Supporting Individuals on the Autism Spectrum: Common Sense Systematically Applied

1
Supporting Individualson theAutism
SpectrumCommon Sense Systematically Applied

• Tim Feeney, Ph.D.
• Clinical Director
• School and Community Support Services
• 600 Franklin Street
• Suite 110
• Schenectady, NY 12305 USA
• [phone]
• tfeeney_at_scssconsulting.com
• www.scssconsulting.com

2

• Our Tasks
• Me
• Present a framework for supporting individuals
• with a variety of needs to regulate themselves
• and their learning to the greatest extent
• possible while being respectful of your
• knowledge and expertise in this area.
• Leave everyone with a least 3 strategies
• to use upon return to their classes.
• You
• Listen
• Ask questions
• Stay awake
• Make plans

3
Staking Out the Turf
4
Applied Behavior Analysis Baer, Wolf, Risley,
1987 Kantor, 1959 Skinner, 1953 Tharp
Wetzel, 1963
Setting Events Establishing Operations Fox
Conroy, 1995 Michael, 19821993
Functional Behavior Assessment Carr Durand,
1995 Iwata et al., 1994
Communication-Based Intervention Carr et al.,
1996 Durand, 1990 Reichle Wacker, 1993
Positive Behavior Supports Carr et al, 2002
Horner et al., 1990
Daily Routines/ Picture Routines Bondy, 1995
Koegel Koegel, 1997 Wetzel Hoschouer, 1984
Generalization Maintenance Carr et al., 1990
Dunlap, 1996
CONTEXT-BASED INTERVENTION
Planning Friedman Scholnick, 1998
Apprenticeship in Thinking Rogoff, 1990
Socially Co-constructed Narratives Hudson
Fivush, 1993
Dynamic Assessment Feurerstein, 1979
Socially Mediated Learning Vygotsky, 1932 1987
5
Grandma Masses Rules for Success The smart
guys are the guys who learn from the other guys.
Dont get all caught up in one thing everyone
believes their thing is the best thing and
theyre usually wrong. So, shut-up and listen
and learn and change. In order to be
successful youve got to be eclectic.
6
AN ADMITTEDLY INCOMPLETE VERSION OF THE AUTISM
SPECTRUM
Childhood Disintegrative Disorder
Rett Syndrome
SOME ARGUE IT IS NOT AN AUTISM SPECTRUM DISORDER
MOST SEVERE DISABILITIES
LEAST SEVERE DISABILITIES
MANY ARGUE IT IS NOT AN AUTISM SPECTRUM DISORDER
Tim Feeney, Ph.D. Wildwood Institute
7
Aspergers Syndrome
Autism
Childhood Disintegrative Disorder
Rett Syndrome
Pervasive Developmental Disorder - Not Otherwise
Specified
from Lord Risi, 2000
8
Four Domains of Behavior Characteristics
Associated with Autism Spectrum Disorders
Communication (especially functional
communication) Social Interaction Behavior
(unusual interests in activities that
are restricted, repetitive, and/or
stereotypic) Sensory Information (unusual
sensory responses and interests)
9
Chucks autism is different than Connors autism
is different than Sarahs autism is different
than Devans autism
While there are common traits, everyones autism
manifests itself differently, so any
intervention strategies will need to be
tailored to address these differences.
10
UNIFORMITY is not necessarily a good quality in
intervention There is no single right
solution - sometimes the best you can do is keep
trying Plan A Plan B Plan C Sometimes what
works today wont work tomorrow!
11
Common Sense Premises for Supporting Students on
the Autism Spectrum
12

• Intelligence is not just a gift-
• its a choice
• George Shaffner The Arithmetic of Life
• Success results from using
• what youve got
• - not from what youve got!

13
You are an opportunity whether or not
people take advantage of that opportunity is up
to them
14
There is a time for everything, and a season for
every activity under heaven. - Ecclesiastes 31
15
Not How can people motivate others? Rather
How can people create the conditions within
which others will motivate themselves? - E.L.
Deci
16
Successful intervention is about establishing
a respectful relationship with someone
whos doing his or her best to tick you off
17
Sow your seed in the morning, and in the evening
let not your hands be idle, for you do not know
which will succeed, whether this or that or
whether both will do equally well. -Ecclesiastes
116
18
Dont fall victim to the tyranny of the clock
19
You can make people do things that they just
dont want to do but the price for doing so will
be high
20
Poodle
21
An impulse is not a choice
22
Functional Conceptions of Choice Free
choice Fixed choice Forced
choice Feeling the natural and logical
results of actions in the environment
23
Understand the Negotiables and Non-negotiables
(most stuff is negotiable)
24
The glass aint half empty, its half full!
and You can teach 1/2 empty people to
become 1/2 full people (its hard to teach 1/2
empties to become 1/2 fulls)
25
A coach gets guys to do the things they dont
want to do so they can become the players that
they want to be. - Walt Harris Were all
coaches
A good coach Alters his/her coaching to
reflect the needs of the player and
conditions of the context. Never tries to play
the game him or herself.
26
(No Transcript)
27
Functional Support Means Moving
from A B C To A B C
28
(No Transcript)
29
Success via Learning from Consequences Presuppose
s
Reasonable intactness of the neural networks
responsible for connecting Memory for the
factual aspects of past behavior and/or Memory
for the Somatic Markers, or the feeling states
associated with the consequences of those
behaviors
Without these connections in memory, past
rewards and punishments lack the power to drive
future behavior
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
Social Stories (Gray)
A short story that describes a situation,
concept or social skill using a format that is
meaningful Often in response to a troubling
situation and also when trying to describe a
skill that is typically successful and problem
free. Descriptive Sentences Statements of
fact Perspective Sentences Statements
describing internal states Directive
Sentences Identify a suggested
response Affirmative Sentences Express
commonly shared value/opinion Partial
Sentences Encourage guesses about next
steps Control Sentences Identify methods of
recalling information Cooperative Sentences
Identify how others will help
PICTURE THE GOAL
GATHER INFORMATION
TAILOR THE TEXT
TEACH WITH THE TITLE
39
TEACCH Treatment and Education of Autistic and
related Communication Handicapped
Children (Schopler Mesibov)
Structured Teaching Arranging the classroom
and the methods of teaching in an organized
pattern Physical Organization Work
areas Scheduling Giving Direction
40
SCERTS (Prizant Wetherby)
Social Communication Accepting
communication intent Directing communication
to assure behavioral regulation, social
interaction and joint attention Presymbolic
to symbolic communication From echolalia to
creative language From unconventional to
conventional language Emotional Regulation
Self-regulation Mutual/interactive
regulation Transactional Supports Outcomes
that are the result of interplay between child
and context over time Family-mediated
interactions Peer-mediated interactions
41
Floortime/DIR Developmental Individual-Difference
, Relationship-Based (Greenspan)
6 Emotional Milestones Self-regulation and
Interest in the World The ability to take
an interest in the sights, sounds, and
sensations of the world and to calm oneself
down Intimacy The ability to engage in
relationships with other people Two-way
Communication The ability to engage in two-way
communication Complex Communication The
ability to create complex gestures and to string
together a series of actions into an elaborate
and deliberate problem-solving
sequence Emotional Ideas The ability to
create ideas Emotional Thinking The ability
to build bridges between ideas to make them
reality-based and logical
42
Common Themes of All These Approaches
Intervention must be delivered early
and intensively, through established
routines, and focus on the development of
self-regulation and problem-solving strategies
in context. In absence of meaningful
engagement in chosen life activities all
interventions will ultimately fail. Long
term, flexible, and frequently adjusted supports
may be needed to prevent behavior problems and
to facilitate social development.
43
Communication
Cognition
Behavior
44
Behavioral Control

Academic Growth
Social Competence
45
Creating Supports
46
(No Transcript)
47
Its important to have fun with and create
opportunities for fun and to laugh a lot even in
the face of significant challenges
48
Context Relevancy How does this stuff apply
to the bigger world? adapted from Sailor, 1999
Useful Do the outcomes that were targeting
produce something useful to the individual in
long run? Desirable Does the individual
choose the outcomes for him/herself when given
the choice? Social Do the outcomes result
in behaviors that will increase or imporve
interactions with persons other than paid
staff? Practical Will the behavior be used
in real contexts without staff
support? Adaptable Is there a focus on
developing skills that can/will be used in a
number of situations and without staff?
49
A CONTINUUM OF STAFF SUPPORTS
Intensive Requiring direct and constant
interaction of staff to participate in, and
benefit from program
Specific Requiring direct support of staff
in order to participate in, and benefit from
specific (and defined) elements of the program
Periodic Requiring direct support of staff in
order to learn new/ difficult elements of the
program
Independent Requiring little support to
participate in the typical elements of the
program
Most Intense
Least Intense
Specialized A specific environment designed to
assist individuals to learn the majority of skills
Modified An environment developed to
assist individuals learn specific (and
defined) skills
Adapted Environmental and time modifications devel
oped to augment typical classroom routines
Typical No environmental modifications are
needed for the individual to to acquire new
skills and maintain already learned skills
A CONTINUUM OF ENVIRONMENTAL SUPPORTS
50
PERSON
Language
Emotion
Volition
Behavior
Motor SKills
Cognition
Human beings are a collection of relatively
independent structures, processes, and systems
51
Johns Cognition
Attention
Perception
Memory
Organization
Reasoning
EF
Sequence Categorize Associate Analyze Synthesize
Arousal Select Direct/ Filter Maintain Divide
Shift
Encode/Store/Retrieve Episodic/Semantic Explicit/I
mplicit Declarative/Procedural Involuntary/Strateg
ic Working Memory/ Knowledge
Base Remote/Recent Pro/retrospective Iconic
Inductive Deductive Analogical Divergent Convergen
t

• Goals for John - John will
• Increase duration of maintained attention
• Increase prospective memory from 3 to 5 minutes
• Increase category naming from 3 to 5 members per
  category

52
Johns Language
Phonology
Morphology
Syntax
Semantics
Pragmatics
Receptive vs. Expressive Phrase Structure
Rules Etc.
Receptive vs. Expressive Lexicon Semantic
Relations Discourse Structures
Receptive vs. Expressive Speech-act
Competence Conversational Competence Socio-ling
uistic Competence

• Goals for John John will
• Decrease mean naming latencies from 3 to 2
  seconds
• Include 5 basic story grammar elements in
  retellings
• Use politeness markers in greeting people 90

53
Johns Behavior
John is the totality of his behaviors and the
systematic relationships among them
John
b1 b3 b12 b4 b1 b7 b62 b17 b17 b17 b4 b6 b9 b17
b12 b3 b8 b8 b5 b6 b17

• Goals for John John will
• Increase frequency of b3 and b12
• Decrease frequency of b17

54
Alternative Understanding of Human Beings
Sarah
Pursuing personally meaningful goals
While participating in culturally valued
activities
In social, cultural, and historical contexts
Mediated as necessary by individuals with
greater expertise in that domain
Using cultural tools, such as language, category
schemes, mathematics, organizational supports,
domain-specific strategies
And the rest is abstraction
In the presence of varied context facilitators
and barriers
55
Intervention Goals

• Sarah will successfully complete ___ meaningful
  task, with ___ supports, possibly using ___
  tools/strategies, in ___ context (setting,
  people, activities), in order to achieve ___
  goal.
• Possibly focusing intervention attention on some
  specific aspects of cognition, communication,
  social skills, behavioral self-regulation, or
  educational/vocational skills aspects that are
  either particularly weak or particularly
  important for Sarah.

56
The Three Big Things
57
When we think of your child at 22 years old we
need to think about the 3 most important things
to work on the things that, if s/he achieves,
s/hell have a meaningful life.
The 3 Things tend to cluster around these
areas Behavioral regulation/self-regulation
Friendships/social-interaction Vocational
skills/meaningful engagement Self-help skills
58
EFFECTIVE SUPPORT PLANS
Identify the 3 Big Things (Remember Program
1st, Place Emerges)
Identify Initial Social/Behavioral Goals and
Objectives Ideally small range of goals and
objectives
ONGOING ASSESSMENT ADJUSTMENT
Create a Flexible System of Support People Places
Events
Create a Plan for Supports Circumstances for
increases decreases
59
FLEXIBLE SUPPORT PLANS

• PLAN A
• Setting Events/Conditions
• Student Expectations
• Environmental Changes
• Staff Expectations

• PLAN B
• Setting Events/Conditions
• Student Expectations
• Environmental Changes
• Staff Expectations

• PLAN C
• Setting Events/Conditions
• Student Expectations
• Environmental Changes
• Staff Expectations

60
EXECUTIVE FUNCTIONS

• those mental capacities necessary for
  formulating goals, planning how to achieve them,
  and carrying out the plans effectively (Lezak,
  1982)
• ability to maintain an appropriate
  problem-solving set for attainment of a future
  goal. (Welsh Pennington, 1988)

61
EXECUTIVE FUNCTIONS

• the executive functions serve as an integrated
  directive system exerting regulatory control over
  the basic domain-specific neuropsychological
  functions (e.g., language, visuospatial
  functions, memory, emotional experience, motor
  skills) in the service of reaching an intended
  goal.
• Gioia Isquith, 2003

62
EXECUTIVE FUNCTIONS

• Organizing and controlling action, thought, and
  emotion in a way that is (1) not determined by
  immediate environmental events, (2) not
  determined by immediate impulse or states of the
  body, (3) not determined by the control of
  others, (4) directed toward personal goals, (5)
  while taking into account the goals and
  intentions of others

63
EXECUTIVE FUNCTIONS

• Routine, habitual, easy
• Versus
• Non-routine, novel, hard, effortful
• Strategic thinking demands
• Working memory demands
• Inhibition of pre-potent response demands
• Maintenance of goal-directed behavior

64
EXECUTIVE FUNCTIONS

• Self-regulation
• Self-determination
• Self-control
• Self-management
• Self-direction
• Maturation

65
Bottom Line (Vygotsky in 80 words or less)
Development/maturation of language, cognition,
volition, and behavioral self-regulation is based
on goal-directed supported participation in
authentic cultural activities, mediated by social
interaction with more mature members of the
culture, with meaningful practice in the use of
cultural tools (including compensatory
strategies), and with demands on the apprentice
within the Zone of Proximal Development. This
is apprenticeship teaching and applies to child
development generally, to regular education, to
professional and vocational training, and to
teaching individuals with disability.
66
EF UNORGANIZED LIST

• Setting and managing goals
• Planning
• Organizing
• Initiating
• Inhibiting
• Self-monitoring
• Strategic thinking
• Problem solving

• Flexible shifting
• Deliberately controlling any cognitive function
• Working memory
• Social perception
• Controlling emotions
• Learning from consequences
• Organized sense of self

67
NEUROPATHOLOGY OF EF DISORDERS

• Congenital or acquired
• Structural or metabolic
• Focal or diffuse
• Focal
• Prefrontal structures
• Prefrontal-striatal-cerebellar systems
• Diffuse
• Perhaps disruption of widely distributed complex
  neural systems can cause EF dysfunction

68
EF SYMPTOMS

• impulsiveness
• poor social judgment
• social disinhibition
• egocentrism
• difficulty interpreting the behavior of others
• perseveration
• poorly regulated attention
• disorganization (in thinking, talking, and
  acting)
• weak goal formulation

• ineffective planning
• decreased flexibility/ shifting
• slowed processing
• diminished divergent thinking
• concrete thinking
• immature problem solving
• weak self-monitoring
• inefficient responses to feedback/ consequences
• reduced initiation
• dulled emotional responses

69
EF FUNCTIONAL DEFINITION

• Based on analysis of strategic action
• Self-awareness of strengths and limitations
  (whats hard to do whats easy to do)
• Goal setting
• Planning/organizing
• Initiating
• Inhibiting
• Self-monitoring and evaluating
• Strategic thinking
• Flexible shifting, adjusting, benefiting from
  feedback

70
OTHER ASPECTS OF EF

• Transfer from learning context to application
  context
• Think abstractly and flexibly
• Assume a non-egocentric perspective (theory of
  mind)

71
METACOGNITION

• STATIC Knowledge/awareness of ones cognitive
  and academic processes and skills, and of
  procedures (strategies) that enhance
  performance
• DYNAMIC Executive control over cognitive and
  academic processes in everyday learning and
  problem solving Doing something special to
  overcome obstacles and succeed with difficult
  tasks

72
SELF-DETERMINATION

• AUTONOMY Act independently, free from undue
  external influence
• SELF-REGULATION Formulate, enact, and evaluate
  plans of action, with revisions as necessary
• PSYCHOLOGICAL EMPOWERMENT Act on the belief that
  one can influence important outcomes
• SELF-REALIZATION Capitalize in a beneficial way
  on a reasonably accurate knowledge of self
• Michael Wehmeyer and colleagues

73
Sense of Self
Executive Functions
Basic Developmental Acquisitions Physical,
Linguistic, Academic,Vocational Social, etc.
74
General Orientation to Intervention (within
this framework)

• Include individuals with and without disability
  in culturally valued activities
• Focus on strengths (versus impairment)
• Prevent secondary disability caused by lack of
  meaningful participation (Matthew effect)
• Facilitate effective, individualized
  compensations within culturally valued
  participation, with expert mediation of learning
  tasks
• Ensure adequate practice and systematic reduction
  of supports

75
IMPORTANCE OF EF

• CRITICAL FACTOR IN
• Social success
• Academic success
• Vocational success
• Independent living

76
EF DEVELOPMENTThemes

• Start early
• Develop slowly
• Continue into adulthood
• Influenced by biologic and environmental factors
• Variability Context (person, setting and task),
  motivation, culture

77
EF DEVELOPMENTThe Role of Experience

• Individuals are more likely to develop effective
  self-regulation if they
• Experience adequate social attachment
• Experience an organized and predictable world
• Receive authoritative/apprenticeship parenting,
  including effective modeling and verbal mediation
• Are rewarded for appropriate self-regulation and
  control by adults who value self-regulation and
  autonomy

78
INFLUENCES ON COMPETENT PLANNING adapted from
Friedman Scholnick, 1997
Task Complexity Supports Familiarity Coher
ence
Environment Resource Availability
Predictability Culture
Internal Self-beliefs
Stress Goals Memory Capacity
Attention Self-regulation Sequencing
Processing Capacity
Planning Sequence Problem Representation Goal
setting Decision to Plan Strategy
Construction Monitoring Adjusting
79
Helping People Choose to Plan
DO NOT plan on planning in situations that
have historical impulsive routines in
place Help individuals to connect the dots
the outcomes associated with planning explicit
and the likely outcomes associated with not
planning equally explicit Show the positive
effects of planning for the individual in the
short term and long term Help the individual
to make small/brief plans with immediate
outcomes Create a culture of planning early
and often Plan with the person, not for the
person
80
DYNAMIC ASSESSMENT
ONGOING CONTEXTUALIZED COLLABORATIVE HYPOTHESIS-TE
STING ASSESSMENT
81
WHY TEST HYPOTHESES?

• Failure on any complex task is multiply
  interpretable
• Complex students can be supported in a variety of
  ways
• Test results do not necessarily indicate how best
  to achieve success on specific tasks

82
WHY COLLABORATE?

• Increase observations and experiments
• Increase compliance
• Educate family, staff, others
• EF training for student
• Show respect

83
WHY IN REAL CONTEXTS?

• Inconsistency
• Validity problems of standardized testing
• Impact of setting, person, activity
• Impact of stress
• Observe real-world initiation, inhibition,
  self-monitoring, problem solving
• Observe effects of real-world supports and
  routines
• Observe support behaviors of others

84
Ongoing Contextualized Collaborative Hypothesis-Te
sting
Whats the problem? (Using the two strangers in
the doorway rule)
Hypothesis Formulation (Why is s/he doing this?)
Hypothesis Selection (Begin with easiest to test
or most obvious)
Hypothesis Testing (Protocol for
experimentation Plan A - Plan B - Plan C Testing
time line)
85
CCH-TA PROCESS

• Define problem
• Identify need for dynamic assessment
• Generate hypotheses
• Choose which (combination) to test
• Create experiments
• Implement (collaborate in context)
• Interpret
• Proceed to intervention or another test
• Continue to monitor and adjust

86
Some Useful Screening Tools
For Autism Autism Screening Instrument for
Educational Planning (ASIEP) Childhood Autism
Rating Scale (CARS) Autism Behavior
Checklist Pervasive Developmental Disorder
Screening Test (PDDST) For Asperger
Syndrome Asperger Syndrome Diagnostic Scale
(ASDS) Krug Aspergers Disorder Index
(KADI) Australian Scale for Aspergers Syndrome
87
Problem Behavior
Primary Symptomatic - Organic Neurophysiological
Limbic Kindling Perceptual Disturbances Electrop
hysiological Seizure Disorders Psychiatric Mood
Disturbances PTSD Physiological Metabolic
Tolerance Pain
Secondary Functional - Learned Escape/Avoid Att
ention Qualitative Aspects Acquisition Sensation
Automatic SR Control
88
Potential Influences on Behavior
Environmental Vulnerability Behavior
Problems Communication Problems
Life Events
Neurological/ Psychiatric Impairments Cognitive/A
cademic/Vocational Failure Physical/Health
Problems
Setting Events
Environmental Rigidity Decontextualized
Intervention Focus on External Control
Us
WE MAKE PEOPLE CRAZY!
89
WHY NOT FOCUS ON EXTERNALLY MEDIATED PUNISHMENTS
OR REWARDS? adapted from Boggiano Deci Schwartz
A consequence is often a euphemism for
punishment. Much of the punishments that are
provided by staff pale in comparison to that
which individuals experience in their everyday
lives. Rewards are often given inconsistently
and are typically effective only as long as
they are used. Learned helplessness and
learned dependence are the typical result of
situations in which the day-to-day behaviors of
individuals are managed by someone else. We
cannot motivate individuals- motivation is an
internal event, no matter how we try to motivate
- carrots or sticks - the reality is that all
were really doing is providing an opportunity

90
(No Transcript)
91
Goal
Plan
Predict
Do
Review
92
(No Transcript)
93
(No Transcript)
94
(No Transcript)
95
? Interventions must be doable in
context.? Interventions must be doable with
available resources.? Interventions must be
sustainable over time.? Interventions must be
constituency owned and operated.? Interventions
must be intuitively appealing.
Some Rules of Thumb for the Development of
Successful Interventions
96
Designing Contextual Supports
Develop a Vision for the Future
? THE THREE BIG THINGS ?
Identify Contexts
Embedded Skills
Priority Environments
Priority Activities
Priority Skills
97
Key Concepts in Antecedent-Focused Skill
Development
Prevention of undesireable behavior
by eliminating provocation. For everybody at
all ages, there are provocations that overwhelm
self-control. For people with disabilities that
threshold is often lowered. Positive
communication from partners. A key component of
prevention is the communication style of
communication partners. Positive setting
events (behavioral momentum). People are more
likely to engage in effective interaction when
they have a background of success.
98
Choice and control. People are more likely to
engage in effective interaction if they have
reasonable control over the tasks, activities,
and routines of life. Interesting,
meaningful, do-able tasks Positive roles and
scripts People are more likely to engage in
effective interaction if they have meaningful
roles in their lives.
99
GOOD INSTRUCTIONAL PRACTICE SELF-REGULATION

• From M. Pressley More about the Development of
  Self-regulation Complex, Long-term, and
  Thoroughly Social Educational Psychology, 1995,
  30(4), 207-212
• Instruction matched to students zones of
  proximal development
• 2. Extensive modeling and explanation
• Massive practice within interesting and authentic
  tasks
• Adult and peer scaffolding to minimize
  frustration and maximize success (apprenticeship
  procedures support)
• Ongoing for at least many years

100
Collaborative/Elaborative Interaction Creating
socially co-constructed narratives of life as we
live it
Intent Sharing Information
Communicating understanding of partners
intent Invites evaluation of
contribution Confirms contribution
Shows enthusiasm for contribution
Equal leadership roles
101
Cognitive Support Give information when
needed Makes memory and organizational
supports available Give cues in a
conversational manner Responds to errors by
giving correct information in a non-threatening
manner Emotional Support Communicating
respect for others concerns Explicitly
acknowledging difficulty of the task
Questions in a non-demanding and supportive manner
102
Elaborative Support Working on topics of
interest Maintain topic for many turns Makes
connections when topics change Makes
connections among day-to-day themes Adds
explanations in a conversational manner Invites
explanations for events Invites discussions of
problems and potential solutions Reflects on
the physical and psychological status of others
103
? Know that an event or activity will be
difficult.? Establish reasonable goals (in some
cases these might be immediate).? Formulate a
plan to achieve the goal (or understand the
plan).? Initiate goal-directed
behavior.? Refrain from actions that interfere
with the successful achievement of
goals.? Attend to and evaluate how well they
are doing.? Try another plan or strategy if
things are not going well.
To Assure Long Term Success Individuals Need to
104
Teaching People to Think
? Think out loud.? Think out loud a
lot.? Think out loud with the person reflect,
plan, problem- solve, observe, organize,
evaluate, remember, review, create, etc.? Make
use of external supports when thinking diagrams,
photos, written routines, day planners, notes,
etc.? Present yourself as an image of
thoughtfulness. Help the individual to embrace
the notion that being thoughtful is a good and
great thing.? Think out loud in a way that
shows that you are fun and flexible and
experimental in your own thoughts.? Think out
loud in a way that captures metaphors,
analogies, similarities, history, etc.
105
ROUTINES Repetition
creating temporal structure to improve memory
about relevant past events Cognitive
predictions about what happens next Natural
occasions for promoting cognitive growth An
impetus for improvisation when trying to avoid a
negative outcome
are a necessary prerequisite for Planning
106
Essential Properties of Routines
Predictable Portable Personal
Essential Effects of Routines
Develop positive behavioral momentum Increase
opportunities for non-contingent positive
feedback Increase the ability to predict
events A natural framework for planning A
natural framework for evaluating
107

• Steps to Organize Routines of Everyday Life
• 1. Identify successful and unsuccessful routines
  of everyday life. Whats working, whats not
  working?
• 2. Identify changes that have the potential to
  transform unsuccessful routines into successful
  routines (including changes in the environment
  and the behaviors of others.)
• 3. Identify how changes in routines include
  activities that are motivating to the
  individual and everyday people.
• 4. Implement needed supports to organize routines
  so that the individual experiences success and
  receives intensive practice in context.
• 5. Systematically withdraw supports and expand
  contexts as much as possible.

108
Concrete Routines Picture Routines Written
Routines
Interaction Routines Language Routines
Activity Sequencing
109
Key Executive System Concepts That Help
Individuals Learn Self-Regulation
Hard - Easy Big Deal - Little Deal Ready -
Not Ready Scary - Not Scary Like - Dont
Like Choice - No Choice
110
Interaction Scripts for Routines
Making Decisions About the
Goal Whatre you going to do? What are
we here for? How will we know were
done? Well know were done when it looks
like this . . .
111
Making Plans OK, so whats the
plan? Whatll you need to get this
done? How will you and I know youll need
help? What will help look like? Dont
tell me what you dont want, tell me what you do
want. OK, so what do you want me to do?
112
Making Decisions About Ease or Difficulty
Before Beginning Do you think this will be
hard or easy? If its hard, then whatll you
need? Have you ever done this before? What
happened? I dont think I could do this! How
do you know that you can? Whaddaya think?
Big deal or little deal?
113
Coaching Through Problems You look upset, is
there anything I can do? OK, youre not
ready. No problem just let me know when youre
ready. Ill know youre ready when you look
like this . . . Ill wait. You know
weve gotta figure this out, lets try . . .
I know its hard, but weve got to do
this.
114
Coaching in Context So, hows it
going? Is that helping you? Not
helping? Is there anything else you can
do? Is there anything I can do to help
you? So when are you going to start?
115
Review What Occurred So howd it
go? Howd you do? Tell me exactly what
happened . . . and then what? What do you
think other people thought? What were you
thinking when you . . . Next time you do
this, whatll you do differently? The
same? What helped? What didnt help?
116
(No Transcript)
117
(No Transcript)
118
My Plan
LISTEN GET MY MATERIALS READY IS IT HARD OR
EASY? MAKE A PLAN JUST DO IT!LOOK IT
OVER HOW DID I DO?
____ ____ ____
119
(No Transcript)
120
Problem-Solving Routines

• Students who are Non-verbal
• Identify/experience
• the problem
• Try alternatives
• 3. Experience effect

• Students Who are Verbal
• Define the problem
• Generate alternatives
• Choose an action
• Self-evaluate
• 5. Self-reinforce

121
A Decision Matrix for Dealing with Difficult
Situations
Mental Health Substance Abuse
Environment Behavior Other
Health/Safety Risk
NO
YES
Short Term Interventions
Inpatient Alternative Program
Staffing
People Provoking events Environment
Long Term Interventions
Support Factors
Internal Factors
Control Motivation Roles Routines Goals
Engagement Activity
Environmental
Interpersonal
Places Events Activities Staffing
Network Staffing Coaching Practice in Context
122
(No Transcript)
123
(No Transcript)
124

General Crisis Prevention Needs
Crisis Response Needs
125
(No Transcript)
126
The Job Help people to learn to develop, and
tell THE STORY Not simply report the news.
127
Four Lessons to Live by
Hope is an essential part of any successful
plan of support. Form follows function.
Think about what the individual needs and then
create a way for that to happen in a flexible
manner. The more you try to force
something or someone to change, the more it (or
he or she) changes you. When all else fails, a
sense of joy and a sense of humor can get
you through a whole lot!