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Starting Strong 2015Understanding Autism Spectrum Disorders and An Introduction to Applied Behavior Analysis
Robin Talley, M.Ed., BCBAUW Autism Center
Presentation Overview
• Overview of Autism Spectrum Disorders (ASD) and How Symptoms Manifest
• Diagnostic Criteria of Autism Spectrum Disorders
• Introduction to Applied Behavior Analysis
• Components of a Teaching Loop
Autism Spectrum Disorder (ASD)• ASD is a neurodevelopmental
disorder1
• The collection of symptoms vary from individual to individual2
• Prevalence: 1 in 68; 1 in 42 boys to 1 in 189 girls
• Prevalence ranges from 1 in 175 in Alabama to 1 in 45 in New Jersey
• Infants with an older sibling with a diagnosis of ASD, are at an elevated risk for ASD and ASD symptoms
http://www.cdc.gov/ncbddd/autism/index.html1 DSM-V, 2013; 2 Siegel, 1996
DSM-IV to DSM-5Core Areas of Impairment
Qualitative Impairment
in Social Interaction
Qualitative Impairments in Communication
Restricted, Repetitive and
Stereotyped Patterns of Behavior
Persistent Deficits in Social Communication
and Social Interaction
Restricted, Repetitive Patterns of Behavior
Social Communication/Social Interaction
• Deficits in social-emotional reciprocity• Atypical social approach
• Difficulty in back-and-forth conversation
• Reduced sharing of interests, emotions or affect
• Difficulty initiating or responding to social interactions
• Deficits in nonverbal communicative behaviors• Poorly integrated verbal and non-verbal
communication
• Differences in eye contact and body language
• Deficits in understanding and use of gestures
• Lack of or reduced facial expressions and nonverbal communicationDSM-V, 2013
Social Communication/Social Interaction
• Deficits in developing, maintaining and understanding relationships
• Difficulties adjusting behavior to suit various social contexts
• Difficulties in making friends
• Reduced interest in peers
DSM-V, 2013
Restricted/Repetitive Patterns of Behavior
• Stereotyped or repetitive motor movements, use of objects or speech• Repetitive motor movements
• Lining up toys or flipping objects
• Echolalia
• Scripted words or phrases
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior • Extreme distress at small changes
• Difficulties with transitions
• Rigid thinking patterns
• Greeting rituals
• Need to take same route or eat same food every dayDSM-V, 2013
Restricted/Repetitive Patterns of Behavior
• Highly restricted, fixated interests that are abnormal in intensity or focus
• Strong attachment to or preoccupation with unusual objects
• Unusual interests or interests of extreme intensity
• Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment
• Apparent indifference to pain/temperature
• Adverse response to specific sounds or textures
• Excessive smelling or touching of objects
• Visual fascination with lights or movement
DSM-V, 2013
Behaviors Observed
Symptoms of ASD
Adapted from Division TEACCH; University of North Carolina at Chapel Hill
Understanding Individuals with ASD
Adapted from Division TEACCH; University of North Carolina at Chapel Hill
Understanding Individuals with ASD
• Reduced sharing of interests, emotions or affect
• Difficulty initiating or responding to social interactions
• Differences in eye contact and body language• Deficits in understanding and use of non-verbal
communication
• Does not engage in typical play with peers• Ignores others when greeted• Looks away when someone is talking to him• Stands too close to others in line
Behaviors Observed
Symptoms of ASD
Adapted from Division TEACCH; University of North Carolina at Chapel Hill
Understanding Individuals with ASD
• Difficulties adjusting behavior to suit various social contexts
• Extreme distress at small changes• Difficulties with transitions
• Speaks too loud at inappropriate times• Has a meltdown when mom drives to school
a different way than usual• Does not want to move from one activity to
the next, resulting in challenging behaviors
Behaviors Observed
Symptoms of ASD
1. Group Activity: How does autism impact participation?
• Consider how the characteristics of ASD impact an individual's participation in one of the following activities and how this behavior could be misinterpreted
1. Making a choice in the lunch line
2. Riding on the bus with peers
3. “Hangin” on the playground
4. A situation that you are experiencing with your student/son/daughter
• Be prepared to share
What is important about an ASD diagnostic evaluation?
• Clarify individual’s behavioral and developmental difficulties
• Psycho-education about Autism Spectrum Disorders (ASD)
• Access to services
• Information about next steps (e.g., treatment recommendations)
• board eligible neurologists (M.D.),
• board eligible psychiatrists (M.D.),
• licensed psychologists(Ph.D., Psy.D.),
• board certified developmental and behavioral pediatricians (M.D.)
• Medical diagnosis of ASD
• Special education eligibility as a student with autism
Who can diagnose ASD in Washington State?
Screening vs. Diagnosis
• Screener Tools:
• Modified Checklist for Autism in Toddlers (M-CHAT-R)
• Screening Tool for Autism (STAT)
• Where and when are they given?
• When is a referral for a full evaluation needed?
A positive screener does NOT guarantee an ASD diagnosis!
Interdisciplinary vs. Multi-Disciplinary vs.
Single Discipline ASD Evaluations
• Single Discipline – one type of professional conducts the diagnostic evaluation
• Multi-Disciplinary – more than one type of professional doing evaluations, not necessarily contributing to one diagnostic formulation
• Inter-disciplinary – more than one type of professional (for example, Psychologist, Neurologist, Speech Language Pathologist) involved in the diagnostic process
UWAC Clinic Diagnostic Evaluation Model
• Four sessions• Intake interview
• Two assessment sessions
• Feedback session
• Use of multiple respondents, standardized assessments, observational data, and review of school and medical records
• Final written report and follow-up call to review results and next steps
Overview of Interventions
• Autism Speaks – 100 Day Toolkit
• Description of treatment for ASD
• https://www.autismspeaks.org/sites/default/files/docs/treatment.pdf
Evidence-Based Practices
• National Standards Project, Phase 2 (2015)
• http://www.nationalautismcenter.org/national-standards-project/results-reports/
• Evidence-based practices for individuals with autism across the lifespan that include ABA-based intervention strategies (ages 0-22+ years)
• Behavioral interventions: ages 3-22+ years
• Comprehensive Behavioral Treatment for Young Children: ages 0-9 years
Applied Behavior Analysis (ABA)
The science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change
What is Applied Behavior Analysis?
• Scientific approach to understanding behavior and how it is affected by the environment
• The use of behavior analytic methods and research findings to change socially important behaviors in meaningful ways
• Consumer confusion…
Cooper, J. O., Heron, T. E., and Heward, W. L. (2006). Applied behavior analysis (2nd ed.)
The “Umbrella” of ABA
Discrete Trial Training
Reciprocal Imitation Training
Incidental Teaching
Pivotal Response Training
Early Start Denver Model
C
Consequence
Events that occur
immediately AFTER the
behavior
Can increase or
decrease the likelihood
that the person will
display the behavior
again
B
Behavior
*Wolery, M., Bailey, D.B., & Sugai, G.M. (1988). Effective teaching: Principles and procedures of applied behavior
analysis with exceptional students. Boston, MA: Allyn and Bacon, Inc.
Events that occur
immediately BEFORE
the behavior
Can be altered to
increase or decrease
the occurrence of the
behavior
Response to the
things and events
around us at any
given time.
A-B-C Model of Behavior
A
Antecedent
ABA Program Features
• A-B-C model of behavior• Comprehensive or specific programs• Blend of teaching strategies (DTT and naturalistic)• Individualized• Intensive
• Repeated practice• Embedded learning opportunities• Quality of learning trials
• Data-driven decisions• Builds on the child's interests and actively engages the child• Teaches tasks as a series of simple steps• Use of reinforcement to teach new behaviors• Generalization of skills targeted
National Research Council (2001). Educating Children with Autism.
BasicABA
Outcomes
Increase desirable
behaviors
Decrease undesirable
behaviors
Teach new skills
Promote generalization of
skills
Teaching Loop
Target Behavior
Request bubbles by giving paired with eye contact
Cue Bubbles with lid closed tightly
Prompt None
Behavior Give bubbles paired with eye contact
Feedback Blow bubbles
Incorrect Teaching Loop
Target Behavior
Receptive color identification
Cue “Can you give me red?”
Prompt Gesture (tap card)
Response Shakes head “no” and picks up orange card
Feedback None, continues to give cue
Teaching Loop: Cue
Cue
Prompt
(if necessary)
Behavior
Feedback
• Also called instruction, antecedent, or SD
• Lets the child know when to respond (question, command, presence of a peer, bell ringing)
• Remember…it’s not always a verbal instruction
Cue: Things to Remember
• Must be clear and concise
• Consistent instructions should be used across team members
• Avoid repeating instructions
• Follow through with every cue given…modifying is okay
• Use cue/instruction that is familiar to the child
• Be sure that the child is interested in the materials being used
Teaching Loop: Prompt
Cue
Prompt
(if necessary)
Behavior
Feedback
• Something that occurs before the response and increases the likelihood of a correct response
• Prompt prior to a response minimizes errors
Types of Prompts
• Physical (Full and Partial): When teaching clapping, adult brings the child's hands together and claps or brings them close together and lets the child complete the action
• Verbal: When teaching expressive label “cup” Adult asks “what is it?” “cup”, “c…”
• Gestural: When teaching functions of objects “what do you drink with?”, Adult holds his/her hand to his/her mouth shaping it like a cup
• Model: Adult models the whole/partial action of clapping while teaching the receptive instruction “ clap hands”
• Visual: When teaching receptive instruction “clap hands”, picture of someone clapping is shown in addition to the auditory direction
Why Prompt?
• To reward child
• To minimize errors
• Frequent errors:
• Tend to be repeated
• Decrease opportunities for praise or positive feedback
• May impact motivation
• Lead to challenging behaviors
Prompt FadingTarget Behavior
Request “swing” by putting planet in Dad’s hand
Trial #1 Gesture (hand) = PROBE SKILL
Trial #2 Full physical (sit)Full physical (give)Gesture (hand)
Trial #3 Full physical (sit)Partial physical (give)Gesture (hand)
Trial #4 Full physical (sit)Proximity/Environmental (give)Gesture (hand)
Trial #5 Environmental
Prompt: Things to Remember
• Plan ahead for how prompts will be used
• Use the least amount of prompting necessary to ensure a correct response – Goldilocks Rule
• Only give an instruction if you know you can prompt the child to complete the task
• A prompt is only considered effective if it results in the child’s correct response
Teaching Loop: Behavior
Cue
Prompt
(if necessary)
Behavior
Feedback
• Demonstrated by the child
• Result of given cue
• Allow time for the student to respond
Teaching Loop: Feedback
Cue
Prompt
(if necessary)
Behavior
Feedback
• Also called consequence
• Follows any response given by the child
• Provides feedback to the child regarding the response
Types of Feedback
• Correct response = reinforcement
• Positive reinforcement
• Negative reinforcement
• Incorrect response = corrective feedback
• “Try again”
• “I didn’t hear you”
• “No”
Feedback: Things to Remember
• Reinforce frequently when first teaching a skill
• Follow the “Goldilocks rule” to determine the right amount of reinforcement to give following a behavior
• Reinforcers should be paired with social praise
• Use behavior specific praise, let the child know what they did correctly
• If you can’t identify a reinforcer…there should be NO instruction