Overview of Day. Pre-Test (1) Planning a Comprehensive Program for Students with ASD. Using Evidenced-Based Practices in the Classroom

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1 Planning a Comprehensive Program for Students with ASD Using 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 Model How 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 ASDs develop 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 and should be discontinued as quickly as possible. 1

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 are never 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 2

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 changes Elementary: 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 3

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 relationships Little sharing of pleasure, achievements, or interests with others Lack of social or emotional reciprocity Communication Restricted, repetitive behaviors, interests, or activities Interests that are narrow in focus, overly intense, and/or unusual Unreasonable insistence on sameness and following familiar routines Repetitive motor mannerisms Preoccupation with parts of objects Delay in or total lack of development of spoken language Difficulty holding conversations Unusual or repetitive language Play that is not appropriate for developmental level 4

5 Asperger s 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 relationships Little sharing of pleasure, achievements, or interests with others Lack of social or emotional reciprocity Restricted, repetitive behaviors, interests, or activities Interests that are narrow in focus, overly intense, and/or unusual Unreasonable insistence on sameness and following familiar routines Repetitive motor mannerisms Preoccupation with parts of objects No clinically significant general delay in language and no significant delay in cognitive development Autism Characteristics Activity Social Communication Restricted/Repetitive Jessy 5

6 Male to Female Ratio 4.3 to 1 Greater difference at higher end of functioning Classic Increasing Variability of Presentation HFA/AS Adapted from Rosenn, D. (1997). Autism spectrum severity wedge. Differential Diagnosis ADHD OCD Bipolar MR Early Speech Delays Reactive Attachment Disorder Schizophrenia Visual Impairment Sensory Integration Disorder 6

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, 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,

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,

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 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 Ziggurat Skills to Teach Task Demands Structure and Visual/Tactile Supports Reinforcement Sensory Differences and Biological Needs Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. 9

10 Intervention Ziggurat Responsive to Characteristics The Ziggurat Model Sensory and Biological Needs Reinforcement Structure and Visual/Tactile Supports Task Demands Skills to Teach Components of the Ziggurat Model Assessment Tools Underlying Characteristics Checklist (UCC) ABC-Iceberg Intervention Ziggurat (Ziggurat Worksheet) Implement interventions at five levels and three points Evaluate outcomes and adjust 10

11 Two pathways to intervention using the Ziggurat Model General Specific General Intervention Plan UCC Intervention Ziggurat (Ziggurat Worksheet) General Intervention Plan UCC Intervention Ziggurat (Ziggurat Worksheet) CAPS 11

12 Specific Behavior Plan UCC ABC-Iceberg Intervention Ziggurat (Ziggurat Worksheet) Specific Behavior Plan UCC ABC-Iceberg Intervention Ziggurat (Ziggurat Worksheet) CAPS Underlying Characteristics Checklist UCC-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 12

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 13

14 ABC-Iceberg Antecedent(s) Behavior Consequence(s) Specific Behaviors Underlying Characteristics* # # # # # * As determined through the Underlying Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. Rick Antecedent(s) Recess Low structure After lunch Behavior Loner on Playground Wandering the perimeter Flapping hands Shaking sticks in front of eyes Talking to self Consequence(s) Isolated from peers Opportunity to engage in stereotypic behavior Hypothesized Function: Gain access to preferred activity Interventions based on FBA Reinforce 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 ABC-Iceberg Rick Antecedent(s) Recess Low structure After lunch Specific Behaviors Behavior Loner on Playground Wandering the perimeter Flapping hands Shaking sticks in front of eyes Talking to self Consequence(s) Isolated from peers Opportunity to engage in stereotypic behavior Underlying Characteristics* [1] Mindblindness [15] Strong need for routine or sameness [7]Difficulty making friends [18] Preoccupied with sensory exploration of objects [8] Difficulty joining an activity [36] Difficulty starting and joining conversation [10]Prefers solitary activities [73] Has athletic skills deficits [13]Appears to be in own world [78] Easily stressed * As determined through the Underlying Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. 14

15 Interventions Based on Underlying Characteristics Underlying Characteristics Preoccupied with sensory exploration Difficulty starting conversations Intervention Provide sensory diet Provide written script for joining play and greetings Reinforce for using conversational skills Difficulty making friends Train and assign peer buddy Teach one or two playground games FBA Compared to ABC-I FBA Intervention Reinforce 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 ABC-I Interventions 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 15

16 The last thing one knows in constructing a work is what to put first -Blaise Pascal Sensory Differences and Biological Needs 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 Sensory Issues in Asperger Syndrome Brenda Smith Myles and the co-authors of Asperger Syndrome and Sensory Issues: Practical Solutions Katie Cook, Nancy Miller, Louann Rinner, Lisa Robbins 16

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. Perceptual Motor Cognition Intellect Academic Learning Daily Living Behavior Activities Auditory Visual Attention Language Spatial Center Eye-hand Coordination Ocular Motor Control Postural Adjustment Development Sensory Motor Sensory Postural Security Body Scheme Reflex Maturity Awareness of Two Sides of the Body Ability to Screen Input Motor Planning Olfactory Visual Auditory Gustatory Development Systems Tactile Vestibular Proprioception Williams & Shellenberger, 1996 Central Nervous System Taylor & Trott, 1991 Sensory Systems Tactile Vestibular Proprioceptive Auditory Visual Gustatory Olfactory 17

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) My Sensory Perceptions are Disordered! 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. E. Notbohm, Ten Things Every Child with Autism Wishes You Knew (Miller & Robbins) My Sensory Perceptions are Disordered! 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. E. Notbohm, Ten Things Every Child with Autism Wishes You Knew (Miller & Robbins) 18

19 My Sensory Perceptions are Disordered! 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. E. Notbohm, Ten Things Every Child with Autism Wishes You Knew (Miller & Robbins) Sensory Problems Most Often Seen in Children with Asperger Syndrome Senseless 19

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 20

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 21

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 22

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: Vestibular: Proprioception: 1 to 1 1/2 hours 4 to 8 hours 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 23

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 24

25 Medical Interventions Antidepressants Social relations Repetitive behaviors and movements Aggression and tantrums Depression and anxiety All medications have potential serious side effects. Medical Interventions Antipsychotics Aggression Impulsivity and hyperactivity Repetitive behaviors Communication All medications have potential serious side effects. Medical Interventions Stimulants Impulsivity and hyperactivity Repetitive movements Oppositional behaviors and tantrums All medications have potential serious side effects. 25

26 Coping Cards Take 2 deep breaths with 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 If there is no reinforcer, there is no lesson -Andrew Bondy Reinforcement 26

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 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 Reinforcement Menu My School Rewards 10 minutes of reviewing baseball statistics in personal magazines/books 15 minutes to research on the internet on baseball/sports statistics/events Time to browse books in the school library Amy Bixler,

28 Home Reinforcement Menu My Home Rewards 30 minutes of time to browse the web Trip to local baseball card store 30 minutes of video games 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 28

29 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 Structure and Visual Supports 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 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 29

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, 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 30

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, Morning Checklist Check Put away backpack Make lunch selection Complete helper chart Turn in homework Take out journal Activity Pick reward from your menu Rating Description Setting Screaming Emergency only Outside voice Recess, ball game Talking voice Classroom, lunchroom Soft voice/whisper No talking Library When someone is talking to me, movies Buron, K.D., & Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC. 31

32 Stress Thermometer When my Lego toys fall apart Most stressed ever 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 No stress 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), Video-Based Instructional Procedures Improve daily living skills Promote generalization Socially 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),

33 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) 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 33

34 Cartooning Combines words with simple drawings in order to explain a simple concept Visual Thesaurus Who is in Charge Dr. Carroll, Principal Ms. Jones (Homeroom) Mr. Davidson (Art) Me 34

35 Exploring Feelings: Session Two 1. Review key points handout from previous session 2. Place relaxation pictures on a rope 3. Heroes who get angry - write on butcher paper 4. A time when I felt angry write on butcher paper 5. Emotional tool box to fix the feeling picture of a hammer, picture of a paintbrush 6. Review 7. 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? Screams and walks away Takes deep breaths and Asks Patrick for help Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington, TX: Future Horizons. 35

36 A Time When I Felt Angry Tell about a time you felt angry How did it effect your body? Cry, swear, yell, frown Say, I m going to kill you Fast breathing, felt hot Sweaty palms Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington, TX: Future Horizons. Emotional Toolbox Physical tools Relaxation tools Attwood, T. (2004). Exploring Feelings: Cognitive behaviour therapy to manage anger. Arlington, TX: Future Horizons. Reducing Anger My Ideas to Relax Watch Sponge Bob Play video games Walk around the yard Rub plastic wrap Mom and Dad s Ideas 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. 36

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 stories TM 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 ). 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 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 Task Demands 37

38 Task Demands Level of Demand Easy (independent skillswith or without modification and structural supports) Challenging/Emerging (possible with assistance) Zone of Proximal Development Too demanding Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Task Demands Three Questions 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 38

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 assignments, reminders 39

40 Examples of Task Demand Interventions Use coping cards Create Circle of Friends Provide narration Provide high interest activities to encourage social interaction Examples of Task Demand Interventions 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 40

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 The teacher who does not understand that it is necessary to teach autistic children seemingly obvious things will feel impatient and irritated -Hans Asperger Skills to Teach 41

42 The Hidden Curriculum Locker room rules If there are people taking showers or changing their clothes, do not stare at them or make comments about their bodies It is not appropriate to touch others in the restroom or shower Change 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 42

43 Mind Reading Afraid Surprised 43

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 44

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 Search: the transporters Penny 45

46 UCC-HF or UCC-CL Not a fine line. When in doubt, select the UCC-HF UCC-HF or UCC-CL UCC-HF Average Skills Classic Autism HFA/AS UCC-CL Complete the UCC 46

47 Two pathways to intervention using the Ziggurat Model General Specific General Intervention Plan UCC Intervention Ziggurat (Ziggurat Worksheet) 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 47

48 Specific Behavior Plan UCC ABC-Iceberg Intervention Ziggurat (Ziggurat Worksheet) The ABCs of Behavior Antecedent Behavior Consequence Antecedents Antecedent Resulting Behavior Written assignment Wanders room Class discussion Insults peers Transitions Loud verbalizations 48

49 Consequences Behavior Consequence Wanders room Finish work at recess Insults peers Private conversation with teacher Loud verbalizations 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 49

50 Points of Intervention Antecedent Behavior Consequence Written assignment Wanders room Finish work at recess Modify Antecedent Allow Penny to type Teach new Behavior Teach coping & relaxation skills Modify Consequence Reward for starting and completing written work Slim Starter Before Intervention A B C Asked for order No answer No breakfast 50

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 alternative communication system Set up contingencies/ reinforcers ABC-Iceberg Penny Antecedent(s) Transitions (e.g., mornings, Mondays, vacations) Class discussions Written assignments Specific Behaviors Behavior Class disruption Says, I don t have to do this work Insults peers Does not complete writing tasks Consequence(s) Peer rejection/isolation from peers Private conversation with teacher Loss of recess time Delay of task Attention/opportunity to participate Underlying Characteristics* # 1. Mindblindness # 4. Lacks tact #16. Unmotivated by customary rewards #18. Difficulty with transition and change #33. Gives false impression of understanding more than she does #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 * As determined through the Underlying Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. 51

52 Complete Intervention Addresses all five levels of the Ziggurat Several core underlying needs are addressed Intervenes at all three points A-B-C 52

53 Intervention Ziggurat Sensory Differences and Biological Needs Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Coping Cards Repeat to myself 3 times, Breathe in, hold, breathe out Ask for help Amy Bixler,

54 Intervention Ziggurat Reinforcement Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. What I want to work for: Circle choice for this morning Insect book break Computer game with peer Wear baseball cap at recess Take bug net to recess Watch ant farm Chew gum Science lab assistant Other Notes: Penny wrote 4 sentences today! Great Job! Ms. Simpson (teacher signature) Intervention Ziggurat Structure and Visual/Tactile Supports Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. 54

55 Morning Checklist Check Put away backpack Make lunch selection Complete helper chart Turn in homework Activity Take out journal Pick reward from your menu Intervention Ziggurat Task Demands Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. 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 55

56 Intervention Ziggurat Skills to Teach Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Kind words Rude words Good job! Great idea Nice job Awesome Yeah So what You re stupid That was dumb That stinks Duh! Interventions Address Multiple Levels Red/Green Card 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] 56

57 Interventions Address Multiple Levels Red/Green Card 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] 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 57

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 Structure and Visual Supports Reinforcement Sensory Differences and Biological Needs 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 Structure and Visual Supports Reinforcement Sensory Differences and Biological Needs 58

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 Structure and Visual Supports Reinforcement Sensory Differences and Biological Needs Anna 59

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 Structure and Visual Supports Reinforcement Sensory Differences and Biological Needs Learning to Walk - UCC [1] Has difficulty recognizing the feelings and thoughts of others [7] Is naïve [68] Has poor motor coordination 60

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 Structure and Visual Supports Reinforcement Sensory Differences and Biological Needs Evaluate Outcomes and Adjust Plan Seek help/work together Hang in there sometimes things get worse before they get better Re-visit assessments UCC 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 61

62 Strengths of the Ziggurat Model 2. Addresses underlying characteristics of HFA/AS Addresses surface needs Tantrums when given writing task Give computer or Provide adult aide for dictation Writes without tantrum Addresses surface and underlying needs Strengths of the Ziggurat Model 3. Emphasizes and enhances evidence-based strategies 62

63 Strengths of the Ziggurat Model 4. Facilitates comprehensive intervention design Strengths of the Ziggurat Model 5. Incorporates assessment Underlying Characteristics Checklist ABC Iceberg Strengths of the Ziggurat Model 6. Emphasizes positive approach/reinforcement 63

64 Strengths of the Ziggurat Model 7. Facilitates the design of proactive interventions 8. Facilitates interdisciplinary interventions Strengths of the Ziggurat Model 9. Consistent with Positive Behavioral Interventions and Supports (PBIS) approach Individualized Evidenced based strategies Comprehensive Functional assessment Skill development Improves environment Team building Contact Information Brenda Myles, Ph.D. Ohio Center for Autism and Low Incidence Ruth Aspy, Ph.D. The Ziggurat Group Barry G. Grossman, Ph.D. The Ziggurat Group