Autism Spectrum Disorders: Strategies and Interventions

Adrianne Da Silva, M.A.Erin Milhem

Cognitive Deficits Executive Functioning Storage and Retrieval of

Information of salient information

Processing Speed Discrepancies between

verbal and nonverbal reasoning skills

Abstract thinking and inferencing

Executive Functioning What is it? An umbrella term that

includes a collection of related functions that are responsible for goal- directed and problem solving behavior.

Executive Functioning The invisible disability

InhibitInability to stop behaviors or impulses

Blurting out answers before being called on

Difficulty taking turns Careless mistakes in schoolwork Distraction from task at hand Beginning task without listening

to full instructions Answering questions without

thinking the question through Difficulty following rules Lack of personal safety and

space

Shift/Cognitive FlexibilityDifficulty changing from one activity to another

Make transitions Problem solve flexibly Switch attention Change focus from one

topic to another

InitiateDifficulties with starting a task, activity, and independently generating ideas, response, or problem solving strategies.

Want to succeed at tasks but trouble getting started

Need lots of prompts to begin

Overwhelmed by large assignments

Working MemoryProblems with holding information in the mind for purpose of

completing tasks.

Trouble remembering things

Losing track of what they are doing

Difficulty following directions

Plan/OrganizeDifficulty with managing current and future tasks.

Anticipate future events Set goals, and develop steps

to carry out. Sequencing a series of steps Finishing Tasks Getting lost in the details Difficulty sorting and classifying

information from the concrete to the conceptual level.

Organization of Materials

Problems organizing personal space. Messy desks, backpacks,

bedrooms, lockers, etc. Trouble cleaning up after

self Keeping track of

possessions

MonitorProblems with personal monitoring.

Rushing through work Careless mistakes Failing to check work Failure to notice if things

bother other people Tracking and modifying

behaviors and mood states

Emotion RegulationAbility to identify, monitor, and inhibit emotional responses

and implement appropriate coping strategies Emotional outbursts Yelling, screaming, swearing Tantrums, Meltdowns, and Rages Physical Aggression and property

destruction Low Frustration Tolerance Depression and withdrawal Inability to implement

appropriate coping strategies

Common Triggers Losing a game Changes in routine When other students don’t follow the

rules When he or she doesn’t get his/her own

way When the student gets excited and

can’t wind down Misunderstanding directions Thinking that their work is not as good

as another student

Deficits that can contribute to Difficulty

with Emotion Regulation Difficulty communicating Social difficulties Motor challenges Cognitive challenges Neuropsychological factors (hyperactivity,

hypo-activity)

Why is emotion regulation important ?

Extreme positive and negative emotions can effect: Communication Attention Problem Solving

Skills Required for Successful ER

Awareness of emotions Read and interpret nonverbal

expressions of emotions Ability to understand and

monitor emotional triggers Clearly and appropriately

express the emotion Regulate the intensity and

timing of the expressed emotion

Steps for Independent emotion regulation

Recognizing the “rumbling” – early warnings signs that the student is starting to escalate

Making plans for coping with emotional events or triggers

Implementing the plan in an appropriate manner

Recognizing the “Rumbling”

As the teacher begin to recognize the signs that the student is beginning to escalate Increased pacing Increased talking or noise making Silly or goofy behaviors restlessness

At first, we may have to recognize for them and help them choose a calming strategy

Begin teaching the students how to notice their signs

Teaching the Skill Make it as concrete as possible Write it down – make it visual Often children need to be taught that

there are degrees of emotions Can be represented with a thermometer

or a scale Coordinate with home plans!

The Incredible 5 Point Scale

Helps individuals rate the emotional state 1 – I am happy and calm 2 – I am a little upset 3 – I am definitely upset 4 – I’m feel like I getting to

the point when I can not control my behavior

5 – I’m unable to control my behavior

Types of Emotion Regulation Strategies

Behavioral Strategies motor actions sensory motor strategies

Language Strategies Self talk Picture communication devices

Advanced Strategies Problem solving Self reflection Perspective taking

The Emotional Toolbox (Attwood, 2004)

Helps students identify tools to use that can help “fix” certain feelings Physical Tools Relaxation Tools Thinking Tools Social Tools

Physical Tools Going for a walk or run Playing wall ball Ride a bike Play an instrument Play a sport Stretching

Relaxation Tools Drawing Reading Listening to music Finding a quiet safe place Organizing Using fidget items

Thinking Tools Using self-talk (“things will be

ok” “it will go better next time” ) Create a personal antidote that

can encourage positive thoughts – write it down – (I can ask for help)

Help put the event in perspective for the student

Have the student engage in academic work that he or she excels in

Teach and Practice Skills Start out with NEUTRAL

situations Role play Social stories Video modeling Develop situations to practice

skills – warn the student ahead of time

Reinforce the Use of Appropriate Strategies

Reinforce in both practice and real life situations

When approaching a high probability situation, rehearse with the student and remind about reinforcer

Reinforce immediately Use behavior specific praise,

emphasizing language you are teaching the student

Interventions

+

Response InhibitionEnvironmental modifications

Increase external controls, restrict access to settings or situations in which the child can get in trouble or distracted.Provide external structure by teaching rules that can be applied and generalized to a variety of situations.Increase supervision/physical proximity and offer support to bolster the “stop” function. Implement ways to cue when to control impulses.

Dawson & Guare, 2010

+ Response InhibitionTeaching the Skill

Walk the child through the process, having them practice the skills using a contrived situation, teaching example, or visual aides.

Teach alternative to negative behaviors.

Reinforce the child immediately for using the skill

Teach them repair strategies

Work with the child on identifying the skill being addressed and your understanding of the intent of the behavior.

Dawson & Guare, 2010

Shifting/Cognitive Flexibility

Create a consistent, predictable environment as much as possible.

Create Visual Cues for routines and schedules.

Highlight changes to the routine and help the child build a bridge from the familiar to the unfamiliar.

Allow additional time to adjust to changes in routine

Provide additional support during transitions.

Provide external reinforcers

Environmental modifications

Shifting/Cognitive Flexibility

Teach the child to walk through new situations. This includes self-talk (e.g. “this is different but doesn’t mean it is bad).

How/when to ask for help. Teach to use a

calendar/schedule Model multiple ways of

approaching a task or situation

Teaching ways to self reinforce

Teaching the Skills

Meltzer, 2007

+Initiation

Provide external structure in the form of general guidelines, cues, and support

Develop schedules and routines. Use technology Begin task with the child Reward completion of tasks Small groups or peer work Self-understanding/Reflection

Meltzer, 2010

Working Memory Visual schedules and

check in with schedule throughout the day

Verbal cues or prompting Timers Work boxes Develop structured

systems for organization (i.e. worksheets, checklists, etc.)

Written and verbal reminders

Environmental Modifications

Meltzer, 2010

Working Memory

How to attend to details

Repetition, rehearsal, and review

Attaching meaning Editing/Chunking

information

Teaching the Skills

Dawson & Guare, 2010 Meltzer, 2010

Plan/Organizing

Provide a plan or schedule Break projects into clearly

defined subtasks and attach deadlines to each subtask

Avoid asking opening ended questions or random questions in class or group setting

Create a templates Offer examples of previously

finished projects

Environmental Modifications.

Dawson & Guare, 2010

Planning/Organizing

Developing an accurate understand of time

Strategy notebooks Ability to assess and

breakdown tasks Prioritizing Tasks

Obligation Aspiration Negotiation Monitoring Progress

Teaching the Skill

Meltzer, 2010

Organization of materials

Help develop a system for organizing a backpack

System for organizing schoolwork and homework

Coming up with a system for organizing room

Work to help child understand the negative and positive consequence of material management

Physical Structure Clear physical and visual

boundaries. Boundaries help to

understand where each area begins and ends.

Boundaries help establish context and segments the environment.

Minimize visual and auditory distractions.

Establish behavioral expectations

Routines Use the need for routine

in a positive way by teaching and building productive and functional routines that individual’s with ASD will use now and in the future

Characteristics: generalizes, go throughout the lifespan, promotes independence.

Routines First work, then play. Concept of finished. Top to bottom. Left to right. Check schedule. Follow directions /

instructions.

Schedules / Transition Systems

Visually communicates what activities will occur and in what sequence.

The concrete reference to the schedule helps promote flexibility.

Individualized at the individuals most independent level of understanding.

Needs to be used by the individual.

Schedule / Transition Systems

Assess visual level of understanding (functional vs. representational objects, pictures, photos, words, etc..).

Assess an amount of visual information to be used in schedule (one at a time, part day, full day, etc..).

Select a process for using the schedule (how to sequence and concept of finished).

Work Systems Gives the individual 4

pieces of information in a visual format:

1. What work/activity?

2. How much work/activity?

3. When finished?

4. What’s next? – reinforcement

Cause / effect

Work Systems Identify:1. Types of routines - left

to right, top to bottom.2. Symbols to be used -

letters, numbers, color, written, etc..

3. Concept of finished – box, shelf, drawer, file folder, etc…

4. Reward or motivator.

Visual Structure Visually communicates

information on how to complete the activity or direction.

Helps to combine and organize a series of elements to obtain a desired outcome.

Visual Structure Teaches flexibility. Promotes generalization of skills. Promotes meaningfulness within

activities. Examples: objects; pictures;

written instructions; jigs; product samples, etc..

Visually communicates information on how to complete the activity or direction.

Helps to combine and organize a series of elements to obtain a desired outcome.

Visual Structure

The 5 Point Scale

How Does Your Engine Run

System for monitoring arousal levels in young children

High Just right Low