“Adulting”: Effectively Preparing Individuals with ASD

MaryE.McDonald,Ph.D.,BCBA-D,LBAEdenII/GenesisPrograms&HofstraUniversity

What Happens to Our Sweet Little Kids?

THEY GROW UP!

“Adulting”

• What do we mean by ”adulting?”

• Adulting (v): to do grown up things and hold responsibilities such as, a 9-5 job, a mortgage/rent, a car payment, or anything else that makes one think of grown ups.

• to behave in an adult manner; engage in activities associated with adulthood

• to make someone behave like an adult; turn someone into an adult

TheNeedisReal• 1in68childrenhaveautism

• Thenumberscontinuetoincrease….

• Overthenext10-years,500,000childrenwithautismwillbecomeadults

• 90%ofadultswithautismareunemployedorunderemployed

WHATWEKNOW

Preschool

Classroomroutines

Playskills

Kindergarten

Classroomroutines

Pre-academicskills

Basicsocialskills

ElementarySchool

SocialSkills

Academicskills

WHATWENEEDtoKNOW

AdolescentandAdultServices

Socialnavigating

Academicskills

Beginningofindependence

Advancedsocialskills

Academicskills

Independence

Organization

Self-monitoring

Vocationalskills

EssentialSkillsNeeded:

SomeImportantSkillAreas• Communication &Socialskills

• Selfhelp/independentlivingskills• Communityawareness/CommunityParticipation

• SelfAdvocacy• Jobskills• jobreadinesstoobtainingand

retainingpaidemployment

• Leisureskills

What does it meant to be independent?

Do you consider yourself to be independent? Why?

This is a Problem!

These are all important skills but some of the most

difficult for individuals with ASD

Do WE Sometimes Limit or Prevent Independence? How can we Move along a

Continuum to Promote Independence?• From 1:1 supervision to independence

• Time on task and transitions

• Personal care

• Behavior and self- monitoring

• Leisure skills

• Vocational preference and choice

Independence vs. Interdependence

• The student is able to complete the task completely by him/herself

• The student is able to complete the task with interaction with others in his/her environment

TheImportanceofInterdependenceSomeSocially-RelatedVocationalSkills

• Askingforhelpwithatask

• Askingforclarificationofatask

• Askingforamissingitem

• Askingforfeedback

• Acceptingfeedback/criticismofwork

• Notifyingsomeoneifmoreworkisneeded

DiscriminatingwhentoASKforHELP(“Ineedhelp”or“Workalone”)

NineGuidingPrinciples(TheAdultWorld)• NADSP(NationalAllianceforDirectServiceProfessionals)codeofethicsforadult

services.AnationalpanelofDSPs,advocates,families,professionals,andresearchersconstructedtheseguidelines.Standardsofconductandprofessionalismareoutlinedacrossnineareas:

1.Person-CenteredSupports:

• Firstcommitmentistotheindividual,everythingthatwedoflowsfromthispremise

2.PromotingPhysicalandEmotionalWell-Being:

• Ensuretheemotional,physical,andpersonalwell-beingoftheindividualsreceivingsupport

• Avoidaversiveordeprivationtechniqueswhenpossible,ifinanapprovedBSPfadeoutASAP

NineGuidingPrinciples3.IntegrityandResponsibility:

• Assistpeopleinleadingself-directedlivesandfosteraspiritofpartnershipwiththeindividualsweserve,otherprofessionals,andthecommunity

4.Confidentiality:

• Safeguardandrespecttheconfidentialityandprivacyoftheindividuals

5.Justice,Fairness,andEquity:

• Promoteandpracticejustice,fairness,andequityfortheindividualsandthecommunityasawhole

6.Respect:

• Respectthehumandignityanduniquenessoftheindividuals.Recognizeeachindividualasvaluableandhelpothersunderstandtheirvalue

NineGuidingPrinciples7.Relationships:

• Assistindividualstomakeandmaintainrelationships

• Assurethatindividualshavetheopportunitytomakeinformedchoicesinsafelyexpressingtheirsexualitywithoutjudgment

8.Self-Determination:

• Assistindividualswithdirectingthecourseoftheirownlives

• Workinpartnershipwithothers

• Honortheindividual'srighttoassumeriskinaninformedmanner

9.Advocacy:

• Advocatewithindividualsforjustice,inclusion,andfullcommunityparticipation

• Promotehuman,legal,andcivilrightsofallindividualsandassistotherstounderstandtheserights

EthicalProcedures• Individualswhoarerecipientsorpotentialrecipientsoftreatment

designedtochangetheirbehaviorhavetherightto

1. Atherapeuticenvironment

2. Serviceswhoseoverridinggoalispersonalwelfare

3. Treatmentbyacompetentbehavioranalyst

4. Programsthatteachfunctionalskills

5. Behavioralassessmentandongoingevaluation

6. Themosteffectivetreatmentproceduresavailable(VanHouten etal.,1988)

Whataresomeoftheissues?• Startingtoteachtheseskillstoolate

• Transitioningat21yearsold

• Can’tstartteachingthislate….

• Communicationskills

• Selfhelp/independentlivingskills

• Socialskills

• Jobskills

• Leisureskills

• 1:1instructionnotprovidedinadultprograms

• Studentsnotusedtofunctioningingroups

• Staffturnovercanbeanissue

Staffing and Fading Supports

SCHOOL-AGEPROGRAMS

•Master’slevelteachersrequired• 1:1and2:1staffratio• Instruction-based/direct

ADULTSERVICES

• H.S.degreerequired• Lowerstaffingpatterns/groups• Experience/community-based

Goals of Adult Services

• Foster skills that develop greater independence for our clients throughout their lives

• Secure opportunities for volunteer job sampling within the community• Teach skills to grow and develop to their maximum workforce potential• Teach skills to develop self-help and independent leisure activities • Teach clients the intricacies of appropriate behavior in the community

The Importance of CHOICE

THISISAMUSTREADARTICLE….

PreferenceAssessment

• Assesspreferenceofspecificskills(e.g.,cuttingfoodvs.stockingitems)• Assesspreferenceforspecificlocationsandconditions(e.g.,noisy,crowded)• Assesspreferencesofparticularjobs(non-verbally&verballyifpossible)• Musthavechoices toassesspreferences• Makeconsiderationsforstudentswhoareverbal/non-verbal

HowtoAssessPreference• Ask• Observe• Interview (family/teachers)• Give choices (e.g., forced choice selections or sample one at a time)• Note behavior/affect in different situations• Very often students let us know we just need to listen!

ChoiceAssessmentoComputer

oPolish Nails

oCut vegetables

oPolish Nails

oEat a snack

oPolish Nails

oClean shelves

oPolish Nails

oEat a snack

oCut vegetables

Polish Nails

Polish Nails

Cut vegetables

Eat a snack

Eat a snack

Transition Skills

AcademicsLifeSkills/SocialSkills

WherearetheeffortsbeingfocusedforstudentswithASD?

SkillsFortransition- AutismSpeaks(Baker,et.al,2015)• Communication

• Schedules

• Self-care

• Breaks

• Chores/household

• Moneyskills

• Safety/communitysafety

• Leisureskills

• Vocationalskills

ISP(IndividualizedServicePlan)Areas(alwaysconsiderpre-requisiteskillsneededforactivities)

• Communicationskills(e.g.,requestforhelp)

• Socialskills(e.g.,turntaking,conversationalskills,bathroometiquette,personalrelationships)

• Socialappropriateness(e.g.,usingpublicrestrooms,eatinginrestaurantswithutensils)

• Lifeskills(e.g.,health,safety&firstaid,personalinformation/identification)

• Self-regulation(e.g.,copingstrategies,deepbreathing,relaxationskills)

• Financial(e.g.,moneymanagement)

• Selfcare(e.g.,leisure,

grooming,toileting,dressing)• selfmanagement(e.g.

medication)• Vocationalskills(e.g.,

answeringphone)• Recreation/leisure(e.g.,

treadmill)• Communityawareness(e.g.,

safetysigns,identificationofcommonstores/grocery)

• Transportation(e.g.traveltraining)

Target across all Settings

üIndependence and Self-Help

üSkill Acquisition and Retention

üFUNCTIONAL Academics

üSocial Skills, Leisure

üQuality of Life

ThingstoThinkAbout…

FortheResume(JobSpecific)

• Collating,sorting,filing,folding,stapling,holepunching,wrapping,cleaning, mailing,ordering,selling,stocking, pricing,alphabetizing,takingcareofplants,sortinglibrarybooks,typing, editingtext,takinginventory etc...

SkillsForLife(AcrossAllEnvironments)• Remainingontask,endurance,

requesting,problemsolving,independence,navigatingenvironment,tolerating, monitoringappearance,monitoringbehavior,statingpreference,beingflexible,respondingtounexpectedcircumstances,greetingpeople, introducingself,usingpolitebehavioretc..

StayCalmandTeach!• Beginteachingearly…REALLYearly!• Communication,Communication,Communication…

• Bythetimetheygettoadulthoodallofthosesmall“problems”becomeBIGones• Fade1:1/2:1instructionasquicklyaspossible(ASAPPROPRIATE)• CommunityIntegration- startwithoutingsatayoungage• ThinkFUNCTIONALeachandeveryday• ThinkINDEPENDENCE/INTERDEPENDENCEeachandeveryday

ISWHATIAMTEACHINGGOINGTOCREATEINDEPENDENCE?ISITFUNCTIONAL???WILLTHEINDIVIDUALUSEIT?

What are some lifelong skills that we can begin TO FOCUS ON at an early age?

• Waiting

• Requesting/needs

• Play----Leisure

• Snack---Meal preparation

• Tolerating groups

• Tolerating crowds/noise

• Tolerating no

• Following a schedule

• Using technology

• Asking for help

• Bathroom skills/ hygiene

• Increased engagement/duration

Sample IEP Goals Related to Transition

* Teach functional and relevant skills*

• Maintain appropriate hygiene and grooming

• Use a public bathroom independently

• Respond appropriately to co-worker and supervisors

• Remain “on-task” at a work-site

• Eat appropriately with co-workers

• Develop Leisure Skills

• Develop ability to use public transportation

• Follow a work schedule

• Job-sampling

• Increase duration on task

• Perform building maintenance skills

• Perform office skills

• Follow directions of co-worker or job coach/instructor

• Develop exercise/fitness skills

A Case for Teaching Functional SkillsMy Other Brother Daryl, by Preston Lewis

“He can put 100 pegs in a board in less than 10 minutes while in his seat with 95% accuracy.”

“But he can’t put quarters in vending machines.”“He can sort blocks by color, up to 10 different colors!”“But he can’t sort clothes; whites from colors for washing.”“He can tell letters of the alphabet with 80% accuracy.” “But he can’t tell the men’s from the ladies’ room when we go out.”

• AssessmentofFunctionalLivingSkills–AFLS(Partingtonbehavioranalysts.com)

• AutismSpeaks- Toolkits• TransitionandEmployment

• Edmark FunctionalSightwords

• ThankYouforCalling(Imaginart)

• CheckWritingPractice(PCI)

• CareerFolio(CareerInfo.CollectionSystem)

• MasteringMath:StepbyStep

• CoinULator Math(worksheetsandProgressChart)

• TheNewspaper(Remedia)

• CatalogsandMailOrders(Remedia)

• MenuMath(Remedia)

• SurvivalSightwords (Remedia)

• Look&CookMicrowave• (Remedia- madefornon-readers)

• CookingtoLearn(PCI)

FunctionalCurriculumResources

FunctionalCurriculumIdeas…

Math

• Addition/ Calculator Use• Counting Money• Making Purchases In-House• Making Purchases in the

community

Reading

• Functional Sight Words• Reading Street Signs• Reading Menus• Reading Recipes

JasonThen&Now

• Addswithnumberline

• Sortsshapes

• Matchesletters

• Writespersonalinformation

• Addswithcalculator

• Sortssilverware

• Playsboggle

• Fillsoutapplication

Using Visual Supports

VISUALS

• Icons

• Pictures

• Graphics

• Visual TA

• Schedules

• Structured Work Systems

UsingMatchingforFull-DayActivitySchedule

SampleSchedules

SampleLeisureSchedule

StructuredWorkSystems(SWS)?• Worksystemsareanevidence-basedpracticethatvisuallystructuresequencesofskillsthatcanbepracticedacrosssettings(Hausler&Bernard-Opitz,2011).

- Providesopportunitiesforindependence- Allowsformoreindividualized/flexibleroomscheduling- HighlightsthestrengthsofindividualswithASD- Supportsthedeficitsofexecutivefunctioning

- Organization- Distractibility- Sequencing- Generalization- Initiation

StructuredWorkSystems1) Tasksmustfollowalefttorightortoptobottomformat.

2) ToDotasksaresetupontheleft.3) Finishedtasksareplacedontheright.4) Giveonlytheamountoftasksthatanindividualcancompleteduringthetime

given.(Planforsuccess!)

5) Onlygiveareasonableamountofworkpertask.

6) Onlyincludemasteredskills.Iftheindividualrequirespromptingtocompletethetask- workononetaskatatime.

7) Ifpromptingisneededtoinitiateatask- promptfrombehind.Limitverbalprompts.

8) Changeouttasksotheindividualcanworkonmoreskills.

The Importance of the CommunityStart this early too!

Adults in the Community

o Access through visiting local restaurants, stores, etc.

o Access through attending community events

o Access through vocational volunteer work-sites: job carve as needed to create individualized tasks in order to participate

o Identify reinforcing locations and activities within the community

o GET OUT THERE!!!

Gaining Community AccessParticipation & Integration

Society/Community

Home/Independent Living:

Daily LivingLeisure/Rec Participation

Vocational Integration:EmploymentJob sample

Participation

Community Integration

Fitness

Participation

Genesis In and Out of House • Newbridge Inn, Taco Tuesday, Food cart

• Mailings/Office work

• Data entry

• Off site- white post farms, movies, home depot…etc

• Social enterprise- in progress- Kiosk at local mall

Behavioral Assessment and Proactive Strategies

KeepinMind…• Challengingbehaviorservesafunctionforanindividual

• individualscanusebehaviortoaccesssomethingorsomeone(obtain/request)oravoidsomethingorsomeone(escape/protest)

• Theprocessofdeterminingthefunctionallowsyoutodeterminereplacement/preventionstrategies

Whattoteach

• Takeaproactiveapproach,lotscanbedonethroughprevention

• Teachalternative/replacementbehaviors

• Teachcommunication- relatedtoeachpossiblefunction

•

Supports/Systems

REMINDERS

DevelopingSocialCompetence

Clubs- toAddressSocialSkillsandPersonalInterests

• ComicBookClub

• GamersClub

• WomanWellnessClub

• BasketballClub

• TalentClub

• GardeningClub

• PhotographyClub

• Scrapbooking

• Jewelrymaking

• Bingo

• Karaoke

• BookClub

• Cardclub

• Currentevents

WhyareClubsImportant…• GroupActivities/Participation• Socialskills• Toleranceforothers• Waitingyourturn(i.e.;largegroups&limiteddevices)• Developinginterests(exposuretonewactivities)• Developingleisureskills• Buildingrelationshipsonsharedinterests

References• Bannerman,D.J.,Sheldon,J.B.,Sherman,J.A.,&Harchik,A.E.(1990).Balancingtherighttohabilitationwiththerightto

personalliberties:therightsofpeoplewithdevelopmentaldisabilitiestoeattoomanydoughnutsandtakeanap. JournalofAppliedBehaviorAnalysis, 23(1),79–89.

• Carr,E.G.,Levin,L.,McConnachie,G.,Carlson,J.I.,Kemp,D.,Smith,C.(1994).Communication-basedinterventionforproblembehavior.Baltimore,MD:BrookesPublishing.

• Cipiani,E.(Ed.).(1989).Thetreatmentofseverebehaviordisorders.Washington,D.C.:AAMR.

• CooperJ.O,HeronT.E,Heward W.L. (2007).Appliedbehavioranalysis(2nded.) UpperSaddleRiver,NJ:Pearson.

• Durand,M.V.(1990).Severebehaviorproblems.Afunctionalcommunicationtrainingapproach.NewYork,NY:TheGuilfordPress.

• Hausler,A.,&Brenard-Opitz,V.(2011).Visualsupportforchildrenwithautismspectrumdisorders. ShawneeMission,KS:AAPCPublishing.

• Holmes,D.L.(1998).Autismthroughthelifespan.Bethseda,MD:WoodbineHouse.

• Maurice,C.,Green,G.,&Luce,S.C.(Eds.).(1996).Behavioralinterventionforyoungchildrenwithautism.Austin,TX:Pro-Ed.

• Reichle,J.&Wacker,D.P.(1993).Communicativealternativestochallengingbehavior.Baltimore,MD:BrookesPublishing.

• Roux,A.M.,Shattuck,P.T.,Cooper,B.P.,Anderson,K.A.,Wagner,M.,&Narendorf,S.C.(2013).PostsecondaryEmploymentExperiencesAmongYoungAdultsWithanAutismSpectrumDisorderRH:EmploymentinYoungAdultsWithAutism. JournaloftheAmericanAcademyofChildandAdolescentPsychiatry, 52(9),931–939.

• VanHouten R,AxelrodS,BaileyJ.S,Favell J.E,FoxxR.N,IwataB.A,etal. (1988).Therighttoeffectivebehavioraltreatment. JournalofAppliedBehaviorAnalysis. ;21:381–384.

VisualSupportVisualSchedules/Communication:• http://www.setbc.org/download/Public/VSS.pdf• http://mrsriley.com/• http://www.google.com/imghpSocialStories:• http://209.197.91.184/socialstories/Independenttasks:• http://www.angelfire.com/pa5/as/asteachersites.html• http://www.positivelyautism.com/free/• http://www.worksheetworks.com/• http://www.tlsbooks.com/

FurtheryourKnowledge• Videodepictingclassroommanagementcomponents:

• http://www.youtube.com/watch?v=SLIpCJybXLI

• CAST(CenterforAppliedScienceTechnology)GuidelinesforUDL:• http://www.cast.org/publications/UDLguidelines/version1.html

• AutismSpeaksTransitionToolKit:• https://www.autismspeaks.org/family-services/tool-kits/transition-tool-kit

• Behaviorallessons:• http://712educators.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.teachers.net%2Flessons%

2Fposts%2F285.htm

• EnforcingClassRules:• http://712educators.about.com/cs/backtoschool/a/classrules.htm

• InteractiveBehavioralAdvisor:• http://712educators.about.com/cs/backtoschool/a/classrules.htm

• GeneralAdviceforTeachers(slideshow)• http://www.teachervision.fen.com/slideshow/teaching-methods-and-management/52294.html?detoured=1