoops and pours water; points to objects; blows bubbles P: Play goal Washes a baby doll; drives a boat to get gas; makes soup S: Social goal Plays peek-a-boo with caregiver using the washcloth; fills in or participates in game ready, set, (go) (then pours water out of a cup or drops a toy in the water to make a splash); shows or points

35 Goal Card for Breakfast C: Communication goal Chooses items (food, bowl, etc.,) either verbally or by pointing A: Academic/Pre-academic goal Sits in a chair for the meal, labels or points to colors/pictures on placemat M: Motor goal Holds and uses spoon, uses a cup, drinks from straw P: Play goal Pretends to feed stuffed animal/animal figurine; feeds baby doll S: Social goal Shares food (hands food to caregiver/sibling when requested); turn taking game ( my turn to take a bit, your turn to take a bite )

36 Goal Card for Riding in the Car C: Communication goal Verbalizes or signs for seatbelt on/off, music on/off, window up/down; signs all done before having seat belt removed A: Academic/Pre-academic goal Labels or points to objects in the environment (red car, yellow house, big truck, moon, etc.); points to picture that indicates destination; listen to audiobook M: Motor goal Claps hands yeah, we re here, uses pointer finger to touch window decals or form board P: Play goal Sings songs with caregiver, If you re happy ; moves or plays with window decals or form board S: Social goal Waving to people or objects ( wave bye-bye to the truck ); play I spy using pictures

37 Goal Card for Putting Shoes On C: Communication goal Labels shoes, socks, requests help me, signs all done when finished putting shoes on; fills in words: all (done) time to (go) A: Academic/Pre-academic goal Labels or points to colors (where s the red shoe?); counts how many shoes do you have? ; finds item, where s the BIG shoe M: Motor goal Pushes foot into shoe; straps velcro P: Play goal Yea, you have your shoes on. Let s hop like a bunny. S: Social goal Responds to absurdities: e.g., caregiver putting shoe on her head; ask, where are my shoes ; show me your shoes

38 Using the 3 Rs to Teach Skills

39 An Applied Behavior Analysis (ABA) Approach to Presenting Instruction Request (Stimulus) Response Reaction (Consequence)

40 The 3 Rs are the same as a Learning Opportunity

41 Intensive Teaching

42 Using the 3 Rs 100% Success is expected Failure is not an option A child will be assisted until he is successful Don t make a request unless you are going to follow through

43 Developmentally Appropriate Practice National Association for the Education of Young Children, 2009 (naeyc.org) Teaching to enhance development and learning Developmentally appropriate teaching practices provide an optimal balance of adultguided and child-guided experiences childguided experience proceeds primarily along the lines of children s interests and actions, with strategic teacher support (p. 17).

44 Strategies to Increase Learning Opportunities & Engagement: Incorporate Child Interests Braiding the ABA and developmental approaches

45 What Does this Look Like with Play Targets? REQUEST: Make the request Put the cups together Stack the blocks Make a train Fly the airplane Feed the baby RESPONSE: Child responds REACTION: If the child doesn t respond, or responds incorrectly, prompt the correct response OR REACTION: Praise and reward the child for the correct response

46 Implementing Learning Opportunities during Natural Play Activities McBride & Schwartz (2003) embedded instructional episodes (Learning Opportunities) into ongoing classroom routines and activities Teachers identified individualized IEP/IFSP goals Addressed the target goals during classroom activities using an ABA approach

47 ABI & DTT

48 ABI plus DTT McBride and Schwartz (2003) Adding instructional trials to a play situation increased: Teacher obligatory and non-obligatory statements Student engagement and correct responses to target objectives

49 Goal cards can also focus on play: Building with Blocks C: Communication goal Requests block; says uh-oh when blocks fall A: Academic/pre-academic goal Touch counts blocks (with help); labels colors of blocks M: Motor goal Coordinates motor movements to build tower P: Play goal Crashes tower with toy car; imitates tower or model made by caregiver; figurine jumps off of tower S: Social goal Hands block to caregiver; plays peek-a-boo behind the tower

50 Incorporate Child Interests If you re working with a child who likes Thomas the Tank Engine, how can you teach important skills using Thomas? Communication - requests Thomas Academic sorts engines by color; completes a Thomas puzzle with help Motor - jumps over Thomas; attaches cars Play - re-enacts basic scene from a Thomas video Social tolerates turn-taking with Thomas

51 What might this look like early in the teaching process?

52 Increasing Imitation Skills

53 Imitation Due to impairments in joint attention & possibly, due to differences in a region of the brain that holds mirror neurons children with ASD often show deficits in imitation Imitation often needs to be systematically taught

54 Increasing Imitation Skills during Daily Routines and Play Activities Strategies to Increase Imitation Reciprocal imitation Teach imitation using the 3 Rs Prompted play with matched toy sets Observational play with matched toy sets

55 For Children who Show Limited Awareness of Others: Use Reciprocal Imitation Reciprocal imitation involves the adult (or a peer) imitating the actions of the child using matched or similar toys (appropriate play actions, not inappropriate behaviors)

56 Reciprocal Imitation

57 Teach Imitation Using the 3Rs Adult: Says Do this and pushes a bus Child: (no response) Adult: physically assists child to push the bus and says This is pushing the bus

58 Embracing Play

59 Embracing Play

60 Peer Model: Demonstrating and Prompting Nick and Potato head

61 Learning through Observation Learning observationally, or learning from the environment Watching peers and/or adults and imitating their behaviors

62 Observational Play

63 Comprehensive Programming for Young Children with ASD

64 A Model Program for Children with ASD age 0-3 Boulware, et al. (2006): Project DATA for Toddlers Integrated playgroup (5 typical peers, 2 children with ASD, 3 children with other disabilities) Individualized instruction (1:1) Family support in home or community 3 hours per week (2, 1.5 hour sessions) 6 hours per week (2 hours 3x/wk) 2 hours per week by Project DATA staff, 5 by family 16 hours of total intervention

65 Expanding Learning Opportunities Pilot Project Infant toddler program 2x/week 3 hours per week (2, 1.5 hour sessions) Individualized instruction (1:1) using Rethink Autism Family support in home 2 hours 2x/wk Project Impact training available to families

66 Selected References Boulware, G., Schwartz, I., Sandall, S & McBride, B. (2006). Project DATA for toddlers: An inclusive approach to very young children with Autism Spectrum Disorder. Topics in Early Childhood Special Education, 26, McBride, B.J. & Schwartz, I.S. (2003). Effects of teaching early interventionists to use discrete trials during ongoing classroom activities. Topics in Early Childhood Special Education, 23, National Association for the Education of the Young Children (NAEYC, 2009). Developmentally Appropriate Practice in early childhood programs serving children from birth to age 8. Willis, C. (2006). Teaching young children with autism spectrum disorders. Beltsville, MD: Gryphon House.

67 Questions / Comments