Dr. Christine Peck

Cooperative Educational Services, Trumbull, CT

(203) 365-8842 ~ peckc@ces.k12.ct.us

Severe and pervasive impairment in several areas of development

ASD In The Classroom

•Conduct thorough assessment of strengths and needs

Uneven profile

•Use visual supports: schedules, tasks lists, first-then boards, visual timers, increased proximity, graphic organizers, etc

Difficulty following directions

•Develop systematic work habits

Organization difficulties

•Simplify language, use visual supports

Concrete thinking

•Provide support for pragmatic language: visual supports, social stories, peer models,

Unusual communication

•Develop proactive plans including use of visuals, social skill instruction, etc.

•Use tools such as behavior charts, token systems etc. when appropriate

Challenging behavior

•Recognize signs of sensory distress and dysregulation, provide interventions and supports

Sensory needs

•Remove distracting stimuli, provide visual supports to increase on-task behavior

Distractibility

•Encourage open communication with parents and exchange relevant information

Co-existing conditions

Build Your Toolbox of Strategies

First Then Board What is a First Then Board?

This strategy shows an expectation followed by something preferred (e.g., first work, ◊ then video game). The First-Then Board shows that one activity (usually a less preferred one) must happen before the next (a preferred one) can occur. The “reward” (the preferred activity) must be immediately available. The “Then” box may represent a choice time, break time, a specific activity (e.g, game boy), or an object (e.g., book). It is okay to place a concrete object (such as a book) on the “Then” box if no pictures are available. Remember, offer rewards prior to negative behavior so the individual does not learn to misbehave in order to have a reward offered.

How are First Then Boards Used?

Are based on a "first-then" strategy; that is, "first you do ___, then you do ___", rather than an "if-then" approach (i.e., "if you do ___, then you can do___"). This first-then strategy allows the "first" expectation (whether a task, activity or assignment) to be modified, as needed. The modification is in terms of task completion and amount of prompting, in order to accommodate the student's daily fluctuations in his ability to process in-coming information. Then he can move on to his next visually scheduled task/activity.

Example: A student is having particular difficulty completing a math worksheet, due to anxiety, sensory processing difficulties, communication, difficulty generalizing, internal/external distracters, change, etc. The assignment can be modified so that the child only has to complete three math problems first, and then he has a sensory break, as indicated on his visual schedule.

Can incorporate various social interactions into the student's daily schedule (e.g. showing completed work to a teacher/parent for social reinforcement, requiring appropriate social greetings).

Can increase a student's motivation to complete less desired activities by strategically alternating more preferred with less-preferred activities on the student's individual visual schedule.

Example: By placing a "computer" time after "math", the student may be more motivated to complete math knowing that "computer" time will be next.

First Then Board Template

To Make:

1. Take photographs or cut out

the images available here to

represent the “first”, lami¬nate

the pictures if possible.

2. Think about possible rewards.

Use photographs, objects, or the

attached images to represent the

“then”, laminate if possible

3. Use the First-Then board

included here, or draw and cut-

out two large squares, one with

“First” above it, and one with

“Then” above it.

4. Use Velcro to attach pictures

on First-Then board in the order

shown in the image.

Visual Schedules

Definition: A daily visual schedule is a critical component in a structured environment. A visual schedule will tell the student with autism what activities will occur and in what sequence.

Visual schedules are important for children with autism because they: o Help address the child's difficulty with sequential memory and organization of time. o Assist children with language comprehension problems to understand what is

expected of them. o Lessen the anxiety level of children with autism, and thus reduce the possible

occurrence of challenging behaviors, by providing the structure for the student to organize and predict daily and weekly events. Schedules clarify that activities happen within a specific time period (e.g., understanding that "break time" is coming, but after "work time"), and also alert the student to any changes that might occur.

o Assist the student in transitioning independently between activities and environments by telling them where they are to go next. Visual schedules can be used in all environments (e.g., classroom, gym, Occupational Therapy, Speech/Language Therapy, home, Sunday School, etc.).

A visual schedule for a student with autism must be directly taught and consistently used. Visual schedules should not be considered as "crutches" for students with autism, from which they should gradually be "weaned". Instead, these individual visual schedules should be considered as "prosthetic" or "assistive tech" devices. For the student with autism, the consistent use of a visual schedule is an extremely important skill. It has the potential to increase independent functioning throughout his life - at school, home and community.

Developing Visual Schedules: In general, schedules should be arranged from a "top-to-bottom" or "left-to-right" format, including a method for the student to manipulate the schedule to indicate that an activity is finished or "all done" .

Example: Cross/mark off with a dry erase marker, place the item in an "all done" envelope/box, check off the item, draw a line through the scheduled activity, etc.

minimum of two scheduled items should be presented at a time so that the student begins to understand that events and activities happen in a sequential manner, not in isolation.

Schedules can be designed using a variety of formats, depending upon the needs of the individual student.

Types of Visual Schedules Classroom Schedules Individual Schedules

Individual Schedule: It is necessary to develop an individual schedule for the child with autism in addition to the general classroom schedule.

o An individual schedule will give the child with autism important information in a visual form that he can readily understand.

o Another consideration when individualizing a schedule for a student with autism is the length of the schedule (number of activities). The length of the schedule may need to be modified due to the student becoming increasingly obsessed and/or anxious regarding an up-coming scheduled activity, or due to difficulty in processing "too much" information presented at once.

Example: A particular student "obsesses" over recess. If at the beginning of his day he sees "recess" scheduled later in the morning, he will continue to be obsessed with "going out for recess", resulting in increased anxiety and distractibility for the rest of the morning activities until recess. The student's schedule could be created with a few activity items at a time, up until recess. Again, individualization is the key to success.

Forms of Visual Schedules

A visual schedule can take many different forms and look many different ways

Example: Object schedule, 3 ring binder schedule, clipboard schedule, manila file folder schedules, dry erase board schedules, Velcro strip across the top of the desk, etc.

Various visual representation systems can be used for an individual visual schedule including:

o Real objects o Photographs (e.g., "Picture This" software

program or own photos) o Realistic drawings o Commercial picture system (e.g., "Boardmaker"

software program) o Written words/lists.

Ways to Use the Visual Schedule

Check Schedule. Some students may need a "check schedule" visual physical prompt to teach them to independently check their schedule, as well as learn the importance of their schedule.

Example: "Check schedule" visual prompts can be made by writing the student's name on laminated colored paper strips or using popsicle sticks or poker chips with a large check printed on the chip, etc.

The "check schedule" prompts are visual and physical cues (as opposed to adult prompts) given to the student for any transition in his daily activities, to cue him to check his schedules.

A child who relies too heavily on adult prompts rather than using "check schedule" prompts in with his schedule, may have more difficulty understanding the importance of his schedule and have limited success in using it.

Transitions. Some students may need to transition to the next scheduled activity by taking their scheduled item (card or object) off their individual schedule and carrying this with them to the next activity/location. This may be due to the child's increased distractibility in maneuvering through the environment. The distractibility, or inability to sustain attention throughout the transition, is independent of the child's cognitive functioning level or verbal skills.

Example: Some non-verbal students with autism, who function at a younger cognitive level, do not require transition schedule cards to get to the next scheduled activity. On the other hand certain higher functioning students with autism require a transition card to get to the next scheduled activity, due to their increased distractibility.

Task Sequences

Definition

A task list breaks down expectations into the individual steps that comprise a task. Task

sequences are good to help students understand expectations of an individual work task. For example,

when a student is told it is “Time for math,” a task sequence may further break that down to explain

that first the child will count, then he will do a math game, then he will complete a math worksheet.

Like visual schedules, task sequences can take many forms. The use of task sequences assists students

to understand expectations and complete work with fewer disruptive behaviors.

Sample task sequence for an Independent Work Activity: (the student is expected to complete each of

these individual work tasks)

A white-board is an easy way to create task lists:

Task sequences are used to explain the steps that comprise an individual skill. This one shows how to

wash your hands:

You can create a check-off system for students to check when they have completed each step of the

sequence:

Emotional Regulation Supports

The 5-Point Scale and Emotional Regulation

Emotional regulation can be defined as the ability to separate your emotional responses to a problem from the thinking you must perform to resolve the problem. The 5-point scale is a visual system that can help to organize a person’s thinking when working through difficult moments, particularly those that require social understanding.

Autism impacts a person’s ability to understand social information. This can involve understanding other people’s intentions, knowing how to manipulate social situations, and repairing social interactions that have gone poorly. Difficulty in social thinking can affect a person’s ability to be comfortable in social situations and cause social confusion and anxiety. Social anxiety makes it even more difficult for a person with ASD to work through big emotions.

Creating a visual system for working through challenging situations can be considered a strength based approach since most individuals with autism tend learn most effectively through concrete, predictable systems (Baron-Cohen).

The first step in using the scale to support emotional regulation is to identify problem areas for this person. For example, problems involving changes in routine, playing with peers, or following rules at work. The next step is to break the problem area into 5 parts clearly illustrating the degrees of the situation and putting this information onto a visual scale. A common issue when discussing emotional regulation is that of stress and anxiety. This is a good place to start, creating a scale that breaks down stress into the following 5 parts:

5 = This could make me lose control. 4 = This can really upset me. 3 = This can make me nervous. 2 = This sometimes bothers me. 1 = This never bothers me.

It is important to get input from the person as much as possible and one way to do this is to

create a pocket activity. The pocket activity can be purchased (www.autismawarenesscentre.org) or made using a file folder and library pockets. The caregiver then generates a list of environments and social situations that the person is exposed to everyday and that might cause stress. Next you make cards that can fit into the pockets with the situations and environments written on each card (commercial product also has picture/word cards for common situations). You then introduce the described scale to your child or student by using the activity to visually illustrate and clarify. Hand the person one card and either have him read it or you read it aloud. Direct the person to then put the card into the number pocket that best describes how that situation makes him feel (as defined above). Keep some blank cards available to add situations that come up that you might not have

anticipated. Once the person has rated a number of key situations, create a scale that clearly illustrates the results. This scale provides the foundation of an emotional regulation program. The scale shown belo w is an example of a scale that was developed in this way.

A young girl named Petal was in a self-contained secondary vocational class of all boys. Each student had his or her own workspace and typically Petal would remain in her own space during work time. Every now and then Petal would get up from her work and quickly walk over and scream at the boys. The educational team determined that this would happen when the boys were talking or laughing loudly. The first intervention tried was to offer Petal a “break card” which she was instructed to take to her teacher if she started to feel frustrated with the boys. She was then able to take a break in another room, away from the boys. After several weeks, the data showed that although Petal was using her break card, she continuously did so after she screamed at the boys. She had learned to give her teacher the card but had missed the point of using it to preempt the loss of control. Working through the pocket and card activity mentioned above, Petal and her teacher were able to systematically determine what things made Petal feel frustrated (#3), what things made her start to feel angry (#4), and what made her lose control (#5). Petal’s teacher wrote her a story about being in class with other students and how those other students often liked to talk and laugh but how that sound was irritating to Petal. The story listed things that Petal could do when she began to feel different ways. The goal of the scale and the memo were to clearly and systematically teach Petal to listen to her own body and to respond to frustration in more adaptive ways. Because she had previously learned to take a

break card to her teacher, the team incorporated a “help” card into the new plan.

In the beginning, it was important for the classroom staff to be aware of the noise level themselves so that they could pre-empt Petal’s loss of control. Teaching Petal to use the card involved prompting her to give the card to an adult when the boys started to get noisy or when she started saying “shut up” to herself. The staff person would then praise Petal and prompt the boys to keep their voices down to a #2 (quiet talking on their volume scales). The program succeeded in helping Petal to recognize that when she started to think too much about the boys she started to talk to herself. When she started talking to herself out loud, it was time to ask for help.

Emotional regulation supports can take many forms. The use of a “feeling thermometer” is

similar to the 5-point scale. Staff members create the scale or help students to create the scale. Each

level of the thermometer represents a different emotional experience. Students are instructed to

identify the current state they are in as staff members show then and tell them.

The Zones of Regulation is a new curriculum

designed to help students learn about their levels of

emotional regulation. Teachers, therapists, and

paraprofessionals can work together to use these tools

and lessons to teach skills to students.

You can also use meters to help students learn to modulate the volume of their voice.

Token Economy

The goals of token economy

Token economies can be used to meet a number of educational and behavioral goals for children:

Increased ability to delay gratification -- Token systems are a great way to build a child's ability to wait for reinforcing items or activities. They concretely relate to the child just how more he has to do before he gets to do something really fun.

Increased sense of time -- Token systems can help kids who have little sense of time become more aware of how long they have been at a task and how much longer they will have to remain at that task.

Lessened satiation -- By increasing the number of responses necessary to obtain a primary (or strong secondary) reinforcer, token economies can lower the rate at which the child becomes satiated with a particular form of reinforcement.

Increased teaching rate -- Even relatively brief reinforcement can greatly slow down the rate of instruction if you're having to deliver it after every response (as in a discrete trial setting). Rewarding a response with a token is quick, and allows for speedy, more fluid instruction.

More natural reinforcement -- In most school settings, it's not terribly common to see teachers walking around handing out Fruit Loops, or passing out bubbles after every correct answer. Using tokens to delay the presentation of those more obvious reinforcers can be less obtrusive in the classroom.

Increased selection of reinforcers -- Because reinforcement is being delivered after several responses than after each response, longer-lasting, possibly more reinforcing items or activities could be chosen for reinforcement. As an example, if one were conducting quick verbal drills, it's probably not terribly effective to use a video as a reinforcer for each correct response. Even just a few seconds of a video after each response can bog down rate of interaction and possibly result in the loss of attention. But, if a child finds a video especially rewarding, he may be willing to work for several (even dozens) of tokens to earn a chance to watch.

What does a token economy system look like?

Token economy systems can take on a wide variety of forms. They can range from very simple, short-lived systems to much more complex systems that require the child to work for days or even weeks before earning his reward. Below are a few examples:

A basic token system

To the left is a picture of a very simple token. In this system, the child has to make six correct responses before he is able to obtain the reinforcer (in this case he is working for tickles). Before the work session starts, the child gets to pick the reinforcer he'd like and place it at the end of the card. It's difficult to make out in the picture, but the space on the board beneath the "tickle" picture is green. This matches the green paper onto which all of the reinforcers the child can choose from are mounted.

Some teachers prefer to use images of the targeted behavior as their tokens. So, if a child were working on sitting appropriately at carpet time, one might use a token system where he earned pictures of a student with his legs crossed and his hands in his lap. However, you'll notice that the tokens in this example are fairly generic "Good Job!" type stickers. The type of token used should be based on the skills and needs of the child. If you feel that the child would benefit from the added visual support of earning tokens which represent the targeted behavior, than such pictures should be used. Keep in mind, however, that choosing to do so will require that a new token system be developed for each targeted behavior (or at least for each group of behaviors -- like sitting, talking, drawing, or whatever you might be working on). If the child can handle it, I'd suggest using more a more generic system, which can be applied to a wide variety of behaviors and activities. Such an approach is cheaper, certainly, and could result in fewer headaches searching for the appropriate token system when shifting between activities.

The major disadvantage of this type of system is that it becomes rather awkward as a desk or table mounted system when you get upwards of a dozen or so expected responses. It just begins to take up too much space. Also, token systems like the one pictured can become expensive, if you're making a number of them, the Velcro and laminating (which aren't completely necessary, but are certainly recommended) can add up after a while.

Punch card

Cammie was a girl who wanted to be at circle with her friends but who was constantly talking out and interrupting the proceedings. This token system, a punch card, was introduced, along with a social story about carpet time, to help address those issues. Cammie was given punches on the card on a fixed interval schedule. We began with a very short delay between intervals, about ten seconds. After each ten-second interval, if she was sitting and listening appropriately, she was given a punch. After 18 punches (approximately three minutes at ten seconds per punch) she got a piece of candy and moved on to

the next activity. As she progressed with the card, the interval between punches was extended, until she was working at five or more minutes between punches. At that point, she'd be working on a card for several days before she was able to fill it up entirely.

Advantages of punch cards:

They are cheap. Run off four cards per sheet of paper, and it's not expensive at all to use even large numbers of punch cards in your program.

With punch cards it's easy to create token systems for specific activities or behaviors. A few Boardmaker symbols and some standard card layouts and you've got a wide variety of available cards.

Punch cards are very convenient and rather discrete. Kids can carry cards with them unobtrusively, and it's easy for a teacher to carry around a small hole punch to dole out punches during targeted activities.

A similar card can be developed which uses stars (we all had star charts at one time or another in our elementary schooling, no?) or other stickers instead of punches.

Unifix cubes

Unifix cubes can be used successfully with children with autism and they've been a big hit in small groups of typical primary school kids as well. Unifix cubes lend themselves easily to a token economy, where the kids get a cube for each correct response, or when caught exhibiting good small group behavior, and can earn prizes for achieving a certain number, but many kids naturally begin to compare the height of their towers to their neighbors'. Even if such comparison isn't spontaneous, you can get kids comparing and counting and measuring pretty easily with this approach.

Money

Money (either actual currency or "school money") can make a very good token system for kids, especially upper elementary or older kids, where stickers and such might not be as appropriate. Working with money is a very functional skill, and using money as a token system lends itself to lots of great math concepts (making change, budgeting, etc.). Token systems can be used to teach or

reinforce money skills. For instance, you could set the price for a jump on the trampoline at five nickels, but might only hand out pennies as reinforcement. The child needs to figure out when he's got enough pennies to make a nickel and cash them in.

Guidelines for creating and using token economy systems

Token systems should clearly provide a visual representation of how much the child has accomplished and how much more he needs to accomplish before reinforcement is delivered. One way to ensure this is to use a line of separate squares of Velcro (or magnets, or printed squares, etc.) instead of a solid strip. The discrete spots can help a child better predict how much more work he needs to do before he gets the reinforcement.

I'd argue that token systems are most effective at maintaining positive behaviors when they are specific to each child, address specific, targeted behaviors, and clearly communicate the expectations and rules to the child. This last point is important if you are designing a token system not for a particular work session, but which may encompass an entire day (or week, or other lengthy span), and which rewards a child for exhibiting positive behaviors. For example, several typical classrooms I have worked in use behavior plans wherein students (and often the class as a whole) are awarded tickets for "getting caught being good". When the student (or class) accumulates a certain number of tickets he get some type of prize or special activity. Such systems often work well in these classroom, and may work well with many kids with autism, as well. However, some kids (autistic or no, I'd imagine) may find such a system too vague to really have any educational benefit. For these kids, the system could be improved by awarding tokens for a small number of precisely defined behaviors, rather than the more ambiguous "be good" feeling that often comes from these class-wide systems.

As when using any reinforcement, choice should be as big a part of your token systems as you can make it. With simple systems have the child choose from an array of available reinforcers the item or activity he'd like to be working towards. With more complex systems you may have a "menu" of reinforcement posted along with the prices of various items (bubbles might cost 15 tokens, a video 60, a trip to McDonald's 150).

Pair verbal praise with the presentation of the token. Giving a "Good sitting!" or "Great reading!" will remind the child why he is getting the token and, when tokens have been established as secondary reinforcers, can help establish social praise as a reinforcer, as well.

Token systems are often a good opportunity to introduce some real-world math skills to the child. Asking questions -- "How many stickers do you have?" "What if I gave you one more?" "How many more do you need to get the bubbles?" "Does Nathan have fewer punches than you?" "How many fewer?" -- can get kids thinking about numbers in a new setting.

Velcro is used a lot in token systems. Though it can get a little spendy, it is ideal for making portable systems that can withstand a lot of use. When using Velcro, make sure you have a uniform system across your program (token systems, picture exchange, games, etc.). In all of the visual tools I create, I mount the hook (scratchy) side of the Velcro to the firm surface and the loop (soft) side to the loose items (like tokens, picture exchange symbols, etc.).

Some thoughts on response cost

Response cost is a form of punishment which involves token economies. An individual is fined a specific number of tokens when he behaves inappropriately, with the hope of reducing that inappropriate behavior. As an example, if I were to drive too fast on the highway (which I would never dream of doing) I might happen to be stopped by the police and fined a certain amount of money

(tokens). The faster I drive (the more inappropriate the behavior) the higher the fines. Similarly, one could create such a system in an educational setting. For instance, if you've a child who occasionally refuses to work at a task, and you find the task important enough to insist upon compliance, you may wish to respond to the behavior with a response cost. So, if the child were collecting pennies to buy a chance to watch his favorite video, you may consequate his initial refusal with the removal of a penny from his jar. Continued refusals may result in higher costs (two or three or more pennies).

Response costs need to be considered carefully before they're implemented, however. A considerable amount of work might be required to teach a child a token system and even more to get him to consider it a reliable tool. Setting up an aversive situation with a token system, as a response cost may do, can cause the child to lose his trust of the system.

If, however, a response cost is determined to be an appropriate tool to address the targeted behavior, ensure that the child is well aware of what behaviors will result in the loss of tokens, the cost of the various qualities of those behaviors, and how those penalties will occur. If appropriate, ensure that there is a chance for the child to earn tokens back.

Basic requirements: Three requirements are basic for a token economy.

1. Tokens

Tokens have to be used as reinforcers. A token is an object or symbol that can be exchanged for

material reinforcers, services or privileges (back-up reinforcers). In applied settings a wide range

of tokens are being used: coins, checkmarks, images of small suns, points on a counter. These

things are worthless. Their value lies in the fact that they can be exchanged for valued things.

Technically speaking tokens aren’t primary reinforcers, but secondary or learned reinforcers.

Lots of research has been done on token reinforcement, including animal studies.

2. Back-up reinforcers

Tokens have no intrinsic value, but can be exchanged for other valued reinforcing events: back-up

reinforcers. Most token economies offer a choice of differing back-up reinforcers:

•Material reinforcers: sweets, cigarettes, journals, money

•Services: breakfast in bed, having your room cleaned, activities

•Privileges and other extras: passes for leaving the building or area, permission to stay in bed,

phone calls, having your name or picture on the wall.

There are plenty of possible back-up reinforcers. They’re chosen in function of the individual or group

for which the token economy is set up, or depending on the possibilities available to the staff. Before

starting they decide how many tokens have to be paid for each back-up reinforcer. Often price lists are

exposed or given to the clients. Some back-up reinforcers can be bought anytime, for other exchange

times are limited (e.g. opening times of a token shop).

3. Specified target behaviors

Using exchangeable tokens isn’t sufficient for a token economy. The contingencies have to be

specified before introducing the program. Sometimes client manuals are written to specify how many

tokens can be earned by each target behavior (including the exact criteria being used). When a staff

member gives tokens to a client just because he judges he’s behaving positively, isn’t part of a token

economy. That’s just arbitrarily giving tokens. Criteria have to be clarified before starting the program. If

making your bed is a target behavior, staff and clients have to know how a well-made bed looks like: do

the sheets have to be put under the mattress, cushion on top? Often these specifications are hard to

make: eating politely, positive cooperation … how to specify these? There’s a broad range of possible

target behaviors: self-care, attending activities, academic behavior, disruptive behavior. Clearly specified

behavioral criteria can facilitate the learning process. A token economy helps people experience the

immediate consequences of their behavior and get a grip on their life. Their social environment

becomes more predictable. While planning how many tokens can be earned by each target behavior

some factors have to be considered: one has to assure that everyone can already earn a minimal

amount of tokens for a minimal effort, and on the other hand one has to arrange that clients don’t earn

too much too soon, making more effort useless. Sometimes the possibility of punishment by token loss

is included, technically called 'response cost': disruptive behavior can be fined with the loss of tokens.

This also should be clearly specified before the application starts. Clients can be involved in the

specifying of the contingencies.

For more information:

Dr. Christine Peck

Cooperative Educational Services

25 Oakview Drive

Trumbull, CT 06611

(203) 365-8842

peckc@ces.k12.ct.us