transition planning for individuals with asd: part 3 of 4 ... · involuntary erections‐these will...
TRANSCRIPT
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Transition Planning for Individuals with ASD: Part 3 of 4: The Central Importance
of Sexual Education in ASD
PeterF.Gerhardt,Ed.D.ExecutiveDirector,TheEPICSchool
Acknowledgements
Iwouldlikerecognizefollowingindividualsfortheircontributionsinthedevelopmentofthispresentation:• MeganAtthowe,R.N.,M.S.,BCBA• FrankCicero,Ph.D.,BCBA• JoanneGerenser,Ph.D.• IsabelleHenault,Ph.D.• LisaMitchell,LCSW• BobbyNewman,Ph.D.BCBA• Sorah Stein,M.S.,BCBA• Zosia Zaks,M.A.,BCBA,and• Many,manystudents,adults,andfamilies.
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AnoteonterminologyAsageneralruleItrytoavoidusingtheterms“highfunctioning”or“lowfunctioning”todescribewheresomeonefallsontheautismspectrum.Thereasonisthatthesetermsoftenjustdescribesomeone’sdegreeofvocalverbalbehaviorthananyactualleveloffunctioning.SoinsteadItrytouse“highverbal”or“lowverbal”whichIthinkismoreaccurate.That,howeverisapersonalchoicemaintainedsolelybyselfreinforcement.Youare,ofcourse,freetoignore.
SometimesIthinkIamanautismprofessionalwhoworksinthefieldofappliedbehavioranalysis.AtothertimesIthinkIamabehavioranalystwhoworksinthefieldofautism.ThetruthisthatIamboth.
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ThisisimportantbecauseIfyouworkwithyoungkidsyougettobeaspecialist.Whetheryou’reaspecialeducator,speechpathologist,occupationaltherapist,orboardcertifiedbehavioranalyst,yougettobeaspecialist.Whenworkingwithadolescentsandyoungadultsyoudon’tgettobeaspecialistand,instead,needtobesomethingofgeneralist.Inotherwords,youneedagoodworkingknowledgeofABA,IDEA,NCLB,DepartmentofLaborregulations,SocialSecurityandSocialSecurityWorkIncentivePrograms,MentalHealthconcerns,medicationsideeffects,sexuality,menstrualcare,jobdevelopment,jobcoaching,community‐basedinstruction,generalizedsystemsofcommunication,stafftraining,communitytraining,andthat’sjusttostart.
Thankfully…
AppliedbehavioranalysishasmyriadapplicationsfarbeyondASDsomyknowledge,expertise,andexperienceintheABA/ASDfieldisgeneralizabletotheseotherareasofneed.TherestofwhatIknowisjustabunchoffactsequallyuseful(andnecessary)inmyworkorasacontestantonJeopardy.
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Itisrelativelyeasytobesuccessfulinourclassroomsaswecontrolmost,ifnotall,oftherelevantvariables.ButgiventhatABAisintendedtodealwithproblemsofsocialimportance,producestrong&sociallyimportanteffects,andoperateinnewenvironments&continueafterformaltreatmentends(Baer,Wolf,&Risley,1968),successinourclassroomsshouldonlybeourfirststepinbehavioralinterventioninASD.
However
Sexualityandsexualbehaviorarecomplex,context‐basedandsocietallymediated
topographyofadaptivebehavior
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AdaptiveBehavior“AdaptiveBehaviorisdefinedasthoseskillsorabilitiesthatenabletheindividualtomeetstandardsofpersonalindependenceandthatwouldbeexpectedofhisorherageandsocialgroup.Adaptivebehavioralsoreferstothetypicalperformanceofindividualswithoutdisabilitiesinmeetingenvironmentalexpectations.Adaptivebehaviorchangesaccordingtoaperson’sage,culturalexpectations,andenvironmentaldemands.”(Heward,2005).
TVMA
Thispresentationcontainslanguageandimageryofasexualnatureandmaybeconsideredinappropriateforyoungerviewersandlisteners.
YourWelcome.
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Remember,youneedtoknowthelimitsofyourexpertiseandthebreadthofyourbehavioranalyticcompetencebeforeventuringdeeplyintothisaspectofourfield.Whenindoubt,getassistancefromsomeonemoreexpertinthisarea.
ForBCBAs(alongwitheveryoneelse)
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PrudishPromiscuity?Sexandsexuality,asserioustopicsfordiscussion,areonesthatmanyofuswouldratheravoidthanaddress.Infact,accordingtotheCDCfewerthanhalfofallhighschoolsandonly20%ofmiddleschoolsofferacomprehensiveSexEdcurriculum.Further,only23statesmandateSexEdatalland,ofthose,only13requireittobemedicallyaccurate.(Orenstein,2016)
Orenstein,P.(March20,2016).Whendidpornbecomesexed? NewYorkTimesSundayReview.pp1,6.
Nowaddtothatthepersonalandsocietalconstraintsthatmovesexualbehavioroutoftherealmofsimplebehaviorandwehaveacohortofskillsinwhichthereishighinterestbutlimited
knowledge.
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Butlet’snotforgetthereis,historically,morethanatouchofmisogynyinallthis…
AndwhenitcametoindividualswithDD
Richards,etal(2006)notedthat,historically,individualswithDDbeenviewedassexuallydeviant,pronetocriminality,asexual,andproblematictosociety.Despitesignificantprogressoverthelast5decadesinmanyareas,thesexualityofindividualswithDDisstillgrosslymisunderstoodbysociety.AndalthoughtodaythesexualityofindividualswithDDisnotentirelyignored,norissexualbehavioruniversallypunished,theperceptionthatpeoplewithdevelopmentaldisabilitiesasperpetualchildren,irrespectiveoftheirage,stilllingerswithsignificant,negativeconsequences.Richards,D.,Miodrag,N.,&Watson,S.L.(2006).Sexualityanddevelopmentaldisability:Obstaclestohealthysexualitythroughoutthelifespan.DevelopmentalDisabilitiesBulletin,34(1‐2),137‐155.
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Puberty
PubertyAccordingtoMedilexicon'son‐linemedicaldictionarypubertyisasequenceofeventsbywhichachildbecomesanadult,characterizedbythebeginningofgonadotropinsecretion,gametogenesis,secretionofgonadalhormones,developmentofsecondarysexualcharacteristics,andreproductivefunctions.Ingirlsthefirstsignsofpubertymaybeevidentafterage8withthebiologicalprocesslargelycompletedbyage16.Inboys,pubertynormallybeginsatage9andislargelycompletedbyage18.Ethnicandgeographicfactorsmayinfluencethetimeatwhichtypicalmilestonesmayoccur.
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PubertyandGirls Sexualorgans ‐ thegirl'sclitorisandtheuterus(womb)will
grow. Menstruationbegins ‐ oneofthefirstthingsthathappens
duringagirl'spubertyisthestartofhermonthlymenstrualcycle. Breastchanges ‐ thegirl'sbreastwillstarttogrow. Vaginaldischarge ‐ vaginaldischargemaystartorchange. Bodyhair ‐ hairwillbegintogrowinherpubicarea‐ firstly
alongthelabiaandthenunderherarmsandonherlegs. Skin ‐ asthegirl'soilandsweatglandsgrowherskinwill
becomemoreoilyandshewillsweatmore.Acneiscommonamonggirlsduringpuberty.
Emotions ‐ agirl'semotionsmaychange,especiallyaroundthetimeherperiodcomeseachmonth.Theseemotionalroller‐coastertypechanges,whichmayincludeirritability,aremainlyduetofluctuatinghormonelevelsthatoccurduringthemenstrualcycle.
PubertyandBoys Scrotum,testiclesandpenis ‐ theboy'sscrotumwillbegintothinandreddenandhis
testicleswillgrow.Later,usuallyaroundtheageof13hispeniswillgrowandlengthenwhilethetesticleswillcontinuetogrow.
Voicechange ‐ theboy'svoicewill"break"or"crack”duetomaturationoflarynx. Wetdreams ‐ boysmayejaculateduringtheirsleepandwakeupinthemorningwith
dampsheetsandpajamas.Thisdoesnotmeantheboywashavingasexualdream. Involuntaryerections ‐ Thesewilloccurwithoutthepenisbeingtouchedandwithout
sexualthoughtstriggeringthem. Breastenlargement ‐ swellingofthebreastsoccurswithmanyboysduringpuberty. Skin ‐ theboy'sskinwillbecomemoreoilyduringpuberty.Hewillalsosweatmuch
more.Itisnotuncommonforboystodevelopacneduringpuberty. Bodysize ‐ growthspurtsoccurduringaboy'spuberty.Thisgrowthpeaksatabouttwo
yearsaftertheonsetofpuberty. Bodyhair ‐ hairwillstarttogrowaroundthepubicarea,underhisarms,onhislegsand
arms,andonhisface.Facialhairusuallystartsaroundtheupperlipandchin. Emotions ‐ boysmayexperiencemoodswings;onemomenttheyarelaughingandthen
theysuddenlyfeellikecrying.Boysmayalsoexperienceintensefeelingsofanger.Thisispartlyduetotheincreasedlevelsofhormonesintheirbody,aswellasthepsychologicalaspectsofcomingtotermswithallthephysicalchangesthataretakingplace.Ithelpsiftheboycantalktoafamilymember,oragoodfriend.Arecentstudy*indicatesthatmoodswingsmaybeexplainedbybiologicalchangesintheadolescentbrain.
*"Reversalofneurosteroideffectsatalpha4beta2deltaGABAAreceptorstriggersanxietyatpuberty."HuiShen,QiHuaGong,ChiyeAoki,MaoliYuan,YevgeniyRuderman,MichaelDattilo,KeithWilliamsandSherylSSmith.NatureNeurosciencePublishedonline:11March2007;doi:10.1038/nn1868.
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PubertyandASD5ThingstorememberaboutpubertyandASD:
1. ThediversityoftheemotionalimpactofadolescenceonindividualswithASD.
2. Reflex,orspontaneous,erectionsarenottheproductofsexualarousal.
3. Genitalstimulationisuniversalandshouldnotbeasourceofpanic.
4. Poorhygieneskillsnowbecomefarmorelimitingsocially
5. Personal(i.e.,sexual)safetyandthe5‐yearrule
ASD,Adolescence,andMentalHealth
Beginninginadolescence,individualswithaDDaretwotofourtimesmorelikelytohaveapsychiatricdisorderthantheirNeurotypicalpeers.(Fletcher,etal.,2007)
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Spencer,D.,Marshall,J.,Post,B.,Kulakodlu,M.,Newschaffer,C.Dennen,T.,Azocar,F.,&Jain,A.(2013).Psychotropicmedicationuseandpolypharmacyinchildrenwithautismspectrumdisorders.Pediatrics.Nov;132(5):833‐40.
Spencer,etal.,(2013)examinedratesofpsychotropicuseamonginsuredchildrenwith(ASD).Usingmedicalandpharmacyclaimslinkedwithhealthplanenrollment[]from2001to2009,theresultsindicatedthatamongchildrenwithASD64%hadafilledprescriptionforatleast1psychotropicmedication,35%hadevidenceofpoly‐pharmacy(≥2classes),and15%usedmedicationsfrom≥3classesconcurrently.Medianlengthofpoly‐pharmacywas346days.
Theauthorsconcludedthatdespiteminimalevidenceoftheeffectiveness[]ofmultidrugtreatmentofASD,psychotropicmedicationsarecommonlyused,singlyandincombination,forASDanditsco‐occurringconditions.
PsychotropicMedicationUseinASD
Sexandsexuality areextensivelyunder‐researchedareasofbehaviorinadolescents&adultswASD
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Butreally,howmuchresearchisthereonsexualityeducation&interventioninASD?
Well,almost“0”actually
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Thereisresearchontheprevalenceofsexualbehaviors,selfreportsofsexuality,parentreports,andparenttrainingonsexeducationandASDbutbasicallynothingintheareaintervention.Forexample….
Knowledgebase
(McCabe&Cummins,1996;Szollo&McCabe,1995)concludedthatindividualswhohaveanintellectualdisabilityhavelowerlevelsofsexualknowledgeandexperienceinallareasexceptmenstruationandbodypartidentificationwhencomparedtoatypicalstudentpopulation.
Watson,Griffiths,Richards,&Dysktra,(2002).SexEducation,InGriffiths,Richards,Federoff,&Watson(Eds.).EthicalDilemmas:SexualityandDevelopmentalDisability.(pp175‐225).Kingston,NY:NADDPress
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SexualityinAdultswithASDinResidentialPrograms
VanBourgondien,Reichle,&Palmer(1997)surveyedthedegreetowhichgrouphomeresidentswithautismengagedinsexualbehavior.Thebehaviorof89adults(72males,17females)wasobservedindicatingthatthemajorityofindividualswereengaginginsomeformofsexualbehaviorwithmasturbationbeingmostcommonsexualbehavior(68%including54malesand4females). Sexualbehaviorwithsignsofarousaldirectedtowardanotherpersonawaspresentinone‐thirdofthesample.
VanBourgondien,M.E.,Reichle,N.C.,&Palmer,A.(1997).Sexualbehaviorinadultswithautism.JournalofAutismandDevelopmentalDisorders,27(2),113‐125
Stalkingmaybeaproblem…Stokes,Newton,&Kaur(2007)examinedthenatureofsocialandromanticfunctioninginadolescentsandadultswithASD.WhattheyfoundwasthatindividualswithASDweremorelikelythantheirNTpeerstoengageininappropriatecourtingbehaviors;tofocustheirattentiononcelebrities,strangers,colleagues,andexes;andtopursuetheirtargetforlongerlengthsoftime(i.e.stalking).Stokes,M.Newton,N.&Kaur,A.,(2007).StalkingandsocialandromanticfunctioningamongadolescentsandadultswithASD.JournalofAutismDevelopomentalDisorders.37,1969‐86.
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Self‐reportsofSexualityinASDGilmour,etal,(2012)viaanon‐linesurvey,comparedthesexualityattitudesandbehaviorsof82(55femaleand17male)adultswithautismwith282typicaladults.TheresultsindicatedthatadultswithASDdisplayedalevelinterestinsexandengagedinavarietyofsexualbehaviorssimilartothatofcontrolgroup.However,ahigherrateofasexualitywasfoundamongindividualswithASD.Inaddition,femaleswithASDreportedalowerdegreeofheterosexualitythandidmaleswithASDalongwithslightlyhigherreportsofhomosexuality.
Dewinter,J.,Vermeiren,R.,Vanwesenbeeck,I.,Lobbestael,J.,&VanNieuwenhuizen,C.(2015).Sexualityinadolescentboyswithautismspectrumdisorder:Self‐reportedbehavioursandattitudes.JournalofAutismandDevelopmentalDisorders,45(3),731‐741.
InappropriateSexualBehaviorinASDBeddows&Brookes(2015)conductedaliteraturereviewtoidentifythetypographiesofinappropriatesexualbehaviordisplayedbyadolescentswithASD.Atotalof5,241articleswerefoundofwhich42metinclusioncriteria.ThereviewindicatedthatadolescentswithASDmayengageinhyper‐masturbation,publicmasturbation,inappropriateromanticgestures,inappropriatearousal,andexhibitionism.TheyattributethistoacombinationoftheabsenceofappropriatesexeducationandthedegreeofseverityofASD. Theauthorsnotethatdespitethisbeingacommonproblemtheliteratureissurprisinglysparseregardingwhyinappropriatebehavioroccursandwhateducationiseffective.Beddows,N., &Brooks,R.(2015).Inappropriatesexualbehaviourinadolescentswithautismspectrumdisorder:Whateducationisrecommendedandwhy.EarlyInterventioninPsychiatry. Advanceonlinepublication8/12/15
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AdditionalresearchoutoftheIntellectualDisabilitiescommunitycanbefoundbutmuchofitisnotdirectlygeneralizabletoindividualswithASD.Besides,muchofitwaspoorlydone,focusedoncongregatepopulations,andisgenerallyprettydated.
AFewReasonsWhyWeShouldTeachHumanSexualityEducationToIndividualsWithAutismSpectrumDisorders
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Number5TheyHaveTheSameHormones&Urges&NeedToMakeThe
SameChoicesAsTheirPeers
Number4Allsexualbehaviorissocialbehaviorand,assuch,isparticularlychallengingforindividualswithASD
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Number3
TheInternetandotherreadilyaccessiblemedia
Mitchell,K.J.;Finkelhor,D,;andWolak,J.(2003).Theexposureofyouthtounwantedsexualmaterialontheinternet:Anationalsurveyofrisk,impact,andprevention.YouthSociety,34,330‐358.
Inanationalsurveyofyouthages10‐17years,Mitchell,etal(2003)reportedthat25%ofyouthhadunwantedexposuretosexualpicturesontheInternetinthepastyear.Theuseoffilteringandblockingsoftwarewasassociatedwithamodestreductioninunwantedexposure,suggestingthatitmayhelpbutisfarfromfoolproof.Theauthorsurgethatsocialscientificresearchbeundertakentoinformthishighlycontentiouspublicpolicycontroversy.
Justhowaccessibleispornography?
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Forexample,asearchfor“womaninkitchen”inBingimageswiththesafefilterofffinds:
Fortypicalkids…AccordingtoCrabbeandCorlette(2010),pornhasbecomeacentralmediatorofyoungpeople’ssexualunderstandingandexperienceanda“goto”sourceforinformationofsexandsexualityintheabsenceofanyformalsexeducation.
Crabbe,M.&Corlette,D.(2010)Eroticizinginequality:Technology,pornography,andyoungpeople.DVRCVQuarterly. 3,1‐6.Accessedonlineon3/36/16at:http://www.awe.asn.au/drupal/sites/default/files/Crabbe%20Corlett%20Eroticising%20Inequality.pdf
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AndthenthereisRule34:“Ifitexists,itexistsasinternetporn.NoExceptions.”
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Butmostproblematic,atleastinmyopinion,isHentaiwhichispornographicAnimethatisoftenverymisogynisticand
violent
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Fromanew friend
"Hey,Iaddedyousinceyoulookfamiliar,butonceIlookedatyourpageIknewIwasmistaken..buthey,youseemlikeagoodguysoi'lljustintroducemyself:)Imquirky,funny,andneverafraidtohaveagoodtime..IrecentlymovedhereaboutsixmonthsagofromasmalltowninIdahoforworkandlikeitsofar!Checkoutmyprofile..ifyouwanttoIwouldlovetomeetsometimeforlunch.Anyway..Iwantedtoattachmorephotosofmebutitsgivingmesomestupiderror!IfyougivemeyouremailaddyIcansendthepicstoyouthatway.Hopetohearfromyousoon!"
Fromanothernew friend
Howareyoudoingtoday??youareareallycoolandenchantingdudethat'swhyididoptforamessagetoyouokwinks....Justwanttoknowmoreaboutyouwithduerespectthat'sifyoudon'tmind.dotakecareandhaveawonderfuldayfeelfreetoreplyok.....withregardsFiona
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Arecent(2/2016)friend
AutismSpecificInternetDating
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Number2
PerhapsthemosturgentissueinsexualityandASDisthepreventionofsexualabuse
ThoughresearchonsexualabuseandASDislimitedSobsey,(1994),reportedthat25percentofwomenwithIDreferredforfamilyplanninghadahistoryofsexualabuse.Inastudyofover55,000childrenwithID,Sullivan&Knutson(2000)foundthatchildrenwithIDwere4timesmorelikelytobethetargetsofsexualabusethentheirtypicalpeers.Mostrecently,Brown‐Lavoie,Viccili,andWeiss(2014)examinedthesexualknowledgeandvictimizationriskinagroup(N=95)ofadultswithhighfunctioningautism.78%oftherespondentswithASDreportedatleastoneincidenceofsexualvictimization(i.e.,unwantedsexualcontact,sexualcoercion,orrape)comparedto47%ofthecomparisoncontrolgroup.Brown‐Lavoie,S.M.,Viecili,M.A.,&Weiss,J.A.(2014).Sexualknowledgeandvictimizationinadults
withautismspectrumdisorders.JournalofAutismandDevelopmentalDisabilities. 44,2185‐2196.
Sobsey,D.(1994).Violenceandabuseinthelivesofpeoplewithdisabilities:Theendofsilentacceptance?Baltimore:PaulH.BrookesPublishingCo.
Sullivan,P.M.&Knutson,J.F.(2000).Maltreatmentanddisabilities:Apopulation‐basedempidemiologicalstudy.ChildAbuseandNeglect,24,1257‐1273.
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Self‐Protection Teachthatrefusingtobetouchedisaright Teachself‐protectionskills Whocan/can’ttouchtheindividualand
whereonhis/herbody Howandwhentosay“No” Howtoaskforassistance Howtorecallremoteeventsandconvey
whereanindividualtouchedhim/her
(AmericanAcademyofPediatrics,1996;Nehring,2005;Roth&Morse,1994;Volkmar&Wiesner,2004)
Number1
BecauseTheyArePeople&LikeAllPeopleIndividualswithAutismHaveTheRightToLearnAllTheyCanToEnableThemToBecomeSexuallyHealthyPersons
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WhyABA‐basedinterventionstoteach
sexuality?
Sexisjustbehavior.Whateverbodypartsareinvolveditisalljustbehavior.
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Despiteafocusonself‐determinationinadulthoodtherecontinuestobeanabsenceofanysignificantresearchintotheeffectivenessofsexeducationandtrainingforpersonswithASDwhichBehaviorAnalysisisabletoprovide.
Manyofthebasicinstructionalgoalsinsexualityeducationboildowntocomplexdiscriminationskills.Forexample: BoyorGirl
Men’sroomorLady’sroom(orBlokesv.Shielas;Senorsv.Senoritas;Mv.W;andsoon…)
Whereorwithwhoyoucan/cannot: Benaked
Masturbate
Curse
Helpwithtoiletingormenstrualcare
Touchcertainpartsofyourbody
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ButhumansexualityisnotanareawhereweinBehaviorAnalysishavedoneourbest
work,orevenmuchwork,atall.
ABSTRACT:Thisarticlepresentsabehavior‐analyticviewsuggestingthatbiologicalfactors,whethergeneticorotherwise,havelittletodowithourpreferenceforsame‐genderoropposite‐gendersexualstimulation.Thisviewstressestheimportanceofbehavioralhistoryandcurrentbehavioralcontingenciesinunderstandingthecausesofanindividual'sbehaviorandvalues.Thisviewstatesthatgeneticandotherbiologicalfactorsarecrucialindeterminingthebehavioralprocessesthatinteractwithourbehavioralhistoryandcurrentbehavioralcontingencies;howeverbiologicalfactorshavelittledirecteffectondifferencesamonghumanbeingsintheirbehaviorandvalues.Inaddition,thisbehavior‐analyticviewsuggeststhattheparticularformsofbehaviorarearbitrary;whateverthehumanbehaviorwithwhichweareconcerned,thecontingenciesofreinforcementandpunishmentdetermineitsparticularforms.
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In1974Bancroft(1974)notedthatthetwobasictreatmentsforsexualdeviancyareaversiontreatmentanddesensitization.Aversiontherapyconsistedofthepresentationofapotentiallyarousing(deviantstimulus)followedbytheadministrationofnoxiousstimulus,oftenelectricshock.Theauthorsnoted,however,thebehavioraltreatmentsengenderthefullireofthedeviantsubculture.
Bancroft,J.(1974).DeviantSexualBehavior:ModificationandAssessment.ClaredonPress:Oxford,UK.
ThingsarestartingtochangehoweverStein,(2013)notesthatwhenworkingwithinsexualityandwithpeoplewhoengageinvaryingtopographiesofsexualbehavior,thefirstthingtorememberisthatsexisbehavioranditfollowsthesamerulesasallothertopographiesofbehavior.Thefieldsofsextherapy,sexualityeducation,sexresearch,andreproductivemedicineallmaintainadescriptiveandevolvingvernacularthatisusedbycliniciansandacademiciansthroughout.However,therearefewwhoworktooperationallydefinethesetermsinbehavioralwaysandthencarryoutresearchandinterventionwithafocusonbehavioranditscontextinsteadofmentalevents.Whileitisdifficultformanyreasonswecanidentifydiscretepatternsofactivityinwhichhumans[]engagebetweensexualarousalandsatietyHowever,itcanbecomeparticularlyconfusingwhenassessingsexualbehaviorwithinthecontextofbehavioranalysisbecausesexualstimulicanservemultiplefunctions.
Stein,S.(2013).Tacklingtermsandconditioningconfusion:Sexualbehaviorandappliedbehavioranalysis.PosterpresentationOctober9,2913.SouthBend,IN.
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RememberInABAandASDinteractionsbetweenstudentandtheBehaviorAnalystmaybemorephysicalthanmostotherprofessionalrelationships.Forexample: Wemayusetickles,hugs andkissesassocialreinforcersfor
younglearnersbutthenneglecttodiscriminateastowhom,what,where,andwhen.
Wemayprovidehelp,intheformofprompting,ingenerallyprivatesituationssuchastoileting,showering,ormenstrualcarebutneglecttodiscriminateastowhom,what,where,andwhen.
Instructioninappropriatesocialdistancinginearlyadolescenceandbeyondisoftenneglectedundertheguiseofsafety.
WorkingDefinitions… Sexuality isanintegralpartofthepersonalityof
everyone:man,woman,andchild.Itisabasicneedandanaspectofbeinghumanthatcannotbeseparatedfromotheraspectsofhumanlife.Sexualityisnotsynonymouswithsexualintercourse[andit]influencesthoughtsfeelings,actions,andinteractionsandtherebyourmentalandphysicalhealth”(WHO,1975)
Sex cansimplymeangender,whetheryou’remaleorfemale.
Sex canalsomeanthephysicalactofsexualintercourse.
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Furthercomplicatingthings
Thereare4levelsofofsexuallanguageincluding: Formal/polite– Vagina Technical – Labia,Cervix,Clitoris,Vulva Cute – Va‐jay‐jay,Muffin,Littlemanintheboat,Punani,Ladyparts,etc.
Slang– Snatch,Beaver,Twat,Pussy,etc.
Further
Individualswithautismcanbeconcretethinkerswhointerpretthingsliterally,so… Beconcreteandfactualduringinstruction
Provideclearvisualandverbalexamples Avoideuphemisms
Forexample…(RatedR)
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Someresponsesofadultswithautismduringanassessment*ofsexualknowledge
Q:Tellmeaboutthispicture.
A:“[T]hepeopleweresittingonthecouch‘beingfriends’.”
http://www.camboday.com/UnderstandingSex/healthsex/img/sex_sofa.jpg
Konstantareas,M.&Lunsky,Y.(1997),Sociosexualknowledge,experience,attitudes,andinterestsofindividualswithautisticdisorderanddevelopmentaldelay.JournalofAutismandDevelopmentalDisorders,27,397‐413.
Someresponsesofadultswithautismduringanassessment*ofsexualknowledge
Q:Whatdoesthispictureshow?
A:“twopeoplelyingonatowel.”
http://www.ural.ru/gallery/news/people/sex/bed.jpg
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MythsaboutSexuality&ASD
Myth1:Folksonthespectrumhavelittle
ornointerestinsexuality
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Myth2:Peopleonthespectrum
arehypersexual
Myth3:Peopleonthespectrumaresolelyheterosexual
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ButtheTruthIs…
PersonswithASDaresexualbeings.However,individualinterestinsexorindevelopinganintimatesexualrelationshipwithanotherpersonvarieswidelyacross,andwithin,individualsatallabilitylevels.Assuch,thereisasignificantneedforindividualized,effectiveinstructionforpersonswithASDacrosstheabilityspectrum.
Sexualityeducationshouldbeproactive
Mostlearnerswithadevelopmentaldisabilityreceivesexualityeducationonlyafterhavingengagedinsexualbehaviorthatisconsideredinappropriate,offensiveorpotentiallydangerous.Thismaybeconsideredsomewhatakintoclosingthebarndoorafterthehorsehasrun.(Griffiths,1999)
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Thethreeprimarygoalsinsexualityeducation
1. Provideaccurateinformation(Relativelyeasy)
2. Developthenecessarysocialcompetence(Relativelyhard)
3. Developpersonalvalues(Somewherebetweenhardandimpossible)
GoalsofComprehensiveSexualityEducation:
INFORMATION
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Basicguidelinesforteaching
Thinkaheadandbeproactive
Beconcrete
Serious,calm,supportive
Taskanalyzeeverythingthatcanbetaskanalyzed
Beconsistent,berepetitive
Whatarethepractical/functionalimplications
Teachallstepsandinthecorrectorder
Considerusingmultipleinstructionalmediums
Incorporatethesocialdimensionofsexuality
CentralInstructionalConcepts Publicversusprivatebehavior Goodtouchversusbadtouch Propernamesofbodyparts “Improper”namesofbodyparts Personalboundaries/personalspaces Masturbation Avoidanceofdanger/Abuseprevention Socialskillsandrelationshipbuilding Datingskills Personalresponsibilityandvalues
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Whattoteachandwhen:Somegeneralguidelines.*
PreschoolthroughElementary Boysv.girls Publicv.private Basicfactsinc. bodyparts Introductiontopuberty(yourchanging
body) Introductiontomenstrualcare Appropriatev.inappropriatetouching
Source:Schwier,K.M.,&Hingsburger,D.(2000)
BoysversusGirls
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Boys versus Girls
MiddleSchooltoHighSchoolandBeyond.. Puberty&Menstruation(ifnotyetaddressed) Ejaculationandwetdreams(ifnotyetaddressed) Howtosay“no”(ifnotyetaddressed) Masturbation(ifnotyetaddressed) Publicrestroomuse Attractionandsexualfeelings Relationshipsanddating Personalresponsibilityandfamilyvalues Lovev.sex Sexualpreference Lawsregardingsexuality Pregnancy,safesex,birthcontrol Etc.
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The6RulesofPresentation:
Simple Visual Individualized Repetitive Fun Concrete
K.I.S.S.B.K.I.A.(KeepItSimpleStupidButKeepItAccurate)
BADVISUAL
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K.I.S.S.B.K.I.A.(KeepItSimpleStupidButKeepItAccurate)
PAINFULANDNOTMUCHBETTER
K.I.S.S.B.K.I.A.(KeepItSimpleStupidButKeepItAccurate)
PRETTYDECENT
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Whatwewouldactuallyuse
PenisShaft
HeadofPenisorGlans
ScrotumorTesticles
or[FamilyChoice]
Foreskin
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TeachingMaterials
Creatingyourowniseasyandlesscostly
Resourcesinclude: Medicalandnursingtextbooks Patienteducationmaterials Sexualityeducationbooksatthelibrary GoogleImagesearch PlannedParenthood Homemadedigitalphotos&videos(NOTofnudityorprivateactivities)
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Commercialproductsinclude: Anatomically‐correctdolls Anatomicalmodelsofbodyparts Writtenmaterialsandpictures Slideshowsandvideos
Shopcarefully‐‐ mostproductswerenotcreatedforpeoplewithASD,andtheyareexpensive
Thescoopaboutmasturbation
Isnormalandshouldnotbecondemned
Explorationofgenitalsforself‐pleasurebeginsininfancy
Mostpeoplewithautismlearntodoitontheirown,althoughsomemayhavedifficultyreachingorgasm
Ineffectivemasturbationmaycontributetoritualisticbehaviorsinsomepeoplewithautism
Masturbationmaybetheonlyrealisticoutletforsexualreleaseforsomepeoplewithautism
(Aileyetal.,2003;Koller,2000;Nehring,2005;Volkmar &Wiesner,2004)
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Preventingproblemswithmasturbation
TeachwhereitisOKtomasturbate Individual’sbedroom Avoidteachinguseofbathroom
Teachrulesforappropriatetime/place
Teachthatsometimesitisnotanoption
Provideopportunitiesforprivatetime
(Baxley&Zendell,2005;Koller,2000;NICHCY,1992;Volkmar&Wiesner,2004)
GoalsofComprehensiveSexualityEducation:
VALUES
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Thegoalherewouldbetodeveloppersonalvaluesreflectiveoffamily,religious,andculturalvaluesinsuchareasas: Personalresponsibility Justice Inclusivity Fairness Rightv.wrong Selfesteem Interpersonalrespect Personallimits
“Values”themselvesfallintotherealmofprivatebehavior.Valuesthemselvesaredifficulttodefine,target,andmeasureaccurately.
BehaviorbaseduponvaluestendstorequireempathywhichmaybelackinginindividualswithASD.
Valuesaregenerallyaconcernofthefamilyandnotthespecialeducator,BCBA,etc.
Onceestablished,valuesaredifficulttoalter
“Values”interventionissomewhatexternaltoourareaofinterestandexpertisegiventhat
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GoalsofComprehensiveSexualityEducation:
SOCIAL
Promotethedevelopmentofadequateandeffectivesocialrepertoiresinclusiveof: Decisionmakingskills Variableresponding Advocacyskills Safetyskills Dating&relationshipskills Andsomuchmore
Source:NICHCYNewsDigest,Vol.1(3),1992.Availableon‐lineatnichcy.org
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\\
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OneThingBehaviorAnalystsNeedtoUnderstandabout
SocialSkills
SocialSkillsareNOTLinear
Hi!Hi! What's Up?
What's Up?
Not Much. You?
Not Much. You?
Not MuchNot
Much
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Butratherarelogarithmic
Hi!
Hi!What’sUp?Yo!
Howyadoing?What’s
happening?Sup?
How’sithanging?
Notmuch?You?Nada.You?
SameoldsameoldWhereyoubeen?
Justwork,really.You?Hanginglowmy
brother
Notmuch.Nada.
SamethingmanBeenaround.Busy.Justbusy
Aslongastheyarehanging
Soremember
"Agreetingisasocialskillthatisthoughttobesimple.However,furtheranalysisshowsthisskill,whichmosttakeforgranted,tobeextremelycomplex.Howachildgreetsafriendintheclassroomdiffersfromthetypeofgreetingthatwouldbeusedifthetwometatthelocalmall.Thegreetingusedthefirsttimethechildseesafrienddiffersfromthegreetingexchangedwhentheyseeeachother30minuteslater.Further,wordsandactionsforgreetingsdiffer,dependingonwhetherthechildisgreetingateacherorapeer....[G]reetingsarecomplex,asaremostsocialskills.”
Myles&Simpson(2001)
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Walton&Ingersoll(2013)notethatmostworkonsocialskillinterventionshasbeenconductedwithyoungchildren,andthatanumberofpotentiallyeffectiveinterventionshavebeendeveloped.Whilesocialskillsinterventionneedsbebeginsoonafterdiagnosis,socialskillinterventionremainsimportantacrossthelifespan.ThisisofparticularimportancegiventhatthesocialdeficitsassociatedwithASDdonotresolvewithdevelopmentandmay,infact,bemorepronouncedgiventhenormativesocialrepertoireoftypicalpeers.
Watson,K.M.&Ingersoll,B.R.,(2013)Improvingsocialskillsinadolescentsandadultswithautismandseveretoprofoundintellectualdisabilities:Areviewoftheliterature.JournalofAutismandDevelopmentalDisorders.43,594‐615
TheIncreasingDemandsoftheSocialWorld
Yoursocialdemandsareoftenlowestwithinyourhome.Why?Becauseyousettherulesofacceptablebehavior.
Yoursocialdemandsatworkarehigher.However,workisasomewhatscriptedsocialenvironmentandonewithasecondarymeasureofcompetence(i.e.,production).
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TheIncreasingDemandsoftheSocialWorld
Nextcomesthecommunityatlarge.Why?Becauseinthecommunityyouhavelesscontrolovereventsandactionsthatimpactyou.
Lastlycomestheworldbeyondyourcommunity.Whetheradifferentsocialcircleordifferentcountry,chancesareyousocialskillrepertoiremaybelessthanadequate.
Thesocialcontextofurinals
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TheUrinalGame
Selfadvocacyisaspecializedsubsetofsocialcompetence
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Selfadvocacyrequires:1) Theabilitytoassessone’sownskillsand
abilitiesasreferencedtopersonalgoalsandtheordemandsoftheenvironment
2) Awarenessofthemostefficientwaytotomeetthesedemands(e.g.,accommodations)
3) Knowledgeoftheirrightstotheseaccommodations,and
4) TheadvocacyskillsnecessarytoexpresstheirneedsacrossmultipleenvironmentsWHILEACKNOWLEDGINGTHATSUCHSKILLSDONOTALWAYSWORK.
AreasinNeedofAdvocacyInstruction
Personalsafety Leisureandrecreation Serviceacquisitionandchoice Socialrelationships Sexualrelationships Legalandcivilrights Clotheschoice,meals,bedtime,breakfastcereal,TVshows,etc.
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Selfadvocacyinstruction Canbeinitiallytaughtintheclassroom.
Canbetaughtusingdirectinstruction,videomodeling,roleplay,orCBTbasedinterventions(e.g.,SocialThinking).
Ismoreeffectiveiftaughtwithafocusonindividualstudentpriorities.
Needstoincludetherealitythatsometimeseventhebestadvocacywillnotwork.
Needstothenbegeneralizedtoenvironmentsandeventsoutsideoftheclassroom
SomePoorlyUnderstoodFormsofSelfAdvocacy
Aggression Selfinjury Disruption Stereotypy Elopement “Non‐compliance” “Obsessing” Naggingorbadgering
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FunctionalAnalysisofSocialResponding
PositiveReinforcement
NegativeReinforcement
PositivePunishment
NegativePunishment
SocialGreeting
Attentionintheformofsocialgreetingreturned
Socialisolation
terminated?Promptingterminated?
Attentionintheformofsocialgreetingreturned
Socialisolationterminated
SharingFood Increasedpeer
interactions(i.e,those
reinforcedbyfood.
Socialisolation
terminated?Promptingterminated?
Increasedpeer
requestsforfood.
Removalofaquantityof
food
Allofwhichleadsmeto:
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Top10PlacestoLiveforQOLn
① Madison,Wisconsin.② Lincoln,Nebraska③ Minneapolis,Minnesota④ St.Paul,Minnesota⑤ Omaha,Nebraska⑥ Buffalo,NewYork⑦ Lexington,Kentucky⑧ Lubbock,Texas⑨ FortWayne,Indiana⑩ Fremont,California
ButIlivehere(andwouldn’tliveanywhereelse)
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Thepointis,QOLisaComplexConstruct
Qualityoflife(QOL)isatermusedtodescribeatemporalconditionofpersonalsatisfactionwithsuchcorelifeconditionsasphysicalwell‐being,emotionalwell‐being,interpersonalrelations,socialinclusion,personalgrowth,materialwellbeing,self‐determination,andindividualrights.(Wehmeyer &Schalock,2001)
Wehmeyer,M.L.&Schalock,R.L.(2001).Selfdeterminationandqualityoflife:Implicationsforspecialeducationservicesandsupports.Focuson
Exceptional Children,33,1‐16.
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ButinASD,whiletheconceptofqualityoflifehasbeenusedforover30yearsinthefieldofintellectualdisabilities,thefactorscontributingtoqualityoflifeofpersonswithASDhavereceivedrelativelylittleattention(Renty&Roeyers,2006)intheliteratureandinpractice.
Renty,J.O.,&Roeyers,H.(2006).Qualityoflifeinhigh‐functioningadultswithautismspectrumdisorder:Thepredictivevalueofdisabilityandsupportcharacteristics.Autism,10,511‐524.
MuchoftheresearchonQOLandASDhasfocusedonalimitednumberofaspectsofadultlife(e.g.,employment)andprimarilyonquantitativeaspectsofthesefewdomains(e.g.,employedv.employmentsatisfaction).QOL,however,ismuchmorecomplexstateofbeing(VanHeijst&Geurts,2015).
VanHeijst,B.FC.,&Geurts,H.M((2015).Qualityoflifeinautismacrossthelifespan:Ameta‐analysis.Autism:TheInternationalJournalofResearchandPractice,19,158‐167.
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VanHeijst&Guerts,(2015)recentlycompletedameta‐analysisonthetopicofQOLandadultswithASD.Anextensiveliteraturereviewidentifiedatotalof10peerreviewedstudiespublishedon2004‐2012.Theresultsindicatedthatthequalityoflifeissignificantlylowerforpeoplewithautismwhencomparedtotheirtypicalpeers.Age,IQandsymptomseveritydidnotpredictqualityoflifeinthissample.Acrossthelifespan,peoplewithautismexperienceamuchlowerqualityoflifecomparedtopeoplewithoutautism.
VanHeijst,B.FC.,&Geurts,H.M((2015).Qualityoflifeinautismacrossthelifespan:Ameta‐analysis.Autism:TheInternationalJournalofResearchandPractice,19,158‐167.
However…Parsons(2015)conductedanonlinesurveydesignedtosolicittheviewsofadultswithASDaboutcurrentlifesatisfaction.Fifty‐fiverespondents,mostofwhomattendedmainstreamschoolsandwerediagnosedlaterinlife,completedthesurvey.Respondentswereleastsatisfiedwiththeircurrentemploymentsituationandmostsatisfiedwithpersonalrelationships.Therewassubstantialindividualvariationinresponsesdemonstratingtheimportanceofrespectingpersonalviews,circumstancesandaspirations.ThisissignificantaslittleisknownabouttheactualviewsofadultswithASDonQOLandthat,ingeneral,"goodoutcomes"inadultlifeareoftenjudgedaccordingtonormativeassumptionsofquality.Parsons,S.,(2015)."WhyAreWeanIgnoredGroup?"MainstreamEducational
ExperiencesandCurrentLifeSatisfactionofAdultsontheAutismSpectrumfromanOnlineSurvey.InternationalJournalofInclusiveEducation.19,397‐
421
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Thisissometimesreferredtoasthe“DisabilityParadox”
Thedisabilityparadox(Levine,1987),states:“Whydomanypeoplewithseriousandpersistentdisabilitiesreportthattheyexperienceagoodorexcellentqualityoflifewhentomostexternalobserverstheseindividualsseemtoliveanundesirabledailyexistence?”Toexamineitsparameters,Albrecht&Devlieger(1999)interviewed153personswithdisabilitiesand54%withsignificantdisabilitiesreportedhavinganexcellentorgoodQOL(i.e,disabilityparadox).Analysisoftheinterviewsindicatesthatqualityoflifewasassociatedwithfindingabalancebetweenbody,mindandspiritandonestablishingandmaintainingapositiverelationshipwiththeperson'ssocialcontextandexternalenvironment.
Albrecht,G.&Devlieger,P.,(1999).Thedisabilityparadox:Highqualityoflifeagainstallodd.SocialScienceandMedicine.48,977‐988.
SoinsummaryWearejustbeginningtounderstandwhatitmeanstobeanadultwithautismwithinthecontextofqualityoflife,directedhabilitation,personalfreedom,andsafety.Thiscomplexunderstandingofadulthoodnowneedstobethegoalofallthebehavioranalyticinterventionacrossanindividual’slife.Withthatwe,asbehavioranalysts,needtogetincreasinglycompetentworkingthepost‐schoolenvironmentwhereservicesareunderfundedandunderstaffed,andneedsarereallycomplicated.Sexualityisoneofthemorecomplexaspectsadulthoodbut,ifweareseriousabouttheabilityofoursciencetoproducesociallysignificantoutcomes,itsimplybecomesanotherchallengetoovercome.
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Afewrecommendationsgoingforward
#1FocusonChoice/DecisionMakingSkills
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Effectivechoicemakingiscentraltomanyofthecompetenciesofadulthood.However,mostofusmastersimpleeither/orchoicespretty
earlyinlife.
“Wouldyoulikeanapple?”
Apple
GrannySmith
Whole Sliced WithCheese
MaybeApplesauce?
RedDelicious Macintosh Yellow
Delicious
Ifyouhavenothingelse
Butevenmostsimplechoicesarelesssimplethanyouthink.Forexample:
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#2
TeachResilienceasPartofProblem
Solving*(*or,asabehavioranalyst,behavioralcuspsthatare
resistancetoextinction)
Resilience isanindividual’sabilitytoproperlyadapttostressandadversity.Resilientbehaviordevelopsovertimeandisiscomposedofavarietyfactorswhichprescribethemannerinwhichwerespondtochallenges.Behavioralcompetenciesassociatedwithresilienceinclude:Perseverance,ortheabilitytocontinuewiththebehaviorinquestionintheabsenceofhighratesofpositivereinforcement.Flexibility,ortheabilitytogeneratenewstrategiestosolveaparticularproblem.Alearninghistorythathasincludederroridentificationandcorrectionasaspecificinstructionalgoal(i.e.,problemsolving)Theabilitytomanageimpulsivebehaviorand/orignoreenvironmentaldistractors
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ProblemSolvingInanattempttoidentifyfactorsthatmaycontributetoimprovingoutcomesforindividualswithASDincollegeprogramsGiaquinto,(2015)surveyed40youngadultsages18‐26across4collegecampusesinordertoinvestigatecorrelationsbetweenmindfulness,socialproblemsolving,socialanxietyandQualityofLife.PredictiverelationshipsamongsocialanxietyandQualityofLifewerealsoexamined.ResultsindicatedPositiveProblemOrientationtosocialproblemsolvingwasapredictorof[high]psychologicalQualityofLifescores.StudentsreportedhigherphysicalQualityofLifescoresthandidtheirparents.
Giaquinto,M.B.(2015).Mindfulness,socialproblemsolving,socialanxietyandqualityoflifeincollegestudentswithautismspectrumdisorders.DissertationAbstractsInternationalSectionA:HumanitiesandSocialSciences,75(10‐A(E)).(UMINo.AAI3622265)
#3Train the Typicals
“Ifyouneurotypicalshavealltheskills,whydon’tyouadaptforawhiledammit!Whyisitalwaysmefault?
DonnaVickers
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KnowledgecanbePowerful!
“…underappropriateconditionsinterpersonalcontactisoneofthemosteffectivewaystoreduceprejudicebetweenmajorityandminoritygroupmembers.”(Alpert,1954)
A corollary to #3
ConsiderAssessingSocialValiditySocialValidityreferstotheacceptabilityof,andsatisfactionwith,interventionprocedures,usuallyassessedbysolicitingopinionsfromthepeoplewhoreceiveandimplementthem.Interventionproceduresforchild[andadult]behavioraresociallyvalidwhenpeoplejudgethemasbeingacceptable.(Luiselli&Reed,2011)
Luiselli,J.K.,Reed,D.D.,(2011).SocialValidity,inS.Goldstein&J.Naglieri(Eds).EncyclopediaofChildBehaviorandDevelopment.Pp.1406.Newyork:Springer.
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#4Teachtherightskillsintherightcontext(i.e.,
wherethebehaviorismostlikelytobedisplayed.
GretchenRubinistheauthorof“BetterthenBefore” and“TheHappinessProject” amongotherbest‐sellingpublications.
Whatyoudoeverydaymightinclude
1. Waketoalarmclock2. Morningroutine
1. Shower,dress,hygiene,etc.
3. Coffee/Breakfast4. Rememberkeys&lockdoor5. Gettoworksomehow6. Followverbal/writtenprompts7. Userestroom8. Takeabreak9. Purchaseandeatlunch10. Fixmistakes11. Askforhelp12. Usecomputer/smartphone13. Gethomesomehow
14. Getthemail15. Unlockthedoor.16. Changeoutofworkclothes17. Getsomethingtoeat18. ADLs19. Preparedinnerandeat20. Cleanup.Usedishwasher21. Goon‐line22. Home/Officework23. Shower24. Prepforbedinc. meds25. Reviewnextdayschedule26. Setalarmclock27. Sleep
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#5Selfmanagement&selfreinforcement
Technology,whetherlowtechorhightech,ispartoftheworldasweknowandischangingthelivesofindividualswithASD.FromassistivecommunicationtechnologyonanI‐Pad,toGPStracking,toApplePay,toselfdrivingcars,andtoinstructionviavirtualrealitywereallyhaveonlyscratchedthesurfaceintermsoftechnology’spotential.
#6AccessTechnologySupports
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Pleasedonotlimityou,oryourstudent,to“specialneeds”apps.Manyofthemostusefulappsaredesignedforthegeneralpopulation.Thismightincludeappsthatallowyoutopurchasewithoutusingmoney,letyouknowwhatbustotakewhereandit’sschedule,identifyappropriateclothingasafunctionoftheweatherreport,orwalksafelyfromPointAtoPointBfollowingamapandverbaldirections.FormanyadolescentsandadultswithASD,thequestionisnot,“Dotheyneedsomeformoftechsupport?”butrather“Whatformoftechsupportdotheyneed?”(Gerhardt&Glickman,2016).
Gerhardt,P.F.,&Glickman,A.,(2016).Hi‐techvisualsupportsforadolescentsandadultswithASD.InM.Cohen&P.Gerhardt(Eds).VisualSupportsforPeoplewithAutism:AGuidetoParentsandProfessionals. (pp.143‐153).Bethesda,MD:WoodbineHouse.
#7RiskisPartofLife
Risksthreatensthingsthatwevalue.Whatwedoaboutthemdependsontheoptionswehave,theoutcomeswevalue,andourbeliefsabouttheoutcomeswevaluethatmightfollowcontingentoneachoptionwemaychoose.Theoutcomescanbecertainoruncertainandourchoicessimpleorcomplex.(Fischhoff&Kadvany,2011)Risk,itseems,isunavoidable.Howeverignoringrisk,undertheguiseofsafety,wouldonlyseemtoinvitegreaterriskfortheindividualinquestion.
(Fischhoff,B.,&Kadvany,J.(2011).Risk:AVeryShortIntroduction.NewYork:OxfordUniversityPress
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MostStudiedRiskFactorsforCancer Growingolder Tobacco Sunlight Ionizingradiation Certainchemicalsandothersubstances Somevirusesandbacteria Certainhormones Familyhistoryofcancer Alcohol Poordiet,lackofphysicalactivity,orbeing
overweightSource:NationalCancerInstitute.AccessedJune,2016at:http://www.cancer.gov/about‐cancer/causes‐prevention/risk
Riskmeansthatlifeisnotperfect Arecentstudyfoundthat15%ofmen&7%ofwomendidn'twashtheir
handsatapublicrestroom.Whentheydidwashtheirhands,only50%ofmenusedsoap,comparedto78%ofwomen.Only5%whowashedtheirhandsscrubbedlongenoughtokillgermsthatcancauseinfections.
Inarecentstudyoncasualsexduringspringbreak,researchersfoundthat15%ofmenand13%ofwomenhadsexwithsomeonetheyjustmet.Further77%ofcollege‐agewomenand83%ofmenreportedhavinghadcasualsexatleastonce.
NationalResearchCounciloftheUSandtheInstituteofMedicine: 39%ofallsexuallyactiveU.S.highschoolstudentsdidnotuseacondomatlast
intercourse. 6%ofallU.S.highschoolstudentshadsexualintercoursebeforeage13.1 Almost14%ofallU.S.highschoolstudentshavehadsexualintercoursewith4or
morepartners. Althoughdataarelimitedonsexualbehaviorsofmiddleschoolstudentsitdoes
appearsthatapproximately20%ofhavehadsexualintercourse.
Errorsandmistakeshappenallthetime.Thetrickisminimizebigmistakeswhileacceptingacertain,“non‐dangerous”errorlevel.Soiscompetencetobeaverage?Betterthanaverage?What?Beawareofrisk,makereasonableattemptstocontrolrisk,butacceptsomelevelofrisk.
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SelectedReferencesBrown‐Lavoie,S.M.,Viecili,M.A.,&Weiss,J.A.(2014).Sexualknowledgeand
victimizationinadultswithautismspectrumdisorders.JournalofAutismand
DevelopmentalDisabilities. 44,2185‐2196.
Cederlund,M.,Hagberg,B.,Billstedt,E.Gillberg,C.,&Gillberg,C.,(2008).Aspergersyndromeandautism:Acomparativelongitudinalfollow‐up
studymore than5yearsaftertheinitialdiagnosis.JournalofAutismandDevelopmental Disorders,38,72‐85.
Glennon,T.J.,(2001).ThestressoftheuniversityexperiencewithstudentswithAspergersyndrome.JournalofAssessment,Prevention,andRehabilitation,17,183‐190.
Green,J.,Gilchrist,A.,Burton,D.,&Cox,A.(2000).SocialandpsychiatricfunctioninginadolescentswithAspergerSyndromecomparedwith
conduct disorder.JournalofAutismandDevelopmentalDisorders,30, 279‐293.
Hagner,D.,&Cooney,B.F.(2005).“Idothatforeverybody”:Supervisingemployeeswithautism.FocusonAutismandotherDevelopmentalDisabilities, 20,91‐97.
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SelectedReferences
Ivey,J.K.(2007).Outcomesforstudentswithautismspectrumdisorders:Whatisimportantandlikelyaccordingtoteachers?EducationandTraininginDevelopmentalDisabilities, 42,3‐13.
Lattimore,L.P.,Parsons,M.B.,&Reid,D.H.(2006).Enhancingjob‐sitetrainingofsupportedworkerswithautism:Areemphasisonsimulation.JournalofAppliedBehaviorAnalysis, 39, 91‐102.
Lee,H.J.,&Park,H.R.,(2007).AnintegratedliteraturereviewontheadaptivebehaviorofindividualswithAspergersyndrome.RemedialandSpecialEducation,28,132‐141.
Mazefsky,C.,Williams,D.,&Minshew,N.(2008).Variabilityinadaptivebehaviorinautism:Evidencefortheimportanceoffamilyhistory.Journal
of AbnormalChildPsychology, 37,921‐928.
McClannahan,L.E.,McGee,G.G.,MacDuff,G.S.,&Krantz,P.J.(1990).Assessingandimprovingchildcare:Apersonalappearanceindexforchildrenwithautism.JournalofAppliedBehaviorAnalysis, 23,469‐482.
SelectedReferences
Mesibov,G.B.,Currentperspectivesandissuesinautismandadolescence.InE.Schopler&G.B.Mesibov(Eds),AutisminAdolescentsandAdults,(pp.37‐56).NewYork:Plenum
Myles,B.S.,Lee,H.J.,Smith,S.M.,Tien,Y.,Swanson,T.C.,&Hudson,J.(2007).AlargescalestudyofthecharacteristicsofAspergersyndrome.EducationandTraininginDevelopmentalDisabilities,42,448‐459.
Okuda,K.(2001).Toilettrainingforanadultwithautism,severelydisturbingbehavior,andmentalretardation23‐31.JapaneseJournalofSpecialEducation, 39, 23‐31.
Quinn,M.M.,Rutherford,R.B.,Leone,P.E.,Osher,D.M.,&Poirier,J.M.(2005).Youthwithdisabilitiesinjuvenilecorrections:AnationalSurvey.ExceptionalChildren, 71,339‐345.
Sobsey,D.(1994).Violenceandabuseinthelivesofpeoplewithdisabilities:Theendofsilentacceptance?Baltimore:PaulH.BrookesPublishingCo.
Smith,M.D.,&Belcher,R.(1985).Teachinglifeskillstoadultsdisabledbyautism.JournalofAutismandDevelopmentalDisorders, 15,163‐175.
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SelectedReferencesStokes,M.,Newton,N.,&Kaur,A.(2007).Stalking,andsocialandromantic
functioningamongadolescentsandadultswithautismspectrumdisorder.JournalofAutism&DevelopmentalDisorders, 37,1969‐1986.
Sullivan,P.M.&Knutson,J.F.(2000).Maltreatmentanddisabilities:Apopulation‐basedepidemiologicalstudy.ChildAbuseandNeglect,24,1257‐1273
Topper,K.,Bremner,W.,&Holmes,E.A.,(2000).Socialcompetence:Thesocialconstructionoftheconcept.InR.Bar‐on&J.D.A.Parker,(Eds.),TheHandbookofEmotionalIntelligence, (pp.28‐39).SanFrancisco:JosseyBass.
Taylor,B.A.,Hughes,C.E.,Richard,E.,Hoch,H.,&Coello,A.R.(2004).Teachingteenagerswithautismtoseekassistancewhenlost.JournalofAppliedBehaviorAnalysis, 37,79‐82.
Watanabe,M.,Uematsu,T.,Kobayashi,S.,(1993).Teachingcommunityskills(busriding)tostudentswithautism.JapaneseJournalofSpecialEducation.31,27‐35.
Watson,Griffiths,Richards,&Dysktra(2002).SexEducation,InGriffiths,Richards,Federoff,&Watson(Eds.).EthicalDilemmas:SexualityandDevelopmentalDisability.(pp175‐225).Kingston,NY:NADDPress