Intervention for Children with Autism

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Intervention for Children with Autism

• Beth Munsch, teacher
• Sandi Pepoli, Speech Language Pathologist
• Jamie Dengler, Occupational Therapist
• Marsha Miller, Behavior Analyst

2
Successful Interventions

• Determine why a behavior is happening
• Teach reward the appropriate behaviors
• Reduce the inappropriate behaviors

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Applied Behavior Analysis

• Looks at the science of the behavior
• Realizes that
• Human Behavior is Functional
• Every behavior serves a purpose
• Human Behavior is Predictable
• There are triggers (antecedents) for behaviors
• Behaviors are learned based on consequences
• Human Behavior is Changeable
• Understanding the antecedents, consequences an
  functions can make problem behaviors irrelevant,
  inefficient and ineffective.

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The F-word!
FUNCTION

• EVERY behavior serves a function
• We need to find that function if we want to
  address the behavior
• The function will still need to be met by a
  Replacement Behavior
• Why stop getting what you want?
• Would you stop working if you had no money?

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Behavior is Functional
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Behavior is Functional
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Behavior is Communication

• Challenging behaviors are most often observed in
  children with limited communication skills
• Use behaviors as a means of communicating with
  others
• Communicative Intent

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What to think about when challenging behaviors
appear

• Ask yourself about the child
• What does child want or need?
• Is the child over/under stimulated?
• Is the child tired or hungry?
• Ask yourself about the context
• Is the child transitioning?

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What to think about when challenging behaviors
appear

• Ask yourself about the task
• Is the task too hard?
• Is the task too easy?
• Are my expectations clear?
• Did I specify amount of work required?
• Ask yourself about communication
• What is the child communicating?
• What is an alternate means of communication?

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What is he trying to request?

• Attention
• Preferred activities/items
• Escaping or evading tasks

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BEHAVIOR MANTRA

• It is easier to prevent a behavior from
  occurring, than to deal with it after it has
  happened.

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When you see a behavior challenge

• Make a hypothesis about the function.

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Competing Behavior Model
(Crone Horner, 2003 ONeill et al., 1997)
Jonny cries and bangs his head
Mom is on the phone in the other room
Jonny is in the room by himself
Mom hangs up comes in the room
Consequence (what happens after)
Behavior Problem
Setting Event
Antecedent (what happens before)
Gain Attention
Function
Permission to reproduce this document is granted.
Rob Horner, OSEP Technical Assistance Center on
Positive Behavioral Interventions and Supports
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Why Determine the Function?

• Short Term Solution
• To teach the student a new skill
  (replacement behavior)
  that achieves the same function as the behavior
  of concern
• Long Term Solution
• To remediate skill deficits so that the function
  is less desirable

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Jonny crying, hitting head
Topography Specific Behaviors

• Pushing
• Hitting
• Spitting
• Throwing

• Communication
• Academics
• Self-management skills
• Social Interaction

Areas to Assess
Jonny needs independent play skills
Adapted from Parent Survival Manual A Guide to
Crisis Resolution in Autism and Related
Developmental Disorders, Schopler, Eric, editor.
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How confident is the hypothesis?

• Does it adequately address the behavior?
• How serious would the consequences be if the
  hypothesis was wrong?
• If youre not confident, you should collect ABC
  data.
• If you are confident, continue with the Competing
  Behavior Model.

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When you see a behavior challenge

• Make a hypothesis about the function.
• Identify what you want to see reward.

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Jonny plays quietly while mom is on phone
Praise
Competing Behavior Model
Behavior Desired
Consequence
(Crone Horner, 2003 ONeill et al., 1997)
Jonny cries and bangs his head
Mom is on the phone in the other room
Jonny is in the room by himself
Mom hangs up comes in the room
Consequence
Behavior Problem
Setting Event
Antecedent
Gain Attention
Function
Permission to reproduce this document is granted.
Rob Horner, OSEP Technical Assistance Center on
Positive Behavioral Interventions and Supports
19
Your intervention

• Must address the function
• Replacement behaviors
• Observable, measurable behaviors that we want to
  see in place of the target behaviors
• When I dont want to bite my nails, I chew gum.
• If student picks his nose to keep hands busy,
  have him doodle.
• If you dont come up with a replacement behavior,
  the student might come up with his own!!
• Must reinforce what you want to see
• Clear consequences for what is not acceptable

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When you see a behavior challenge

• Make a hypothesis about the function.
• Identify what you want to see reward (goal).
• Identify the replacement behavior that you can
  use to get to the goal.

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Replacement Behavior

• Constructive Approach
• Replacing a problematic behavior with a more
  desirable alternative that fulfills the function
  of the problematic behavior

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Jonny plays quietly while mom is on phone
Praise
Competing Behavior Model
Behavior Desired
Consequence
(Crone Horner, 2003 ONeill et al., 1997)
Jonny cries and bangs his head
Mom is on the phone in the other room
Jonny is in the room by himself
Mom hangs up comes in the room
Consequence
Behavior Problem
Setting Event
Antecedent
Gain Attention
Go to mom and raise hand so she knows you have a
question
Function
Behavior Replacement
Alternative /
Positive
Permission to reproduce this document is granted.
Rob Horner, OSEP Technical Assistance Center on
Positive Behavioral Interventions and Supports
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C CONSEQUENCE
any event that follows a behavior and
influences the future rate of the behavior

• Reinforcement
• a consequence that results in increasing or
  maintaining the future rate of the behavior it
  follows
• Punishment
• a consequence that results in decreasing the
  future rate of the behavior it follows
• Both are defined by the effect on behavior
• Not by our intentions!!

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Perspective Check
Alberto,P. Troutman, A. (1990). Applied
Behavior Analysis for Teacher. Prentice Hall
NJ.
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Reinforcement/Punishment?
ABC's of Behavior
Reinforcement/Punishment?
We only know if a consequence is reinforcement
or punishment by its effect on future rate of
behavior NOT by our intent!!!
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Change AntecedentsVisual Supports

• Visual rules for the classroom (words or
  pictures)-remind of expectations, use positive
  terms
• Behavioral Charts remind of progress toward
  goal
• Choice boards remind of available choices
• Timers/alarm watches increase predictability
  and motivation

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Change AntecedentsSocial StoriesTM

• Introduce a social story about the environment in
  which the problem behavior most often occurs
• Gives child information about appropriate
  behaviors in context, discuss feelings, give
  concrete examples
• Read Social StoriesTM daily as reminder of
  appropriate behavior in difficult context

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Change the ConsequencesTeach appropriate
alternatives

• Reinforce what you want to see (remember
  reinforcement is defined by effect on behavior
  not intent)
• Teach appropriate alternatives of communication
  that serve the same function

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Change the ConsequencesTeach self-management

• Teach the child to monitor own behavior
• Can record occurrence of appropriate behavior or
  absence of challenging behavior
• May need timer for intervals
• Teach to record and indicate when earned reward
• Increase independence by fading prompts

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Change the ConsequencesIgnore and redirect

• Ignore the behavior dont give attention or
  preferred activities for challenging behavior
• Do not ignore the child dont allow to avoid or
  postpone task at hand
• Redirect to other, more appropriate choices once
  calm

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PowerPoint by Sandi Pepoli
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Managing Behaviorin Groups

• Negative behaviors in school is something that
  interferes with the educational and social
  processes. This can include benign but negative
  behaviors.
• not attending to learning
• refusal to work
• behavior perceived as mildly rude
• behaviors that send one out of the social
• group
• behaviors that cause people to have weird
  thoughts
• about person
• anything that impacts ones own ability to
• function in environment

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Definition of Behavior Problems

• Often applied to a person who uses aggressive or
  very assertive behavior that causes another
  person to feel unsafe.
• Used to describe a person who cant and wont
  act in accordance with socially recognized
  behavior norms for the situation.
• Are not only behaviors that include physical
  aggression
• Behavior problems include pervasive negative
  behaviors
• In the educational and home setting behavior
  problems should be seen as any behavior that
  interferes with the process of learning or
  participating.

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Behavior Change

• Mandates that the behavior of both adult and
  student changes!
• It is not a passive process.
• Success is dependent on positive adult
  intervention.
• Whole team must be consistent and on board on how
  we react to the student.

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Behavior Can Be Modified

• 1. Externally - from others giving feedback
  (reward systems) e.g. applied behaviorism
• -identify behavior dont want and
• reward approximations
• -should eliminate external systems by 3rd
  grade but no later than 5th
• grade

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Cont

• 2. Internally- teaching the student
• about how to change behavior.
• Need to teach
• Self awareness
• Self Monitoring
• Self Control

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External Control

• When students hold on to behavior. They are
  taught how to control only externally.
• We dont teach internal control.

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The BIG Goal

• Our goal is to teach internal behavior control
  because when our students graduate they will not
  be exposed to external behavior control systems
  again.

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Key Concept of Social Behavior Mapping

• When adjusting own behavior they are adjusting
  the way others feel about them.

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• WE MUST WORK WITH THEM ON AVOIDING NEGOTIATION!!!

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Social Behavior and Social Regulation Goal

• Someone wants to stay with you after youve
  produced those expected social behaviors.

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Behavior Change is SLOW

• When teaching behavior expectations to span
  across environments, behavior change is slow.
  However, it appears to be more deeply learned and
  integrated.
• Students need to learn the whys and hows of
  behavior changes. One way to learn this is
  through a technique called Cognitive Behavioral
  Therapy or CBT.

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COGNITIVE BEHAVIOR THERAPY (CBT)

• According to research CBT is a promising
  technique to teach internal behavioral change.
• Used by psychologist and counselors
• Was first developed in 1960s and continues to
  evolve in its application.
• Often a treatment chosen for higher cognitive
  level students.

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CBT is anchored by three fundamental concepts
(Dobson Dozois, 2001)

• Cognitive activity affects behavior
• Cognitive activity may be monitored and altered
• Desired behavior change may be affected through
  cognitive activity

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CBT

• Is internal regulation
• Requires students to develop an internal sense to
  behavior modification.
• Behaviors are modified as the students develop a
  stronger sense of self-awareness and self-control

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Many of these kids dont understand that their
behavior is perceived as weird and odd.
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What we think is weird and odd they dont
perceive it as that.
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CBT as a Promising Practice

• Cognitive behavior therapy is considered a
  promising practice for working with higher
  functioning persons with ASD. (Perry Condillac,
  2003 Atwood, 2006)
• Many ASD treatments are based on CBT
• Social Stories (Gray)
• Comic Strip Conversations (Gray)
• Incredible 5 Point Scale (Curtis Buron)
• Social Behavior Mapping (Winner)

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Social Behavior Mapping (SBM)

• Was designed to help students learn about how
  their behavior (expected unexpected) impacts
  how people feel, which then impacts how they
  treat us, which then impacts how we feel about
  ourselves.
• Demonstrates how we all impact each other
  emotionally and behaviorally.

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We expect students to behave. However, not all
students intuitively understand these
expectations.
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Key Factors to Explore
with SBM

• Social Rules change with age.
• Social Rules are sensitive to contexts more than
  environment.
• Peoples behavior impacts how other people feel.
• How people are treated is in large part based on
  how they make others feel.
• Each person has an emotional reaction to how they
  are treated.

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SBM Steps

• 1. Define the behaviors for the student
• expected and unexpected
• 2. Show how they are linked to the emotions
• of others.
• 3. Show that emotions are linked to good and bad
  consequences.
• 4. Show how the consequences impact how the
  student feels.

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STEP 1 Define behaviors as
belonging to a set of behaviors

• Peoples behaviors are perceived by others
  according to how predictable they are.
• Normal expected
• Weird unexpected

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Define Social

• Social is being able to adapt effectively when
  sharing space with others.

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Step 2 Mapping
Perspective/Emotion

• Assume the child does not perceive how he is
  affecting others through his behavior
• Teach perspective of others as part of the plan!

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You need to look deeply to find the information
the student doesnt know.
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In social behavior, people treat you based on how
your behavior makes them feel about you.
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How people treat you affects the way you feel
about yourself.
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We cant assess our own social behavior. We can
only assess our own emotions.
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Your job is to catch them doing the expected.
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When we give them attention for unexpected we are
increasing the behavior.
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Use other techniques in conjunction with SBM

• Incredible 5 Point Scale
• A 5 is against the Law
• Comic Strip Conversations
• Social Stories

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When not to use the SBM

• Severe aggressive behavior problems
• Students with low cognitive functioning (below 60
  IQ)
• Students without systematic language without the
  ability for meta-cognition

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SBM

• Teach kids to think about thinking

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SBM are not the total teaching tool and are not a
panacea

• SBM is logical approach to describing what we all
  process and respond to but normally dont talk
  about.
• SBM is one of the tools that can be used to help
  a student monitor and develop self-control.
• SBM is often used in conjunction with a student
  keeping data on their own production of their
  expected behavior, combining CBT with more
  traditional behaviorism.

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BE CONSISTENT!!!!!!
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Behavior plans take a lot of work from staff to
make it happen!!
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Expect regression before progression!!!
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Expect it to take time.
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Take Data!!!!!!!!
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Sensory Processing
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Why is sensory processing important?

• Sensory processing disorder is estimated to
  impact 5 to 15 of all children (Miller, 2006).
  
• Sensory processing difficulties are found in 42
  to 88 of individuals with autism (Volkmar, Paul,
  Klin, Cohen, 2005).

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Why is sensory processing important?

• Sensory integration is an underlying foundation
  for academic learning (Ayers, 2005).
• Difficulty with sensory modulation are commonly
  associated with
• difficulty with social skills
• self-esteem
• attention
• regulating reactions to others
• skill development (Parham, 1996).

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Sensory Terminology

• Sensory integration is the organization of
  senses for use (Ayers, 2005, p. 5).
• Sensory processing refers to the reception,
  modulation, integration and organization of
  sensory stimuli, including behavioral responses
  to sensory input (Miller and Lane, 2000, p. 1).
  

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Sensory Terminology Cont

• Sensory modulation is the ability to regulate
  and organize reactions to sensory input in a
  graded and adaptive manner (Lane, 2002, p. 103).
  
• Sensory modulation disorder occurs when a person
  has difficulty responding to sensory input with
  behavior that is graded relative the degree,
  nature, or intensity of the sensory information
  (Miller, Anzalone, Lane, Chermak, Olsten, 2007,
  p. 2).

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Sensory Modulation Disorder (SMD)

• Over-responsive
• Under-responsive
• Sensory seeking
• Miller, L. J. (2006)

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Over-responsive respond to sensation faster,
more intensely, or for longer periods of time
(sensory defensiveness).

• Is bothered by glue on hands
• Does not tolerate various food textures
• Has trouble concentrating with background noises
• Becomes upset with loud or unexpected noises

• Aggressive or impulsive when overwhelmed
• Irritable, fussy, moody
• Unsociable
• Afraid to try new things
• Upset by transitions and unexpected changes

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Under-responsive - take longer to respond,
display less of a response, or require intense/
prolonged sensory input before reacting.

• Does not hear named called or feel when touched
• Typically chooses sedentary activities
• Does not like trying new physical activities
• Does not notice food on mouth

• Passive, quiet withdrawn
• Difficult to engage in social interactions
• Easily tired
• Slow to respond to directions/questions

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Sensory Seeking- crave an insatiable amount of
sensory input and often attempt to gain this
input in socially unacceptable ways.

• Always on the go
• Likes crashing, bumping, jumping, spinning,
  swinging, or rolling
• Frequently touched objects
• Intrudes others personal space
• Has trouble taking turn during conversation
• Takes excessive risk during play

• Licks, chews, or sucks non-food objects
• Difficulty sitting still in a chair
• Smells or tastes objects while playing with them
• Becomes angry when required to sit still or stop
  his current activity
• Very affectionate physically

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Strategies

• Provide opportunities to engage in calming or
  alerting activities to encourage appropriate ways
  to self-regulate.
• Explicit instruction.
• See handout for examples.

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References

• Ayers, A. J. (2005). Sensory integration and the
  child. Los Angeles Western Psychological
  Services.
• Lane, S. L. (2002). Sensory modulation. In A. C.
  Bundy, S. J. Lane, E. A. Murray (Eds). Sensory
  integration Theory and practice (pp. 101-122).
  Philadelphia F. A. Davis.
• Miller, L. J. (2006). Sensational kids. New York
  G. P. Putnams Son.
• Miller, L. J., Anzalone, M. E., Lane, S. J.,
  Chermak, S. A. Olsten, E. T. (2007). Concept
  evolution in sensory integration A proposed
  nosology for diagnosis. American Journal of
  Occupational Therapy, 61, 135-140.
• Miller, L. J., Lane, S. J. (2000, March).
  Toward a consensus in terminology in sensory
  integration theory and practice Part 1 Taxonomy
  of neurophysiology processes. Sensory Integration
  Special Interest Section Quarterly, 23, 1-4.
• Parham, D. P, Mailloux, Z. (1996). Sensory
  integration. In J. Case-Smith (Ed). Occupational
  therapy for children (pp. 307-352). St Louis, MO
  Mosby.
• Filipek, P. A. (2005). Medical aspects of autism.
  In F. Volkmar, R. Paul, A. Klin, D. Cohen
  (Eds.), Handbook of autism and pervasive
  developmental disorders (pp. 534-582). Hoboken,
  NJ John Wiley Sons, Inc.