Presentation slides - Idaho Training Clearinghouse

1

The Ziggurat Model Designing Comprehensive Behavior Interventions for

Students with ASD

Ruth Aspy, Ph.D., and Barry G. Grossman, Ph.D. The Ziggurat Group, PA

www.texasautism.com

Idaho Webinar – Day 2

Overview of Presentation

 Review   Levels of the Intervention Ziggurat Pt. 1

 Sensory and Biological  Reinforcement  Structure and Visual/Tactile Support

 Case study  Q&A

The Ziggurat Model Despite an enormous increase in

knowhow, the autistic way of looking at autism has resulted in too little

knowwhy. We have protocols for diagnostics and various methods of treatment, but the core of autism is

sometimes missed, due to a tendency to focus too much on the behavior of

people with autism (often even details of that behavior) without sufficiently

taking into account the context of what is taking place in the mind of people

with autism. - Peter Vermeulen

  Social   Communication   Repetitive Patterns

Associated Features   Sensory   Motor   Cognitive   Emotional Vulnerability   Medical and Biological

Factors

Characteristics Interventions

Implmt. Design Characteristics 1 2 3 4

5 Steps to Designing a Comprehensive Intervention Plan

5

2

UCC ISSI Global Guide

Ziggurat Worksheet CAPS

Provides a snapshot of ASD Iden4fies strengths and skills Iden4fies meaningful priori4es

Ensures development of a comprehensive plan Ensures implementa4on of the comprehensive plan

Present Levels of

Func4onal Performance

IEP Team Considera4ons: Parent Concerns, Transi4on,

and Person-‐Centered Planning

Evalua4on Data

Special Educa4on Supports, Related Services/Accommoda4ons and Behavior Interven4on Plan

Opera4onalized IEP: Student Schedule with Embedded Benchmarks/Short-‐term Objec4ves

and Supports 1

 Helps you to “see” the autism

 Provides a “snapshot” of how autism is expressed for an individual

 A descriptive instrument  Can be completed by a

team  Provides a tool for

assessing progress/change

Underlying Characteristics Checklist

2

 Social  Behavior, Interests,

and Activities  Communication  Sensory  Cognitive  Motor  Emotional  Biological

Individual Strengths and Skills Inventory

3Designing a Global Intervention Plan

Sensory Differences and Biological Needs

Task Demands

Structure and Visual /Tactile Supports

Reinforcement


“The last thing one knows in constructing a work is what to put first”

-Blaise Pascal

3


  Provide a sensory diet

  Monitor and address environmental stressors:   Sound, light,

proximity/personal space, textures

  Movement needs

  Monitor and address:   Appetite/hunger   Arousal/activity

level (e.g., fatigue, hyper)

  Posture and movement

  Medical needs

Addressing Sensory Issues

Sensory Issues

 Smell  Taste  Touch  Visual Input  Auditory  Vestibular

(balance)  Proprioception

(body awareness)

Emotional Reactivity

 Displays emotional outbursts when unsuccessful

 Is stubborn or uncooperative  Often gets “stuck” in a situation  Is overly sensitive  Reacts overtly when sensory

systems needs are not met

Brenda Smith Myles

Sensory Diet Is ...

 A planned and scheduled activity program designed to meet a child’s specific sensory needs (Yack et al., 1998)

 Incorporates naturally occurring opportunities for children to get the sensory stimulation they need (Willbarger, 1995)

Miller & Robbins, 2005

Calming and Alerting Sensory Activities

Sensory Area

Calming Activities Alerting Activities

Visual • Work in dim light or with lights turned off

• Block distractions by using a screen, room divider, or study carrel

• Wear sunglasses •  Provide visual materials such as a glitter wand, oil and water toys, fish tank

• Work at distraction-free desk

• Work in bright lights • Use brightly colored paper

• Use a highlighter to underline important text

• Use a slant board to place materials at an angle

Myles, Adreon, Gitlitz (2006). Simple Strategies that Work. AAPC p. 19

4

Calming and Alerting Sensory Activities

Sensory Area

Calming Activities Alerting Activities

Auditory • Cover ears when a loud or unexpected noise happens

• Work in a quiet environment

• Use headphones to shield from noise

•  Prepare in advance for loud/strange noises

•  Listen to music with varied pitch, sound loudness or uneven/fast beat


Sample Sensory/Motor Interventions

How Long Does it Last?

Tactile: 1 to 1 1/2 hours

Vestibular: 4 to 8 hours

Proprioception: Up to 1 1/2 hours

Auditory,Gustatory, Transitory & Olfactory:

Brenda Smith Myles

Sensory - Key Points

 Sensory dysfunction influences all aspects of an individual’s life.

 There are seven types of sensory dysfunction

  Interventions need to occur in ALL of the individual’s environments.

 Assessments must be completed and interventions must be supervised by a trained occupational therapist.

Coping Cards

Take 2 deep breaths with your eyes closed

Press hands together and count to 10 slowly

Amy Bixler, 2006

Reinforcement

“If you do not have good reinforcers and are not working to establish them, you might as well just go home”

-Leaf & McEachin

5

Reinforcement Reminders

Reinforcement increases the likelihood of a behavior

“The way positive reinforcement is carried out is more important than the amount”

-B.F. Skinner

Reinforcement Stinginess Disorder (RSD) – Adult Onset

(A) Qualitative impairment in reinforcement delivery behaviors, as manifested by at least two of the following:  marked impairment in the use of praise

and positive feedback in response to demonstrations of new skills

  failure to reinforce behaviors that were prompted or modeled


 a lack of spontaneous seeking to encourage the achievements of others (e.g., by a lack of giving, or delivering a reinforcer following a goal behavior)

 delay in, or total lack of, the development of compassion for those who are reinforced by non-traditional reinforcers or who achieve skills at a rate different from their typically developing peers


  in individuals with adequate speech, marked impairment in the ability to distinguish “fair” from “equal”

 stereotyped and repetitive use of ineffective strategies such as delivering punishment in order to change behaviors related to a neurological disorder

  lack of varied, spontaneous approaches to maintaining meaningful reinforcers for all learners


(B) Onset post 21 years of age

(C) The disturbance is not better accounted for by lack of common sense or the belief that you can “punish the ASD” out of someone.

Rate of Disciplinary Measures

Special Education (Per 100)

General Education (Per 100)

56 In School Suspensions

33 In School Suspensions

25 Out of School Suspensions

12 Out of School Suspensions

Heasley, S. (2010). Disability Scoop. www.disabilityscoop.com

Based on Texas Department of Education Records

6


  Involve students/clients in the process of selecting reinforcers

 Start with high rate of reinforcement for new skills

 Use variable rate of reinforcement for maintenance

 Reinforce practice  Reinforce prompted behavior  Reserve some reinforcers to maintain

their effectiveness

The Purpose of Special Education (IDEA)

To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique need and prepare them for further education, employment, and independent living

§300.1 (emphasis added)


“You may not have to look any further than your child’s special interest to find the perfect reward”

-Sakai, 2005, p. 52

Structure and Visual/Tactile Supports

“And it is best if you know a good thing is going to happen, like an eclipse or getting a microscope… And it’s bad if you know a bad thing is going to happen like having a filling or going to France. But I think it is worst if you don’t know whether it is a good thing or bad thing which is going to happen.”

- From: The Curious Incident of the Dog in the Night Time, by Mark Haddon, 2003

People with autism do not cope well with vagueness and ambiguity. In practice, things not being very clear is the number-one challenge for people with autism; they are confused. And that confusion often results in cognitive and emotional breakdowns, p.108

Vermeulen, Autism as Context Blindness

7


“I like everything still. It gives you a full feeling. It gives you a full attention. With something quick, you don’t get the full idea of it. With something still, you take a look at it and you get to know the whole look and feeling”

-Warden from Rage for Order (BBC, 1996)

Common Misperceptions

  If an individual can read then he/she does not need pictures or symbols

  He’s in high school, he does not need an individualized schedule

  I can stop using a visual schedule once my client learns the routine

  If an individual has not looked at his/her schedule in three weeks he/she does not need it anymore

Raise Your Hand Structure

 Highly structured environments – provide an opportunity for those with ASDs to succeed

  Increased predictability and understanding results in:  Decreased problem behavior   Increased independence

Bopp, K., Brown, K., Mirenda, P. (2004). Speech-Language Pathologists’ Roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech-Language Pathology 13, 5-19.

Visual Schedules

Research on visual schedules shows that they are:

 Effective across age ranges  Effective across settings

Visual Schedules

Schedules are effective in decreasing  off-task behaviors  disruptive behavior  noncompliance  aggression   tantrums  property destruction

8


Research-Based Literacy Strategies

Edited by Christina Carnahan, Ed.D., And Pamela Williamson, Ph.D. AAPC

Work System for Reading Group

Carnaham, Williamson (2010). Quality Literacy Instruction for Students with ASD. AAPC.

Choices at Handwriting Station

Carnaham, Williamson (2010). Quality Literacy Instruction for Students with ASD. AAPC.

Choice Board Bathroom Task Strip

9

Check Activity

√ Put away backpack

√ Make lunch selection

Complete helper chart

Turn in homework

Take out journal

Morning Checklist

Pick reward from your menu

Screaming

Outside voice

Talking voice

Soft voice/whisper

No talking

Rating Description Setting

Emergency only

Recess, ball game

Classroom, lunchroom

Library

When someone is talking to me, movies

Buron, K.D., & Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC.

Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)

Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)

Things That Can Run Out…

 Stickers  Chocolate milk  Time  Glue

Problem Solving Chart

Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing.

10

Problem Solving Chart

Mataya, K., & Owens, P. (2012). Successful Problem-Solving for High-Functioning Students with Autism Spectrum Disorders. AAPC Publishing.

Video-Based Instructional Procedures

  Video Modeling   video of someone completing the task   well validated behavioral intervention

  Video Prompting   video of each step (often from the perspective of

the participant) with opportunity to complete each step

  rapid skill acquisition in daily living skill study

Canella-Malone, O’Reilly, de la Cruz, Edrisinha, Sigafoos, and Lancioni (2006). Comparing video prompting to video modeling for teaching daily living skills to six adults with developmental disabilities. Education and Training in Developmental Disabilities, 41(4) 344-356.

How to Make Popcorn

Open plastic bag

Unfold bag

Power Card - Adolescent

  12th grade adolescent with Asperger’s   Served in general education   Received social skills training to address:

  Difficulty with eye contact   Understanding humor   Relating to peers in age-appropriate manner

  Talked about cartoon characters as if they were real

  Became upset when people did not understand his sense of humor or special interests

  Lonely   Preoccupied with Yu-Gi-Oh   Hero was Kazuki Takahashi

Davis, Boon, Cihak, & Fore. (2010). Power cards to improve conversation skills in adolescents with Asperger Syndrome. Focus on Autism and Developmental Disorders, 25,12-22.



11

Per

cent

age

of T

ime

Eng

aged

in O

ther

s-Fo

cuse

d C

onve

rsat

ion

Sessions

Pre Post

Generalization

Generalization


Social Behavior Mapping Participating in Class Discussions

Garcia Winner (2007). Social Behavior Mapping. Think Social Publishing, Inc. pp. 38-39

Expected Behaviors

How They Make Others

Feel

Consequences You

Experience

How you Feel about

Yourself •  Make

comments and ask questions related to the topic being discussed

•  Share your thoughts and opinions in a way that isn’t offensive to others.

•  Interested

•  Calm

•  Relaxed

•  Involved

•  The teacher knows you are paying attention to the topic.

•  Students know you are thinking about the discussion and listening to them when they talk.

•  Part of the group

•  Proud

•  Relaxed

•  Successful

Social Behavior Mapping Participating in Class Discussions

Garcia Winner (2007). Social Behavior Mapping. Think Social Publishing, Inc. pp. 38-39

Unexpected Behaviors

How They Make Others

Feel

Consequences You

Experience

How you Feel about

Yourself •  Add

thoughts/ask questions that aren’t related to the discussion

•  Turn your body and eyes away from the group.

•  Dominate the conversation

•  Confused

•  Irritated

•  Annoyed

•  Hostile

•  Others may tell you to be quiet.

•  The teacher won’t include you in the discussion.

•  Others may not want you to be in the group.

•  Embarrassed

•  Frustrated

•  Left out

•  Anxious

•  Sad

Cartooning

 Combines words with simple drawings in order to explain a simple concept

Case Study

Chad

Chad

12

Chad

 Diagnosed with Asperger’s Disorder  Obsessive interest with trains  Displays meltdowns when routine is

changed   Leaving train yard before routine is

complete  Hokey Pokey – misunderstanding.

Thought that song would be sung one more time – it was one more time for each student in class

Chad’s Selected UCC Items

[9] Difficulty understanding others’ nonverbal communication

[14] Has eccentric or intense preoccupations

[18] Has Problems handling transition and change

[19] Has strong need for closure [24] Interprets words literally

[52] Displays poor problem-solving skills

[80] Exhibits “meltdowns”

[85] Has low frustration tolerance

[87] Difficulty identifying and expressing emotions

[89] Difficulty managing stress and/or anxiety

Intervention Ziggurat


© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.

Quiet Corner

UCC Items Addressed



[89] Difficulty managing stress and/ or anxiety


Reinforcement


13

Books about Trains UCC Items Addressed

[14] Has eccentric or intense preoccupations



[89] Difficulty managing stress and/ or anxiety




Hokey Pokey

Get in circle

Follow the words to the music

Sing one verse for each student

Sit on square



[19] Has strong need for closure

[24] Interprets words literally



Task Demands


14

First-Then

First Then






Prime - Words and Their Meaning Word

  One more time

  Just a minute

  “Button your lips”

  Lunch is at 11:00

Meaning   Everyone gets one

more turn

  In a little while

  No talking

  Around 11:00







Skills to Teach


Feeling Anxious

Sometimes our bodies help us to know when we are stressed and need a break. When Thomas is anxious, his face turns red and he does not look at others. His mouth turns down in a frown. Sometimes, when you think that something is wrong, your body shows signs too. You clinch your fists, stiffen your body, and frown. Your face turns red. When you feel your body do this, it is a sign that you are anxious and need a break.

15


[52] Displays poor problem-solving skills



[87] Difficulty identifying and expressing emotions

[89] Difficulty managing stress and/or anxiety

Contact Information

Ruth Aspy, Ph.D. [email protected] 214-227-7741

Barry G. Grossman, Ph.D. [email protected] 214-227-7741

www.texasautism.com

Documents

Presentation slides - Idaho Training Clearinghouse