Autism 101 For Home and CommunityPresented by BHSSC:Ronda Feterl, MSShirley Hauge, MA SLP CCCConnie Tucker, Ed.Sp.

The wh questions?What is Autism, Autism Spectrum Disorder, PDD-NOS, and Aspergers Syndrome?What is the Prevalence of Autism?Who first described Autism?When was Autism and the other forms of it first described?Why does it need to be identified as soon as possible?Where is it best identified?

What is Autism?It is not a disease!It is a very heterogeneous developmental disorder characterized by dysfunction in these 3 areas:Impairment in reciprocal social interactionQualitative abnormalities in communicationRestricted, repetitive, and stereotyped patterns of behaviors, interests, and activitiesOther forms of Autism have different degrees of the above dysfunctions.

Communication ImpairmentRestricted Interests & CompulsivityOCDAutismAspergers DisorderSchizoid-SchizotypalSocial PhobiaSocial Impairment

Autism StatisticsOnset of symptoms before 36 months of ageMales > females by 4-5:1Seizures may develop in 25 - 33%70 - 75% identified as MR (assessment means and requirement of communication?Eating abnormalities, sleep disordersExaggerated reaction to sensory stimulation High incidence of non-right handers

Sound and SensitivityMy hearing is like having a sound amplifier on maximum loudness. My ears are like a microphone that picks up and amplifies sound.Sudden loud noises hurt my ears---like a dentists drill hitting a nerve. A sudden noise (even a faint one) will often make my heart race.Autistics may fear dogs and babies because barking dogs and crying babies may hurt their ears. Dogs and babies are unpredictable, and they can make a hurtful noise without warning.It is impossible for an autistic to concentrate in a classroom if he is bombarded with noises that blast through his brain like a jet engine.Temple Grandin

Visual StimulationI like the visual stimulation of watching automatic sliding doors; whereas another child might run and scream when he sees an automatic sliding door. When I look at moving sliding doors, I get the same pleasurable feeling that used to occur when I engaged in rocking or other stereotypical autistic behavior.Temple Grandin

Tactile ExperiencesI pulled away when people tried to hug me, because being touched sent an overwhelming tidal wave of stimulation through my body.I wanted to feel the comforting feeling of being held, but then when somebody held me, the effect on my nervous system was overwhelming.Small itches and scratches that most people ignore were torture. A scratchy under ware was like sand paper rubbing my skin raw. Hair washing makes my scalp hurt. I wear long pants because I dislike my legs touching each other. Temple Grandin

Atypical - behaviorsEye contact- Visual trackingLack of visual attention- Orienting to name (6 months)Social smiling (4-6 months)-ReactivityImitation babble at 6 mo imitating by 9-10 monthsSocial interest and affect different kinds of crySensory oriented behaviorsWithdrawn- Display poor social initiativeLack of emotional modulation- Looking at othersLack of showing/pointing- Failure to orient to name

87.5% display symptoms in the 1st year91% of cases were correctly identified

Early temperamentMarked passivity and decrease activity at 6 months.Followed by extreme distress reactions.Tendency to fixate on particular objects in the environment. Decrease expression of positive affect by 12 months.

Young Children with Autism Less likely to:Respond to social bids (hard to reach)Smile responsively (in response to praise or smile)Reciprocate affection (return a hug)Establish eye contact during interactionsImitate the actions of others (wave good-bye)Repeat actions that produce attention or laughter (show off)Show interest in other childrenUse gestures to communicate (point to request, shake head no to protest)Understand language or gesturesEngage in broad repertoire of functional play activitiesCreate simple play schemes or sequences with toysEngage in function play with dollsEngage in imaginative play

Young Children with Autism May:Engage in repetitive play activitiesLining up toys, opening/closing doors, playing with wheelsDemonstrate repetitive motor behaviorsSpinning self, finger posturingRespond inconsistently to soundsSeems deafShow unusual visual interestsSpinning objects, studying objects

Parental Concerns Absolute indicationsNo babbling by 12 monthsNo gesturing (pointing, waving bye-bye, etc by 12 months)No single words by 16 monthsNo 2 word spontaneous (not echolalia) phrases by 24 monthsAny loss of language or social skills at any ageFilipek et al, 1999

What were Parents initial concerns78% concerned about their childs language (18 months noticed)35% concerned about no attention to caregiver30% identified poor socializationOnly 16% concerned about lack of eye contactA few parents endorsed stereotypical behaviors, lack of pointing, lack of imitative playYoung et al, 2003

Young et al, 2003On average parents notice developmental signs of ASD at 15 monthsThese same parents sought professional assistance at 26 monthsThese children were diagnosed with an ASD at 41 months

Movement disturbances (Teitelbaum et al, 1998)Used Eshkol-Wachman Movement Notation (to understand abnormal movement)Compared: patterns of lying, righting from back to stomach, sitting, crawling, standing and walkingConclusions:All 17 children with autism showed disturbances of movementDetection occurs as early as 4-6 months, and even sometimes at birthNo generalized disturbance across all children; each had something wrong but not everything was compromised in every child

Zwaigenbaum, Bryson, Rogers, Roberts, Brian, Szatmari 2005Early Identification (Canada)Autism Observation Scale for Infants first standardized checklist designed to measure autism-related behaviors in young infants11/13 children who exhibit 7 or more of the 16 behavioral marker on the AOSI will have a diagnosis of autism by age 2 Families with 1 child with autism have a 5-10% chance of having a 2nd child being diagnosed

Questions for ParentsDoes your child enjoy being swung, bounced on your knee, etc?Does your child take an interest in other children?Does your child like climbing on things (i.e. stairs)?Does your child enjoy playing peek-a-boo / hide-and-seek?Does your child pretend (i.e. make a cup of tea using a toy cup and teapot, or other things)?

Questions (continued)Does your child ever use his/her index finger to point to ask for something? Does your child ever use his/her index finger to indicate interest in something? Can your child play properly with small toys (i.e. cars of blocks) without just mouthing, fiddling, or dropping them?Does your child ever bring objects to you to show something?

ClassificationSouth Dakota ARSD 24:05:24.01:13 Autism is a lifelong developmental disability of biological origin that significantly affects verbal and non verbal communications and social interactions and results in adverse effects on the students educational performance. Other characteristics include: engagement in repetitive behaviors, resistance to change, unusual response to sensory.

What is the Prevalence of Autism?Before 1980, the prevalence was 4-5/10,000 births using Kanners Criteria.In the 1980s, prevalence of 13-16/10,000 using the DSM-III criteria.In 1990s Autism and ASD were differentiated and the ratio was 1 child with autism to 2-3 with ASD using DSM-III criteria (67/10,000 with Autism to 8-15/10,000 with ASDIn 2007, the prevalence was 1/149 with ASD

Who first described Autism?Leo Kanner, the father of child and adolescent psychiatry, first described what is now known as classis autism in 1943.Hans Asperger, an Austrian psychiatrist, described an abnormality of personality that he called autistic psychopathy in 1944. It was not translated into English until the early 1970s but was not until the late 1980s that Aspergers syndrome was diagnosed much in this country.

When was Autism first describedKanner first described classic autism in 1943Hans Asperger first described the syndrome that bears his name a year later. It was not widely known in this country for another 35-40 years.The DSM-III first described PDD in 1980. It was later revised and corrected in the DSM-III-R in 1987.

Why does autism need to be identified as soon as possible?The only proven treatment is intensive behavioral and Early Communication InterventionThe neuro-developmental window for social and communication development closes very rapidly

Early Diagnosis is Stable

Can diagnose usually 2-4 years with accuracyBut much research is suggesting that this is even too lateClinicians can agree on whether a child is on the spectrumWhere on the spectrum is much more difficult and often depends upon experience of children diagnosed @ age 2 have diagnosis @ age 9 (June 2006)

Where is it best identified?The classic form of autism can be recognized as young as 18-24 months.

Milder forms of autism (PDD-ASD) can be diagnosed between 24-36 months.

All forms of autism can be recognized in the doctors office.

Therapy ApproachesStructured TeachingApplied Behavior AnalysisVisual Strategies/PECSSkill-Based Assessment (Play)

Structured TeachingPhysical Structure

Daily Schedule

Activities/Play Systems

Why utilize Structured Teaching?Helps the child understand the world.

Helps the child be calmer, less agitated and therefore increase skills.

Helps the child learn better because their attention is focused.

Helps the child achieve independence

Physical StructureHow a space is organized.

Helps person with autism understand what is expected.

Defines the environment using natural occurring boundaries.

Physical or Visual Boundaries

Defines the beginning and ending of a space.

Establishes context and function of each area.

Basic Teaching AreasGroup/Snack AreaPlay/Leisure/BreakWork areas: -1:1 instruction area-Independent work areaTransition AreaA neutral place to receive information.A place for the daily schedule.

Classroom Plan

Group Area

Snack

Snack

Play

Play

Work Set

1:1 Teaching Area

Transition

Daily ScheduleTells What Happens Next and Where.Tells the child the concept of discreet events and the difference between activities.Decreases Power Struggles.Teaches the child how to anticipate events.

Types of Daily SchedulesObject to object sequenceSingle photosPart day pictures or photosAll day picture/photo All day picture cards and written ListAll day written and written lists

Schedule Considerations:

Type of visual cue.Object, photo/label, picture symbol, wordLength of Schedule.Single, partial, half day, whole dayArrangement of ScheduleLeft to Right/Top to BottomHow manipulated/where located/travel

Object

Left to Right Object Schedule

Left to Right Photo Schedule

Picture Symbol Top to Bottom Schedule

Work SetsA systematic way for children to receive and understand information.Helps children understand the concept of finished.Teaches cause and effect.Increases productivity.Allows for Independence!

Types of Work SetsLeft to Right----Finished Box

Matching: Colors or Shapes-Sequencing

Matching Symbols-Alphabet of Numbers

Written

Left to Right-Finished Basket

Shape Match

Left to Right Shape Match

Matching Symbols

Sequence Simple Words with Pictures

Written Work Set

Work Sets Must answer four questions

How much work?

What Work?

Concept of Finished.

What to do next?

What, How Much, Finished, Next

Visual StructureOrganization

Instruction

Clarity

Visual OrganizationOrganizing materials and space.

Teaches organization and sequencing

Container organization

Limiting the area

Toy Visual Organization

Visual ClarityHigh lights the important information

Visually clarifies the relevant concepts

Emphasizes specific parts of information

Visual ClarityHi-light important wordsBold text that are importantUnderline important wordsMake the work obvious; dirty it upTape areas to clean

Visual InstructionTells the order and sequence of the activity

Teaches children a way to approach a task or activity.

Teaches flexibility and generalization

Visual InstructionMini schedulesCalendarsWritten listsChoice boards Menus

Applied Behavior Analysis and Verbal BehaviorPresented by:Connie Tuckerctucker@dsdk12.net

Human BehaviorAnything someoneDoesSaysThinksFeels

Applied Behavior AnalysisMethod of behavioral intervention based on scientific principles of behavior to:Build socially useful repertoiresReduce problematic behaviorsAnalyze Behavior to determine:How to teachHow to capture motivationWhat to teach (including language)

Instructional Techniques(Derived from Behavior Analysis)Direct InstructionDiscrete Trial TrainingMand-Model (Verbal Behavior)Incidental Teaching

Discrete Trial Training versus Applied Behavior AnalysisDTT: Systematic training of a specific skill

ABA: Determining the communicative function of the behavior (escape, attention, sensory, or tangible object)

Philosophical PerspectivesEither change the environment to fit the child or change the child to fit the environment

TEACCH: Changes environmentDTT: Changes the child

ABA - LovaasDr. O. Ivar Lovaas, Dept. of Psychology, University of California at Los AngelesLovaas Home Program - intensive (40 hours per week suggested for 7 to 24 months)Use of aversives (sharp verbal reprimands and light thigh slaps) reported as necessary to effect meaningful reductions in problem behavior in some children.

Commonalities Between ABA and Discrete Trial Traininginvolves the breakdown of any skill into discrete taskstaught in a highly structured and hierarchical manneruse of differential reinforcement (systematic rewards/reinforcement for desired behaviors)

Continued discouragement of inappropriate behaviors (ignore, redirect)data collection to closely monitor what is and isnt workinga wide range of skills and behaviors can be shaped or taught (learning not to scream, to use communicative language, social interactions, appropriate play)

Discrete Trial TrainingTeaching small, measurable units of behavior systematicallyEach step is taught by presenting a specific cue or instructionAppropriate responses are followed by consequences that function effectively as reinforcers

Child is given discrete units of learning and the opportunities for continuous teaching. Task: Broken down into discrete events. SD________R_________SR InstructionChilds ResponseFeedback Three discrete events with each trial.

ReinforcementA technique to increase behavior

A stimulus that maintains or increases behavior

Given when the target behavior occurs

Types of ReinforcersPOSITIVE: Apply a stimulus to increase a response

NEGATIVE: Remove an aversive stimulus to increase a response

CORRECTIVE: Any stimulus that decreases a behavior

Autism and BehaviorAutism is a syndrome of behavioral deficits and excesses with a neurological basisABA focuses on teaching small, measurable units of behaviorSimple responses (looking/eye contact)Spontaneous Communication and Social Interaction

Defining AutismQualitative Impairment in CommunicationQualitative Impairment in Social SkillsRestricted Range of Interests/Activities and Stereotypical Behaviors

CommunicationBehavior is a form of CommunicationLook at environmental factors in studying function of responseLanguage is a form of CommunicationLanguage is Social BehaviorLanguage is learned in the context of daily activitiesUse everyday experiences for learningGeneralize skills through teaching

ConsiderationsWhy should children work with us?Success (good things happen with us; things get better)Access to Reinforcers (attainable)Develop CooperationPairing with ReinforcersKeep child successfulStart with easy tasks; set them up for successEstablish yourself as a contingent reinforcerIf children dont like interacting with others, verbals wont occur frequently.

FocusFocus on acquisition of skillsUse interests as teaching toolsMove as quickly as the child is movingEstablish Instructional Control = compliance in presentation of skills and acquisition of skillsGoals: happy children who are engaged in acquiring skills

Incidental TeachingUsed to facilitate increased language by waiting for initiation on a topic and responding to encourage more

Initiations reflect current language repertoires (phrases, approximations of words, reaching for, pointing to, or gesturing toward)

Steps in Incidental TeachingArrange a setting containing materials of interest (Stimulus)Wait for initiation of interaction (Response)Request more elaborate languageProvide object for which the child initiated (Feedback)

Differences between DTT and Incidental Teaching (IT)Teaching initiated by asking question or giving instructionOccurs in structured settingMaterials and rewards selected by instructorFocus on tacting or labeling

Child initiates for materials, activity, or topic impromptuConducted in childs natural environmentMaterials selected serve as rewardAddresses mand training or requesting

Verbal Behavior1938 B.F. Skinner The Behavior of OrganismsLearning occurs as the result of selection by consequences of behavior*A-B-C = consequences strengthen/weaken behavior*Analysis of Behavior*First description of Discrete Trial Training

1953 B.F. Skinner Verbal Behavior Extended Operant Conditioning to verbal behavior

Analysis of Verbal BehaviorAnalyzed functions of verbal behaviorVerbal operants (functional units of language)EchoicsMandsTactsIntraverbals

EchoicsIn order to learn any skill, a child must have an imitation repertoireSign requires good motor imitation (mimetic)Speaking requires strong vocal imitation (echoic)Echoic = verbal behavior controlled by someone elses verbal behavior in 1:1 correspondence

MandThe function of a mand is to request or to obtain what is desireddemand or commandMands are reinforced by delivering what is requestedDesired items, information, assistance, missing items, actions, attention, negative reinforcement*First step in teaching language because its based on the childs motivation

Gains with Manding BehaviorAttending - social aspect (eye contact and communication)Cooperation Imitation - use signing, paired with vocalization to make verbal requestsIconic feature of sign = similar to action when engaging in activitySocial Interaction - alternate way to gain reinforcers while developing languageLanguage

TactVerbal Behavior controlled by nonverbal environment (nouns, actions, adjectives, pronouns, relations, others)Label of something in the environment, vocabularyTact = making contact with the nonverbal environmentReinforced by generalized reinforcers

IntraverbalVerbal behavior under the control of others verbal behaviors Discuss stimuli that arent presentStrengthened by social reinforcementReinforced by praise, generalized reinforcers, naturally & continued conversational exchangeConversational languageResponses to language of another persons languageAnswers to wh- questionsFill-ins and wh questions

Receptive LanguageReceptive by Function, Feature, and Class (RFFC)Function = the things once can do with an itemFeatures = descriptions or common characteristics of items (parts, shapes, size, texture)Classes = general categories items can be grouped in together

Expressive LanguageExpressive Language - multi-functionalA B CMand(want book) book get bookTact(see book) book praiseIntraverbal (can read) book praiseEchoic(hear book) book praise

ABA and VBVerbal Behavior is a form of ABA with emphasis on teaching verbal skillsABA Procedures:ShapingPromptingFadingChainingDifferential Reinforcement

ShapingGradually modifying the childs existing behavior into what we want it to beAdjusting the requirements before reinforcement is givenArtistry of Teaching is manipulating reinforcersPairing delivery of reinforcers is important to further develop social language

PromptingAssistance given to promote correct responsesVB uses errorless learningTraditional ABA uses no, no promptPrompts range in intrusiveness (physical guidance > demonstration > verbal cues > visual cues > pointing > proximity

FadingCritical so as not to teach children to become dependent on promptsPrompts are gradually removed (most intrusive to least intrusive)

ChainingSkills broken down into smallest unitsSkills taught in smallest units and chained togetherForward and Backward ChainingTeach units from beginning to endTeach units in reverse

Differential ReinforcementReinforcement is the most important part of teachingProvides response to childs learning that will most likely increase behaviorDifferential = vary level of reinforcementDifficult tasks reinforced heavilyEasy tasks minimal reinforcement

ReinforcementGoal to change reinforcement while establishing behavior so that child responds under natural schedules of reinforcement (occasional)Natural types of reinforcers (social)

Natural Environment TrainingLanguage-based environment - require child to talk as much as parents/teacherOpportunities for learning in the homeRooms in home equipped with huge vocabulary examplesTeaching should occur everywhere

Visual Strategies& Communication

As human beings, our job in life is to help people realize how rare and valuable each one of us really is, that each of us has something that no one else hasor ever will havesomething inside that is unique to all time. It's our job to encourage each other to discover that uniqueness and to provide ways of developing its expression.Fred Rogers

Systems or Levels of Communication (How/form?)TantrumsMotoricGesturesObjectsPicturesWritten wordsSign languageExpressive communication

Directive/reactivePulls/leadsPoints/shrugsCups/basketsLabels/photos/PCSCommercial/teacher/student madeAbstract/transientVerbal/written/keyboard

Researchers describe the normal communication message

55% visual - things that we seegestures, facial expressions, body movement, & objects in the environment37% vocal - vocal intonation, rate, intensity or volume7% verbal - the actual words that are spoken Barry Prizant

Visual Supports are those things we see that enhance the communication process.Visual tools provide the support necessary to raise children to increased levels of participation and independence.Linda A. Hodgdon

Visual Strategies95% of all people put themselves in the visual learner categoryVisual tools and supports provide the structure & routine necessary to enhance the lives of the ASD individualVisual tools are the things that you see1. You (the teacher) - as a tool2. Things in the environment3. Things that we make - schedule, calendars, rule charts, lists, etc.

Strategies to organize the environmentLabel the environment.Organize life in generalmake lists, signs, charts, messages

Why and when do we use visual tools and supports?Improve communication both understanding & expressionGive children informationSupport the child through his routinesTeach skillsPrevent problemsIntervene when there is a problem

Teach Communication Not Just SpeechUse a picture to support communication Use gestures while vocalizing noPoint or write down a wordHold up an object while requesting helpUse body languageEstablish proximity

Other kinds of visual tools:Mini SchedulesCalendarsChoice Boards MenusUniversal No sign/Stop SignsVisual Reminders Checklists

Mini Schedules/ChecklistsProvide a mini schedule or a checklist when the student has to:

complete a short series of related activities or several steps to complete an activityORorganize materials

Scrape the food off the dishes.Rinse off the dishes.Put the dishes in the dishwasher.Ask mom if there are more chores.

Done_____

Done_____

Done_____

Done_____Mini Schedule

Dishwasher

Mini-ScheduleAssignments Top Right Corner of the Paper

Write your nameDone _____Write the assignmentDone _____Write the dateDone _____Do the assignmentDone _____Give assignment to teacherDone _____

First-Then Mini Schedule

Mini Schedule

Mini Schedule

Visual CalendarsGives information about routine eventsGive information about new experiencesWhat is changing or differentA good communication tool about the past, present, and future

Visual Calendars

Universal No

The Universal No Symbol

Stop Signs

Choice Board/Mini Schedule

Choice Board

Changes in the Schedule

Visual Reward System

Waiting Chair

Visual Tools Give InformationWhat is going to happenWhen something is going to happenWhat are the choices What is changingWho is comingEtc., Etc., Etc.,

SummaryVisual strategies can be used at all developmental levels and do not restrict the curriculum.These methods are a concrete visually based instruction model to emphasis child strengths.Develops a level of independence needed for adult life.

Developed by Andrew Bondy, Ph.D. & Lori Frost, M.S., CCC/SLP in 1992Developed specifically for young children with autism & other social-communication deficitsNo complex materials or highly technical trainingNo expensive equipment, comprehensive testing, or costly trainingUsed in all settings-home, classroom, & communityPECS

Developed because speech training can involve lengthy training, eye contact, sign language requirements & relies on social rewardsDeveloped to specifically to address both the communicative and social deficitsChildren are taught to approach & give a picture to a communication partner in exchange for a high level reinforcersPECS is a way to teach functional communication skills including spontaneous communicationPECS

PECSNo prerequisite trainingFirst step: teach spontaneous requestresult initiate social interactionAdditional steps - grammar and additional communicative functionsDoes NOT inhibit speech developmentMay avoid prompt dependency

PECSReinforcer Assessment Phase I The Physical Exchange Phase II - Persistence & Distance Phase III Discrimination Training Phase IV Sentence Structure Phase V Answering What do you want? Phase VI Answering comment questions.

PECSFor more information:www.pecs.com Lori Frost or Andrew Bondy Pyramid Educational Consultants, Inc.226 West Park Place, Suite 1,Newark, DE 19711

PECS - ABA TEACCH - DTTAll a part of the PECS ApproachNot a teacher- led drillShort but frequentWithin functional routines - avoid the magic roomAcquire fundamental aspect of communication including INITIATION

Life is like an ice-cream cone; you have to lick it one day at a time.Charles Schulz, American cartoonist

If my possessions were taken from me with one exception, I would choose to keep the power of communication, for by it I would soon regain all the rest.

Daniel Webster

Skill-based Assessment (Play)

What is play/socialization?What will play /social skills do for a child with autism?

Plays Role in ChildhoodPlay as childrens culturePlay as a universal phenomenonPlays contribution to developmentPlay is a human rightPlay as a path to inclusion

Impairment in Social InteractionMarked impairment in the use of multiple nonverbal behaviorsFailure to develop peer relationships appropriate to developmental levelLack of spontaneous seeking to share enjoyment, interests or achievements with other peopleLack of social or emotional reciprocity

What Does That Look LikeLack of reciprocityLittle understanding of social cuesFailure to share enjoyment and interests with othersWithdrawn/prefer to be aloneDifficulty or inability to read others Often show emotional states that do not match their words/outward appearanceDifficultly with other nonverbal skills

Potential Social Challenges for Individuals with ASDWanting or needing to be left alone at timesTrouble with reciprocal social interactionsInability to respond to social cuesInability to understand how someone else may feel (empathy)Inappropriate giggling/laughing (emotional regulation)Impaired imitation

Challenges continuedLittle sense of others boundariesEngaging in stereotypic questioningInappropriately intrusive in social situationsMimicking actions/repeating scripts from TV (not in a reciprocal manner)Unusual sense of eye contactPoor use of non-verbal gestures

Existing research has drawn a number of conclusions:Some form of teaching or training is necessary; directed either to the peer, the child with autism, or both.Typical children benefit from learning specific skills for interacting with children with autism.

Why Be Concerned About Social Skills?Best predictor of positive, long-term outcomes for people with special needsFoundation upon which many other crucial skills are builtMajor defining characteristic of children with special needs regardless of diagnosisOften the first priority for families

Social Skills PredictHappinessEmployment and relationship successHealthPersonal Adjustment

In All People!

Teaching Play/Social Skills in a Structured Systematic Way Will:Allow the child to avoid social rejection and frustrationAllow the child to be perceived by other children as a competent playerGive the child the tools to play independently and interact with other children

Our Mission:To provide a haven for children with diverse abilities to create genuine play worlds together where they may reach their social and imaginative potential as well as have fun and make friends.

Play AssessmentEvaluate the childs interest in and the ability to use toys appropriately as well as assist in determining which toys can be used independently.

What is the childs play style?AloofPassiveActive/OddOther

Where is the child developmentally?(symbolically)Not engagedManipulation-sensoryFunctionalSymbolic-pretend

Where is the child developmentally?(socially)IsolatedOrientation/onlookerParallel-proximityCommon focusCommon goal

What is the childs communicative function and means?Function the purpose the child is communicatingMeans the variety of verbal and non-verbal communication

What are the childs play preferences?Play fascinationsPlay materialsActions with materialsPlay activitiesPlay themesPlay with others

Teaching Play/Social Skills in a Structured Systematic Way Will:Allow the child to avoid social rejection and frustrationAllow the child to be perceived by other children as a competent playerGive the child the tools to play independently and interact with other children

Teaching TechniquesAnalyze play/social behaviorProvide repetitionReinforceUse the individuals own stereotypical and repetitive play for motivation purposesAllow the individual to experience play and make mistakes

Peer Mediated StrategiesChildren have more influence over other children than adults do. This is a profound influence.Therefore children should play a therapeutic role in the development of social skills.

Interactions are Important for:Self-EsteemSocial competencyCognitionLanguage developmentRelationship formation (friendships vs. helping relationships)School and life adjustment

**********2*4*5*8*13*14*17*20Critical in teaching new language. A childs ability to imitate vocally provides opportunities to reinforce speech. Key in teaching of verbal operants.Positive consequence (reinforcement) of mand makes it more likely that the behavior will occur in the future.Associate the sound of of using his/her voice with positive consequence.

Differentiate the request for cookie verse the identification of cookiePraise or confirmation are best reinforcersReinforced more socially - implications of Autism make it important to teachRepetitive types of patterns help develop intraverbals (5 little monkeys)Life experiences verbalized to develop intraverbalsRemove visuals - talk about things in their absenceMand - provided object requested as reinforcementTact - praise = nonverbal stimuliIntraverbal - praise = verbal stimuli, different responseEchoic - praise = verbal stimuli, verbal responseWhat is communication? Exchange of information Pound table. Flip off.

Behavior is communicationSo what we do communicates but our kiddos dont do so well reading the unwritten social rules.Valedictorians auditory learnerslive by lists love lists Label the environment picture/word teach readingResearch has shown 2 limit behaviors schedule/routine visual strategies/communication system Leah storyProcess information differently Research miller, light, schlosser, 2004 pictures helped 89% 11 no change (1975-2003)Writing activity then listen to musicShows the big picture Ronda example I like to have the year planned out. I need to prepare themselves. Worry wartDoes X mean neverNo PE no STNo run from classroom30Picture day no recess33Miller, light, schlosserTeaches more of what communication is - exchangeReinforcement assessment malable brain birth -5Seeking to share enjoyment = Show off criteriaEmotional reciprocity = showing concern for others

EmpathyMindblindnessEmotional RegulationGive and TakeThe DSM-IV:Social challenges:Failure to develop peer relationships appropriate to developmental levelLack of spontaneous seeking to share enjoyment/interestsLack of social/emotional reciprocityjoint attentionspontaneous imitationSymbolic challenges:Lack of varied spontaneous make-believe play or social imitative play appropriate to developmental levelRestricted and repetitive and stereotyped patterns of behavior, interests and activities.It is not unusual for an individual with autism to accumulate a verbal repertoire (script). Verbalization is likely to surround personal interests or conditioned manners. They seldom use their verbal skills to relate to their peers and/or engage in pretend play.

Their verbal skills are typically not used in a social nature, such as commenting, describing, or sharing.

Motivation to communicate tends to revolve around requests and protests. These challenges present a a major challenge to the individual working with these children.

Engagement in peer play provides a prime context for coordination of joint action and social referencing. Children will learn the art of negotiation to access toys and play structures, how to shift gaze between themselves and their environment and learn how to interact and relate to people and objects at the same time.

It is important to be thinking about the culture of play and using more socially referenced forms of learning. As teachers of children on the autism spectrum you will need to consider scaffolding and the power of using more flexible child-centered structures.

When you closely look at children with ASD during pretend play you may notice that their play is highly repetitive; in contrast to the rich thematic variations evident in the play of typically developing children. You may describe it as echoplaylia. Without specific support, children with autism will gravitate to repetitive play activity ranging from manipulating objects and enacting elaborate routines to pursuing obsessive and narrowly focused interests

Baseline data in most studies indicate that prior to or in absence of specific intervention, social interaction between children with autism and their peers was minimal. Research indicates that the development of specific goals and the implementation of carefully planned behavioral intervention are necessary to teach functional peer social skills to children with autism.

Using these skills (sharing organizing play, assisting, persisting, requesting, and getting attention) resulted in increased rates of initiation by the typical peers and socially relevant responses by the children with autism.

# 1 predictorThese are lifelong skills.Lack of opportunities to learn peer related social skills = doubly disabledChildren that dont learn social skills will often check out or act out because they dont understand what is expected/ not reading the social situations.Effective interventions are highly structured, providing individuals with autism with more routines and predictability that they typically face in everyday interactions.

Error free learning procedure

Remember play is not perfectNow we know how important play is in the life of a child what will we do about it. This assessment can be completed by parents and professionals. This same assessment can be used with adults with a few adaptations to encourage leisure activities or work skills.1. Prepare a box of toys you believe the child will be interested in and have the ability to manage independently.2. Develop a checklist to help with your observations of the childs play.Relax and be a good observer. These are a few of the things we will want to observe. What type of play styles that are evident : Aloof - withdraws or avoids peers, wanders among peers but doesnt take notice of them, unresponsive to peer initiations passive appears indifferent toward peers, easily led into play, compliant toward peers, shows little or no self initiation. active/odd active interest in playing with peers, socially awkward, carries on one-sided conversations focused on personal interests, attempts to join in are poorly timed. Other behavior patterns dont reflect a distinct pattern of play, patterns reflect a combination of social play styles

Dimensions of play: not engaged: no apparent play actmanipulative/sensory: exploratory or sensory motor forms of playfunctional: conventional play with objects and simple scriptsSymbolic-pretend: imaginary forms of play and complex scripts

isolate (play alone), onlooker (watches others), plays in proximity ( plays beside peers), common focus( plays with peers in a reciprocal fashion, common goal (collaborates with peers in an organized fashion).

Look at the communicative function and means of communication.No clear communicative intentRequest objectsRequests action or assistanceRequests peer interactionRequests affectionsCommentsProtestsDoes the individual use facial expression,Eye gazePhysical proximityTouchingShowing, giving and taking and objectEnactmentGaze shiftIntonationVocalizationNon-focused echolaliaFocused echolaliaSimple speech-sign-written wordsComplex speech-sign-written words

Play fascinations how does the child mostly prefer to pass the time?wanders, sorting, measuring, reading, drawing, collectingPlay materials what types of toys or props are most attractive to the child?wind up toys, marbles, shiny objects, boxesActions with materials how does the child prefer to engage with toys or props?Smell, mouth, gaze , spin , fill and dump, hoards, lines them upPlay activities what play activities does the child prefer?physical, sensory, constructive (building), dress-up art, music, gamesPlay themes what play themes does the child prefer?life routines, fantasy play, invented storiesPlay with others With whom does the child prefer to play with?No one in particular, one or more specific peer, one or more specific adultEffective interventions are highly structured, providing individuals with autism with more routines and predictability that they typically face in everyday interactions.

Error free learning procedure

Remember play is not perfectBreak down each play behavior into small increments as are needed to teach the child. If the child is having difficulty, analyze where the point where the child is having difficulty, modify the procedure, the step or the reinforcement.Children with autism need to repeat behavior many times before they are a part of their repertoire. This is not much different from the way we learn behaviors in our lives. If the individual you work with has a special interest, mine that interest. Find ways to expand on the theme. This will improve motivation.Keep in mind: the child decides on the materials, you decide on what will be taught.Example Star Wars (interest)Star Wars Legos, Star Wars costumes, Star Wars figurines and vehicles, Star Wars puzzles, games art projects, and books. Star Wars at the movie theatre, Star Wars videos etc. Initially stick to the basic toys children have played with for years.Teach classic games, Tag, Red Light, Green Light etc.) so the individual is a good player rather than teaching over a dozen games that he/she cant play well.Long term studies indicates 1:1 instruction does not translate in to friendships and relationships.Article/studies by Phil Strain