overview of self-management strategies and their effective use for individuals with autism spectrum...

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Overview of Self-Management Strategies and their Effective use for Individuals with Autism Spectrum Disorders in School, Employment, and Community Settings Keith Storey Touro University, Graduate School of Education [email protected] Michal Post Touro University, Graduate School of Education [email protected]

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Overview of Self-Management Strategies and their Effective use for Individuals with Autism Spectrum

Disorders in School, Employment, and Community Settings

Keith StoreyTouro University, Graduate School of Education

[email protected]

Michal PostTouro University, Graduate School of Education

[email protected]

3 Key Points of Self-Management

1. Gives power to the person

2. Increases generalizationBehaviors.

Times.

People.

Settings.

3. Very flexible

What is Self-Management?

Giving the person more control over their own life

Control is given through teaching the person skills

Giving the person specific strategies to control or modify their own behavior

The terms self-regulation and self-control are often used interchangeably with self-management.

Self-management ideally involves:

Recognizing one’s own problem Translating problems into behaviors to be

changed Finding natural contingencies or contriving

them to support change Arranging the contingencies for change to

occur

Published Cases of Successful Self-Modification (From Watson & Tharp, 2007)

Increasing creative productivity (Herren, 1989). Improving study habits (Richards, 1976) Controlling weight (Mahoney, Moura, &Wade, 1973) Handling anxiety in social situations (Rehm &

Marston, 1968) Controlling nervous habits such as scratching, nail

biting, and hair pulling (Perkins & Perkins, 1976; Watson, Tharp, & Krisberg, 1972)

Overcoming depression (Hamilton & Waldman, 1983; Tharp, Watson, & Kaya, 1974)

Eliminating teeth grinding (Pawlicki & Galotti, 1978) Speaking up in class (Barrera & Glasgow, 1976) Exercising (Kau & Fisher, 1974)

Advantages to Self-Management

Involve the person in their own behavior change

Instead of always doing something to somebody you are helping them to do something independently and thus working with them

For people with disabilities often the choices of what to do, where to go, who to be friends with is taken away – This gives back the control

Advantages to Self-Management

Generalization of the behavior change can be enhanced – likely to use self management strategy in multi settings

Example – Cleaning dining tables using a checking-off job tasks list can use same strategy for cleaning the kitchen area

Avoid Learned Helplessness Less dependant on job coaches or other

support providers

Advantages of Self-Management

Disadvantages of externally controlled procedures may be reduced such as:

Performing behavior only in presence of those who administer consequences

Teachers and others often miss a great deal of behavior when applying reinforcement or punishment

Advantages of Self-Management

Self-management procedures are effective with people with all types of disabilities

People with very severe disabilities can learn to use self-management procedures effectively (Browder & Shapiro, 1985)

Self-management procedures can and should be adapted to meet the individual needs of the person – not based on disability type

Disadvantages to Self-Management

Could be stigmatizing to the person using the procedure

May be time consuming up front teaching the self-management skills

Components of Self-Management

Self-management broadly refers to all processes used by an individual to influence her or her behavior (Browder & Shapiro, 1985)

Self management techniques Antecedent cue regulation devices Self-monitoring Self-determined consequences Self-punishment Combination of techniques

Usually is part of an instructional package – not isolated

Self Management Techniques

Antecedent cue regulation devices: Use of prompts and operations that lead the

user to the correct response ACR can be used to lead a person to perform

every stop within a task analysis To perform an entire task To perform a series of tasks in the correct

order over a longer period of time Checklists – arranged in order of task Modified clock face – task symbol in place of time Auditory prompts - Micro cassette tape or MP3 players

Self Monitoring Cards

Antecedent cue regulation

Self-management techniques

Self-monitoring Involves procedures that help a person to

identify a specific response Detects whether the response in question has

occurred Make some record of the response

Charts and checklists – tasks over a number of times

Manual counters – golf beads Timers – time spent on tasks

Self-management techniques

Self-monitoring (continued) the use of a cell phone, personal digital

assistant (PDA) or other electronic device in which cues are programmed (such as a cell phone being programmed to give a signal and say “time to go to lunch” at noon and then signal and say “time to get back to work” at 12:30).

MONDAY PUT PLUS MARK WHEN CHECKED1. Look in mirror after eating lunch.1. Check face, mustache, shirt, and tie for

food.1. If there is food on face or mustache, wet

washcloth.1. Use wet washcloth to wash all food off

face and/or mustache.1. Brush any crumbs off short and tie.

When the timer sounds, place a + beside the number if you were on-task and a 0 beside the number if you were not on-task.

Monday Tuesday Wednesday Thursday Friday1 1 1 1 12 2 2 2 23 3 3 3 34 4 4 4 45 5 5 5 56 6 6 6 67 7 7 7 78 8 8 8 89 9 9 9 910 10 10 10 10

Self Monitoring Cards

Self Monitoring Cards

Self Monitoring Cards

Self-management techniques

Self-determined consequences Self-Delivery of coins or tokens – take tokens

upon completion of task and exchange for an item or activity that the person values

Analysis of performance records – learn to view the data in light of reinforcing value

Self-recruited feedback – submit self-monitored record to supervisor

Self-punishment

Rarely used because reinforcement techniques are usually viable alternatives

Less likely to evoke undesirable side effects Rubber band on wrist Response cost

General Self-Management Steps (Koegel, Koegel, & Park, 1992)

Getting Ready

Teaching Self-Management

Creating Independence

General Self-Management Steps (Koegel, Koegel, & Park, 1992)

Getting Ready Define behaviors Measure behaviors Choose a reinforcer Select an initial goal

Teaching Self-Management Get materials Identify the behavior Record the behavior Reinforce self-management

General Self-Management Steps (Koegel, Koegel, & Park, 1992)

Creating independence Increase amount of time your student self-

manages behavior Fade your student’s reliance on prompts Increase the number of responses necessary for

a reward Fade the presence of the treatment provider

Implications for Instruction

Include a self-management from the start if warranted

Instituted after fading of instructional procedures

Environment must be considered – Device (e.g.,checklist, ipod, picture board etc.)

should not draw undue negative attention Looking at what devices are currently being

used for person’s without disabilities and modify as needed

Using “Auditory Prompts” as a Support System in Work and Community Environments

from Post & Storey (2002) What are “auditory prompts”? Auditory prompts consist of verbal

commands using single word or multiple word phrases to encourage and guide an individual to complete a task.

Using “Auditory Prompts” as a Support System in Work and Community Environmentsfrom Post & Storey (2002)

How are recorded auditory prompts used? Recorded auditory prompt systems can be used to

transfer instruction onto a portable electronic device (MP3, cell phone, ipod, ipad, iphone, etc.) and used as a teaching tool to:

support the teaching of a new skill, provide on going reinforcement to make the

learned skill permanent maintain focus on task and filter out some auditory

distractions provide independence from constant direct

supervision

Using “Auditory Prompts” as a Support System in Work and Community Environments

from Post & Storey (2002) How is a recorded auditory prompt system used? Auditory prompts are recorded on an electronic

device and listened to through attached headphones:

The recording device should be portable enough to be easily worn without interfering with the work task

The spacing and delivery of prompts are tailored to the work pace, skill level, and specific support needs of the individual

Using “Auditory Prompts” as a Support System in Work and Community Environments

from Post & Storey (2002) What kinds of prompts are used in an auditory prompt

system? An auditory prompt system may involve: the recording of step by step instructions for completing a

specific task a recording of phrases that compliment performance and /or

encourage continuation of work a recording of questions directing self-evaluation of work

performance a recording of selected music embedded with intermittent

prompts that deliver positive reinforcement or instructional guidance

An audio recording paired with picture prompts a recording using a combination of the above

Visual paired with audio task analysis for handheld device.(Davies et al.)

HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructionsfrom Post & Storey (2002) Create a Task Analysis for the targeted task. This

analysis involves breaking down the targeted task into small incremental teachable steps.

Using understandable language, write these steps in script form for recording.

For the script reading, choose a familiar voice known to produce a positive response from the student, or experiment with various voices for clarity and positive effect

Record the step-by-step instructional prompts. Insert necessary wait time needed to perform the task. The spacing of prompts can be determined by observing the student’s work pace. Spacing may need to be adjusted once the student becomes comfortable with the system.

HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructionsfrom Post & Storey (2002) One option is to insert prompts of encouragement, praise,

or evaluation within the “wait time” between instructional prompts. Such prompts used might be “You are doing a fine job” or “Keep up the good work”. An example of an evaluation prompt for teaching the use of a clothes dryer might be “Are all the clothes in the dryer?”

A second or additional option is to embed recorded music between instructional prompts. Studies using music had the students select their favorite recordings or used classical music or recordings that produced a calming effect.

Once the recording is ready, introduce the recorded auditory prompt system by first demonstrating how to physically operate the device with the headsets.

After the above modeling, have the student’s practice putting on the equipment.

HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructionsfrom Post & Storey (2002) Determine that the students can operate the on/off

controls. For this step, a recording containing the student’s favorite music could be used. If needed, make modifications to the operation icons/controls, etc. Making only the on/off controls available for pressing may be necessary for some students. Modifications may include:

Removing any fast forward controls to prevent inadvertent pressing,

Adding a drop of whiteout to the volume control to allow supervisor to visually monitor volume,

Color-coding the on and off control for easier reference,

Using a remote switch carried in the participant’s pocket that contained only an on/off option.

HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step InstructionsTaken from Post & Storey (2002) Once the student has demonstrated competence in the

use of the system, allow the student to independently use the auditory prompt system. Closely monitoring the student using the system may be necessary initially. However, fading personal assistance can be managed according to the support needs of the student.

Many studies showed student being able to learn the targeted task and no longer needing to use the prompt system once the specific skill was learned. The prompt system was then only reintroduced if the skill was to be performed in a different setting. A few studies indicated the need for continuous use of the auditory prompt system to maintain the improved performance.

HOW TO DESIGN AN AUDITORY PROMPT SYSTEM Step by Step Instructionsfrom Post & Storey (2002) Once the student has mastered the on/off operation, have

the students practice removing the equipment. Now instruct the students to independently put on the

recording device and headset. Introduce the recorded script containing the task analysis.

Have the students press the on control, listen to the first step, then turn off the device and perform the step.

If the student has difficulty performing the task, ask the student to repeat the recorded instructions out loud, then perform the step.

If there is still confusion, model the performance of the step for the student, or give enough assistance necessary to enable the student to perform the step. Continue in this way until the student demonstrates accuracy in performing the step.

Troubleshooting Treefrom Post, Montgomery, & Storey (2009)

Client Not Performing Job Task

Client Not Performing Job Task

Follows direction But forgets Steps

of Task

Follows direction But forgets Steps

of Task

Follows instructions and completes task

but poor accuracy and

quality

Follows instructions and completes task

but poor accuracy and

quality

Follows and remembers

directions but becomes

distracted easily and often

Follows and remembers

directions but becomes

distracted easily and often

Does not follow directions and does not respond to oral

prompts of reminders or

encouragement appears disoriented

Does not follow directions and does not respond to oral

prompts of reminders or

encouragement appears disoriented

Develop task analysis

Record step by step

instructions

Develop task analysis

Record step by step

instructions

Record selected music and insert self

evaluation prompts

Record selected music and insert self

evaluation prompts

Recorded selected music and embed with

prompts of encouragement

Recorded selected music and embed with

prompts of encouragement

Explore Other Options

Explore Other Options

Study 1

Facilitating Task Acquisition Through

The Use of a Self-Operated Auditory Prompting System

Paul A. Alberto, Georgia State University

William R. Sharpton, University of New Orleans

Anita Briggs and Mary Helen Stright, Georgia State University

Facilitating Task Acquisition Through the Use of a Self-Operated Auditory Prompting System

Who were the participants? Four adolescents (12, 14, 15, and 16 years

old) with moderate to severe developmental disabilities.

What was the problem? Participants were required to perform the tasks

of: using a clothes washing machine, preparing a cup of soup, and preparing a peanut butter sandwich without the presence of a personal assistant guiding them with verbal and/or physical assistance. Prior to the introduction of the auditory prompt system, none of the adolescents successfully completed any of the tasks.

Facilitating Task Acquisition Through the Use of a Self-Operated Auditory Prompting System

Before introducing the tape recorded script of prompts, the teacher guided the participants with verbal and physical prompts by reading the script with the step-by-step instructions for correctly completing each task.

Colored-coding was used for the on/off controls. Step by step instructions used with length of pause between

instruction tailored to each participant. Self-evaluation prompts were used. A question was heard on the

tape asking the participant if they had completed all the steps. If there was a problem, the teacher was called to demonstrate how the step should be completed. Prompt for contacting the teacher was eventually eliminated..

When 90% correct performance for three consecutive sessions was attained, the participants then performed the task with only a beginning cue (“Wash these clothes in the machine” and “make a cup of soup”) and without the use of the recording.

Facilitating Task Acquisition Through the Use of a Self-Operated Auditory Prompting System

What were the results? The participants learned the task

quickly, accurately and were able to perform task 8 months later without the use of the prompt system.

Study II

Generalized Use of a Self-Operated Audio Prompt System

Anita Briggs and Paul Alberto, Georgia State University

William Sharpton, University of New Orleans

Karen Berlin and Carolyn Mc Kinley, Dekalb County Schools

Chris Ritts, Fulton County Schools

Generalized Use of a Self-Operated Audio Prompt System

Who were the participants? Four students (14 to 19 years old)

with moderate and severe disabilities.What was the problem? Students were required to correctly

use a coin operated washer and dryer without the personal assistance of a support person. Prior to intervention, teacher and parents reported that students were unskilled on these tasks.

Generalized Use of a Self-Operated Audio Prompt System

How was the tape-recorded auditory prompt system used as a support?

The participants were given the materials they needed to use a washing machine and dryer.

Listened to the step-by-step instructions embedded with a bell tone signaling them when to turn off the device and perform the task.

Self-evaluation questions were given after each step. Such questions were: “Are the clothes in the washer?’ and “Are all the coin slots filled with quarters?’

When the participant completed the task with 80% accuracy for three consecutive sessions, the participant was trained to perform the same task in a second setting.

Generalized Use of a Self-Operated Audio Prompt System

What were the results? Successful use of the washer and dryer in

the school setting with the help of the recorded prompting system

Students were able to generalize the use of the prompt system to transfer the skill to successfully use a washer and dryer in a community setting.

Study III

The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental Retardation

Carol Ann Davis Michael P. Brady

Robert E. Williams Michele Burta

University of Houston

The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental Retardation

Who were the participants? Three high school students (16, 16, and 20 years old)

with severe mental retardation working in a food preparation facility.

What was the problem? Students needed to increase the work pace Correctly fill salt and pepper shakers, drying serving

trays, and lining trays with paper liners. Prior to the study were able to perform the tasks but

needed to increase fluency.

The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental RetardationHow was the tape-recorded auditory prompt system used as a support?

After four to seven days of performing the task, participants were given an electronic device for listening to music while performing the task.

The fast forward control was eliminated to avoid inadvertent fast forwarding.. All sessions began with the teacher’s cue.

After six days of listening to a tape of music, an auditory prompt system consisting of music with verbal prompts interspersed throughout was implemented.

The delivery of prompts was individually determined according to the time needed for each student. The timing for delivery of cues was varied averaging 30, 18, 10, or 7 seconds between cues.

Cue’s consisted of phrases as, “Keep working” or “Don’t stop working until the alarm rings.” The student’s name was also spoken.

The Effects of Self-Operated Auditory Prompting Tapes On the Performance Fluency of Persons with Severe Mental RetardationWhat were the results? The use of the auditory prompt system led to increased work

fluency for all three participants.

Prior to the study, one student filled salt and pepper shakers averaging .4 per minute.

After intervention with the audio prompt system the average increased to 2.8 salt and pepper shakers filled per minute.

A second student increased her average from 2.0 shakers filled per minute to an average of 4.4 per minute

An increase in trays dried and lined went from an average of 1.8 trays per minute to 3.1 trays per minute

Study IV

Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills.

Sandra A. Trask-Tyler Theresa A. Grossi

William L. Heward

Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills

Who were the participants? Three young adults (17, 20, and 21 years old) with

moderate developmental disabilities and visual impairments preparing food recipes in apartment kitchens in a school setting.

What was the problem? Participants were required to prepare edible food by

accurately following the steps in a recipe. Prior to the intervention of the tape-recorded recipes, none of the students prepared an edible item. Recipes used in the study were microwave french fries, microwave pizza, microwave popcorn, automatic drip coffee, automatic drip tea, instant pudding, instant cheesecake, microwave brownies, and microwave cake.

Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills

How was the tape recorded auditory prompt system used as a support?

After instruction in the use of the audio prompt system, students were instructed to use the system to prepare a specified recipe they had previously been unsuccessful at preparing.

Participants were told to turn the recording device off when they heard a “beep” sound, perform the food preparation step and then turn on the device for the next instruction. A remote switch containing only an on/off button was carried in the participant’s pocket.

If a student incorrectly began a step, the experimenter gave a verbal prompt, and then a verbal prompt paired with physical guidance if further help was needed. If participant did not respond to prompts, hand-over-hand manipulation and verbal prompts were used.

After two successful recipe preparations were completed, students were asked to prepare a new recipe with the pre-recorded recipe instructions.

Teaching Young Adults with Developmental Disabilities and Visual Impairments to Use Tape-Recorded Recipes: Acquisition, Generalization, and Maintenance of Cooking Skills

What were the results? Students prepared edible food by correctly

following the step by step recipe instructions Students prepared more complex and

unfamiliar recipes without pre-training by staff.

Unpublished study

The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training

Joyce Montgomery, Keith Storey, Michal Post, and Jacky Lemley

Touro University – California and Vallejo City Unified School District

The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment TrainingWho were the participants? Two students (17 years old) with autism and mental

retardationWhat was the problem? Students were participants in an employment training

program sponsored by a school district program. Student worked at two local restaurants participating as part of the restaurant prep crew. Students washed tables and chairs as well as set the tables for the day service. The students had received instruction on their tasks and were able to perform the tasks however; they required constant verbal and physical prompts to complete the tasks in a timely manner otherwise, they may spend much of the training session on one table.

The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment TrainingHow was the tape-recorded auditory prompt system

used as a support? Students received their assignment and materials for

their assigned tasks. With assistance as needed, students turned on their

recording device and put on their headphones. Their favorite music was embedded with prompts of encouragement and self evaluation to continue working and maintain the productivity and quality of their work.

Students would listen to the music with prompts while competing their tasks

Support staff continued to provide verbal and physical prompts as needed

The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training

What were the results? Students were able to complete their assigned tasks

within the allocated amount of time with minimal prompting from support staff

During the reversal phase of the study, students again required verbal and physical prompting from the support staff to complete their assignments

When the tape recorder was reintroduced, the students performance again increased and the prompts decreased

The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training

The Use of Auditory Prompting Systems for Increasing Independent Performance of Students with Autism in Employment Training

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ReferencesAlberto, P. A., Sharpton, W. R., Briggs, A., & Stright, M. (1986). Facilitating task

acquisition through the use of a self-operated auditory prompting system. Journal of the Association for Persons with Severe Handicaps, 11, 85–91.

Briggs, A., Alberto, P., Sharpton, W., Berlin, K., McKinley, C., & Ritts, C. (1990). Generalized use of a self-operated audio prompt system. Education and Training in Mental Retardation, 25, 39–50.

Browder, D. M., & Shapiro, E. S. (1985). Applications of self-management to individuals with severe handicaps: A review. Journal of the Association for Persons with Severe Handicaps, 10, 200-208.

Davies, D., Stock, S. & Wehmeyer, M. (2002). Enhancing independent task performance for individuals with mental retardation through use of a handheld self-directed visual and audio prompting system. Education and Training in Mental Retardation and Developmental Disabilities 37, 209-218.

Davis, C. A., Brady, M. P., Willliams, R. E., & Burta, M. (1992). The effect of self-operated auditory prompting tapes on the performance fluency of persons with severe mental retardation. Education and Training in Mental Retardation, 27, 39–50.

Koegel, L. K., Koegel, R. L., & Parks, D. R. (1992). How to teach self-management to people with severe disabilities: A training manual. Santa Barbara, CA: University of California, Santa Barbara.

Post, M., Montgomery, J., & Storey, K. (2009). A decision tree for the use of auditory prompting strategies. Journal of Vocational Rehabilitation, 31, 51-54.

Post, M., & Storey, K. (2002). Review of using auditory prompting systems for persons who have moderate to severe disabilities. Education and Training in Mental Retardation and Developmental Disabilities, 37, 317-327.

Post, M., Storey, K., & Karabin, M. (2002). Cool headphone for effective prompts: Supporting students and adults in work and community environments.

Teaching Exceptional Children, 34(3), 60-65.

Sarafino, E. P. (2011). Self-management: Using behavioral and cognitive principles to manage your life. Hoboken, NJ: Wiley.

Storey, K., & Post, M. (in press). Positive behavior supports in classrooms and schools: Effective and practical strategies for teachers and other service providers. Springfield, IL: Charles C. Thomas Publisher, Inc.

Tollison, P. K., Synatschk, K. O., & Logan, G. (2011). Self-regulation for kids K-12: Strategies for calming minds and behavior. Austin, TX: Pro-Ed.

Trask-Tyler, S. A., Grossi, T. A., & Heward, W. L. (1994). Teaching young adults withdevelopmental disabilities and visual impairments to use tape-recorded

recipes:Acquisition, generalization, and maintenance of cooking skills. Journal of Behavioral Education, 4, 283–311.

Vohs, K. D., & Baumeister, R. F. (2010). Handbook of self-regulation: Research, theory, and applications (2nd ed.). New York: Guilford Press.

Watson, D. L., & Tharp, R. G. (2007). Self-directed behavior: Self-modification for Personal adjustment (9th ed.). Belmont, CA: Wadsworth/Thomson Learning.

Workman, E. A., & Katz, A. M. (1995). Teaching behavioral self-control to students. Austin, TX: Pro-Ed.