presentation slides - idaho training clearinghouse
TRANSCRIPT
1
The Ziggurat Model Designing Comprehensive Behavior Interventions for
Students with ASD
Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA
www.texasautism.com
Idaho Webinar – Day 2
Overview of Presentation
Review Levels of the Intervention Ziggurat Pt. 1
Sensory and Biological Reinforcement Structure and Visual/Tactile Support
Case study Q&A
The Ziggurat Model Despite an enormous increase in
knowhow, the autistic way of looking at autism has resulted in too little
knowwhy. We have protocols for diagnostics and various methods of treatment, but the core of autism is
sometimes missed, due to a tendency to focus too much on the behavior of
people with autism (often even details of that behavior) without sufficiently
taking into account the context of what is taking place in the mind of people
with autism. - Peter Vermeulen
Social Communication Repetitive Patterns
Associated Features Sensory Motor Cognitive Emotional Vulnerability Medical and Biological
Factors
Characteristics Interventions
Implmt. Design Characteristics 1 2 3 4
5 Steps to Designing a Comprehensive Intervention Plan
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2
UCC ISSI Global Guide
Ziggurat Worksheet CAPS
Provides a snapshot of ASD Iden4fies strengths and skills Iden4fies meaningful priori4es
Ensures development of a comprehensive plan Ensures implementa4on of the comprehensive plan
Present Levels of
Func4onal Performance
IEP Team Considera4ons: Parent Concerns, Transi4on,
and Person-‐Centered Planning
Evalua4on Data
Special Educa4on Supports, Related Services/Accommoda4ons and Behavior Interven4on Plan
Opera4onalized IEP: Student Schedule with Embedded Benchmarks/Short-‐term Objec4ves
and Supports 1
Helps you to “see” the autism
Provides a “snapshot” of how autism is expressed for an individual
A descriptive instrument Can be completed by a
team Provides a tool for
assessing progress/change
Underlying Characteristics Checklist
2
Social Behavior, Interests,
and Activities Communication Sensory Cognitive Motor Emotional Biological
Individual Strengths and Skills Inventory
3Designing a Global Intervention Plan
Sensory Differences and Biological Needs
Task Demands
Structure and Visual /Tactile Supports
Reinforcement
Sensory Differences and Biological Needs
“The last thing one knows in constructing a work is what to put first”
-Blaise Pascal
3
Sensory Differences and Biological Needs
Provide a sensory diet
Monitor and address environmental stressors: Sound, light,
proximity/personal space, textures
Movement needs
Monitor and address: Appetite/hunger Arousal/activity
level (e.g., fatigue, hyper)
Posture and movement
Medical needs
Addressing Sensory Issues
Sensory Issues
Smell Taste Touch Visual Input Auditory Vestibular
(balance) Proprioception
(body awareness)
Emotional Reactivity
Displays emotional outbursts when unsuccessful
Is stubborn or uncooperative Often gets “stuck” in a situation Is overly sensitive Reacts overtly when sensory
systems needs are not met
Brenda Smith Myles
Sensory Diet Is ...
A planned and scheduled activity program designed to meet a child’s specific sensory needs (Yack et al., 1998)
Incorporates naturally occurring opportunities for children to get the sensory stimulation they need (Willbarger, 1995)
Miller & Robbins, 2005
Calming and Alerting Sensory Activities
Sensory Area
Calming Activities Alerting Activities
Visual • Work in dim light or with lights turned off
• Block distractions by using a screen, room divider, or study carrel
• Wear sunglasses • Provide visual materials such as a glitter wand, oil and water toys, fish tank
• Work at distraction-free desk
• Work in bright lights • Use brightly colored paper
• Use a highlighter to underline important text
• Use a slant board to place materials at an angle
Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 19
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Calming and Alerting Sensory Activities
Sensory Area
Calming Activities Alerting Activities
Auditory • Cover ears when a loud or unexpected noise happens
• Work in a quiet environment
• Use headphones to shield from noise
• Prepare in advance for loud/strange noises
• Listen to music with varied pitch, sound loudness or uneven/fast beat
Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 19
Sample Sensory/Motor Interventions
How Long Does it Last?
Tactile: 1 to 1 1/2 hours
Vestibular: 4 to 8 hours
Proprioception: Up to 1 1/2 hours
Auditory,Gustatory, Transitory & Olfactory:
Brenda Smith Myles
Sensory - Key Points
Sensory dysfunction influences all aspects of an individual’s life.
There are seven types of sensory dysfunction
Interventions need to occur in ALL of the individual’s environments.
Assessments must be completed and interventions must be supervised by a trained occupational therapist.
Coping Cards
Take 2 deep breaths with your eyes closed
Press hands together and count to 10 slowly
Amy Bixler, 2006
Reinforcement
“If you do not have good reinforcers and are not working to establish them, you might as well just go home”
-Leaf & McEachin
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Reinforcement Reminders
Reinforcement increases the likelihood of a behavior
“The way positive reinforcement is carried out is more important than the amount”
-B.F. Skinner
Reinforcement Stinginess Disorder (RSD) – Adult Onset
(A) Qualitative impairment in reinforcement delivery behaviors, as manifested by at least two of the following: marked impairment in the use of praise
and positive feedback in response to demonstrations of new skills
failure to reinforce behaviors that were prompted or modeled
Reinforcement Stinginess Disorder (RSD) – Adult Onset
a lack of spontaneous seeking to encourage the achievements of others (e.g., by a lack of giving, or delivering a reinforcer following a goal behavior)
delay in, or total lack of, the development of compassion for those who are reinforced by non-traditional reinforcers or who achieve skills at a rate different from their typically developing peers
Reinforcement Stinginess Disorder (RSD) – Adult Onset
in individuals with adequate speech, marked impairment in the ability to distinguish “fair” from “equal”
stereotyped and repetitive use of ineffective strategies such as delivering punishment in order to change behaviors related to a neurological disorder
lack of varied, spontaneous approaches to maintaining meaningful reinforcers for all learners
Reinforcement Stinginess Disorder (RSD) – Adult Onset
(B) Onset post 21 years of age
(C) The disturbance is not better accounted for by lack of common sense or the belief that you can “punish the ASD” out of someone.
Rate of Disciplinary Measures
Special Education (Per 100)
General Education (Per 100)
56 In School Suspensions
33 In School Suspensions
25 Out of School Suspensions
12 Out of School Suspensions
Heasley, S. (2010). Disability Scoop. www.disabilityscoop.com
Based on Texas Department of Education Records
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Reinforcement Reminders
Involve students/clients in the process of selecting reinforcers
Start with high rate of reinforcement for new skills
Use variable rate of reinforcement for maintenance
Reinforce practice Reinforce prompted behavior Reserve some reinforcers to maintain
their effectiveness
The Purpose of Special Education (IDEA)
To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique need and prepare them for further education, employment, and independent living
§300.1 (emphasis added)
Reinforcement Reminders
“You may not have to look any further than your child’s special interest to find the perfect reward”
-Sakai, 2005, p. 52
Structure and Visual/Tactile Supports
“And it is best if you know a good thing is going to happen, like an eclipse or getting a microscope… And it’s bad if you know a bad thing is going to happen like having a filling or going to France. But I think it is worst if you don’t know whether it is a good thing or bad thing which is going to happen.”
- From: The Curious Incident of the Dog in the Night Time, by Mark Haddon, 2003
People with autism do not cope well with vagueness and ambiguity. In practice, things not being very clear is the number-one challenge for people with autism; they are confused. And that confusion often results in cognitive and emotional breakdowns, p.108
Vermeulen, Autism as Context Blindness
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Structure and Visual/Tactile Supports
“I like everything still. It gives you a full feeling. It gives you a full attention. With something quick, you don’t get the full idea of it. With something still, you take a look at it and you get to know the whole look and feeling”
-Warden from Rage for Order (BBC, 1996)
Common Misperceptions
If an individual can read then he/she does not need pictures or symbols
He’s in high school, he does not need an individualized schedule
I can stop using a visual schedule once my client learns the routine
If an individual has not looked at his/her schedule in three weeks he/she does not need it anymore
Raise Your Hand Structure
Highly structured environments – provide an opportunity for those with ASDs to succeed
Increased predictability and understanding results in: Decreased problem behavior Increased independence
Bopp, K., Brown, K., Mirenda, P. (2004). Speech-Language Pathologists’ Roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech-Language Pathology 13, 5-19.
Visual Schedules
Research on visual schedules shows that they are:
Effective across age ranges Effective across settings
Visual Schedules
Schedules are effective in decreasing off-task behaviors disruptive behavior noncompliance aggression tantrums property destruction
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Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 10
Research-Based Literacy Strategies
Edited by Christina Carnahan, Ed.D., And Pamela Williamson, Ph.D. AAPC
Work System for Reading Group
Carnaham, Williamson (2010). Quality Literacy Instruction for Students with ASD. AAPC.
Choices at Handwriting Station
Carnaham, Williamson (2010). Quality Literacy Instruction for Students with ASD. AAPC.
Choice Board Bathroom Task Strip
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Check Activity
√ Put away backpack
√ Make lunch selection
Complete helper chart
Turn in homework
Take out journal
Morning Checklist
Pick reward from your menu
Screaming
Outside voice
Talking voice
Soft voice/whisper
No talking
Rating Description Setting
Emergency only
Recess, ball game
Classroom, lunchroom
Library
When someone is talking to me, movies
Buron, K.D., & Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC.
Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)
Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)
Things That Can Run Out…
Stickers Chocolate milk Time Glue
Problem Solving Chart
Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing.
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Problem Solving Chart
Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing.
Video-Based Instructional Procedures
Video Modeling video of someone completing the task well validated behavioral intervention
Video Prompting video of each step (often from the perspective of
the participant) with opportunity to complete each step
rapid skill acquisition in daily living skill study
Canella-Malone, O’Reilly, de la Cruz, Edrisinha, Sigafoos, and Lancioni (2006). Comparing video prompting to video modeling for teaching daily living skills to six adults with developmental disabilities. Education and Training in Developmental Disabilities, 41(4) 344-356.
How to Make Popcorn
Open plastic bag
Unfold bag
Power Card - Adolescent
12th grade adolescent with Asperger’s Served in general education Received social skills training to address:
Difficulty with eye contact Understanding humor Relating to peers in age-appropriate manner
Talked about cartoon characters as if they were real
Became upset when people did not understand his sense of humor or special interests
Lonely Preoccupied with Yu-Gi-Oh Hero was Kazuki Takahashi
Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25,12-22.
Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25,12-22.
Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25,12-22.
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Per
cent
age
of T
ime
Eng
aged
in O
ther
s-Fo
cuse
d C
onve
rsat
ion
Sessions
Pre Post
Generalization
Generalization
Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25,12-22.
Social Behavior Mapping Participating in Class Discussions
Garcia Winner (2007). Social Behavior Mapping. Think Social Publishing, Inc. pp. 38-39
Expected Behaviors
How They Make Others
Feel
Consequences You
Experience
How you Feel about
Yourself • Make
comments and ask questions related to the topic being discussed
• Share your thoughts and opinions in a way that isn’t offensive to others.
• Interested
• Calm
• Relaxed
• Involved
• The teacher knows you are paying attention to the topic.
• Students know you are thinking about the discussion and listening to them when they talk.
• Part of the group
• Proud
• Relaxed
• Successful
Social Behavior Mapping Participating in Class Discussions
Garcia Winner (2007). Social Behavior Mapping. Think Social Publishing, Inc. pp. 38-39
Unexpected Behaviors
How They Make Others
Feel
Consequences You
Experience
How you Feel about
Yourself • Add
thoughts/ask questions that aren’t related to the discussion
• Turn your body and eyes away from the group.
• Dominate the conversation
• Confused
• Irritated
• Annoyed
• Hostile
• Others may tell you to be quiet.
• The teacher won’t include you in the discussion.
• Others may not want you to be in the group.
• Embarrassed
• Frustrated
• Left out
• Anxious
• Sad
Cartooning
Combines words with simple drawings in order to explain a simple concept
Case Study
Chad
Chad
12
Chad
Diagnosed with Asperger’s Disorder Obsessive interest with trains Displays meltdowns when routine is
changed Leaving train yard before routine is
complete Hokey Pokey – misunderstanding.
Thought that song would be sung one more time – it was one more time for each student in class
Chad’s Selected UCC Items
[9] Difficulty understanding others’ nonverbal communication
[14] Has eccentric or intense preoccupations
[18] Has Problems handling transition and change
[19] Has strong need for closure [24] Interprets words literally
[52] Displays poor problem-solving skills
[80] Exhibits “meltdowns”
[85] Has low frustration tolerance
[87] Difficulty identifying and expressing emotions
[89] Difficulty managing stress and/or anxiety
Intervention Ziggurat
Sensory Differences and Biological Needs
© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.
Quiet Corner
UCC Items Addressed
[80] Exhibits “meltdowns”
[85] Has low frustration tolerance
[89] Difficulty managing stress and/ or anxiety
Intervention Ziggurat
Reinforcement
© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.
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Books about Trains UCC Items Addressed
[14] Has eccentric or intense preoccupations
[80] Exhibits “meltdowns”
[85] Has low frustration tolerance
[89] Difficulty managing stress and/ or anxiety
Intervention Ziggurat
Structure and Visual/Tactile Supports
© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.
Hokey Pokey
Get in circle
Follow the words to the music
Sing one verse for each student
Sit on square
Chad’s Selected UCC Items
[18] Has Problems handling transition and change
[19] Has strong need for closure
[24] Interprets words literally
[80] Exhibits “meltdowns”
Intervention Ziggurat
Task Demands
© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.
14
First-Then
First Then
Chad’s Selected UCC Items
[18] Has Problems handling transition and change
[19] Has strong need for closure
[24] Interprets words literally
[80] Exhibits “meltdowns”
Prime - Words and Their Meaning Word
One more time
Just a minute
“Button your lips”
Lunch is at 11:00
Meaning Everyone gets one
more turn
In a little while
No talking
Around 11:00
Chad’s Selected UCC Items
[18] Has Problems handling transition and change
[19] Has strong need for closure
[24] Interprets words literally
[80] Exhibits “meltdowns”
Intervention Ziggurat
Skills to Teach
© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.
Feeling Anxious
Sometimes our bodies help us to know when we are stressed and need a break. When Thomas is anxious, his face turns red and he does not look at others. His mouth turns down in a frown. Sometimes, when you think that something is wrong, your body shows signs too. You clinch your fists, stiffen your body, and frown. Your face turns red. When you feel your body do this, it is a sign that you are anxious and need a break.
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Chad’s Selected UCC Items
[52] Displays poor problem-solving skills
[80] Exhibits “meltdowns”
[85] Has low frustration tolerance
[87] Difficulty identifying and expressing emotions
[89] Difficulty managing stress and/or anxiety
Contact Information
Ruth Aspy, Ph.D. [email protected] 214-227-7741
Barry G. Grossman, Ph.D. [email protected] 214-227-7741
www.texasautism.com