How Autism Spectrum Disorder Affects Learning in the Classroom

1
How Autism Spectrum Disorder Affects Learning in
the Classroom

• B.J. Freeman, PhD
• Professor Emerita, UCLA School of Medicine
• Alabama CASE Conference
• February 25, 2014

2

• Autism Spectrum Disorders are best viewed as
  social-communication learning disabilities.
• ASDs represent a wide spectrum of abilities and
  disabilities.

3

• All children with ASDs require intense
  multi-disciplinary evaluations and intensive
  early intervention (as soon as diagnosed) that
  focuses on teaching social communication skills
  in the natural environment.

4

• Research has shown that even very mild social
  communication issues in younger children can
  result in significant behavior issues as they
  age.
• Current consensus is that the best approach to
  intervention for the core symptoms of ASDs
  includes a program of coordinated, intensive
  educational and behavioral intervention.

5

• The most tested intervention is applied
  behavior analysis (ABA) which has been shown
  to significantly improve the core symptoms in
  almost all children.
• Complete recovery is rare, but the number of
  children showing recovery has been increasing
  over the past few years.

6

• Recent research has demonstrated that early
  intervention actually changes brain function.

7
Diagnostic Criteria For 299.0 ASD

1. Persistent deficits in social communication and
   social interaction across multiple contexts, as
   manifested by the following, currently or by
   history

8

• 1. Deficits in social-emotional reciprocity,
  ranging, for example, from abnormal social
  approach and failure of normal back-and-forth
  conversation to reduced sharing of interests,
  emotions or affect to failure to initiate or
  respond to social interactions.

9

• 2. Deficits in nonverbal communicative behaviors
  used for social interaction ranging, for example,
  from poorly integrated verbal and nonverbal
  communication, to abnormalities in eye contact
  and body language or deficits in understanding
  and use of gestures, to a total lack of facial
  expressions and nonverbal communication.

10

• 3. Deficits in developing, maintaining and
  understanding relationships ranging, for example,
  from difficulties adjusting behavior to suit
  different social contexts, to difficulties in
  sharing imaginative play and in making
  friends, to absence of interest in peers.

11

• Severity Level is specified based on the persons
  specific communication impairments.

12

• Severity Level 1 Requires support for deficits
  in social communication that cause noticeable
  impairments without supports in place difficulty
  initiating social interactions, and clear
  examples of atypical or unsuccessful response to
  social overtures of others.
• (For example, a person who is able to speak in
  full sentences and engages in communication but
  whose to- and-fro conversation with others fails,
  and whose attempts to make friends are odd and
  typically unsuccessful.)

13

• Severity Level 2 Requires substantial support
  for marked deficits in verbal and nonverbal
  social communication skills social impairments
  apparent even with supports in place limited
  initiation of social interactions and reduced or
  abnormal responses to social overtures from
  others.
• (For example, a person who speaks simple
  sentences, whose interaction is limited to narrow
  special interests, and who has markedly odd
  nonverbal communication.)

14

• Severity Level 3 Requires very substantial
  support for severe deficits in verbal and
  nonverbal social communication skills that cause
  severe impairments in functioning very limited
  initiation of social interactions and minimal
  response to social overtures from others.
• (For example, a person with few words of
  intelligible speech who rarely initiates
  interaction and, when he or she does, makes
  unusual approaches to meet needs only and
  responds to only very direct social approaches.)

15

• B. Restricted, repetitive patterns of behavior,
  interests or activities as manifested by at least
  two of the following, currently or by history

16

• 1. Stereotyped or repetitive motor movements, use
  of objects, or speech, (e.g., simple motor
  stereotypies, lining up toys, or flipping
  objects, echolalia, idiosyncratic phrases). 

17

• 2. Insistence on sameness, inflexible adherence
  to routines, or ritualized patterns of verbal or
  nonverbal behavior (e.g., extreme distress at
  small changes, difficulty with transitions, rigid
  thinking patterns, greeting rituals, need to take
  same route or eat same food every day).

18

• 3. Highly restricted, fixated interests that are
  abnormal in intensity or focus (e.g., strong
  attachment to or preoccupation with unusual
  objects, excessively circumscribed or
  perseverative interests).

19

• 4. Hyper- or hyporeactivity to sensory input or
  unusual interest in sensory aspects of the
  environment (e.g., apparent indifference to
  pain/temperature, adverse response to specific
  sounds or textures, excessive smelling or
  touching of objects, visual fascination with
  lights or movement).

20

• Severity Level is specified based on the persons
  restricted, repetitive patterns of behavior.

21

• Severity Level 1 Requires support for
  inflexibility of behavior that causes significant
  interference with functioning in one or more
  contexts difficulty switching between
  activities problems of organization and planning
  that hamper independence.

22

• Severity Level 2 Requires substantial support
  for inflexibility of behavior, difficulty coping
  with change, or other restricted/repetitive
  behaviors that appear frequently enough to be
  obvious to the casual observer and interfere with
  functioning in a variety of contexts distress
  and/or difficulty changing focus or action.

23

• Severity Level 3 Requires very substantial
  support for inflexibility of behavior, extreme
  difficulty coping with change, or other
  restricted/repetitive behaviors that markedly
  interfere with functioning in all spheres great
  distress/difficulty changing focus or action.

24

• C. Symptoms must be present in the early
  developmental period (but may not become fully
  manifest until social demands exceed limited
  capacities, or may be masked by learned
  strategies in later life).

25

• D. Symptoms cause clinically significant
  impairment in social, occupational of other
  important areas of current functioning.

26

• E. These disturbances are not better explained by
  intellectual disability (intellectual
  developmental disorder) or global developmental
  delay. Intellectual disability and autism
  spectrum disorder frequently co-occur to make
  comorbid diagnoses of autism spectrum disorder
  and intellectual disability, social communication
  should be below that expected for general
  developmental level.

27
Characteristics of Curriculum

• How to Select Skills/What to Teach
• Skills should be meaningful to the student,
  functional, age appropriate and lead to
  independent functioning in the natural
  environment.

28

• What Skills Should Be Selected?
• Multiple environments Skill will enhance
  students functioning in increased number and
  range of environments.
• Functionality If student does not perform the
  skill, someone else will have to do it for them.

29

• Chronological Age Appropriateness Skill is
  culturally sanctioned within students age group.
• Practice Student will have opportunities to
  perform skill under non-instructional conditions,
  once acquired.

30

• Required in Adulthood Skill is required, needed,
  respected or allowed expression in post school
  years.
• Student Preference Student will enjoy being able
  to perform the task.
• Parent Preference Parent would like student to
  learn the skill.

31

• Physical Enhancement Skill will enhance the
  students physical well being.
• Social Contact Enhancement Skill will increase
  students chances for positive social
  interactions, particularly with non-disabled
  peers.

32

• Acquisition Probability Student should be able
  to acquire skill in a reasonable period of time
  if adequate resources are devoted to its
  instruction.
• Status Enhancement Skill will enhance students
  status in the eyes of many non-disabled people.

33

• Six kinds of intervention should have priority
• Functional, spontaneous communication should be
  the primary focus of early education.
• Social instruction should be delivered throughout
  the day in various settings, using specific
  activities and interventions planned to meet age
  appropriate, individualized social goals.

34

• 3. Teaching of leisure skills should focus on
  activities with peers, with additional
  instruction in appropriate use of toys, games and
  other materials.

35

• 4. Other instruction aimed at goals for cognitive
  development should be carried out in the context
  in which skills are expected to be used, with
  generalization and maintenance in natural
  contexts as important as acquisition of new
  skills.

36

• Because new skills have to be learned before they
  can be generalized, documentation of rates of
  acquisition is an important first step.
• Methods of introduction on new skills may differ
  from teaching strategies to support
  generalization and maintenance.

37

• 5. Intervention strategies that address problem
  behaviors should incorporate information about
  the contexts in which behaviors occur, positive
  proactive approaches, and a range of techniques
  that have empirical support (e.g., functional
  behavior assessment, functional communication
  training, reinforcement of alternative behaviors).

38

• 6. Functional academic skills should be taught
  when appropriate to the child.

39

• Taking into account the needs and strengths of an
  individual child and his/her family, the childs
  schedule and educational environment in and out
  of the classroom should be adapted as needed in
  order to implement the IEP.

40

• Educational services should include a minimum of
  25 hours a week, with no more than a 2-week
  break, where the child is engaged in
  systematically planned, developmentally
  appropriate activities aimed toward identified
  objectives.

41

• Where activities take place and content of
  activities should be determined on an individual
  basis, depending on characteristics of the
  activity, the child and family.

42

• Individual Instruction
• The child must receive sufficient individualized
  attention on a daily basis so that individual
  objectives can be effectively implemented.
• Individualized attention should include
  individual therapies, developmentally appropriate
  small group instruction, and direct 11 contact
  with teaching staff.

43

• Need to teach readiness skills for learning
  before curriculum.
• Ongoing assessment of the childs progress in
  meeting objectives should be used to further
  refine the IEP.

44

• Lack of objectively documentable progress over
  3-month period should be taken to indicate a need
  to increase intensity by lowering student/teacher
  ratios, increasing programming time,
  reformulating curricula, or providing additional
  training and consultation.

45

• To the extent that it leads to specified
  educational goals (e.g., peer interaction skills,
  independent participation in regular education),
  children should receive specialized instruction
  in settings in which ongoing interactions occur
  with typically developing children.

46

• Characteristics of Teacher
• Interaction Strategies
• working knowledge of ASD characteristics
• develop sense of trust between teacher and
  student with ASD
• accept students cognitive and social abilities,
  and learning potential
• accept student for who he or she is
• training in ABA

47

• Characteristics of Learning Environment
• Individualized Supports Services
• Should be based on applied behavior analysis
  (ABA).

48

• Incorporation of childs preferences special
  interests into instructional program.
• Focus on childs strengths weaknesses to
  determine the most appropriate density and level
  of instruction to meet childs individual goals.

49

• Systematic Instruction
• Targeting meaningful skills to be taught.
• Planning when how to provide instruction based
  on unique characteristics of student.
• Determining data collection method to measure
  students progress instructional effectiveness.

50

• Comprehensible, Structured Learning Environment
• Organize instructional setting
• Provide schedule of activities
• Carefully plan provide choice-making
  opportunities
• Provide behavioral support

51

• Define specific areas of classroom, school
  settings
• Provide temporal relations
• Facilitate transitions, flexibility, change

52

• Goals of the Classroom
• Increase accessibility to learning by decreasing
  disruptive/aggressive behaviors.
• Maximize learning (pre-academic, academic,
  self-care, motor skills, receptive/expressive
  learning, etc.)
• Maximize communication
• Readiness for learning

53

• Signs of a Good Class
• extensive reinforcement
• systematic intervention plans
• continuous teaching/no down time
• comprehensive programming
• natural teaching

54

• Instructions designed for Educators
• Communicating to the student
• Encouraging communication with the student
• Social supports includes specific teaching,
  rehearsal, practice modeling of social skills
  in natural settings.

55

• Environment Routine
• Presentation of material
• Assessment assignments
• Homework
• Self-management of behavior

56
Functional Behavior Assessment

• Dynamic process that addresses behavior on
  individual basis.
• Is a work in progress should not be fixed.
• Key to success

57

• 10 steps toward supporting appropriate behavior
  in the classroom
• Understand characteristics of ASDs that may
  influence students ability to learn and function
  in school environment.
• Acknowledge that behavior serves a function, is
  related to a context, and is a form of
  communication.

58

• Use FBA as first step in designing behavior
  support plan
• identify, describe behavior
• describe setting, demand, antecedent
• collect baseline data, work samples

59

• complete functional analysis, develop hypothesis
• develop implement positive behavior support
  plan
• collect data, monitor effectiveness
• revise as needed

60

1. Think PREVENTION.
2. Use antecedent and setting event strategies.
3. Make teaching alternative skills an integral part
   of program.
4. Effective behavioral change may require everyone
   involved to change their behavior as well.

61

1. Design long-term prevention plan.
2. Discuss how student fits into school-wide
   discipline practices procedures.
3. Collaborate, hold regular team meetings.

62

• ABA Strategies
• Should not focus on excessive behaviors, but lack
  of new skills
• Most studied, most scientific support
• Curriculum consisting of simple complex target
  behaviors involving hundreds of programs
  developed through years of research.

63

• Child-specific curriculum adaptations
• Task analysis
• Repeated practice through discrete trials
• Masses expanded, dispersed formats
• Clear, discriminable instructions

64

• Common Behavior Strategies
• Proactive procedures
• identify function of disruptive behavior
• select replacement behavior
• break skill into discrete parts
• teach discrete skill until mastery
• concentrated systematic teaching
• provide assistance as necessary
• make learning fun as natural as possible
• provide reinforcer for appropriate behavior

65

• Reactive procedures
• create behavioral momentum
• provide reinforcer for absence of disruptive
  behavior
• disruptive behaviors result in least amount of
  attention necessary loss of opportunity for
  reinforcement
• shape de-escalation
• remain calm

66

• Reinforcement guidelines
• Cannot assume!
• Reinforcers should be reinforcing.
• Reinforcement should be contingent may have to
  be taught.
• Use a variety of reinforcers.
• Pair social with tangible reinforcers.
• Continuously develop reinforcers.

67

• Initially, reinforcement should occur
  immediately.
• Thin reinforcement schedule as soon as possible.
• Label behavior being reinforced.
• Dont use bribery.
• Utilize differential reinforcement.

68

• Goal is for the natural environment to take over
  the reinforcement and the person learns to
  control his/her own behavior.

69

• Common Misunderstood Behaviors
• Compliance
• Is the instruction necessary?
• Does the child understand instruction?
• Will you/Can you follow through?
• Dont issue multiple instructions.
• Provide choices when possible.
• Phrase with expectation of compliance.

70

• Create behavioral momentum.
• Catch the child listening.
• Give in early.
• Provide meaningful consequences.
• Utilize errorless compliance training program.
• If non-compliance occurs, provide least amount of
  attention.

71

• Stress management
• Develop calming place
• Create calming object
• Teach concept of calm
• Identify stressors
• Arrange stressors into a hierarchy
• Teach relaxation skills (holding object, guided
  imagery)

72

• Expose to mild stressor
• Cue relaxation
• Reinforce calm
• Fade cueing
• Systematically expose to more natural environment
• Expose systematically to higher stress levels

73

• Teachers learn according to the same principles
  as their students. Multiple exposures,
  opportunities to practice, and active involvement
  in learning are all important aspects of learning
  for teachers as well as students.
• Educating Children with Autism
  National Research Council, Lord et al, 2001