Developing Evidence-based Interventions for Students with Autism and Asperger s Disorder Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA www.texasautism.com 214-227-7741 Functional al Assessment ABCs Antecedent Consequences Presentation presented at the Texas Psychological Association November 17, 2007 FBA: Key Assumptions may be impacted by factors outside of immediate antecedents and consequences may result from biological factors Characteristics of ASD that Elicit Difficult s Impaired Theory of Mind/Mindblindness Weak Central Coherence Executive Dysfunction Sensory Differences Comorbid Disorders may result from skill deficits Foster-Johnson & Dunlap, 1993; O Neil, et al., 1997 Impaired Theory of Mind- Mindblindness Difficulty understanding the thoughts, feelings, and beliefs of others Difficulty predicting the actions of others Difficulty using words to describe one s own feelings Difficulty understanding non-literal language (e.g., sarcasm) Weak Central Coherence Tendency to focus on details and miss the big picture Difficulty understanding social situations 1
Problem Solving One way of viewing a problem Stuck thinking Sees facts instead of a whole Problems with cause and effect Does not see problems as having more than one option Problem solving is often literal Executive Dysfunction Difficulty with change Problems with regulating emotion Attention problems Disorganized Top 10 Situations that Trigger Insistence on Sameness 1. Annoying behavior 2. Activity interrupted 3. Losing a game 4. Object breaks 5. Event cancelled 6. Event delayed 7. Materials run out 8. Item misplaced 9. Sequence changed 10. Momentary separation Impact of Sensory Differences 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 Green, Sigafoos, Pituch, Itchon, O Reilly, & Lancioni (2006). Assessing al Flexibility in Individuals with Developmental Disabilities. Focus on Autism and Other Developmental Disabilities, 21(4) 230-236. Emotional Reactivity Due to Sensory Differences 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 Comorbid Psychiatric Disorders Comorbidity is to be expected (Gillberg & Billstedt, 200, p.237) ~65% comorbid psychiatric disorder (Ghaziuddin et al, 1998) 44% Phobia (Leyfer, et al., 2006) 37% Obsessive Compulsive Disorder (Leyfer, et al., 2006) 31% ADHD (Leyfer, et al., 2006) ~10% Major Depression (Leyfer, et al., 2006) Brenda Smith Myles 2
Keys to comprehensive intervention planning Plan UCC/ISSI Characteristics Intervention Ziggurat (Ziggurat Worksheet) Design Characteristics Design Implement CAPS Implement Intervention Ziggurat Skills to Teach Task Demands Structure and Visual/Tactile Supports Reinforcement Sensory Differences and Biological Needs Characteristics Social Communication Repetitive Patterns Associated Features Sensory Motor Cognitive Emotional Vulnerability Medical and Biological Factors Interventions 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. The Ziggurat Sensory and Biological Needs Reinforcement Structure and Visual/Tactile Supports Task Demands Skills to Teach Components of the Ziggurat Assessment Tools Characteristics Checklist (UCC) Individual Strengths and Skills Inventory (ISSI) Intervention Ziggurat (Ziggurat Worksheet) Implement interventions at five levels and three points Evaluate outcomes and adjust 3
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 Designing a Plan for The ABCs of Operationalize Definition Antecedent Consequence Operationalized Definitions Vague She s lazy Operationalized Does not turn in homework s He does not listen Looks away when spoken to He is oppositional Drops to floor when given assignment * As determined through the Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. 4
Antecedents Antecedent Wore makeup to school Compliment Peer group setting Resulting Head down on desk Appears Tearful Does not respond to peers Antecedent(s) Wore makeup to school Compliment Peer group setting Peers talking to s Consequence(s) * As determined through the Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. Consequences Head down on desk Appears Tearful Does not respond to peers Consequence End of group conversation Isolation from peers Peers asking her if she is okay Private conversation with peer Antecedent(s) Wore makeup to school Compliment Peer group setting Peers talking to s Consequence(s) End of group conversation Isolation from peers Peers asking her if she is okay Private conversation with peer * As determined through the Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. Common Functions for Escape/avoidance Adult/peer attention Tangible items Access to preferred activities Sensory stimulation Antecedent(s) Wore makeup to school Compliment Peer group setting Peers talking to s [1] Mindblindness [6] Difficulty joining [7] Is naïve [18] Difficulty with change [77] Appears sad [80] Meltdowns [88] Limited understanding of emotions [89] Difficulty with stress and anxiety Consequence(s) End of group conversation Isolation from peers Peers asking her if she is okay Private conversation with peer * As determined through the Characteristics Checklist Ruth Aspy, Ph.D. and Barry G. Grossman, Ph.D. 5
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 2. Addresses underlying characteristics of ASD 3. Emphasizes and enhances evidence-based strategies 4. Facilitates comprehensive intervention design 5. Incorporates assessment Characteristics Checklist ABC Iceberg 6. Emphasizes positive approach/reinforcement 7. Facilitates the design of proactive interventions 8. Facilitates interdisciplinary interventions 9. Consistent with Positive al Interventions and Supports (PBIS) approach Contact Information Ruth Aspy, Ph.D. The Ziggurat Group aspy@texasautism.com 214-227-7741 Barry G. Grossman, Ph.D. The Ziggurat Group grossman@texasautism.com 214-227-7741 Individualized Evidenced based strategies Comprehensive Functional assessment Skill development Improves environment Team building www.texasautism.com 6