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Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
Autism Areas Of Need, Presentation And Intervention
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Autism Areas Of Need, Presentation And Intervention

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  • 1. Autism: Areas of Need Presentation and Intervention Lee Stickle, M. S.Ed. October 22, 2007
  • 2. 0 Traditionally autism has been identified through an evaluation that is designed to rule out other causes of a cluster of deficits. In order to make a determination of autism, clinicians look at three areas: 0 Communication ° Social Interaction 0 Behavior
  • 3. Language and Communication 0 Difficulty in expressing needs; uses gestures or pointing instead of words 0 Repeats words or phrases in place of typical, responsive language 0 Interprets language very literally 0 Difficulty in understanding nonverbal cues, including facial expression 0 Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.
  • 4. Social Interaction 0 Lack of social interaction 0 Little or no eye contact 0 No sense or feeling of personal distance from others 0 Inappropriate peer interactions 0 Responses that do not match situations; being over- or under-reaction
  • 5. Unique Behaviors 0 insistence on sameness; resistance to change 0 Tantrums/ meltdowns 0 Sustained odd play (e. g., spins or lines up objects) 0 Special interests or inappropriate attachment to objects 0 Stereotyped behaviors, including hand flapping, whole-body rocking, clapping, and so on
  • 6. Integrating these deficits creates a greater disabilit than the ieces alone 0 People with ASD exhibit difficultyz 0 cognitively integrating information gathered in a variety of settings 0 with ability to see shades of gray ° identifying similarities to incorporate new information/ knowledge and skills with those previously learned.
  • 7. Related Issues 0 inability to establish joint attention 0 autism is much like a cylinder that is dropped over the individual with autism; the degree of impairment can almost be measured in feet and inches in some ways. For example, I have worked with kiddos that were so withdrawn that in order to solicit a response, I had to be literally within 18 inches of them, in most traditional classrooms, teachers can be anywhere from 2 to 3 feet from their students to 30 or more and still get a response.
  • 8. Inability to read multiple cues at any iven time 0 Neuro-typical brains are able to process using inductive and deductive reasoning virtually simultaneously, we see the behavior of others, attribute emotion, while all the long checking the environment to measure the reaction against it. Multiple reads of multiple cues, wow, talk about complex, it requires a tremendous amount of “connectivity” that persons with ASD seem to struggle to develop.
  • 9. What to do? 0 The individual deficits of autism can be managed, overcome, compensated for. .. . however it is only when we have successfully integrated a plan of intervention that we can have a significant impact on a student’s quality of life.
  • 10. What might we see in the area of Communication and Lanuae? 0 Children who communicate through tantrums, grabbing desired items, crying, leading, indiscriminant point or the use of personalized sounds or gestures.
  • 11. 0 Provide an immediate manner in which the student can communicate his/ her wants and needs in an appropriate / functional manner. Those interventions include the use of pictures, objects, leading you to the area, for those kiddos with language, model the language that they need to use. Create an environment that has those supports available for all children to use. Understand that a multi-tiered system of support encourages children to communicate in a manner that is fitting with their current level of skill while promoting the next level. Specific interventions go by the name of Picture Exchange Communication System (PECS) Visual Bridges, Visual Schedules. Task Organizers, Written Strategies, Picture Strategies.
  • 12. 0 Remember to USE those supports when communicating with the student. We learn to communicate by modeling communication, by the same token we must understand that children with ASDs need to be specifically taught, that means we have to meet them at their present level and provide opportunities for them to successfully communicate using both direct and indirect instructional methods.
  • 13. Our instructional model may incorporate drill and practice (discrete trials) to introduce new labels for items followed immediately by generalization opportunities. For example, before free play I would work with the child to teach favorite item labels truck, blocks crayons and then provide him with the opportunity to request his preferred activity to engage in during free play. The number of labels that I would introduce would be dependent on the child.
  • 14. What might we see in the area of Communication and Lanuae? Sometimes referred to as echolalic speech, the repetition of words is how children learn to speak, however children with autism frequently don’t move beyond and own the language, so when asked: “ do you want cookies or crackers for snack” they may repeat the entire phrase or just the last few words. Some children engage in lengthy echolalic speech, such as reciting entire Disney videos or commercials, weather reports or stock quotes. We have learned a great deal over the years about echolalic speech, we understand now that echolalia has a purpose for those who engage in it.
  • 15. The treatment for echolalia has changed drastically in the past 15 years. As a result best practice is telling us that we need to first assign intent to the echolalic speech and second model appropriate responses. i/ iciviorrow and Fox): have developed an intervention that has been successful when applied methodically.
  • 16. What might we see in the area of Communication and Lanuae? Sometimes very unusual behaviors are observed, socially inappropriate responses are seen when the interpretation of communication doesn't fit the environment or circumstance. For example you may witness a child being reprimanded for leaving a classroom without permission after having asked to get a drink and being told “wait a minute”. Frequently, language is taken at face value, the phrase of “wait a minute” was interpreted to mean “it is permissible to leave the room in 60 seconds” not, “not right now, we are working, I am instructing” etc.
  • 17. Intervention 0 Unusual responses are sometimes quite predictable when we understand how children on the spectrum interpret language, however we need to teach them to interpret in a more traditional manner in addition to changing our own patterns of communication.
  • 18. It is my belief that initially modifying our behavior to meet the needs of the student (making sure that we are specific enough to convey exactly what we mean) and then developing the skills the child will need to function with the more “typical world”. We can do that through the use of Social Stories“ ; direct instruction of idioms, metaphors and slang; identifying and sorting phrases with like meanings.
  • 19. For many with ASD, interpreting non—verba| cues is extremely difficult, the blending of language, environmental cues, body langua e, tone of voice, and facial expression in ‘‘real time” beyon them. You and I process information virtually simultaneously, students with ASD don't, they may first react to the routine within the environment, then the language followed by the “person cues” For example, I was in the home of a young man with HFA one evening. The student was playing the piano while his father and I were talking, the boy was layin pretty loudly, Dad went into the other room, and with a 00k 0 exasperation on his face, put his hands on his hips, sighed, and said in a very sarcastic tone, “do you think you could play any louder? ” The answer was given in a crescendo second to none! Dad just laughed at himself, turned to me and said, “Why I believe he can play louder, what do you think? ” Clearly, this youngster couldn't interpret that the environment changed with the addition of another person, nor did he understand all 0 the “cues" (hands on hips, sighing, sarcasms etc)
  • 20. Intervention 0 Interpreting non-verbal cues: direct instruction using photographs, Mindreading Software and/ or emotion cards and asking the child to identify what the person is feeling. Categorizing behaviors and where they might be appropriate, such as clapping at a concert, sporting event, but not necessarily at church. Videotape review of social situations with a printed guide direct attention.
  • 21. jll’ ; I I I’ ‘I . __ — . . . .. _.s. ..__. _.L_. . _. .._. n.j_. ... _-_. a_—. _.a¢ Many kiddos with ASD do not attend to verbal stimulus without additional sensory input, a touch on the arm, a specific call of their name. Directions given to a roup may not be interpreted to be inclusive 0 them. A ain, we see joint attention rearing its’ ugl hea here. Auditory processing for kiddos with A D is traditionally a weakness; so many times you will see a response that does not “fit” the stimulus that you provided. Example: You may ask the child to “get your art materials, make sure that you cut the shapes out following the lines and then throw away your trash” Multi-step directions, given without any support may lead to the child cutting the shapes out and throwing away ALL of his/ her work, rather than just the scraps.
  • 22. Intervention Providing students with visual supports to help guide their understanding of the demands in their environment is an essential component to a quality program. Fluency/ Precision Teaching has been used effectively to teach children with ASD to develop Joint Attention (a critical element to successful inclusion in the general education setting).
  • 23. What might we see in the area of Social Interaction? Children playing by themselves or on the perimeter of others, kiddos whose attempts to join in or to show an interest are primitive in nature and therefore misinterpreted. Literally, they are frequently observed on the outside looking in.
  • 24. Intervention In order to help children begin to interact with others we need to make social exchanges a bit more predictable, in order to do that the use of Social StoriesT'V' have been very helpful. In addition, scripting of social interactions has proven successful in beginning readers.
  • 25. Children who speak to you and look elsewhere (usually at your mouth! ) these are kiddos that seem to find it painful to look at people in the eyes, I taught a young boy who uickly became angry with me when I insisted on eye contact, e said: “Alright, listen up I can either look at you, or I can listen, what’s it gonna be? ” Truly it was one of the most enlightening moments of my _ educational career, at the same time we know that in order to read the facial expressions of others, we must look at their eyes. As the old proverb says” The eyes are the window to the soul. ” Culturally Americans believe that our eyes convey information regarding ' honesty and integrity that our other communication systems can shroud. However it is the Japanese use of emoticons that reall illustrate how important the eyes are. In Japan, emoticons ten to: emphasize the eyes, such as the happy face ("_") and the sad face (; _;). [1] [1] httpt‘/ /wwwrlivescie‘nce: co'm7h‘e‘althI0705‘1’0:fa‘cial; cultu‘re. html
  • 26. Intervention 0 Eye contact, the hallmark of autism, however guiding them to stay engaged with materials and through the use of “props” will often be more beneficial to their social development than insisting on eye contact.
  • 27. Frequently, peer interactions are limited in scope and in frequency. The number of peers with whom the child interacts is significantly fewer than same age peers. In most instances, students with ASD gravitate toward younger children. One of the limiting factors for many kids on the spectrum is the narrow scope of interests that many students with ASD have, clearly, not sharing interests with others makes appropriate peer relationships difficult. For those fortunate enough to have similar interests as those around them, they can still exhibit differences in their intensity of interest or their knowledge base of the topic, all of which can deter same age peers.
  • 28. Developing shared/ common interests with neuro-typical children. Linda Hodgdon wrote an article in Autism Spectrum Quarterly (GREATPUBLICA TION! ) on incorporating visual strategies for teaching social skills. In the article she speaks of “People Pages” and other interventions that have been used successfully to develop social opportunities for kids. In addition, Scott Bellini has book out that is summarized on the Indiana Autism Resource Center’s website and is an excellent resource.
  • 29. Children with ASD frequently can be seen pressed up against other students, sitting on the lap of a staff member far beyond the age that we view that behavior as acceptable and investigating others in a fairly "personal" manner. For Americans, the optimal distance for normal social conversation can roughly be measured by standing face-to-face with an individual, extending your arm, and sticking yourthumb into the erson's ear(Yeah, reall , try it and see! But tell them what you are oing firstl). For the Britis , the preferred distance is slightly further away (approximated by putting the palm of your hand on the forehead), and for Latin America, Arabs, and many Mediterranean peoples, the distance will be closer (approximated by putting the aim of your hand against the back of their head). While there will a ways be some inter- and intra-group variation, “preferred" social distance is remarkably stable even simple casual observation will reveal what is the local norm at your study abroad site. [1] U] http: //, w_w, w,. uop. e_du(SlS(cultui; e(p_ubL1 . .5.2_; _Public_and_Private_. htm
  • 30. Personal Space is another common issue the neuro-typical population has with those with ASD. In order to teach the concepts, we need to make the teaching visual; the use of the Circle Program can help to provide the visual that is needed to develop understanding and safety. We have tried a number of other interventions such as being an arm’s length away, or for those kids who consistently get too close to teach them to approach and then take a step back.
  • 31. For some kids on the spectrum, it is the interpretation of social settings that drives their response, so think about it, if you and I perceive things differently and attend to radically different aspects of any given situation our response will be dramatically different. For example, the loss of a privilege (even for a short time) can cause extreme distress, a sin le good grade, a feeling of euphoria. Or on more of a socia note, not being chosen for a Scholar Bowl Competition completely unfair, “those other people don’t know half of what I do about ” ASD has been coined “extreme male brain”. Literal, linear thinking, that language is slower to develop, spatial relations are a strength, reliance on pictures and other visual supports to enhance learning is more essentIal. [1] [ll . http? //vwvwtautismres‘e‘a'rch‘ce‘ntretco‘m/ docs/ papersi’1 999;BC _extrememaIebrain. pdf
  • 32. Intervention 0 Once again interventions such as Social Stories“ can help the child to prepare and understand the social situations when otherwise he/ she might just react. Exposure to a variety of social settings, increasing the number of opportunities and priming the student for success is always best practice.
  • 33. What are these Unique Behaviors? 0 Over emphasis of routine, being late to school, having to take a different route to the store, a substitute teacher, a change in locker location at the beginning of a new year. .. any of these events may act as a trigger for stress and ultimately even a behavior issue.
  • 34. Over emphasizing routine is frequently referred to as r/ igidity. Rigidity can prove to be a formidable foe! ith a poor ability to internally structure time sequence events and predict the future persons with ASD rely on routines to provide structure. It is essential that we provide environmental structures through physical arrangement of the environment, providing visual schedules, and teaching the use of the schedule. We want the child to be able to depend on the schedule, not the routine. It is so much easier to change the schedule because we do so through the relative strength of visual processing as opposed to changing a routine through the auditory channel.
  • 35. What are these Unique Behaviors? Tantrums or Meltdowns are frequently seen when the child is unsure as to what needs to be done or his/ her ability to successfully complete the work. Tantrums come in a variety of forms, sometimes they involve screaming, profanity, throwing of objects, putting oneself to the floor, aggression towards others or objects, crying. All of these behaviors indicate the need for additional supports.
  • 36. 0 Tantrums and Meltdown are failures; they are failures on our part to adequately predict the child's response to any given set of demands or circumstances. Once a meltdown has occurred it is much more likely to happen again (as with any behavior), with that said it is important to understand the underlying characteristic(s) (UC) that is supporting the behavior and then look at preventative measures. If a Functional Behavior Assessment has been completed and the behavior persists, we need to dig down to the UC to ferret out the real issue.
  • 37. What are these Unique Behaviors? 0 Prolonged engagement with materials that others of the same age do not engage with, sifting of rocks, sand, bark on the playground. Twirling of a straw, the lining up of objects, drawing the same image repeatedly.
  • 38. Intervention 0 Battling self-stimulatory behavior can be a challenge for students with ASD. The addition of structure, the use of contracts and contingencies for replacing the behavior with more appropriate behavior and shaping are all interventions that have been used successfully with self-stimulatory behavior
  • 39. What are these Unique Behaviors? Interests that become restrictive and limiting, for example being an expert on Royal brand vacuum cleaners or only talking about Dachshunds, being able to recite the signers of the US Constitution and who they represented. Being attached to favorite toys, parts of objects, continually clutching those items to the point that it interferes with their ability to function in the current setting.
  • 40. Intervention 0 Once again, Social Stories” have been used extensively with children exhibiting these behaviors as have reinforcement systems that are visual in nature. Providing a time for them to further explore their interests, and using those interests to reinforce new and challenging tasks and skills.
  • 41. , especially during times that lack structure or meaning. Sometimes being in proximity to others that are active will incite these behaviors. lnterpretin stereotypical behavior is a real hit and miss affair. I_itera Iy, these behaviors can be a sign of joy, terror, boredom or excitement; we know that they almost always are indicative of extremes. While we all hope that those around us get to enjoy the feeling of excitement and joy, the evidence with persons with autism tells us that they will struggle to regilate their responses and that at times the responses may be inappropriate. I worked with a youn man who was so excited about a field trip that we h planned to o to the circus that he became very impulsive, engage in extensive flapping, and escalated into aggressive behavior.
  • 42. Intervention Priming, pre-teaching, written strategies, contingency contracts have been effective interventions when working with kiddos who struggle with self-regulation.
  • 43. What are the Big Ideas? 0 Effective Programming : 0 Underlying Characteristics 0 Integration 0 Focused 0 Comprehensive 0 Fluency
  • 44. When things are going poorly. .. 0 Ask the Three Essential Questions 0 Are you asking for performance of a skill that is too hard? 0 Are you asking for performance of a skill that has not been taught? 0 Are you asking for a task to be completed? From The Ziggurat Model Aspy and Grossman
  • 45. Lee’s email and phone 0 | stickle@kumc. edu 0 http: //wvvw. s|ideshare. net/ Istickle 0 816-223-8181 0 wvvw. ksndsp. org (lending library)

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