Ask and Observe. Most Common Approaches Used 7/28/09

Transcription

1 By Tracy Vail,MS,CCC/SLP Letstalksls.com What Are Important Skills to Teach Young Children with Autism? Communication skills: allow the child to get their needs met and replace maladaptive behaviors and engage in social interactions. Non-verbal communication: Teaches the child that people s faces/bodies carry important information. Interactive Play Skills: teaches flexibility, improves relationships, replaces self-stimulatory behaviors Imitation Skills: Allows the child to learn from the environment. Ask and Observe Ask the parents! What are their priorities? Observe the child- What areas are causing the child the most difficulty in life right now? Look at where the child is currently functioning and determine the necessary component behaviors/skills to meet the goals of the parents and child. What are the goals of the family in 1 yr? 5 yrs? 10 yrs? Most Common Approaches Used Behavioral Approaches- ABA- Applied Behavior Analysis and Applied Verbal Behavior, TEACCH Developmental Approaches- SCERTS, Floortime/ DIR, RDI 1

2 Developmental, Individual Differences, Relationship Based Intervention, DIR/ Floortime A warm and intimate way of relating to a child. A floor time philosophy means engaging, respecting and getting in tune with the child in order to help the child elaborate through gestures, words and pretend play what is on the child s mind. As a technique it is a process that is used to support the emotional and social development of the child. (Greenspan, 2002) This model serves as the context or container of the therapy we do. But what does it mean? Relationship Development Intervention (RDI) A cognitive- developmental approach designed to remediate Autism. Deals with autism as a neurologically based, information processing disorder. Proposes to remediate the Core Deficits in Autism including motivation, communication, emotional regulation, episodic memory, rapid attention shifting, self-awareness, appraisal, executive functioning, flexible thinking, and creative problem solving. Great stuff based on research by many in the field of psychology but what do these core deficits mean? How do we know when these skills have improved? What is the child doing? How can we measure it? AND, is it really necessary to spend thousands of dollars being trained to address these issues? Hanen Method Teaching communication and play skills through adult- child interactions. Parents/therapists are to: Observe, Wait and Listen (OWL) This approach is very similar to DIR in that the child leads and teaching is conducted based on the interests of the child. Behavioral Approaches Scientifically validated based on many years of research. Based on measurable behaviors either internal or observable. Based on the laws of learning Places the responsibility of learning on the teacher rather than the student Many faces to behavioral interventions. Not all programs look alike Data driven program decisions 2

3 Applied Verbal Behavior Based on the research of BF Skinner on why people communicate Language is categorized into verbal operants or functions: Mand, Tact, Echoic, Intraverbal (as well as listener behaviors) There s a strong focus on developing intraverbal links or relationships between words. Language is taught as a behavior with specific teaching procedures used Both natural environment teaching and intensive teaching are used based on the age and skills of the child TEACCH The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called Structured Teaching. The principles of Structured Teaching include: Understanding the culture of autism. Developing an individualized person- and family-centered plan for each client or student, rather than using a standard curriculum. Structuring the physical environment. Using visual supports to make the sequence of daily activities predictable and understandable. Using visual supports to make individual tasks understandable (TEACCH Website) Can We Combine Behavioral and Developmental Approaches? YES!!! Factors to Consider No single program works for all children to address all their needs. Every human being s learning is a combination of internal and external factors. Motivation of the child is the most important factor to consider when making treatment decisions. Parents often have preferences and skill sets that should be respected. Different children respond better to different approaches. 3

4 Relevant Information About Learners with Autism They tend to have very analytical minds They tend to have unusual motivations and consequently unusual reinforcers They tend to be rule based learners Their bodies experience the world in an unusual way Some are quite rigid and anxious They often have difficulty understanding the rules of social interaction and communication So what..now what? Use Whatever Works to Teach the Most Important Skills to each Individual child at the Given Time The Language We Use Often it isn t what we do but how we talk about what we do that makes approaches seem so different. The language we use to talk about what we do should be precise, agreed upon and based on observable or measurable change. As professionals we are charged to provide evidenced based practices. Show me the data!! What do you see happening? 4

5 A Few Possible Observations He interacted with the instructor for 3.5 minutes. He requested using gestures 4 times with no prompting. He imitated body movements twice with no prompting. He looked at the instructor twice and smiled. He laughed in response to the instructors actions twice. He initiated a social game twice with no prompting. He shared affect He shared attention He both opened and closed 5 circles of communication The instructor followed the child s lead He demonstrated a preference to engage in a regulatory pattern with ongoing variations He regulated his actions to maintain social coordination He responded to guides role actions to maintain the regulatory status of the pair. Children are Complete Human Beings They have a right to communicate to get their needs met They want and need successful relationships in their lives While they have some similarities, they all have unique needs that should be addressed Each family structure is different and has unique priorities and needs Child and family needs will change over time and programs need to reflect that General Language Categories Language used to meet the needs of the individual Language used for social interactions and building relationships Language used for learning or academic settings Verbal Operants Antecedent/Stimulus Behavior Consequence Mand Motivation Says car gets car Echoic Say car Says car social/secondary Tact Car present Says car social/secondary Intraverbal We ride in the.. Says car social/sec. 5

6 Motivation and Reinforcement Motivation- 1. Temporarily increases the value of a reinforcer 2. Temporarily increases the behaviors that have been followed by that reinforcer in the past Reinforcer- increases the likelihood that a behavior will happen again in the future If a behavior is increasing in frequency, it is being reinforced! Communication To Meet Needs Mands/requests Use an augmentative system if the child is not yet vocal: signs, PECS, voice output devices Teach errorlessly - full prompts then fade your prompts Make sure you have motivation before teaching the request Target 3-4 words at any given time. Conditions to Teach Fill-ins: choo choo little R= train Echoic- shape articulation Choices- Block? Car? Do you want block or car? What do you want? What should I do? Noting said- object present Nothing said- object absent (pure mand) Choose a Response Form If child is non-vocal, must use an alternative/ augmentative system Augmentative communication encourages rather than discourages vocal productions Experiment to determine how the child responds to various forms Picture/object exchange Signs Communication Boards Vocal Voice output devices 6

7 Teaching Signs Make sure the signs you teach can be immediately reinforced. Choose iconic signs to begin teaching (look like the object) Make sure all those in the child s environment know the child s signs so they can be reinforced. Early signs to avoid: more, yes/no, potty, open Think: Objects, then actions, then adjectives Introducing Signs Signing Block Picture Exchange Communication System 7

8 Communication Boards Shaping Speech Begin with vowels since they carry the most meaning Shape the syllable structure to increase intelligibility Avoid teaching simplification patterns typical in young children as they tend to be VERY hard to correct in children with Autism. Continue reinforcing requests with augmentative systems until vocals are intelligible to most people Dropping Signs Make Meaning through Reinforcement 8

9 Shape Speech in the Context of Requesting Use Music Avoid reinforcing extra sounds Use Books 9

10 Interactive Play Build trust/relationship by being predictable Teach flexibility by slowly introducing change Focus on engagement, shared affect, joint attention Social imitation, social smiles non-verbal communication Move In and Out of the Comfort Zone Comfort Zone Learning Zone Over the Edge Beginning Patterns Start a pattern based on what the child is doing or introduce your own pattern Make sure the child has a role in the interaction. You can be doing the same things or different things. As soon as the child is taking a role consistently, vary the pattern. If the child withdrawals from the interaction, make the change more gradual next time. Use silly sounds, breath intake, pauses right before the change will occur. Reinforce behaviors you want to see more of! Facial gazing, social imitation, pattern 10

11 Follow the Child s Lead Use the child s interests Expand Language and Play Skills Advanced Pretend Play 11

12 Negotiating/Problem Solving Non-Verbal Communication Pairing Experience pairing people with reinforcement/establish social reciprocity /engagement- non-verbal behaviors exhibited by 2 people for the function of sharing reinforcing interactions. (many may be considered requests for the interaction to continue- imitate as a mand for the listener to repeat the behavior.) Affect Sharing/Social Smiles Imitation/Shared Affect Mirroring Behaviors: Shared affect- Reinforced by adult imitating the child s affect in an exaggerated manner. Social imitation- reinforced by continued presence of adult/child who s attention has been established as a conditioned reinforcer. 12

13 Non-vocal Requests Mands/Requests= non-vocal behaviors exhibited by the child that serve the function of obtain an item or action Look- reinforced by obtaining access to the item being looked at. Reach (+ look)- reinforced by obtaining access to the item being reached for. Point (+look)- reinforced by obtaining access to the item at which the child pointed Give to activate (+look)- reinforced by activation of the object/toy. Action to sustain (+look)- reinforced by repetition of the action. Following Non-Verbal Directions Gestural Listener= responding to gestural mands /requests of others to exhibit a behavior. Follow point reinforced by adult attention or other conditioned reinforcer Follow gaze- reinforced by adult attention or other conditioned reinforcer Follow yes/no- reinforced by adult attention or other conditioned reinforce. Chains of Behaviors Combined- chains of behaviors that involve looking to request information then following a non-verbal receptive instruction. Look + follow point- look is reinforced by having information provided and follow point is reinforced by conditioned reinforcement Look + follow gaze- look is reinforced by having information provided and follow gaze is reinforced by conditioned reinforcement Combined Continued Look + respond to head nod/shake (yes/no)- look is reinforced by obtaining information and response to yes/no reinforced by conditioned reinforcement Point and look + respond to head nod/shake (yes /no)- point and look reinforced by obtaining information and response to yes/no reinforced by conditioned reinforcement 13

14 Joint Attention Gestural Bid for Joint Attention = child exhibits non-verbal behaviors for the function of drawing another s attention to an object, event, or other environmental stimulus. The attention of the adult must be established as a conditioned reinforcer. (True Joint Attention as defined in behavioral literature) Show object (+look)- reinforced by affective response/attention of adult/child Joint Attention Cont. Look at object (+ look at person) reinforced by affective response/attention of adult/child Give object (+look)- reinforced by affective response/attention of adult/child Point at object (+ look)- reinforced by affective response/attention of adult/child Thanks for All You Give to Children! 14