Implementing Evidence-Based Practices in Schools Dr. Cathy Pratt, BCBA-D Director Indiana Resource Center for Autism Indiana Institute on Disability and Community Indiana University Phone: (812) 855-6508 Fax: (812) 855-9630 www.iidc.indiana.edu/irca Instructional Approaches • A single instructional strategy should not drive a student’s program. What we want students to learn and how each learns best should guide our choice of instructional approaches and serve as the framework for how we teach a student. Process versus outcomes. Strategies • One size does not fit all….need to find best fit for child and for family. • Business of Autism • Helping families make informed decisions. http://www.iidc.indiana.edu/styles/iidc/ defiles/irca/abaproviders2014.pdf • Utilizing strategies that are evidencebased. Process In Indiana • • • • • • History of Project Initial Focus on Secondary Close to 100 Schools Focus on Student Outcomes School Assessment: APERS School-wide Impact Evidence-Based Practices • According to the National Professional Center on Autism funded by OSEP (http://autismpdc.fpg.unc.edu/), evidence-based practices include the following: What are these evidencebased practices? • • • • • • • • Antecedent-Based Interventions Cognitive Behavior Intervention Differential Reinforcement Discrete Trial Teaching Exercise Extinction Functional Behavioral Assessment Functional Communication Training What are these evidencebased practices? • • • • • Modeling Naturalistic Intervention Parent-Implemented Intervention Peer-Mediated Instruction Picture Exchange Communication System • Pivotal Response Training • Prompting • Reinforcement What are these evidencebased practices? • • • • • • • • Response Interruption/Redirection Scripting Self-Management Social Skills Training Social Narratives Structured Play Groups Task Analysis Technology-Aided Instruction and Intervention What are these evidencebased practices? • Time Delay • Video Modeling • Visual Support More Websites • http://www.nationalautismcenter.org/nsp/ • http://autisminternetmodules.org/ Fidelity of Implementation Learning Characteristics Associated With Autism Spectrum Disorders • • • • • • • • • • • Concrete/Hands On Literal/Difficulty with Comprehension Highly Distractible/Intensely Focused Variability in Performance Rule Bound/Insistence on Sameness Immediate Perfection/Closure Transitions/Unstructured Time Difficult Organizational Difficulties Need for Predictability and Routine Need for Activities that Motivate Need for Repetition Engagement/Intensity of Instruction • Engage Often • Importance of Routines • Incidental Teaching: Every moment is a teachable moment. • At the same time, some children may need planned breaks. • Engage/read/talk to the child. Will talk about this within social narratives. Classroom Schedule • Calendar • Reading • Daily 5 • Lunch • Recess Functional Behavioral Assessment: • A process for determining the relationship between a person’s internal/external environment and the occurrence of problematic behavior. Hypothesis Statement (Problem Behavior Pathway) Setting Events Autism/Anxiety Seizures Medications Allergies Communication Limitations Sensory Challenges Lack Self-Regulation and Self-Management Poor Social Skills Triggering Antecedents Certain Demands Too Much Talking Transitions: Leaving School Bus Changes in Routines Certain academic work…too much paperwork and being read to or lectured to. Problem Behavior Pinching Yelling Screaming Elopement Refusal Kicking Hitting Maintaining Consequence Ends an Activity Gains Access to Desired Event/Activity Attention Sensory Hypothesis Statement (Problem Behavior Pathway) Setting Events Triggering Antecedents Strengths/Skills: Problem Behavior Maintaining Consequence Self-Management System • Increases Desired Behavior • Decreases Interfering Behavior • Teaches Students How To: • Monitor their own behavior • Record their own performance • Obtain reinforcement purposefully http://autismpdc.fpg.unc.edu/sites/autismpdc.fp g.unc.edu/files/SelfManagement_Steps.pdf Ultimate Goals • Decrease Use of Paraprofessional • Enhance Skills Needed for Employment • Enhance Skills Needed for PostSecondary Options • Enhance Quality of Life Sample Self-Monitoring: Assignment Completion/ Check-in/Check-out Direct Instruction • Direct, Systematic and Purposeful Instruction. Exercise • Now considered an evidencebased practice. • Build in structured play and exercise….swimming and other types of physical activity. Communication • Challenge For All • Opportunities Must be Embedded Across the Day and Across the Grades • Not Simply About Services of SLP • Everyone has to encourage communication. Communication • May be nonverbal or minimally verbal • Difficulty with practical conversation • Echolalic: immediate or delayed • Pronoun difficulties • Repetitive language • Difficulty with sarcasm…very literal • Interrupts others Communication • Difficulty starting, joining or ending conversation • Difficulty asking for help • Difficulty staying on topic • Unusual voice or speech • When instructions given to whole group, may not understand they apply to him/her as well • Slow in processing information Overview – Functional Communication • FCT is used to decrease the incidence of interfering behaviors and to replace subtle, less clear communicative forms with clearer communicative forms. • Teaching functional communication will increase an individual’s independence and decrease some challenging behaviors. How FCT Works • An FBA is conducted to identify the purpose of the challenging behavior. • A more desirable or acceptable form of communication for the child to use as a replacement for the challenging behavior is identified. • Challenging behaviors are ignored and only replacement behaviors are acknowledged and prompted. Again, can not ignore challenging behaviors that are potentially dangerous. FCT • Can use any or all modalities to teach functional communication – speech, pictures, sign language, gestures, writing. • Create opportunities for communication by controlling access to materials or sabotaging a routine. FCT • Offer opportunities for requesting (choices, small portions, etc.). • Teach communication within functional routines. Naturalistic Language Strategies • Activities are child-centered and take place during naturally occurring routines and activities. Naturalistic Language Strategies • This teaching strategy is a hybrid approach that promotes communication/language development through environmental arrangement; responsive communication partners; and prompting, modeling, and reinforcement. Naturalistic Language Strategies • Naturalistic language strategies promote more complex skill acquisition and generalization and maintenance of skills. Examples of Naturalistic Interventions • Learner-directed activity – learners select what they want to do within the environment. Examples of Naturalistic Interventions • Goal is to label animals. Different animal toys are offered, but the child decides to work on an animal insert puzzle. Staff then encourages the child to label each puzzle piece representing an animal. Examples of Naturalistic Interventions • Routine activity – routine activities take place on a regular basis. Examples of Naturalistic Interventions • Goal – Jeff is to use words to request: “open.” During snack time, staff present several tasty options in a clear, partitioned container in small portions. This presentation gives Jeff several opportunities throughout snack time to request “open.” Staff will open the container, and he can select his snack option. Picture Exchange Communication System (PECS) • PECS is a behaviorallybased, alternative (aided) communication system. • Children and adolescents with ASD use visualgraphic systems to communicate with others. Picture Exchange Communication System (PECS) • PECS has been shown to promote speech development and production in previously nonverbal learners. Total Communication • May use a combination of sign, words, and pictures. • Sabotage during routines...instead of just giving a child a cookie. Prompt them to ask. Instead of just tickling, prompt them to ask. Repetition • Teaching and practicing across settings and people. • Hundreds may be required. • Assists with generalization. • Do not confuse rote memorization with true comprehension. Receptive Communication • If child does not follow directions, try to say it in a different way. • Sometimes we use too many words. • Sometimes we are too abstract. • Saying the same thing over and over again that has not worked will not be successful. • Fewer words. Visuals. Gestures. Prompting. • The majority of students with ASD are VISUAL learners. Visual strategies can benefit all children by enhancing the individual’s understanding. Learn more quickly Reduce aggressive or self-injurious behavior Decrease frustration and anxiety Learn to adjust to changes Complete tasks by themselves Gain independence Individual 5 point scales SHOW them what TO DO! Visual Supports • 5 point scale How to Line Up Rules for Reinforcement • Reinforcers must be individually determined. • Based on observation of behavior change. • When teaching or strengthening a new behavior, reinforce frequently. • When maintaining behavior, use intermittently. • Must directly follow behavior. • Specifically state why a behavior is being reinforced. Reinforcers • Can identify through various means what is reinforcing. • Primary includes edible and sensory • Secondary includes a tangible, privilege or activity. • Generalized conditioned reinforces are items that can be used in exchange for a wide range of back-up reinforcers such a money, tokens, stickers. Reinforcement Systems Reinforcement Systems Reinforcement Schedules • Variable • Fixed Created 2006 IRCA Shaping • Reinforcing successive approximation toward the desired goal. Expectations for success and reinforcement are gradually increased. • Example: picking a toy up. Putting a shoe on. • Don’t expect immediate perfection. Differential Reinforcement Schedules • Differential Reinforcement of Higher Rates of Behavior (DRH).. to increase low social initiations • Differential Reinforcement of Lower Rates of Behavior (DRL)…to decrease self-stimulatory behaviors • Differential Reinforcement of Other Behavior (DRO)… to increase nonoccurrence of out of seat behavior Differential Reinforcement Strategies • Differential Reinforcement of Incompatible Behavior (DRI)…reinforcing behavior that is physically incompatible. Eating at table versus walking around house. • Differential Reinforcement of Alternative Behaviors (DRA)…to increase hand-raising versus talking out in class. Rapport/Praise and Feedback • • • • Specify Behavior Praised Rapport Building Positives Outweigh Negatives Coach parents and others in telling child what to do; not what not to do. Errorless Learning • Teaching tasks correctly upfront. Does not allow child to get into incorrect patterns of behaving. • Corrective feedback is less effective. Extinction • Ignoring a Behavior • Extinction burst. • Should not use with dangerous behavior. • Use with other strategies. • Choose your battles. Prompts • • • • No Universal Prompt Hierarchies Fading Prompt Dependency Types: Verbal, Visual, Modeling, Physical, Gestural • May use different prompts for different situations. Discrete Trial Teaching • Great to use for teaching specific tasks. • Mass trials. • Can be used individually or in group. • Prompt to Response to Consequence • Have to make sure generalization and maintenance are planned. Premack Principle • A less preferred behavior, followed by a highly preferred behavior, becomes stronger. • If-then….. Task Analysis • Task broken down into discrete steps • Observe a number of competence individuals • Consult with experts • Perform the task yourself • Develop task analysis of common home activity. Sequenceof of dressing Sequence Dressing 1 2 3 4 Chaining • Backward: Last part of chain is taught first. • Forward: First step is taught first until mastery. • Total Task: Training assistance provided for steps not mastered. Behavioral Momentum • Deliver 3 to 4 highly preferred activities or requests and then introduce a less preferred tasks with support. Choice Making • Identify preferred and nonpreferred objects or activities • Determine if choices are acceptable. • Present Choices • What opportunities do you see for building choice into the day? How would you guide parents on this? Social Challenges • A primary challenge of those on the autism spectrum. • According to Gresham and Elliot, socially acceptable learned behaviors enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses. Social Skills • Difficulty recognizing non-verbal behavior, body language, and facial expressions • Difficulty waiting • May prefer solitary play • Social rules may be confusing • May appear to be in own world • May prefer to play with toys then with people Social Skills • Difficulty making and maintaining friends • Socially awkward • May appear rude • May intrude on personal space • May not understand turn taking Strategies Overview • • • • Social Narratives Social Skills Training/Groups Video Self-Modeling Peer-Mediated Instruction Power Card Strategy • The Power Card Strategy uses the child’s special interests to motivate and improve specific behaviors. • Summarizes steps the special hero wants the student to remember in specific situations • Acts as a cognitive rehearsal Power Card Clifford wants all of the children to be safe, so remember: 1.Never run away from the playground. 2.Stay with the children and teachers. 3.Have fun and play with other boys and girls. Power Card Strategy Using the Bathroom Superman and the Bathroom During his many flights to help people in need, Superman has found it necessary to stop and use the bathroom once in a while. He knows it is important to go when he needs to, and he doesn’t wait for someone to ask him if he has to go. He knows that it is important for superheroes to take care of their bathroom needs on their own. Superman would like for you to consider these three facts: : 1. When you are at home, don’t wait for someone to ask if you need to go to the bathroom. Just go when you need to go. (Don’t ask, just go.) 2. When you are at school, tell your teacher that you need to go to the bathroom. Try to go every time there is a scheduled break, even if you don’t feel you need to. (Tell teacher, then go.) Superman would like for you to consider these three facts: : 3. If you are away from home, tell an adult you are with that you need to use the bathroom and have them show you where it is located. (Tell adult, have them show where.) Superman is proud of young men who can take care of their own bathroom needs! Social Story Comic Strips I want to work on the computer, NOW! No, I have to finish my math and ask the teacher before I can work on the computer. Mrs. Smith, my math is done. Can I work on the computer now? 48 Comic Strip Social Story by Glenda Pate Video Self-Modeling • Mode of teaching that uses video recording and display equipment to provide a visual model of the targeted behavior. • Videos on teeth brushing, washing hands, etc. Social Skills Groups • Used to teach individuals with ASD ways to appropriately interact using small groups of 2 to 8. Pros and cons of this approach. Peer-Mediated Instruction Used to teach typically developing peers ways to interact with and help learners with ASD in increasing social opportunities within natural environment. May need to support siblings in playing with their brother/sister on the autism spectrum. Play • Structure play to teach the child how to follow directions, interact with others, imitate, attend for increasing periods of time, and so forth. • Again, engagement is critical and should be fun. Importance of Imitation • Imitation is a critical developmental milestone. • Imitation is central to the understanding of self and others. Importance of Imitation • Imitation helps children and adolescents acquire and practice important social and communication skills. • Imitation is often an important component of play. Generalization • Teach Sufficient Examples • Training in Multiple Settings with Multiple People • Training Loosely • Use Intermittent Reinforcer Parent Implemented Intervention • ASD impacts the entire family. • Be reasonable and realistic. • Realize they may be balancing multiple family member needs. • Coach and demonstrate. • Encourage them to take care of themselves and of other family members. Give them permission to do so. Parent Implemented Interventions • Minimize guilt. • Understand the big picture of family life. • Providing resources so parents can educate siblings and other family members. Change Process • • • • • Takes Time Takes Strong Leadership Entire School Effort Embed within Other Initiatives Measured Outcomes Finally: • Individuals with autism spectrum disorders present complex challenges. There is no easy answer. Because of the differences in these individuals there is no standard approach that will work with all. At the same time, good instruction works with all students. Think in terms of universal design.