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  • **Give handoutEstablished Treatments – An extensive review of treatment literature indicated that there was sufficient evidence to determine that these 11 treatments are effective.Antecedent Package: Modifying the events that happen before the target behavior occurs. These modifications are intended to increase the likelihood the student will be successful and / or decrease the occurrence of problem behavior. Treatments that fit into this category include applied behavior analysis (ABA) and positive behavior supports. Some examples include: behavioral momentum, prompting / prompt fading, environmental modification of task demands, inter-trial interval, seating, errorless learning, non-contingent reinforcement, and stimulus variation.Behavioral Package: The goal is to use behavior change principles to reduce problem behavior and to teach a more appropriate replacement behavior. Treatments that fit into this category ABA and positive behavior supports. Some examples include:chaining, differential reinforcement strategies, discrete trial teaching, functional communication training, mand training, reinforcement, shaping, successive approximation, task analysis, and token economy.Comprehensive Behavioral Treatment for Young Children: This treatment reflects programs that include a combination of ABA procedures, which are delivered to children typically 8 years old or younger in a variety of locations (e.g., home, self-contained classroom, inclusive classroom, community). These programs usually involve a low student-to-teacher ratio (e.g., 1:1). You may also hear these programs referred to as ABA programs.  Joint Attention Intervention: This involves teaching a child to respond to the nonverbal social bids of others or to initiate joint attention interactions. Examples include pointing to objects, showing items / activities to another person, and following eye gaze.Modeling: These interventions rely on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with ASD. Modeling can include simple and complex behaviors. This intervention is often combined with other strategies such as prompting and reinforcement. Examples include live modeling and video modeling. Naturalistic Teaching Strategies: These interventions involve using primarily child-directed interactions to teach functional skills in the natural environment. These interventions often involve providing a stimulating environment, modeling how to play, encouraging conversation, providing choices and direct / natural reinforcers, and rewarding reasonable attempts. Examples of this type of approach include but are not limited to focused stimulation, incidental teaching, milieu teaching, embedded teaching, and responsive education and prelinguistic milieu teaching. Peer Training Package: These interventions involve teaching children without disabilities strategies for facilitating play and social interactions with children on the autism spectrum. Peers may often include classmates or siblings. Common names for intervention strategies include peer networks, circle of friends, buddy skills package, Integrated Play Groups, peer initiation training, and peer-mediated social interactions. Pivotal Response Treatment: This treatment is also referred to as PRT, Pivotal Response Teaching, and Pivotal Response Training. PRT focuses on targeting “pivotal” behavioral areas – such as motivation to engage in social communication, self-initiation, and self-management, and responsiveness to multiple cues, with the development of these areas having the goal of very widespread and fluently integrated collateral improvements. Key aspects of PRT intervention delivery also focus on parent involvement in the intervention delivery, and on intervention in the natural environment such as homes and schools with the goal of producing naturalized behavioral improvements. This treatment is an expansion of Natural Language Paradigm, which is also included in this category.Schedules: These interventions involve the presentation of a task list that communicates a series of activities or steps required to complete a specific activity. Schedules are often supplemented by other interventions such as reinforcement. Schedules can take several forms including written words, pictures or photographs, or work stations. Self-management: These interventions involve promoting independence by teaching individuals with ASD to regulate their behavior by recording the occurrence/non-occurrence of the target behavior, and securing reinforcement for doing so. Initial skills development may involve other strategies and may include the task of setting one’s own goals. In addition, reinforcement is a component of this intervention with the individual with ASD independently seeking and / or delivering reinforcers. Examples include the use of checklists (using checks, smiley/frowning faces), wrist counters, visual prompts, and tokens. Story-based Intervention Package: Treatments that involve a written description of the situations under which specific behaviors are expected to occur. Stories may be supplemented with additional components (e.g., prompting, reinforcement, discussion, etc.). Social Stories are the most well-known story-based interventions and they seek to answer the “who,” “what,” “when,” “where,” and “why” in order to improve perspective-taking. 
  • University of Chicago –Comer Children’s Hospital
  • Grace Baranek, Ph.D., and Steve Reznick, Ph.D. All are team members in UNC’sProgram for Early Autism Research, Leadership & Service (PEARLS), 2002
  • Joseph Piven, MD – Infant Brain Imaging Study a longtitudinal study **Brains studies via MRI and 6, 12 and 24 monthsChildren’s Hospital of Philadelphia, University of North Carolina, University of Washington and Washington University in St. LousPiven and his colleagues followed 92 infants to study early brain and behavior development. Many of these infants had older siblings on the autism spectrum and, so, were at elevated risk of developing ASD themselves.
  • Examples include but are not restricted to: behavior chain interruption (for increasing behaviors); behavioral momentum; choice; contriving motivational operations; cueing and prompting/prompt fading procedures; environmental enrichment; environmental modification of task demands, social comments, adult presence, intertrial interval, seating, familiarity with stimuli; errorless learning; errorless compliance; habit reversal; incorporating echolalia, special interests, thematic activities, or ritualistic/obsessional activities into tasks; maintenance interspersal; noncontingent access; noncontingent reinforcement; priming; stimulus variation; and time delay.
  • This is how many environments look to our students with autism: OVERWHELMING
  • Nonverbal Communication Difficulties:- Recognizing the facial expression of others, maintaining eye contact, facial expressions that are congruent with emotion, modulating tone of voice, recognizing the “meaning behind the tone of another’s voice, recognizing nonverbal cues/body language, uses gestures to communicate needs, correctly interpreting emotions of others, demonstrate wide range of facial expressionsSocial Initiation - Joining in activities with peers, asking a question to request info, requesting assistance, demonstrating timing with social initiation, asking question to request info about topic, invite peers to join activities, joins a conversation with two or more people, initiates greetings with others, introduces self to othersSocial Reciprocity- Taking turns, responds to the greeting of others, allows peers to join in activities or assists with tasks, ends conversations properly, maintain give/take of conversations, reads .Social Cognition – (compromises during disagreements, responds promptly in conversations, talks about topics others find interesting, understanding of jokes/humor, considers multiple view points, correctly interprets the intention of others, staying on-topic during conversations, using eye contact or other gestures to direct another’s attention.Perspective Taking and Self-Awareness – expresses sympathy for others, talks about or acknowledges the interests of others, provides compliments to others, engages in socially appropriate behaviors,
  • Research indicates a correlation between poor social skills and negative peer relationships, peer rejection, depression, aggression, anxiety, poor school performance, and delinquency (e.g., Parker & Asher, 1987). ExamplesSocial Domain -Interactions with peers, empathy, social participationPeer relationshipsSelf-management - Self-control, responsibility, classroom compliance, independence, social conventionAcademic - Following rules, task orientation, academic responsibilityCompliance - Cooperation to explicit and implied rulesAssertion - Assertive social skills, initiation
  • This is a process..We have to assess before we can teach/support
  • Very Literal“Keep your heads up”…Must be taught these skills directlyNoticed anything unusual about the dramatic play area in the classroom here? (KIDS ARE NOT REALLY USING THIS AREA AS OTHER YOUNG CHILDREN
  • Very Literal“Keep your heads up”…Must be taught these skills directlyNoticed anything unusual about the dramatic play area in the classroom here? (KIDS ARE NOT REALLY USING THIS AREA AS OTHER YOUNG CHILDREN
  • If the problem is an acquisition deficit, or a “can’t do” problem, you can use effective instruction to teach the missing skills. Effective instruction consists of six key elements:1. Review and check the previous day’s work (and reteach, if necessary).2. Present new content or skills (model demonstration).3. Provide guided student practice (and check for student understanding).4. Provide feedback and correction (and reteach if necessary).5. Provide independent student practice.6. Review frequently.
  • Facilitate = set up opportunity for “it” to happen
  • Example of Answering the phone – video is on the drop box under videos for vsm
  • IDEA definition of challenging behavior Repeated pattern that interferes with daily functioning Smith, B., & Fox, L. (2003). Systems of service delivery: A synthesis of evidence relevant to young children at risk of or who have challenging behavior. Tampa,FL: Center for Evidence-Based Practice: Young Children with Challenging Behavior, University of SouthFlorida.
  • AcademicAdaptive living skillsBehaviorCommunicationSocialVocational
  • Timmy videoShow video clips and practice taking ABC data and completing the behavior support plan for the child in the video.
  • Examples include but are not restricted to: behavior chain interruption (for increasing behaviors); behavioral momentum; choice; contriving motivational operations; cueing and prompting/prompt fading procedures; environmental enrichment; environmental modification of task demands, social comments, adult presence, intertrial interval, seating, familiarity with stimuli; errorless learning; errorless compliance; habit reversal; incorporating echolalia, special interests, thematic activities, or ritualistic/obsessional activities into tasks; maintenance interspersal; noncontingent access; noncontingent reinforcement; priming; stimulus variation; and time delay.
  • Examples include but are not restricted to: behavioral sleep package; behavioral toilet training/dry bed training; chaining; contingency contracting; contingency mapping; delayed contingencies; differential reinforcement strategies; discrete trial teaching; functional communication training; generalization training; mand training; noncontingent escape with instructional fading; progressive relaxation; reinforcement; scheduled awakenings; shaping; stimulus-stimulus pairing with reinforcement; successive approximation; task analysis; and token economy. Examples include but are not restricted to: choice + embedding + functional communication training + reinforcement; task interspersal with differential reinforcement; tokens + reinforcement + choice + contingent exercise + overcorrection; noncontingent reinforcement + differential reinforcement; modeling + contingency management; and schedules + reinforcement + redirection + response prevention. Studies targeting verbal operants also fall into this category
  • Choices: may need to be provided depending on the situation (i.e., wouldn’t do extinction in Walmart)
  • ***Update referencesDuker, P.C., & Rasing, E. (1989). Effects of redesigning the physical environment and on-task behavior in three autistic-type developmentally disabled individuals. Journal of Autism and Other Developmental Disorders, 19, 449-60.Flannery, K. B., & Horner, R. H. (1994). The relationship between predictability and problem behavior for students with severe disabilities. Journal of Behavioral Education, 4, 157-176.Horn, 2003?????????Kozol, J. (1991). Savage inequalities: Children in America’s schools. New York: Crown.\\Minshew, N., Goldstein, G., Muenz, L., & Payton, J. (1992). Neuropsychological functioning of non-mentally retarded autistic individuals. Journal of Clinical and Experimental Neuropsychology, 14, 749-761. Steingard, R.J., Zimnitzky, B., DeMaso, D.R., Bauman, M.L. & Bucci, J.P. (1997). Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder. Journal of Child and Adolescent Psychopharmacology, 7, 9-15.Schopler, R.J., Brehm, S., Kinsbourne, M., & Reichler, R.J. (1971). The effect of treatment structure on development of autistic children. Archives of General Psychiatry, 24, 415-421Schopler, E., Mesibov, G., and Heasey, K. (1995). Structured teaching in the TEACCH system. In E. Schopler and G.B. Mesibov, Eds., Learning and Cognition in Autism (pp 243-268).
  • ***Update referencesDuker, P.C., & Rasing, E. (1989). Effects of redesigning the physical environment and on-task behavior in three autistic-type developmentally disabled individuals. Journal of Autism and Other Developmental Disorders, 19, 449-60.Flannery, K. B., & Horner, R. H. (1994). The relationship between predictability and problem behavior for students with severe disabilities. Journal of Behavioral Education, 4, 157-176.Horn, 2003?????????Kozol, J. (1991). Savage inequalities: Children in America’s schools. New York: Crown.\\Minshew, N., Goldstein, G., Muenz, L., & Payton, J. (1992). Neuropsychological functioning of non-mentally retarded autistic individuals. Journal of Clinical and Experimental Neuropsychology, 14, 749-761. Steingard, R.J., Zimnitzky, B., DeMaso, D.R., Bauman, M.L. & Bucci, J.P. (1997). Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder. Journal of Child and Adolescent Psychopharmacology, 7, 9-15.Schopler, R.J., Brehm, S., Kinsbourne, M., & Reichler, R.J. (1971). The effect of treatment structure on development of autistic children. Archives of General Psychiatry, 24, 415-421Schopler, E., Mesibov, G., and Heasey, K. (1995). Structured teaching in the TEACCH system. In E. Schopler and G.B. Mesibov, Eds., Learning and Cognition in Autism (pp 243-268).
  • ***Update references
  • Update references
  • FRC

    1. 1. +Providing Support for Individuals with Autism SpectrumDisorders and Significant Disabilities Angela Johnston Suzanne Holmes-Bunde Wendy Acri
    2. 2. +By the end of this training, allparticipants will:  Know  Understand  Do
    3. 3. +Characteristics:Autism SpectrumDisorders
    4. 4. Autistic DisorderAsperger’sSyndromePervasiveDevelopmental DisorderNot Otherwise Specified(PDD-NOS)Rett’sSyndromeChildren’s DisintegrativeDisorder
    5. 5. +
    6. 6. Developmental Rate and Sequences:+ Implications • May have unusual or peak skills • Uneven skill development • Skill development may not follow normal developmental patterns
    7. 7. +Cognition:Implications• Inconsistent intellectual responses• May function nearly normally in one or more intellectual areas• Difficulties with imitation• Low cognitive skills
    8. 8. +Communication: Implications• Lacks understanding of body language, gestures, facial expressions and hand signals• Difficulties with conversational turn-taking• May use immediate or delayed echolalia; repeats questions• Unusual language structure• Unusual intonation, tone, pitch, rate and/or rhythm• Speech can be literal or concrete (doesn’t understand metaphors, jokes, idioms, sarcasm or humor)• Deficits in expressive/receptive language; skills range from no communication to adequate speech with idiosyncrasies
    9. 9. • + Appears to be hearing impaired; unpredictable response to sounds• Difficulty filtering out extraneous sensory information• Tactile defensiveness• Sensitivity to smells, tastes, and textures; licks, chews, mouths, smells objects• Avoids looking at people; views things at unusual angles• Stares through people/space; strange responses to mirrors/lights Sensory Processing: Implications
    10. 10. + Social Participation: Implications• Difficulty understanding another person’s perspective• Difficulty establishing or maintaining relationships• Difficulties with imagination• Inappropriate/odd play• Lacks understanding of reciprocity (turn taking)• Lack of eye gaze• Prefers solitary play or work
    11. 11. +Repertoire of Activities: Implications  Difficulty with change/transitions  Need for routine and sameness, may have rituals  May use toys in inappropriate or odd ways.  Repetitive, non-functional movements that serve no purpose (body rocking, finger and hand posturing, spinning)  Displays behaviors characterized as self- stimulatory (paper flapping)  Stereotypical patterns of behavior; strong attachment to particular objects
    12. 12. +Facts About ASD  Developmental disability that life long is  Occurs in approximately 1/88 births  Ratio of males to females is 4:1  Occurs on a continuum from mild to severe  Some children appear to be developing normally until they are about 18 months of age  Many parents report that they knew something was different about their child as an infant  Lifetime costs associates with ASD are high – reduce costs by choosing effective treatments
    13. 13. 1. Antecedent Package + 2. Behavioral PackageEvidence-Based Practice and Autism in the 3. Comprehensive Behavioral Treatment for Young Children 4. Joint Attention InterventionSchools: NAC Report (2009) 5. Modeling 6. Naturalistic Teaching Strategies 7. Peer Training Package 8. Pivotal Response Treatment 9. Schedules 10. Self-management: 11. Story-based Intervention Package
    14. 14. + Research from the University of Chicago – warning signs no eye contact at 3 to 4 month no babbling, pointing, or gesturing by age 12 months no single words spoken by age 16 months no two-word spontaneous (non- echolalic, or not merely repeating the sounds of others) expressions by age 24 months loss of any language or social skills at any age
    15. 15. +By a child’s firstbirthday she/heshould:•Turn to look at you when you calltheir name?•Seem bothered by loud sounds?•Should look at a familiar face forcomfort in a new or unfamiliarsituation?•Becontent to play alone for anhour or more at a time?
    16. 16. + Infant Brain Imaging- EmergingLongitudinal Study Differences evident in communication pathways between parts of the brain
    17. 17. + SUPPORTS AND STRUCTURE
    18. 18. + Basic Assumptions  A cookbook approach DOES NOT work  Ifuniversal interventions and targeted group interventions are not successful, a student with ASD may require individualized interventions.  Current literature suggests need for VISUAL SUPPORTS for student with autism.  Research has demonstrated that students with ASD tended to perform better in a STRUCTURED teaching situation compared to unstructured environments.  Changing the environment is easier than changing the person.
    19. 19. Elements of the+ Environment Physical Environment Routines and Procedures Activities and Schedules Visually-Cued Instruction
    20. 20. EVIDENCE-BASE: AntecedentStrategiesNational Autism Center Standards Report (2009): Antecedent Package (EstablishedPractice) +“These interventions involve the modification of situational events that typicallyprecede the occurrence of a target behavior. These alterations are made toincrease the likelihood of success or reduce the likelihood of problems occurring.Treatments falling into this category reflect research representing the fields of appliedbehavior analysis (ABA), behavioral psychology, and positive behaviorsupports. ” (NAC, page 44)
    21. 21. +  The physical structure of an area establishes the basic foundation for the learning space and can have tremendous influence on student behavior, thus it is an ANTECEDENT.PhysicalEnvironment
    22. 22. +
    23. 23. + How do you know if you need to modify the physical environment? Child may be wandering Child may spend a lot of time self-stimulating Leaving the area or room Distractibility Lack of engagement Unaware of spatial boundaries
    24. 24. + Setting up the Environment to meet Your Child’s Needs Things needed to meet your child’s needs: Visual Cues Predictability Structure
    25. 25. +Visual Cuesassist in providingPredictabilityand Structure*People with autism learn by seeing They help your child know:  What to do  When to do it  Where to do it  How to do it  What will happen when it is done
    26. 26. + Packaging Groceries
    27. 27. +  THINK OF YOUR CURRENT ROOM ARRANGEMENT:  Does it pass the strangerStranger Test test?  If a stranger walked in, is it visually clear where different activities occur?
    28. 28. + How do we know that a person may need support while working? Not starting or completing work Not moving on to the next activity Work is done incorrectly Adult prompt dependent Stereotypy/self-stim Disorganized, can’t find materials
    29. 29. + Considerations  Level of functioning and age of person  Prompts needed  Reinforcers that support independent work  Life skills  Need to match work content to student’s ability level
    30. 30. Promoting Social Competence andInteraction Skills for People withAutism Spectrum Disorder +
    31. 31. + Common Difficulties Nonverbal communication Social initiation Reciprocity and terminating interactions Social cognition Behaviors associated with perspective taking and self-awareness Social anxiety and social withdrawal Bellini, Building Social Relationships, 2006
    32. 32. People withAutism Spectrum Disorders Social dysfunction is the single most defining feature of autism and arguably its most handicapping as well.
    33. 33. +
    34. 34. +Social Skills are Learned BehaviorsRelated to Getting Along in Everyday Life.
    35. 35. Life ImplicationsHow can we help people with AutismSpectrum Disorder increase meaningfulsocial interactions and socialcompetence?
    36. 36. +Social Skills 5 Step Model in Assessing/Intervening 1. Assess Social Functioning 2. Distinguish Between Skill Acquisition and Performance Deficits 3. Select Intervention Strategies • Strategies That Promote Skill Acquisition • Strategies That Enhance Performance 4. Implement Intervention 5. Evaluate and Monitor Progress Scott Bellini, Building Social Relationships
    37. 37. + Strategies to Enhance Socialization and Social Competence“Students with AutismSpectrum Disorder maylack the prerequisite skillsimitation, play, andattending/engagement,which facilitate thedevelopment of appropriatesocial skills. Thesestudents need directinstruction to remediatethese skill deficits.”( National research council, 2001;Wolery and Garfinkle,2002)
    38. 38. + Social Skill Differences Areas to Consider When Assessing Social Interaction and Competence Play/Leisure functional toy play to cooperative play Social Reciprocity “give and take of social interactions” Imitation “Doing what I do, following peers” Joint Attention Attending in Unison to an Object with another Person
    39. 39. + Areas to Consider When Assessing Play or Leisure Skills Social Reciprocity Imitation Joint Attention Acquisition Performance / Fluency Can They Do Will They Do It? It?
    40. 40. Three Areas of Social Skills Deficits Acquisition – “Can’t Do” Performance – “Won’t Do” Fluency – “Might Do”
    41. 41. + I Know the Difficulties, Now What?
    42. 42. + Matching Intervention to Problem
    43. 43. +Acquisition Deficits Results from lack of knowledge about social skills. Teach skill using effective instruction guidelines. Reinforcement of skill. Generalization – practice in multiple settings.
    44. 44. Effective Instruction for AcquisitionDeficitsReview and check Present new content or skill (I doit) Provide guided student practice(We do it) Provide feedback and correction Independent practice (You Do it) Frequent review
    45. 45. Teaching Social SkillsAcquisition DeficitsSocial Skills should be taught explicitly (Good Direct Instruction Strategies)!
    46. 46. Acquisition Deficits: Instructional Strategies Direct teaching of social skills I Do, We Do, You Do Feedback/Correction Frequent Review/Opportunities to Practice Facilitating expected behavior Methods to supplement direct instruction Social stories Video Modeling Comic strip conversations Concept mastery Social autopsies Cost/payoff
    47. 47. +
    48. 48. + Performance DeficitsOccurs when student has been taught abehavior, but does not consistently use thebehavior. The problem behavior is more effectivethan the appropriate social skill in gettingthe student’s needs met.
    49. 49. Effective Instruction forPerformance Deficits – 4 steps 1. Provide guided practice • “We do it” 2. Provide feedback and correction • reinforcement of appropriate behavior • withholding of reinforcement for displays of inappropriate behavior 3. Independent practice  “You do it” 4. Frequent review
    50. 50. Priming Performance DeficitsFocus on Enhancing Performance of Existing Skills *Remove barriers that impede performance
    51. 51. Performance Deficits:Instructional Strategies Facilitate Expected Behavior Peer Training Methods to supplement Direct Instruction Social Narratives (social stories, scripts and action Cards” Video Modeling Comic strip conversations Cognitive Mapping Social autopsies Cost/payoff Visual Supports (cues, “Action Cards”)
    52. 52. + Fluency Deficits Know the correct response,have exhibited the correctresponse in the past, but havenot practiced to the point ofmastery. Practice of skills in multiplesettings Reinforcement of skills
    53. 53. Effective Instruction for Fluency Deficits – 3 steps1. Provide feedback and correction  reinforcement of appropriate behavior  withholding of reinforcement for displays of inappropriate behavior2. Independent practice3. Frequent review
    54. 54. + Generalizing Social Skills-an example From “Using key instructional elements to systematically promote social skill generalization for students with challenging behavior” by S. W. Smith and D. L. Gilles, 2003, Intervention in School and Clinic, 39, pp. 30-37. Copyright (2003) by PRO-ED, Inc. Reprinted with permission.
    55. 55. + Social Stories Presents information visually Describes expected behavior Helps student see social situations from another person’s perspective Proactive strategy Designed to reduce future social dilemmas Developed by Carol Gray
    56. 56. + Social Stories – type of sentences Descriptive sentences- describes the situation Directive sentences-explains the expected behavior Perspective sentences-what people might be thinking, feeling, or believing Affirmative sentences- helps identify important concepts Cooperative sentences-a description of roles others play in a situation Control sentences-written by student to assist in recall
    57. 57. + Social Scripts Provide pre-taught language for specific situations based around social interactions.  When I go to a fast food restaurant I stand in line until it is my time to order. The person taking the order will say something like, “Hi, what would you like to order?” I will say, “I want a cheeseburger, a small order of fries and a small coke.” If he asks me if I want anything else, I will say “No.” I will then hand him a five dollar bill and will be given some change. I will say, “Thank you,” when I get my food.
    58. 58. +
    59. 59. + Video Modeling  Involvesthe presentation and observation of a videotaped episode of target behaviors being completed by a model or by the student themselves (Video Self-Modeling)
    60. 60. Comic Strip ConversationsAllows the person to seethe invisible thoughts andreactions of others. Adult encourages andprompts student toconsider situationalfeatures of a specificconversation.
    61. 61. +
    62. 62. +Peer Training Teaching others without disabilities strategies (initiation and peer training) for facilitating leisure and social interactions with people on the autism spectrum.
    63. 63. + Behavior
    64. 64. + Activity: What is challenging behavior?  What words come to mind when you think of challenging behavior?  Tantrums  Stress  Fighting  Ignoring directions  Others????
    65. 65. + Challenging Behavior Defined  “Any repeated pattern of behavior that interferes with or is at risk of interfering with optimal learning or engagement in pro- social interactions with peers and adults.”  Smith & Fox (2003)
    66. 66. +Behaviorsare actions we can seeand they have purpose….
    67. 67. + Prove it’s ExistenceBehavior is Observable See It Hear it Touch it
    68. 68. +Behavior is MeasurableIf a behavior is measurable you candetermine: How many (frequency) How long (duration) How severe/forceful (intensity) How long between (latency) How accurate
    69. 69. + Behavior Examples Examples: Non-examples:  Hitting  Angry  Crying  Depression  Throwing  Autism  Not following  Sad directions  Running away
    70. 70. + Challenging Behavior Communicates a Message Behavior = communication  Used instead of language when people have limited communication skills, social skills, or has learned that behavior will result in meeting his/her needs
    71. 71. + Challenging Behavior Works People engage in behavior because it “works” for them Challenging behaviors result in the person “gaining” or “escaping” something or someone Challenging behavior is functional
    72. 72. + Basic Three-Term Contingency A (antecedent) ->B (behavior) ->C (consequence) The Three-Term Contingency is used to:  Teach new behaviors/skills in any domain  Understand and decrease problem behaviors Antecedent-Behavior-Consequence (ABC) Relationship  Antecedent = environment and what happens before a target behavior  Behavior = the observable actions an individual displays  Consequence = responses to the target behavior that determine whether or not the behavior will occur in the future (reinforcement) or not (punishment)
    73. 73. + How Do We Learn? Antecedent (Stimulus) Consequence Behavior (Reinforcement) (Response)
    74. 74. + How Do We Learn?I want “it”!! Antecedent/S timulus “It’s available!” It worked!! Behavior/Resp Consequence/ onse Reinforcement I cry or take I get it it
    75. 75. + How Do We Learn?I don’t know how todo it. Antecedent/S timulus Clean the kitchen Consequence/ It worked!! Reinforcement Behavior/Resp onse You help me I cry, hit or don’t myself or make me do hide it
    76. 76. + How Do We Learn? Antecedent/S timulus I don’t want to work” It worked!! Behavior/Resp Consequence/ onse Reinforcement I cry , run “I stay in my away or hit room” myself
    77. 77. + Information for an FBA Antecedents Behavior Consequences Data
    78. 78. Behavior Problem Underlying Purpose (Function) (usually Escape from… or Gain access to…)Skill deficits, neurological differences,and learning history combine to lead toproblem behavior.
    79. 79. + GAIN: ESCAPE/AVOID:Activity, Toy or Item Unwanted Attention Parent’s Attention Non-Preferred or Activities, Items or Family Member’s Objects, Difficult attention Tasks AUTOMATIC: While multiple factors contribute to the development of these behaviors, understanding their purpose or function is the key to addressing the problem.
    80. 80. + Functions of Challenging Behavior  Gain  Escape  Things (money, food,  Things (unwanted toys, etc.) tasks, something scary, etc.)  Attention (smiles, conversations,  Attention (reprimands, reprimands, etc.) conversation, hugs, etc.) Function = Purpose
    81. 81. Escape :Negativereinforcement70-75%Gain:PositiveReinforcement20-25%Automatic:AutomaticReinforcementLess than 2%
    82. 82. + Process for Behavior Support Step 1: Gathering information (Functional Behavior Assessment) Step 2: Develop a hypothesis (best guess) Step 3: Design a Behavior Intervention Plan Step 4: Implement, monitor, evaluate outcomes Step 5: Revise plan, generalize plan into other environments
    83. 83. + What is a Functional Behavior Assessment (FBA)?  “Identify the function(s) of an individual student’s behavior and provide information leading to effective interventions and needed supports” (State Special Education Manual)  A process for developing an understanding of challenging behavior and how the behavior is governed by environmental events.  Results in the identification of the “purpose” or “function” of the challenging behavior.
    84. 84. + Step 1: Gathering Information  Review records  Interview those who interact with the child  Observe the child in target routines and settings  Collect data on challenging behavior  Situations/settings that likely result in the behavior occurring (triggers)  Situations/settings that are linked with appropriate behavior occurring  What changes to the environment immediately occur as a result of the behavior occurring
    85. 85. +  Define behavior (describe what you see)  Behavior measurement (frequency, intensity, duration, etc.)  Identify predictors (triggers)  Identify immediate environmental changes due to behavior  Identify current communicative functions  Identify how fast the behavior “works”  Identify previous efforts for intervention  Identify possible reinforcers
    86. 86. + Step 2: Develop a Hypothesis  Putting ALL the information together  A hypothesis includes:  Antecedents: Triggers of the challenging behavior  Consequences: Responses that maintain the challenging behavior (why behavior increases or decreases)  Function: Purpose of the behavior
    87. 87. +  Possible antecedents/triggers:  Possible  Type of work/direction consequences/responses:  Difficulty of work  Adult or peer gives attention  Quality of attention  Adult or peer gives help  Communication skills  Toys or items are provided  Availability of preferred items  Work/direction is removed or temporarily delayed  NOTE: consequences do NOT always equate to punishment
    88. 88. + Example: Ethan  Ethan is playing with Legos. He tries to attach a block to his stack of 3. He can’t quite get the blocks to connect. He looks up at the adult and begins fussing. He holds the stack of blocks up, looks at the blocks, and looks at the adult. The adult helps him put the blocks together.
    89. 89. + The “ABC’s” Consequence/Resp onse Antecedent/Trigger Behavior Playing alone, can’t Looks at adult and Adult provides get blocks to work starts fussing assistance Function: gain adult attention/assistanc e
    90. 90. + Example: Claire  Claire is playing in her room. Her mom says, “Come on Claire. Time to go to brush your teeth.” Her mom pulls on her arm to try to get Claire to stand and go to the bathroom. Claire yells, screams, and begins throwing her toys. Her father says, “All right, 5 more minutes. But then we have to brush teeth.” Claire’s dad walks away, and Claire continues playing with her toys.
    91. 91. + The “ABC’s” Consequence/Resp onse Antecedent/Trigger Behavior Playing with toys Yelling, screaming, Dad gives 5 more and Dad gives throwing toys minutes to play, direction to “brush Function: escape delays brushing teeth” direction, gain teeth access to toys
    92. 92. +Let’s Practice: ABC Data Collection
    93. 93. + Step 3: Develop a Behavior Intervention Plan  Prevention Strategies  New skills  New responses to challenging behavior
    94. 94. + EVIDENCE-BASE: Antecedent Strategies  National Autism Center Standards Report (2009): Antecedent Package (Established Practice)  “These interventions involve the modification of situational events that typically precede the occurrence of a target behavior. These alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. Treatments falling into this category reflect research representing the fields of applied behavior analysis (ABA), behavioral psychology, and positive behavior supports.” (NAC, page 44)
    95. 95. + EVIDENCE-BASE: Consequence Strategies  National Autism Center Standards Report (2009): Behavioral Package (Established Practice)  “These interventions are designed to reduce problem behavior and teach functional alternative behaviors or skills through the application of basic principles of behavior change. Treatments falling into this category reflect research representing the fields of applied behavior analysis, behavioral psychology, and positive behavior supports. Treatments involving a complex combination of behavioral procedures that may be listed elsewhere in this document are also included in the behavioral package category..” (NAC, page 45)
    96. 96. + Prevention Strategies  Ways to make events and interactions that trigger challenging behavior easier for the person to manage  How can the environment be changed to reduce the likelihood that challenging behavior will occur?  What can be done to make challenging behavior irrelevant?  What procedures can I select that fit in the natural routines and structure of the home or family?  How can I build on what works?  What can be done to help the person not respond to the trigger or change the trigger so it does not cause challenging behavior?
    97. 97. + Sample Prevention Strategies  Modify instruction, materials, or activities  “Catch them being good”  Remind of rules/expectations prior to behavior occurring  Use visual supports: schedules, timers, first/then, etc.  Provide choices
    98. 98. + New Skills  New skills to teach throughout the day to replace the challenging behavior  Replacement skills must be efficient and effective (i.e., work quickly for the child).  Consider skills that the person already has  Make sure the response for appropriate behavior is consistent
    99. 99. + Does it feed the function? Identify an acceptable way that the person can deliver the same message. Make sure that the new response is socially appropriate and will access the person’s desired outcome. Teach the person a skill that honors that function of the behavior (e.g., if the person wants out of activity, teach child to gesture “finished”).
    100. 100. + Sample Replacement Behavior  Gain  Escape  Request leisure items  Request a break  Request more time  Say “all done”  Ask for help/attention  Request “a minute”  Ask for a turn  Say “no” or protest  Raise hand
    101. 101. + Response Strategies  What adults will do when the challenging behavior occurs to ensure that the challenging behavior is not maintained and the new skill is learned  Respond in a way that will make challenging behavior ineffective.  Make sure responses for appropriate behavior are equal to or exceed responses for challenging behavior.
    102. 102. + Sample Response Strategies  Gain  Escape  Planned ignoring  Avoid removing the demand  Restrict access to the  Redirect to use replacement preferred item behavior that allows for  Redirect to use replacement escape behavior that allows gain  Break activity down into  Use “wait time” smaller steps  Avoid using time-out
    103. 103. Ethan’s Behavior Intervention+ Trigger Behavior Maintaining Consequence• Playing alone: can’t get Looking at adult, fussing • Adults provided assistance toys to work Function: gain attention Preventions New Skills New Responses • Adult remains • Request adult help when • Ignore fussing but within close he is unable to work a toy prompt to request help proximity during play (individualized dependent • Provide immediate on current verbal skills attention for appropriate • Prior to play review new skill such as sign, picture card, help request • Provide toys that gesture, etc.) he is more likely successful with
    104. 104. Claire’s Behavior Intervention+ Trigger Behavior Maintaining Consequence• Playing with toys: Dad Screams, yells, throws toys • Dad gives 5 more minutes gives direction to brush • Temporarily delays teeth Function: brushing teeth gain access to toys, delay direction Preventions New Skills New Responses • Use visual cues of • Request more time with • Restrict access to toys timer; provide toys (i.e., one more during challenging transition warning minutes) behavior • Have her clean up • Request to take a toy with • Continue to provide the prior to giving the direction to brush her to brush teeth direction to brush teeth teeth • Prompt to use new • First/then: first skill(s) brush teeth, then • Immediately honor play with toys appropriate use of new again skill
    105. 105. + Step 4:  Identify outcomes valued by the team  “KIS it” (Keep It Simple) Create simple, user-friendly forms to monitor outcomes (e.g., rating scales, check sheets)  Schedule dates for check-ins
    106. 106. + If Challenging Behavior Returns:  First,  Review plan and make sure it is being implemented as planned.  Review evaluation data to determine if the pattern is an extinction burst (worse before it gets better).  Examine events to see if there are new triggers for behavior.
    107. 107. + If Challenging Behavior Returns (cont.) Then,  Restore support plan and implement with fidelity  Continue plan through extinction burst  Add components to plan to address new triggers  Conduct a new functional assessment and develop new support strategies.
    108. 108. + Step 5: Revise plan, generalize plan into other environments  Teach student to wait  Reduce supports  Increase expectations  Practice in new settings  Gradually decrease levels of reinforcement **NOTE: These changes should be made utilizing a planful team decision making process
    109. 109. How to Intervene withEscape/Avoid Behaviors+ Teach an alternative acceptable way to escape/avoid: •Ask for break or ALL DONE • This is too difficult • I need HELP
    110. 110. +How to Intervene with Escape/AvoidBehaviors  Provide break from nonpreferred following appropriate request or appropriate behavior.  Proactively decrease or eliminate the demand and gradually increase demand once successful (shaping).  Break an activity down into smaller steps.  Teacher should avoid removing demand (e.g., assignment) immediately following
    111. 111. How to Intervene with Attention-Maintained Behaviors Teach an alternative acceptable way to gain attention: + •Ask for ADULT attention • Request to talk • I need HELP • I want to play
    112. 112. + References Cooper, J. O., Heron, T. E., & Heward, W., L. (2007). Applied behavior analysis 2nd edition. Upper Saddle River, New Jersey: Pearson Education, Inc. Dooley, P., Wilczenski, F. L., & Torem, C. (2001). Using an activity schedule to smooth school transitions. Journal of Positive Behavior Interventions, 3(1), 57-61. Heflin, L.J. & Alaimo, D.F. (2007). Students with autism spectrum disorders: Effective instructional practices. Upper Saddle River, NJ: Pearson Education, Inc. Hume, K. & Odom, S. (2007). Effects of an individual work system on the independent functioning of students with autism. Journal of Autism and Developmental Disorders, 37, 1166-1180.
    113. 113. + References Kanner, 1943 Bellini,S (2006), Building Social Relationships, Autism Asperger Publishing Co. Peterson and Haralick, 1977;Mundy et al., 1987;Wetherby and Prutting, 1984;Corona et al., 1988 Dawson, Meltzoff, Osterling, Rinaldi, and Brown, 1998 National research council, 2001;Wolery and Garfinkle, 2002 Terpstera et al., 2002 Gray, Bulgren and Lenz,1996 Winner Utley and Mortweet, 1997
    114. 114. + References Lequia, J., Machalicek, W., & Rispoli, M. J. (2012). Effects of activity schedules on challenging behavior exhibited in children with autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 6, 480-492. MacDuff, G., Krantz, P., & McClannahan, L. (1993). Teaching children with autism to use pictographic activity schedules: Maintenance and generalization of complex response chains. Journal of Applied Behavior Analysis, 26, 89-97. Mayer, G. R., Sulzer-Azaroff, B., Wallace. M. (2012). Behavior analysis for lasting change (2nd Ed.) Cornwall-on-Hudson, NY: Sloan Publishing. National Autism Center (2009). National standards report. The national standards project: Addressing the need for evidence- based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center.
    115. 115. + References O’Reilly, M., Sigafoos, J., Lancioni, G., Edrisinha, C., & Andrews, A. (2005). An examination of the effects of a classroom activity schedule on levels of self-injury and engagement for a child with severe autism. Journal of Autism and Developmental Disorders, 35, 305-311. Panerai, S., Ferrante, L., & Zingale, M. (2002). Benefits of the treatment and education of autistic and communication handicapped children (TEACCH) program as compared with a non-specific approach. Journal of Intellectual Disability Research, 46(4), 318-327. Quill, K. (1995b). Visually-cued instruction for children with autism and pervasive developmental disorders.. Focus on Autistic Behavior, 10, 10-20. Saunders, R. R., Saunders, M. D., Brewer, A., & Roach, T. (1996). Reduction of self injury in two adolescents with profound
    116. 116. + References  National Research Council (2002) Educating Children with Autism. Committee on Education Interventions for Children with Autism. Catherine Lord and James P. McGee, eds. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.  Osterling, J., Dawson, G. & Munson, J. (2002). Early recognition of one year old infants with autism spectrum disorder versus mental retardation: A study of first birthday party home videotapes. Development and Psychopathology, 14: 239-252.  Wolff, J.J., Piven, J. & et al. (2012)Differences in White Matter Fiber Tract Development Present From 6 to 24 Months in Infants With Autism. American Journal of Psychiatry, 169: 6.  Watson, L. R., Crais, E.R., Translating Between Research and Practice in Serving Infants at Risk for ASD: Perspectives on Language Learning and Education February 2013 vol. 20 no. 1 4-1
    117. 117. +References  Alberto, P. A. & Troutman, A. C. (2012). Applied behavior analysis for teachers, 9th Edition. Columbus, OH: Merrill Prentice Hall.  Cooper, J. O., Heron, T. E., &Heward, W., L. (2007). Applied behavior analysis 2nd edition. Upper Saddle River, New Jersey: Pearson Education, Inc.  Crone, D. A. & Horner, R. H. (2003). Building positive behavior supports in schools: functional behavior assessment. New York, NY: Guilford Press.  Gage, N. A., Lewis, T. J., &Stichter, J. P. (2012). Functional behavioral assessment-based interventions for students with or at risk for emotional and/or behavioral disorders in school: A hierarchical linear modeling meta-analysis. Behavioral Disorders, 37 (2), 55-77.  Knoster, T., Wells, T., & McDowell, K. C. (2003). Using timeout in an effective and ethical manner. Des Moines, IA: Iowa Department of Education.  Mayer, G. R., Sulzer-Azaroff, B., Wallace. M. (2012). Behavior analysis for lasting change (2nd Ed.) Cornwall-on-Hudson, NY: Sloan Publishing.  National Autism Center (2009). National standards report. The national standards project: Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center.

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