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Autism Spectrum Disorders

IntégréTéléchargement
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
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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?
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Antecedent-Based Interventions
Cognitive Behavior Intervention
Differential Reinforcement
Discrete Trial Teaching
Exercise
Extinction
Functional Behavioral Assessment
Functional Communication
Training
What are these evidencebased practices?
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Modeling
Naturalistic Intervention
Parent-Implemented Intervention
Peer-Mediated Instruction
Picture Exchange Communication
System
• Pivotal Response Training
• Prompting
• Reinforcement
What are these evidencebased practices?
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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
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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
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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
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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
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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
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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.
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