The Ziggurat Model Designing Comprehensive Behavior Interventions for Students with ASD Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA Overview of Presentation Review Levels of the Intervention Ziggurat Pt. 2 Skills to Teach Case study Q&A www.texasautism.com Ziggurat Webinar Day 3 The Ziggurat Model 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 Three Areas of Expertise for Effective Intervention Planning Intervention Ziggurat Characteristics of ASD Range of effective interventions Comprehensive planning process Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D 1
Characteristics Social Communication Repetitive Patterns Associated Features Sensory Motor Cognitive Emotional Vulnerability Medical and Biological Factors Interventions 5 Steps to Designing a Comprehensive Intervention Plan 1 2 3 4 Characteristics Design 5 Implmt. UCC ISSI Global Guide Evalua4on Data Provides a snapshot of ASD Iden4fies strengths and skills Iden4fies meaningful priori4es Ziggurat Worksheet Special Educa4on Supports, Related Services/Accommoda4ons and Behavior Interven4on Plan Present Levels of Func4onal Performance IEP Team Considera4ons: Parent Concerns, Transi4on, and Person- Centered Planning CAPS 1 Opera4onalized IEP: Student Schedule with Embedded Benchmarks/Short- term Objec4ves and Supports Underlying Characteristics Checklist Helps you to see the autism Provides a snapshot of how autism is expressed for an individual A descriptive instrument Can be completed by a team Provides a tool for assessing progress/ change Ensures development of a comprehensive plan Ensures implementa4on of the comprehensive plan Social 1 The UCC Areas 1 UCC-HF for HFA and AS Restricted Patterns of Behavior, Interests, and Activities Communication Sensory Differences Cognitive Differences Motor Differences Emotional Vulnerability Known Medical or other Biological Factors 2
1 UCC-CL for Autistic Disorder UCC-EI 1 Early Intervention Individual Strengths and Skills Inventory 2 Social Behavior, Interests, and Activities Communication Sensory Cognitive Motor Emotional Biological UCC to IEP UCC to IEP UCC to IEP UCC Item IEP Objective UCC Item IEP Objective Has difficulty recognizing the thoughts and feelings of others Identify feelings of others in context by correctly predicting the feelings of others in a story or video 8 out of 10 times Problems with transition and change Given a reinforcer, utilize individualized daily schedule by checking of each activity as completed 95% of the time 3
Intervention Ziggurat Structure and Visual /Tactile Supports Sensory Differences and Biological Needs Sensory Differences and Biological Needs Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Intervention Ziggurat Intervention Ziggurat Structure & Visual/Tactile Supports Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. We don t fix things that aren t broken, we remove obstacles for kids with infinite potential I m in the obstacle removal business - Eric Blackwell - Eric Blackwell 4
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. Too Demanding Ability Demands Ability Demands and Skills to Teach To Balance Reduce Demands, Add Supports &/or Skills Supports Skills Supports Skills Demands Ability Demands Ability Task Demands Skills to Teach Task Demands Group Work Skills to Teach 5
Examples of Task Demand Interventions Coping Cards Take 2 deep breaths with your eyes closed Press hands together and count to 10 slowly Amy Bixler, 2006 The Incredible 5 Point Scale Keyboarding Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009) First-Then Peer Buddies 6
Augmentative Communication System Visual Support for Communication Priming with Visual Support Prepare for Change The Seemingly Obvious 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 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. 7
The Hidden Curriculum Context Context Context 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 What vs. Why & Skill vs. Understanding Eye contact (stare at you) Why do we give compliments? I don t know, the teacher said so. Pants Masturbation IEP Development Requirements 614(d)(3)(A) Requires the IEP Team consider: Strengths of the child Concerns of the parents Evaluation results Academic, developmental, and functional needs of the child [emphasis added] The Purpose of Special Education (IDEA) To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique need and prepare them for further education, employment, and independent living 300.1 (emphasis added) IDEA Findings Sec 601 Almost 30 years of research and experience has demonstrated that the education of children with disabilities can be made more effective by (A) having high expectations for such children and ensuring their access to the general education curriculum in the regular classroom, to the maximum extent possible, in order to (i) meet developmental goals and, to the maximum extent possible, the challenging expectations that have been established for all children; and (ii) be prepared to lead productive and independent adult lives, to the maximum extent possible; 8
Daily Living Skills Wake up on own Brush teeth Comb hair Take medicine Dress appropriately for weather Keep track of belongings Communication Skills Use appropriate greetings Communicate needs, ask questions Start/sustain/terminate conversations Match affect to situation/topic Asperger Syndrome: An Owner s Manual by Ellen S. Heller Korin Asperger Syndrome: An Owner s Manual by Ellen S. Heller Korin Problem Solving Skills Mind Reading Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing. Emotion Regulation Emotion Regulation 9
Social Skills Life Skills Bryan - Background Case Example Bryan Elementary School Student - ASD Over 25 In School Suspensions Hides under desk Work refusal Body slams adults and peers Leaves class Teased by peers Bryan - IEP Has 42 objectives in IEP 40 of those are academic (writing/grammar, number operations, penmanship, geometry and spatial reasoning, geography) Bryan - BIP Well defined limits Timer for self-monitoring Point system Redirect Private discussion Study carrel Physical Intervention Canned 10
Bryan Psychological IEP objectives Bryan will identify three alternative behaviors to replace negative behaviors. 90% Brian will identify 3 support services in the school setting. 100% Alternative Perspective: Using the Ziggurat and CAPS Models Bryan 5 Steps to Designing a Comprehensive Intervention Plan Bryan UCC and ISSI 1 2 3 4 Characteristics Design 5 Implmt. Sample UCC Items Has problems handling transition and change Has strong need for closure or difficulty stopping a task before it is completed Has eccentric or intense preoccupations Difficulty understanding nonverbal communication Tends to be less involved in group activities Interprets words or conversations literally Has difficulty following instructions Responds in an unusual manner to sounds Seeks activities that provide touch, pressure, or movement Individual Strengths and Skills Inventory Social Caring and giving Comforts peers Makes gifts for others Communication Able to hold a conversation on preferred topics Behavior Copes with change in routine with adequate advance notice Cognitive Intelligent Creative Enjoys reading Biological Energetic Sleeps well Goes to bed easily 11
Designing a Global Intervention Plan Designing a Global Intervention UCC Selected UCC Areas 3 Selected UCC Areas Selected UCC Items Bryan-Select UCC Areas Vision What is the short and long-term vision for the individual? Select UCC Areas UCC Long-term Have friends Attend college Increased independence Improved coping skills Short-term Play with peers at recess Accurately identify feelings of self and others Participate in group work Selected UCC Areas Social Restricted Patterns Communication Sensory Differences Cognitive Differences UCC Areas Motor Differences Emotional Vulnerability Known Medical/ Biological Factors Vision Bryan- Select UCC Areas Vision Which UCC areas would have the greatest impact on achieving this vision? Social Communication Emotional Vulnerability Remember to stay on target 12
Bryan- Select UCC Areas Settings In what settings does the individual participate? School (e.g., classroom, PE, lunchroom, hallways) Home Community (e.g. church, grocery store, mall) Bryan- Select UCC Areas Settings Settings Which UCC areas have the greatest impact on the individual s ability to function in multiple settings? Social Communication Emotional Vulnerability Remember to stay on target Bryan- Select UCC Areas Quality of Life What is most important to the individual? What provides a sense of well-being? Make friends Feel safe Preferred activities (animals, art projects, etc.). Bryan- Select UCC Areas Quality of Life Quality of Life Which UCC areas have the greatest impact on the individual s quality of life? Social Restricted Patterns Emotional Vulnerability Remember to stay on target Bryan- Select UCC Areas Key UCC Areas Select UCC Items Based on your answers to the questions, place a mark next to the key UCC areas. Selected UCC Areas Social Restricted Patterns Communication Emotional Vulnerability Selected UCC Items 13
Select Key UCC Items from UCC Areas Bryan- Selected UCC Items Select key UCC items for each of the Selected UCC areas. Choose items that are essential (necessary for progress) and developmentally appropriate. Emphasize items that are more pivotal (building blocks for additional skills). Avoid selecting redundant items. [1] Mindblindness [5] Has difficulty making or keeping friends [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [19]Has strong need for closure or difficulty stopping a task before it is completed [29] Has difficulty asking for help [39] Has difficulty talking about others interests [76] Is easily stressed-worries obsessively [87] Has difficulty identifying, quantifying, expressing, and/or controlling emotions Bryan s Intervention Ziggurat Structure and Visual /Tactile Supports Cafeteria Use of ear plugs or headphones to dampen noise level Shortening time in the cafeteria Use of a calming activity prior to lunch (seek advice of occupational therapist for activities that would be calming to Bryan) Sensory Differences and Biological Needs Thinking in Levels Bryan- Selected UCC Items Structure and Visual /Tactile Supports Sensory Differences and Biological Needs [1] Mindblindness [5] Has difficulty making or keeping friends [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [19]Has strong need for closure or difficulty stopping a task before it is completed [29] Has difficulty asking for help [39] Has difficulty talking about others interests [76] Is easily stressed-worries obsessively [87] Has difficulty identifying, quantifying, expressing, and/or controlling emotions 14
Cafeteria Prime Bryan prior to lunch to remind him of coping skills for this setting (e.g., ask help, access to safe place, ear plugs,) Use trained peer buddies during lunchtime Thinking in Levels Structure and Visual /Tactile Supports Sensory Differences and Biological Needs Bryan - Interventions Do not ask Bryan to independently resolve conflicts with peers. He does not have the skills and will be overwhelmed by the demands of the task. Assist Bryan to resolve conflicts and teach him the process gradually. Teach Bryan the warning signs of teasing or bullying. Use role play, video, and scenarios. Bryan - Interventions Use social autopsies following any bullying episode. This is a strategy where each part of a situation is analyzed in order to understand what went wrong. Reinforce Bryan for removing himself from conflict using strategies outlined for him Thinking in Levels Bryan- Selected UCC Items Structure and Visual /Tactile Supports Sensory Differences and Biological Needs [1] Mindblindness [5] Has difficulty making or keeping friends [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [19]Has strong need for closure or difficulty stopping a task before it is completed [29] Has difficulty asking for help [39] Has difficulty talking about others interests [76] Is easily stressed-worries obsessively [87] Has difficulty identifying, quantifying, expressing, and/or controlling emotions 15
Bryan s Interventions Reinforce Bryan for demonstrating new skills. Create reinforcer menu. Reinforce both practiced and prompted skills. Thinking in Levels Structure and Visual /Tactile Supports Sensory Differences and Biological Needs Bryan- Selected UCC Items [1] Mindblindness [5] Has difficulty making or keeping friends [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [19]Has strong need for closure or difficulty stopping a task before it is completed [29] Has difficulty asking for help [39] Has difficulty talking about others interests [76] Is easily stressed-worries obsessively [87] Has difficulty identifying, quantifying, expressing, and/or controlling emotions Comprehensive Autism Planning System 5 Making the Program a Reality UCC ISSI Global Guide Ziggurat Worksheet CAPS 16
Lunch Time Activity Skills/STO Structure/ Modifications 11:00 Lunch *Use coping/ calming skills Identify/ quantify emotions Visual schedule Shortened lunch Trained peer buddies Prime for coping skills Use end of lunch to research animals (or other menu item) Reinforce for demonstrating new skills. Taken from Prioritized UCC Items: [76] Is easily stressed-worries obsessively [87] Has difficulty identifying, quantifying, expressing, and/or controlling emotions Lunch Lunch Time Activity Skills/STO Structure/ Modifications Time Activity Skills/STO Structure/ Modifications 11:00 Priming Use coping/ calming skills Identify/ quantify emotions *Visual schedule *Shortened lunch *Trained peer buddies *Prime for coping skills Use end of lunch to research animals (or other menu item) Reinforce for demonstrating new skills. 11:00 Lunch Use coping/ calming skills Identify/ quantify emotions Visual schedule Shortened lunch Trained peer buddies Prime for coping skills *Use end of lunch to research animals (or other menu item) Reinforce for demonstrating new skills. Taken from Structure & Visual/Tactile Supports and Task Demands Taken from level of the Ziggurat Worksheet Lunch Time Activity Skills/STO Sensory Lunch Time Activity Skills/STO Sensory Social Skills/ Communication 11:00 Lunch Use coping/ calming skills Identify/ quantify emotions *Headphones *Use of a calming activity at 10:50 11:00 Lunch Use coping/ calming skills Identify/ quantify emotions Headphones Use of a calming activity at 10:50 *Peer buddies *Asking for help Taken from Sensory/Biological Needs level of the Ziggurat Worksheet Taken from and Skills to Teach levels of the Ziggurat Worksheet 17
Lunch Lunch Time Activity Skills/STO Data Collection Generalization Time Activity Skills/STO Data Collection Generalization 11:00 Lunch Use coping/ calming skills Identify/ quantify emotions *Asking for help (#) Identification of emotion (yes/no) Earn reward (# days/wk) Prime to use skills at recess. 11:00 Lunch Use coping/ calming skills Identify/ quantify emotions Asking for help (#) Identification of emotion (yes/no) Earn reward (# days/wk) *Prime to use skills at recess. These match Skills/STO These are from the Sensory and Social Skills/ Communication part of the CAPS Strengths of the Ziggurat and CAPS Models 1. Provides a process and framework for designing an intervention plan Make everything as simple as possible but not simpler - Albert Einstein Strengths of the Ziggurat and CAPS Models 2. Addresses underlying characteristics of ASD by utilizing strengths and building skills Strengths of the Ziggurat and CAPS Models 3. Emphasizes and enhances evidence-based strategies Strengths of the Ziggurat and CAPS Models 4. Facilitates comprehensive intervention design and implementation 18
Strengths of the Ziggurat and CAPS Models 5. Facilitates use of proactive interventions 6. Facilitates interdisciplinary interventions Strengths of the Ziggurat and CAPS Models 7. Consistent with Positive Behavioral Interventions and Supports (PBIS) and other guidelines State standards Response to Intervention Individualized Evidenced based strategies Functional assessment Comprehensive Skill development Improves environment Team building Facilitates transitions Contact Information Ruth Aspy, Ph.D. aspy@texasautism.com 214-227-7741 Barry G. Grossman, Ph.D. grossman@texasautism.com 214-227-7741 www.texasautism.com 19