multidisciplinary interventions for students with asd in ... · stereotyped or repetitive motor...
TRANSCRIPT
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Multidisciplinary Interventions
For Students with ASD in Public Schools
Lynn Chachkes, Ph.D.
Lori Franzella, MS, CCC-SLP
Trisha Poirier, OTR/L
Our Work Together
How long? We have worked together as
part of a school based team for the past 13 years.
Setting: K to 5th grade school in a district with a focus on inclusion.
Caseload observation: Increase in number of children we service with ASD.
DOE Practice Advisory: 2006
IEP Teams Need to Consider: Verbal and nonverbal communication Social interaction skills
Unusual responses to sensory
Trouble with change in environment or daily routines
Repetitive behaviors, motor movements and vocalizations.
Positive behaviors interventions Social and Emotional Development
Social Skills to avoid and respond to bullying
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Schedule of the Day 9:00 to 12:30 Presentations
Break 10ish
12:30-1:15 Lunch
1:15 – 2:15 Case study
2:15 – 2:30 Questions
Autism Spectrum Disorders & Anxiety
Dr. Lynn Chachkes
Licensed School Psychologist
Licensed Psychologist
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Objectives
Overview of DSM-5 and Autism
Reasons for anxiety in children with ASD
Characteristics of children with ASD to
target for intervention.
Overview of Cognitive-Behavioral Therapy
Affective Education
Behavioral Strategies
Cognitive Strategies
DSM 5 and ASD
Autism Spectrum Disorder is under category of Neurodevelopmental Disorders
Prior Categories including PDD:NOS and Asperger’s Disorder are collapsed into one distinct Autism Spectrum Disorder
DSM 5 ASD Criteria
A. Persistent Deficits in Social
Communication and Social Interactions
Social-Emotional Reciprocity
Nonverbal Communicative Behaviors
Development, Maintaining &
Understanding relationships
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DSM 5 ASD Criteria B. Restricted, repetitive patterns of behavior, interests or activities (need 2):
Stereotyped or repetitive motor movements, use of objects or speech
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior.
Highly restricted, fixated interests that are abnormal in intensity or focus
Hyper- or hyporeactivity to sensory input or unusual sensory aspects of the environment.
DSM 5 ASD Criteria
With or without accompanying
intellectual impairment
With or without accompanying language impairment
Important intervention implications
DSM 5 Changes ASD
Inclusion of:
Social Communication Disorder
Distinct from Autism Spectrum Disorder
Need to rule/out ASD to diagnose Social Communication Disorder
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ASD and Anxiety
• High rates of secondary anxiety disorders in children with Autism Spectrum Disorders.
Why?
• Risk due to life stressors created by disorder:
• Feeling that life is unpredictable
• Feeling that life is stressful and overwhelming due to social and social
challenges; understanding others, and environmental sensory issues.
Therapy Interventions: CBT
Cognitive-Behavioral Therapy
Integration of Cognitive and Behavioral Approaches
Purpose is to make specific changes in thoughts, feelings or behaviors.
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CBT and Children with ASD
Best use with children who are
verbal and cognitive functioning
Average or Above.
Even with Average to Above IQ,
important to understand cognitive
profile for uneven patterns, strength
and weaknesses.
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Learning Profile and
Intervention
Child A:
Verbal IQ – 130
Visual Spatial -80
Working Mem - 125
Process Speed – 80
Child B:
Verbal IQ – 85
Visual Spatial – 130
Working Mem- 87
Process Speed – 95
ASD Characteristics: Targets
for CBT Interventions
ASD Characteristics: Targets for CBT Interventions
Children with ASD often have a
more limited set of reactions to their
emotions.
Shutdown meltdown
Tantrum - upset
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ASD Characteristics and
Targets for CBT Interventions
Logical thinking
Black and White – Literal Focus on physical symptoms associated with anxiety
rather than simply the subjective feeling.
Subjective feelings are hard to
understand.
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ASD Characteristics and
Targets for CBT Interventions
Executive Functioning Problems with planning and
organization
Chunking information into smaller pieces
Use of visuals/workbooks/concrete helpful as a result
ASD Characteristics and
Targets for CBT Interventions
One-Track Mind
Inflexibility in thinking and problem solving
Trouble set shifting (e.g., trouble learning from mistakes, continue to use wrong strategy)
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ASD Characteristics and
Targets for CBT Interventions
Rigidity
Fear of making a mistake – looking stupid to peers
Intellectual Superiority
Can trigger flight, flight or freeze response
ASD Characteristics and
Targets for CBT Interventions
Insistence on Sameness
Format of sessions/visual schedules
Compulsion for Closure – Due to
overfocusing on details and perfectionism.
Leads to trouble ending tasks
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ASD Characteristics and
Targets for CBT Interventions
Function of Special Talents and
Interests Enjoyment of new items or knowledge
Admiration of parents and peers
Blocks thoughts of sadness, anxiety or anger
Integration into treatment and increased
motivation/attention/understanding
Use of Power Cards
CBT: Part I
Affective Education
Affective Education
Goals
Experience of emotions
Why do we have them
Expression of emotions and level of intensity
Distinction among emotions:
Use of Emotion Chart
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Modifications to CBT: Affective Education
Affective Education
Awareness and monitoring of emotions
Start simple with basic positive emotions (e.g., happy) to learn this technique - move to negative.
Can begin with special interest to identify happy emotion and begin to understand cues.
Keep notebook to track observations of
feelings.
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Affective Education: Feelings
Baseline assessment of nature anxiety
Help child self-identify on visual level of anxiety
Use 5-point scale as a check-in each session
Child may need help identifying anxiety level
Modifications to CBT: Affective Education
Identify underlying internal and external cues
Create list of physiological, cognitive and behavioral cues that indicate an increase in emotional arousal in themselves.
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Modifications to CBT: Affective Education
Physical Cues
Heart beat
Breathe quicker
Face red
Butterflies in stomach
Cognitive
Catastrophic thoughts
Black and White Thinking
Increase in negative self-talk
Inner critic
Behavioral
Low Energy
High Energy
Avoid Work
Withdraw from others
Functional Behavior
Assessments
Need to look at external behaviors
Need to look at internal triggers
Important for positive behavioral support
plans
CBT: Part 2
Behavior
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Therapy Interventions: CBT
Assessment of Behavioral Indicators
Identify time spent engaging in interest and solitary activities; rigidity, behavioral control strategies.
Collection of data from parents and teachers critical.
Repetitive Behaviors & Interests
Stress
Anxiety
Increased Behaviors
Stress & Anxiety
Reduction
Negative Feedback
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Power Cards
CBT: Behavioral Work
Stress management strategies
Active Strategies: Exercise
Distress Tolerance: Calming and Grounding
Slowing Down Strategies
Belly Breathing
Lazy Eight Breathing
Guided Imagery
Progressive Muscle Relaxation
Belly Breathing: Kindergarten
to Grade 3
Elmo Belly Breathing
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CBT: Part 3
Cognitive
Cognitive Strategies
Thinking Errors
Help understand the “errors” used and how to
modify/challenge these.
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Cognitive Restructuring
Challenging thinking with logical evidence
Children with Autism make false assumptions of their circumstances, consequences and intentions of others
Tendency toward literal interpretation; casual comments taken out of context and to extreme.
Less able to put things into perspective, seek clarification and consider alternative explanations.
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Cognitive Restructuring
CBT: Cognitive Restructuring
Child may blame others OR
Child may excessively blame themselves for events
Inner coach/ Inner critic
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CBT: Cognitive Restructuring
Safety and choice of words may need to be addressed with child
Two column – Very literal – Safe/Unsafe words/actions
CBT: Two Column for Black/White
Thinking
Safe
My hands stay to myself
Use kind words
Remain in the classroom
Unsafe
I cannot hit others
I cannot say unkind words to others
I cannot leave the classroom without permission
Implications for IEP &
Consultation to Teachers
Goals & Objectives
Consultation to generalize skills
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References
Power Cards: Using Special Interests to Motivate Children and Youth with Autism
(Gagnon, E., 2001).
What to Do When You Worry Too Much: A Kids
Guide to Overcoming Anxiety (Huebner, D., 2006).
CBT for Children and Adolescents with High Functioning Autism Spectrum Disorders
(Scarpa, A., White, S., Attwood, T., 2013).
Multidisciplinary Interventions For Students With ASD In Public
Schools
Practical strategies and ideas of how to
implement social thinking skills to support children’s needs in an inclusive setting.
Goals for today Define the concept of Social Thinking and
distinguish it from Social Pragmatics/ Skills
Establish the Importance of Social Thinking in the
Classroom
Define Key Social Thinking Vocabulary
Provide Hands-On, User-Friendly Resources, Suggestions and Activities to use RIGHT AWAY to integrate Social Thinking Vocabulary into your school’s classroom routines!
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Parts of Language
Language
Form Content Use
Morphology:
internal structure of
words Syntax:
how words
combine to make sentences
Semantics:
meaning of words
Pragmatics:
social use of
language
Social Skills
How do YOU define social skills?
What are Social skills?
“Social skills are socially acceptable behaviors that enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses” (Elliot &
Gresham, 1984).
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Social skills
Using eye contact Greeting someone
Saying goodbye Using names to get
someone’s attention Turn-taking in a
game
Initiating interactions with a peer
Giving compliments
Handling winning and losing
Initiating, maintaining, repairing and ending conversations
Reading nonverbal body language
Maintaining appropriate physical space
Cooperating with peers
Dealing with teasing
Social Thinking: 3 Part Definition (from Social Thinking and Me: Thinksheets for Social Emotional
Learning; Winner & Murphy, 2016
Part 1: First Engage in Social Thinking:
Social Thinking is the ability to consider our
own and others’ thoughts, emotions, beliefs,
intentions, knowledge, etc., and think about
all this within the context of a situation.
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Social Thinking: 3 Part
Definition
Part 2: Next Comes Social Skills
Based on the social thinking and the social
data we gather, we then adapt our social behaviors based on the situation and what
we know (or don’t know) about the people in the situation.
Social Thinking: 3 Part
Definition
Part 3: Consider the desired emotional response we want in others
Our social skills are interpreted and responded to by others first at the
emotional level and then at the intellectual level.
Michelle Garcia Winner
Defines Social Thinking
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Teaching
Social skills vs social thinking The outcome may appear similar, but with social
thinking we are working to teach the underlying social cognitive process that ultimately produces the outwardly apparent skills.
Implications for you, as the
teacher/therapist/parent, etc.??? Impacts how you will frame, guide, and coach
interactions with the student(s) you are working with.
Social Skill Coaching: Imperative vs. Declarative Language
Imperative vs. declarative communication
Imperative Language is a means-to-an-end has responses that can
be right or wrong has scripted/predictable
answers is instrumental in nature
Examples: “Put on your coat.” “Ask Sam what he has for
lunch today.” “Don’t forget to put your
folder in your backpack!”
Declarative Language takes pressure off child to perform
and provide the “right” answer is an invitation to interact is more than just talking - it’s a
way of interacting with another person
is a way of being side by side with another person, looking out at the world together
Examples: “I think you’ll be cold if you go
outside in a t-shirt.” “I wonder if anyone has something
interesting for lunch.” “I wonder what you might need from
school tonight.”
Imperative vs. Declarative
responses What type of milk do
you want?
Pick up your coat.
Don’t do that.
Slow down!
Say goodbye to Billy!
I see lots of different kinds of milk!
Uh-oh! Your coat is on the floor.
It makes me sad when you do that.
You’re walking too fast for me!
Billy is leaving now.
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Why have social thinking
concepts?
Common vocabulary among parents, teachers,
counselors, and other school faculty
Assists in development of concrete strategies for abstract communication concepts
Vocabulary describes what is happening in the moment of social breakdown - easier for coaches to accurately describe the social glitch
(MGH Youthcare)
Example: Eye Contact vs.
Thinking with your Eyes
Eye Contact
Look at the speaker’s eyes/face/body
Why: it’s polite; you want them to know you’re listening
Then shape and reinforce the behavior in clinical and natural environments (generalization)
Thinking with your Eyes
Looking = Thinking
What someone is looking at is often what they are thinking about
You can get clues about what a person is thinking about by figuring out what they are looking at
People who are looking for clues will then look at another person’s eyes
Who needs social thinking?
Sheldon Cooper • Form & Content in tact
• Use???? Not so much
• Video Clip: Sheldon Lends Penny Money
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The Concepts
SOCIAL THINKING CONCEPTS Today we will cover:
Whole Body Listening
Thinking with your Eyes
Expected/Unexpected
Size of Problems
Whole Body Listening
WBL requires that when we pay attention to others,
our eyes, ears, mouth, brain, hands, feet, and heart are all involved.
Books: Can You Listen With Your Eyes
(Nita Everly)
Whole Body Listening Larry at School
(Kristen Wilson, MS, CCC, Elizabeth Sautter, MA, CCC)
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Whole Body Listening
Ideas for the
Classroom:
Trace Student Body &
Label Body Parts
Visuals: board, desk,
etc.
Mystery Student
Games:
What’s Different?
Simon Says
How can I use this tomorrow?
How Can You Integrate WBL in Your Classroom/ School? Ideas? Games?
Thinking with our eyes Definition: Using our eyes to listen, helps us
understand what non-verbal messages others are sending as well as what others might be thinking
about
Prerequisite skill: tracking eye gaze. This may need to be taught. (Eyes are like arrows)
Thinking with our eyes Ideas for the
Classroom: Movie
clips/Commercials
Doritos Commercial
Book Illustrations
Visuals around room
Determine whose turn it is to speak based on who you are looking at and not by using names.
Eye Power (Playtime with Zeebu)
Games:
Charades
Build a block tower
Mirror Game
Books
Duck on a Bike
How can I use this tomorrow?
How Can You Integrate Thinking with Your Eyes in Your Classrooms? Ideas? Games?
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Expected/Unexpected Definition: Expected and unexpected behaviors
are the unwritten or hidden social rules.
Expected behavior makes people feel more positive
(proud, happy, comfortable).
Unexpected behavior makes people feel more
negative (frustrated, uncomfortable, angry).
Expected/ Unexpected
How many unexpected behaviors can you identify
in the following clips?
Brick from “The Middle”
Elf
Expected or Unexpected????
Field Trip!!!!!
Barnes and Noble
Entering the Building Rules: a) Lower the volume of your voice b) Hold the door open for the person
behind you
c) Slow down the pace of your walking d) If you are with a group, keep your
body in the group even if you are
interested in a specific section. e) Tell people in your group where you
are interested in looking or what you
what to do.
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Barnes & Noble
• Book Stack (Hidden) Rules
• Magazine Section (Hidden) Rules
• Kids Section (Hidden) Rules
• Music Section (Hidden) Rules
• Café (Hidden) Rules
• Nook/TV (Hidden) Rules
Visual: http://jillkuzma.files.wordpress.com/2008/10/expe
cted-and-unexpected-definitions.pdf
IEP Meetings/ Parent conferences
EXPECTED Behaviors
Listen without interrupting
Turn off or put cell phone on vibrate
Share information about child at home
Ask relevant questions
Leave after designated time allotment
UNEXPECTED Behaviors
Interrupt repeatedly
Answer phone calls and send texts
Pass out 5 pages of typed demands
Blow bubbles with their gum
Give a high 5 at the end of the meeting
Continue to talk after meeting time is over
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Expected/Unexpected: Hidden Rules
Books:
How Do Dinosaurs Go To School
Expected/Unexpected section of You are a Social Detective (Winner/Crooke)
Ideas: Morning Meeting: tell the students you have picked one or two kids to
do something UNEXPECTED (tell them beforehand and give them the unexpected behavior). Can kids identify the unexpected behaviors? How did the behavior make them feel? Did they have any strange thoughts?
UNEXPECTED behaviors could include: have a student go turn the lights off and come back to the circle
have a student take off their shoes and socks and place them in the
middle of the floor
have a student to start clapping after you finish talking
have a student to go to the class library and just start reading a book
Class Posters: Identify hidden rules for activities that can be challenging for students.
Social Behavior Mapping: Connect expectations to consequences
What are the Hidden Rules
In Your Classroom/ Office???? Ask Yourself:
How many sections are there in your classroom?
Are there different rules for each section?
How explicit are you in explaining these rules?
Do these rules change without warning?
How can I use this tomorrow?
How Can You Integrate Hidden Rules in Your Classroom/ School? Ideas? Games?
Size of Problems
Not all problems are created equal!
You are out of K-cups vs. the copy machine being busted
The size of your reaction should match the size of the
problem!!!!!
Toddler Tantrum!
The Middle: TORNADO!
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Size of Problems
Activity
With the people sitting around you, use the 5 point size of problems chart to categorize at least 3 of the following problems. Keep in mind:
Do you agree?
Can a problem fit in different sizes? Why?
How will you handle differences in opinions?
1) It’s science time and you can’t stop thinking about your new video game.
2) Somebody is in your meeting space on the rug.
3) You suspect a student at your table is copying your answers on a spelling assessment.
4) Your friend is sharing a secret she promised to keep.
5) You play football at recess and you get a grass stain on your jeans.
6) Your final project in social studies got dropped in a puddle on the way to school.
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Size of Problems
Ideas:
Keep a chart in classroom with
problems that
come up frequently and put
them in the appropriate
category
Books:
Superflex curriculum:
Glassman
Alexander and the No Good Very Bad Day
Elephant & Piggie Books (Mo Willems)
How can I use this tomorrow?
How Can You Integrate Size of Problems in Your Classroom/ School? Ideas? Games?
Additional concepts
Body/ Brain in the Group
Thinking of you/Just ME Kid
Whopping Topic Change
Friend Files
Social Smarts
Smart Guess/ Wacky Guess
Social Spying
The Boring Moment
Some Final Thoughts
All professionals, paraprofessionals and
parents need to work together to build a
child’s social thinking and related skills. It
is not just the job of the person running
the “social group”. (Winner)
Social skills and expectations are different as children get older. What’s appropriate in kindergarten is not the same as in second grade.
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Resources
Michelle Garcia Winner’s Social Thinking
Website www.socialthinking.com
Jill Kuzma’s SLP Social and Emotional Skill
Sharing Site http://jillkuzma.wordpress.com
You Tube
Teachers Pay Teachers
Self-Regulation Strategies
for Students with ASD
Trisha Poirier, OTR/L
Learning Objectives Identify sensory processing challenges in
students with ASD.
Learn and identify self-regulation strategies to support students with ASD in
a school setting.
Overview of self-regulation programs.
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What is Sensory Processing? The way a student’s nervous system receives messages from the senses
How a student interprets the information received
Uses the information for appropriate motor, behavioral and emotional responses
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Seven Sensory Systems
Proprioception System
Provides a student with information related to his/her
body awareness.
Provides a student with information about when and how muscles contract and stretch.
Supports a student in knowing where he/she is spatially in the environment and how to interact with objects in
that environment.
Provides a student with how much force to use on objects.
Vestibular System Provides a student with information received through
movement in the inner ear.
This system helps a student know how his/her head is moving through space.
It supports a student in knowing if he/she is in motion and the direction they’re in.
Examples: swinging, standing, sitting, upside down, balance, etc.
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Each student with ASD reacts
differently to sensory input!
Reacting to Sensory Input
Hyposensitive (Under-responsive): an individual tends to have a high threshold for
typically aversive stimuli, such as loud noise or pain.
Hypersensitive (Over-responsive): an individual
tends to react to sensory information with avoidance, defensiveness, or strong dislike to
the sensory input received.
How to support students with ASD and SPD in the school setting
Sensory Diet: An individualized plan of activities to provide a student appropriate sensory input he/she requires to remain focused, organized and regulated throughout the school day.
Classroom Accommodations
Use of Self-Regulation programs
Social Stories
Take Data
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Behaviors Observed in the
Visual System
•Sensory sensitivities to changes in light.
•Easily distracted by visual stimuli in the environment.
•Looks intently at people or objects.
•Difficulty reading facial expressions.
•Has difficulty guiding movements with eyes, such as for eating.
•Has difficulty finding objects in cluttered background.
•Unable to visually scan across a page without losing words or sentence.
Strategies to support the Visual System
•Limit visual input by dimming lights.
•Student may wear visor or baseball cap. •Use a privacy shield when working independently.
•Keep desk area free from clutter.
•Place student’s desk away from windows and hallway.
•Use a tracking tool to help students read across a line(s).
•Cover up problems on worksheets and/or half of page at a time. Sticky notes work well for this.
•Clean out desk and locker weekly. Take a picture of what an organized desk/locker area looks like and work off that.
•Provide a quiet space for the student to “chill out” in and regroup.
Behaviors Observed in the Tactile System
•Tactile sensitivity:
-Avoids touch or reacts aggressively to touch.
-Has difficulty tolerating touch by peers, standing close to peers in a line or while sitting on the floor.
-Dislikes messy play (using glue, shaving cream, etc).
-Dislikes certain textures of clothing or tags in shirts and seams in socks.
-Dislikes certain textures of food.
• Does not feel food on face (Under-responsive)
• Touches objects or people excessively (sensory seeking)
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Strategies to Support the Tactile System
For tactile sensitivities:
•Seat the student at a table with the least amount of classroom traffic.
•Have the student stand at the back of a line or sit in back row on the floor to decrease bumping of peers.
•Have the student transition a minute or two early or late when needing to transition to a new part of the school.
•Cut tags of clothes.
Tactile Strategies continued….
•Have“mirror checks”after snack and lunch to help the student who lacks the ability to feel food on the face.
•Use of fidgets, sand or rice bin and shaving
cream play.
Behaviors Observed in the Auditory System
•Becomes upset with loud or unexpected
noises-may cover ears.
•Hum or sing to screen out unwanted noise.
•Easily distracted by sounds.
•Appears not to hear, even when called
(Under-responsive).
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Strategies to Support the Auditory System
•Keep classroom door closed to limit auditory distractions from the hallway.
•If possible, forewarn student of fire drills-use social stories.
•Use of headphones for assemblies, fire drills, cafeteria and/or the classroom.
•Provide a quiet space for students to self-regulate after being in an overwhelming noisy environment.
•Listen to music-calming or alerting.
Behaviors Observed in the Taste/Smell Systems
•Dislikes strong smells or tastes, may
gag easily.
•Is described as a picky eater.
•Eats non-edible items.
•Smells or tastes toys prior to play.
Strategies to Support the Taste/Smell Systems
•Put something in the mouth.
-Chewy foods (Organizing)
-Granola bars, fruit snacks, dried fruit, bagels, cheese, gum
-Crunchy foods (Alerting)
-Pretzels, crackers, popcorn, raw vegetables, ice cubes
-Sucking foods (Calming)
-hard candy, peanut butter
•Use of whistles, straws or other blow toys
•Oral-motor exercises
•Avoid smells the student cannot handle (i.e. food, perfume)
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Behaviors Observed in the Proprioceptive System
AVODIANCE BEHAVIORS
•Poor body awareness. •Exerts not enough
pressure for handling objects
•Difficulty changing body position for specific tasks.
•Dislikes movement activities.
•Stabilizes self against furniture in the classroom.
•Is clumsy and accident prone.
•Frequently drops items.
SENSORY SEEKING BEHAVIORS
•Enjoys rough and tumble play, such as “crashing” and falling into objects.
•Seeks deep pressure by squeezing between objects/furniture.
•Exerts to much pressure on objects.
-may stomp feet on the ground
•Chewing on pencils or clothing
Strategies to Support the Proprioceptive System
•Use of body sock, cotton ribbing tunnel.
•Roll up student in crash mat.
•Have student jump in crash mat.
•Wheelbarrow walking.
•Trampoline activities.
•Theraputty tasks.
•Medicine ball games.
•Heavy work activities, such as carrying books.
•Have student hang from monkey bars.
•Chair or wall push-ups. •Steamroll with therapy
ball. •Use of backjack chair to
support a student in sitting upright on the floor.
•Have student sit against wall on the floor or on stomach propped on elbows.
•Scooter board activities. •Yoga
Behaviors Observed in the Vestibular System
•Craves or avoids movement.
•Engages in frequent spinning, jumping, bouncing, or running.
•Avoids playground equipment or balancing activities.
•Demonstrates poor balance in chairs or on floor while changing body position.
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Strategies to Support the Vestibular System
•Use of an inflated cushion on chair, such as a Move-n-Sit cushion.
•Use of theraband on chair legs. •Have student run errands for teacher, pass out
papers, or take a walk.
•Use playground equipment, such as swings, slides, and monkey bars.
•Spinning activities, such as a Dizzy Disc or Sit ‘N Spin.
•Jump on hippity hop, trampoline or bounce on therapy ball.
•Scooter board activities.
•Slow rocking over therapy ball or on net swing for calming input.
When in doubt, use Heavy Work!!
Heavy Work in School 1. Place chairs on desks or floor at the beginning or end of the day.
2. Erase or clean white boards and tables.
3. Move heavy containers around the school, such as Xerox paper, library books, lunch box and recycle bins.
4. Climb on playground equipment. Hang/swing from trapeze bar.
5. Wall or chair push-ups.
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More Heavy Work Ideas…..
6. Student job of “door holder”.
7. Crab or wheelbarrow walking.
8. Pushing self on scooter board on belly.
9. Play tug of war.
10. Yoga poses or exercises.
What is self-regulation? Self-regulation involves components of
executive functioning (e.g., attention, inhibitory control, problem solving),
understanding and interpreting emotional and autonomic states, and controlling responses to those states (Kuypers, 2011).
Self-regulation is key for student success.
The Alert Program The Alert Program for Self-Regulation
(Mary Sue Williams, OTR/L, Sherry Shellenberger, 1994).
“How Does Your Engine Run?”
For children who have sensory processing difficulties.
Purpose of the program:
Help children monitor and change their level of alertness in a given situation.
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High-Low Chart
The ZONES of Regulation The ZONES of REGULATION (Leah M.
Kuypers, MA Ed. OTR/L, 2011)
Incorporates Social Thinking to support students with Self-Regulation and Emotional Control
For children who have:
Sensory processing difficulties
Executive Functioning
Trouble Controlling Emotions
The Four Zones
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Zones Check-In
Zones Tools Worksheet
A Student Zones Toolbox
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What my peers think?
Zone Calming Strategies Lazy 8 Breathing
The Six Sides of Breathing
My Calming Sequence
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ZONES across the day
ZONES in the classroom
Quiet Space in the Classroom
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A Classroom Favorite…..
GO NOODLE!
gonoodle.com
Videos that support self-regulation in
students
Use with the ZONES of Regulation (student check-ins before and after a video)
Go Noodle in Action
More Go Noodle!
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References Williams, M.S., & Shellenberger, S. (1994). “How does your engine run?” A
leader’s guide to the alert program for self-regulation. Albuquerque, NM: Therapy Works.
Kranowitz, C. & Szklut S. (April 2003). Answers to Questions Teachers Ask About Sensory Integration. Las Vegas, NV: Sensory Resources.
Yack, E., Aquilla P., & Sutton S. (2002). Building Bridges Through Sensory Integration. Arlington, TX: Future Horizons.
Kuypers, L. (2011). The ZONES of Regulation. Santa Clara, CA: Think Social Publishing, Inc.
Case Study #1: Jason Move-in 3rd Grade Male Student diagnosed
with ASD
Psychological Functioning: High average IQ (Verbal & Perceptual Reasoning), < 2%ile TOM, Clinically Significant SRS2, Hyperactivity, Anxiety, Aggression, Severe repetitive and restricted behaviors
Language Skills: Average to above average receptive/ expressive; Social pragmatics average to above average in standardized testing. Informal social pragmatics testing revealed significant areas of weakness.
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Jason…..continued
Sensory Processing:
Auditory/ Tactile sensitivities
Sensory sensitivities to auditory and tactile
input.
Could become easily over stimulated in a
classroom setting.
Overall, high arousal level and sensory
modulation difficulties.
Anxiety Management
Addressing anger management
Take a break strategies – letting angry thoughts go
Putting angry thoughts in the thought box
Addressing concrete “All or nothing”
thinking
Using thinking as part of his intervention:
2 Column Approach
To address black and white
thinking:
Safe
My hands stay to myself
Use kind words
Remain in the classroom
Unsafe
I cannot hit others
I cannot say unkind words to others
I cannot leave the classroom without permission
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Social Cognition
Perspective Taking
Social Thinking Vocabulary
Prosody: Questions vs. Statements
Conversation Skills
Friend Files
Social Spying
Figurative/Abstract Language
Eye Gaze
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Perspective Taking
Worksheet taken from
Therasimplicity
Conversation Skills
Co m m e n t i n g
When someone is talking to me, I can make these comments to show that I am listening:
1. That’s cool. 2. Wow! 3. Awesome!
4. That’s crazy! 5. Oh, man!
6. That’s great.! 7. Whoa. 8. No way!
9. Oh, no! 10. Yikes! 11. Yuck!! 12. Awww.
13. Okay. 14. Huh. 15. Oh really? 16. Oh yeah?
slpmaterials.blogspot.com Free clipart from sweetclipart.com
Eye Gaze
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Self-Regulation
Use of the Zones of Regulation; daily
schedule.
Noise canceling headphones.
Quiet spot in and out of the classroom.
Needed proprioceptive input throughout
the day.
Use of the body sock
Heavy work through school jobs
Self-Regulation
Case Study #2: Oliver
Move-in 5th Grade Male Student
diagnosed with ASD & Depression
Psychological Functioning: Above
average Verbal Reasoning, Average Perceptual Reasoning, Below Average Working Memory & Processing Speed
FBA (Sept/Oct): bolting behavior and noncompliant to escape teacher
demands
Language Skills: Below average ability for
inferencing and pragmatic judgment
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Oliver…..continued
Sensory Processing Measure (SPM)was
completed.
Challenges with sensory modulation for
auditory input, touch sensations and movement.
Over-stimulated in busy, bright and noisy environments, resulting in him shutting down
or walking away from environment.
Overall, low arousal level.
Anxiety Management
Relationship building
Emotional vocabulary
Drawings & cartoon characters
Self identification of emotions
Identification of self talk
Social Cognition
Keep him in the room!
Conversation Skills
Friend Files
Emotional Vocabulary/ Recognition
Nonverbals (gestures, facial expressions)
Hidden Rules
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Self-Regulation
Classroom Accommodations:
Move and sit cushion
Noise canceling headphones
Use of a “Hand Tool Kit”
fidgets, theraputty, koosh balls
Water bottle with straw
Chewy and crunchy snacks
Privacy shield when working independently
Opportunities for drawing and reading
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Self-Regulation continued…
A combination of Zones and Alert
Program were used.
Pit Stop Breaks from Alert Program.
Could identify zones through characters he liked or book characters.
Visual of Zones check-in with characters.
Tracking Sheet for BT to complete.
Oliver’s Pit Stop Breaks
1. Stand up and stretch arms to ceiling. Stand on tiptoes and take a deep breath. Lower arms and breathe out slowly. Repeat 3 times.
2. 10 jumping jacks. 3. 10 chair push-ups.
4. Walk and get a drink of water. 5. Use “hand tool kit” for 3-5 minutes.
6. Listen to music.
Oliver’s Zone Check-in
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Oliver Zone Check-In
Check-in Time What Zone? Strategy Used
Arrival
10:30
Before Lunch
After Lunch
Contact Information:
Dr. Lynn Chachkes [email protected]
Trisha Poirier [email protected]
Lori Franzella [email protected]