aspects of asperger`s disorder and high functioning autism

ASPECTS OF ASPERGER’S DISORDER
AND HIGH FUNCTIONING AUTISM
Laurie Stephens, Ph.D.
Director of Clinical Services
Education Spectrum
September 2011
[email protected]
OVERVIEW OF
AUTISM SPECTRUM DISORDERS
• In the Diagnostic and Statistical Manual- 4th Edition
(DSM-IV), autism and related disorders come under
Pervasive Developmental Disorders (PDD’s)
• PDD because it is present from birth- or very early
on- and stays with the person throughout his/her
lifetime
• Notice the diagnosis does not allow for “curing” a
person with a PDD. The assumption is that ASD’s
are a lifelong disorder
OVERVIEW OF ASD
• Children with ASD all share the following
challenges:
– Difficulty socializing & making friends
– Difficulty communicating with others
– Behaviors that are rigid, repetitive or unusual
• A child who does not present with deficits in all 3
areas, should not be diagnosed with an ASD
• However, all 3 deficits may not be noticeable in the
educational environment, and will impact students
in different ways
THE SPECTRUM: AUTISM
• Current diagnostic criteria for
Autism:
1. Lacks social interest/skills
2. Delayed and/or deviant language
development
3. Limited behavioral repertoire
AUTISM
4.
5.
Symptoms must be present by 30 months of
age
Current research shows symptoms are
present before child’s first birthday:
– Lack of response to name
– Lack of joint attention (does not follow the
gaze/point of others to share in their
attention)
– No coordination of eye gaze & affect
(smiles, but without looking at person)
ASPERGER’S DISORDER
Current diagnostic criteria for
Asperger’s Disorder:
1. Impaired social interest/skills
2. Limited behavioral repertoire
3. No DELAY in language development
4. But- early language is odd or
deviant
COMPARING AUTISM TO ASPERGER’S
AUTISM
ASPERGER’S
•
Symptoms evident by 30
months of age
•
Symptoms often masked
until 5 years of age
•
Show less social interest/
initiative
•
Display social desire, but
often unsuccessful
•
Delayed/deviant language
development
•
Language development
advanced, but deviant
•
Non-verbal IQ likely ⇑ than
Verbal IQ
•
Verbal IQ likely ⇑ then
Non-verbal IQ
•
Good gross motor skills
•
Poor gross motor skills
•
Repetitive actions
•
Repetitive thoughts,
speech
•
Rarely enter into
relationships or have
children
•
Often enter into
relationships and have
children
BUT CHANGES ARE AFOOT!
• In 2013, the whole diagnostic process
and what we call each disorder will
change
• The fact is, there isn’t enough
scientific evidence to support the
actual “existence” of 3 clearly
separate disorders
• ASD will change to one large diagnosis
with “sub-rating” for mild to severe
PROPOSED CHANGES TO THE
DSM-V
• The new category will be Autism
Spectrum Disorders
• There will NO LONGER be
Asperger’s or PDD-NOS as a
diagnostic category
NEW DIAGNOSTIC CRITERIA
• Must meet criteria 1, 2 & 3
• Criteria 1:
• Clinically significant, persistent deficits in
social communication and interactions, as
manifest by all of the following:
a) Marked deficits in nonverbal and verbal
communication used for social interaction:
b) Lack of social reciprocity;
c) Failure to develop and maintain peer
relationships appropriate to developmental level
NEW DIAGNOSTIC CRITERIA
• Criteria 2:
• Restricted, repetitive patterns of behavior,
interests, and activities, as manifested by at least
TWO of the following:
a) Stereotyped motor or verbal behaviors, or unusual
sensory behaviors
b) Excessive adherence to routines and ritualized patterns
of behavior
c) Restricted, fixated interests
• Criteria 3:
• Symptoms must be present in early childhood (but
may not become fully manifest until social demands
exceed limited capacities)
PREVALENCE
• Difficult to determine accurately as
diagnostic specificity is lacking
–
–
–
–
–
In 1989………………...2-4 per 10,000
2000…………..…………1 in 500
2004……………………..1 in 250
2007……………………..1 in 150
2010……………………..1 in 100 to 94
• More common in boys than girls
– (4:1 for Autism… 10:1 for Asperger’s)
• Found in every culture around the world,
and prevalence is increasing in every
culture that reports on such data
CURRENT ETIOLOGIC THEORIES
• MIND Institute: the reason we can’t find the
cause of autism is because it is really
“AutismS”- several distinct disorders that
share similar features
• Two current subtypes (2011) have been
found
– Those who seem to regress and have rapid brain
growth (boys only)
– Those who have typical brain development, but
show signs of ASD by 1st birthday (all girls found in
this cluster)
• Thinking is a genetic cause and a potential
environmental cause
CHARACTERISTICS THAT
IMPEDE LEARNING
• Poor/Inappropriate Attention
– 70% initially dx’d with ADD/ADHD
– Unusual attention- cannot determine
relevant stimuli in the environment
• Poor Imitation/Observation Skills
• Motivational Differences
• Poor Non-Verbal Communication
– Lack of/unusual eye contact
– Limited understanding of facial expression &
gestures
– Does not understand tone of voice
CHARACTERISTICS THAT
IMPEDE LEARNING
• Language Deviance
Delayed expressive/receptive skills
Poor conversation skills
Pedantic (e.g. “little professor”)
Repetitive question asking
Extensive vocabulary, without full
comprehension
– Concrete understanding of language
– Poor understanding of slang, idioms,
figurative language, double meanings
– Lack of, or idiosyncratic sense of humor
–
–
–
–
–
CHARACTERISTICS THAT
IMPEDE LEARNING
• Poor Central Coherence/ Multi-Modal
Processing
–
–
–
–
Does not see the big picture
Over focus on irrelevant details
Difficulty listening, looking, writing at once
Lack of generalization
• Excessive Need for Routine
– Demands sameness, order and routine
– Does not handle change well
– Perfectionistic
CHARACTERISTICS THAT
IMPEDE LEARNING
• Lack of Theory of Mind
– “Thinking about thinking”
– “Social Thinking”
– One of the most important components to
being successful and independent
CHARACTERISTICS THAT
IMPEDE LEARNING
• Executive Functioning Deficit
– Our ability to maintain a proper
problem-solving set to attain
a future goal
– Hypothesis testing
– Organizational skills (materials, time,
searching)
– Ability to inhibit a thought/solution
– Behavioral inflexibility
CHARACTERISTICS THAT
IMPEDE LEARNING
• Intense preoccupation with particular topics, may
be obscure or fact-based. Common interests:
•
•
•
•
•
•
Dinosaurs
Time Tables/ Schedules
Animals/Insects
Books/Reading
Planets/Science
Trains/Vehicles
Electronic Gadgets
Geography
Maps
Statistics/Trivia
Machinery
Japanese Anime
CHARACTERISTICS THAT
IMPEDE LEARNING
• Sensory Dysfunctions
–
–
–
–
Over responsiveness to lights, sounds, smell, texture
Sensitivity to clothing, smells, texture
Poor proprioceptive skills
Delay in initiating motoric responses
• Motor Stereotypies/Clumsiness
• Visual Thinkers
• Cognitive Splinter Skills
COMMON COGNITIVE STRENGTHS
& WEAKNESSES
Strengths
• Visual memory
• Auditory memory
• Rote learning (facts,
rules)
• Reading/decoding
• Spelling
• Esoteric knowledge
• Arts (but not crafts)
• Science
Weaknesses
• Visual spatial skills
• Auditory processing
• Abstract problem
solving
• Reading
comprehension
• Math-word problems
• Synthesizing
information
• Attention deployment &
maintenance
CHARACTERISTICS THAT IMPEDE
LEARNING
• Poor Auditory Processing Skills
– While students with ASD rarely have hearing
impairments, most have delayed auditory
processing skills
– They hear everything said, but it takes them longer
to process it
– Longer processing time means it takes them longer
to produce an answer
– The more we repeat the question- or talk, the less
likely the student is to understand, or to produce a
coherent response
CHARACTERISTICS THAT IMPEDE
LEARNING
• Poor Fine Motor Skills
– Graphomotor (the act of writing) skills are poor
– Many students will be able to say an answer, but
literally not be able to write it down
– An 11 yo Asperger’s client of mine said the
following- it is worth remembering!
• “I can think a page, I can say a paragraph and I can
write a sentence.”
THINGS TO REMEMBER
• Our students are not good “incidental
learners”
• They think in a concrete fashion. Remember
they will take at face value anything you say
• You should take a face value anything they
say. Likely when they say “I don’t know”
they probably don’t
• They do not seem to take in generalized
feedback to help change their behaviors
OPTIMIZING LEARNING
• Make sure you have student’s
attention
• Do not use too much language
when speaking
• Always “prime” the student
• Provide a visual/written schedule
• Warn of upcoming changes
– Discuss what to expect when you’re absent
– Let students be involved in changes
(redesign the bulletin board, etc.)
OPTIMIZING LEARNING
• Plan for transitions
– Have students stand and shake out all the
math from their hands, legs, brain. Now
they’re ready to do art
– Have class take a bow after each activity
• Try to avoid multi-step directions
– DON’T SAY, “Go to the orange table, get
the pencils, have your paper on the front
side and then write your name on the top”
– DO SAY, “Go to the orange table” (wait)…
“Get your pencils out” (wait…) etc.
OPTIMIZING LEARNING
• Make expectations clear
– What exactly do they have to do?
– When are they done? (I often say, “you
have to work for at least 5 minutes” for an
unstructured activity, such as an art
project
– Set a timer if necessary
– Can they call out answers, or do they
need to raise their hands?
• After giving instructions, check for
understanding (e.g. “Can you say that in your own
words?”)
OPTIMIZING LEARNING
• Remove irrelevant stimuli
• Use preferred activities to build up skills
– If they have a particular “special interest” use it to
motivate them to learn
• Give students enough time to process questions/
suggestions/directions
• Information presented visually first (look at the
pictures to predict what will happen), then
presented in an auditory fashion (spoken or read)
and also presented in a tactile fashion, allowing
manipulation of information (sequencing story
cards initially rather than retelling a story
OPTIMIZING LEARNING
• Provide visual models/Use real life
materials
– Student’s may not get abstract information
or gestural/graphic representation
– Better to teach them hot/cold with actual
hot/cold items, then move to graphic
depictions. Talk about what the clues the
graphics provide
OPTIMIZING LEARNING
• Avoid saying, “okay” at the end of a
command as this makes it a question
• Do not use idioms, slang, sarcasm, until you
have taught the meaning of such: “Oh that’s
a smart thing to do”
• Be careful of the order in which you give
commands
• Beware of sensory overload
• Provide a high degree of repetition and
corrective feedback. Instructions should be
presented several times
OPTIMIZING LEARNING
• Identify what the child should be
paying attention to:
– You need to be looking at me now
– You need to be watching what I write on
the board
– You need to listen to me, when I’m done
talking you can read what I wrote on the
board
– If you’re talking to Sally, you need to look
at her and listen to her answers
OPTIMIZING LEARNING
• Important information on a page should be
highlighted
• Ensure student can differentiate important
information from supplemental information
• Example: highlight the sign of math
problems; highlight important parts of text
• Then allow student to highlight himself
CURRICULUM MATERIALS
• Anything from socialthinking.com
• Social Language Training Series (linguisystems.com)
• Reading Programs:
9
9
9
9
Lindamood Bell – LIPS and Visualizing/Verbalizing
SRA Direct Instruction and Reach
Language!
Wilson Reading
• Written Language Programs:
9 Handwriting Without Tears
• Math Programs:
9 Saxon
9 Touch Math
A WORD ON READING
COMPREHENSION
•
Allow students to pre-read (or pre-listen) the
stories/passages they will be reading in class.
Assists them in gathering information more
than one time
•
Have student write/say what they thought the
story was about in a few words (getting the
gist)
•
Provide a list of “wh” questions students can
ask themselves upon completion of reading
•
Use a cloze procedure
•
Focus on anaphoric principles
A WORD ON READING
COMPREHENSION
•
There is research suggesting students with
ASD who also have attention, language and
theory of mind deficits have difficulty
understanding anaphora
•
The reference of a text back to earlier elements
•
Ability to put character/noun with pronoun: Mr.
Moore wasn’t a good owner. Bubba was
hungry and tired and feeling very lonely. He
hadn’t eaten for 3 days.
•
When the word “he” appears, a reader must be
able to have held the prior referent in memory
and understand that “he” refers to the last
named character (typically) in the text
A WORD ON READING
COMPREHENSION
• Students with ASD should be assessed for
anaphoric understanding
• If it is an issue, then provide anaphoric cuing
• Underline all pronouns in text and have student stop
and either state who the pronoun is referring to, or
to make a choice of who the pronoun is referring to
(is it Bubba or Tabby)
• Have student rewrite (or re-state) sentences
containing pronouns with actual referent word used
(rewriting “He had to take a bath when he got back
from the walk” to “Bubba had to take a bath…”)
THE IMPORTANCE OF
SOCIAL THINKING
• What is so difficult about teaching social
skills?
– The problem is that most of us never had to
be taught social skills
– How did we learn to read body language, to
change our tone of voice or have a
conversation?
– Social skill are “perfected” through trial and
error-our desire to be social creatures
means we are responsive to social feedback
THE IMPORTANCE OF
SOCIAL THINKING
• For children with special needs, social
skills do not develop naturally; they don’t
benefit from social feedback
• Social skills are “expected behaviors”thus we often struggle to really define them
• Life is more than “passing the test”
• Lack of social functioning is the main
stumbling block to student’s achieving
their potential
WHAT ARE SOCIAL SKILLS?
• Our ability to interact with others in a
manner that is mutually beneficial or
primarily beneficial to others
• They are NOT just behaviors
• Ability to perceive situations and know
which behaviors will lead to a positive
outcome
• Ability to read a social situation and be
flexible in our responses
• Problem-solving & thinking to change our
behaviors for a positive outcome
TEACHING SOCIAL SKILLS
• Think about teaching social skills as you do
all other academic subjects. You don’t
teach chemistry to 5 year olds for a reason
• A child must have the prerequisite skills to
move onto the next step
• In the same way that you wouldn’t throw a
child off a pier and say, “swim”…
EYE CONTACT
• One of the most basic skills in human
development
• Foundation for developing theory of
mind (ToM)
• One of the earliest symptoms of ASD
• Why do we, as humans, make eye
contact?
EYE CONTACT
• Remember, ToM: “read” other people,
to know what they are thinking/feeling
• If you aren’t interested in “reading”
other people why make eye contact?
• To a person with ASD, your eyes are
no more important than your feet
• Thus, poor eye contact may be due to
lack of understanding that eyes give
useful information
EYE CONTACT
• But there is another reason we don’t
make eye contact
• Sometimes we are overwhelmed by
input and can’t look, listen, think at
the same time
• We always break eye contact, even
those of us with the best theory of
mind!
• We tend to break eye contact to think
and/ or process a difficult task
PROMOTING EYE CONTACT
• We need to know when lack of eye contact is
due to poor ToM vs stimulus overload
• If a child is overwhelmed already, asking for
eye contact will not help them (or you)
• Attending/listening at times will be more
important
• Think: Where should child be looking and
direct eyes there!
“LOOK
AT ME”
TEACHING EYE CONTACT
• Explain why eye contact is important
• Always give the reason for eye contact
• Let kids know they can be mind
readers or social detectives
• And all they need to start is to follow
other people’s eyes!
TEACHING EYE CONTACT
• Use a game like “Charlie’s Eyes”- then
have kids do it with their own eyes
• Remind them: WE LOOK AT WHAT
WE’RE THINKING ABOUT!
• Michelle Garcia Winner’s phrase- “If
I’m not looking at you, I’m not thinking
about you”
TEACHING EYE CONTACT
• Say, “I’m going to look at Billy so he
knows I’m ready to listen to him.”
• Look directly at one child then call on
another. Ask, “Who do you think I’m
going to call on next?”
• Use natural explanations- “If you want
the wall to answer you, look at the
wall, but if you want me to answer
you, please look at me”
TEACHING FACIAL EXPRESSIONS
• We really need only 3 things to figure
out a person’s emotion from their face:
•
MOUTH
• EYES
•
EYEBROWS
TEACHING NON-VERBAL SKILLS
• Make a gestures dictionary: positive vs.
negative gestures
• Pair a body part with an emotion word or
statement. Have student act it out
– “Show happy with your hands”
– “Show scared with your ears”
TEACHING NON-VERBAL SKILLS
• Cut out pictures of body language and
have student’s make up a story that
incorporates the gestures
• Do a body language quiz:
» Jesse wasn’t a very good baseball player, but he
was happy thinking about the game
» Henry didn’t care too much for math and had a
hard time concentrating on long division
THEORY OF MIND
• To think about/understand the social world
• Ability to infer mental states in others
• Being able to explain observable events
based upon desires or emotions
• Knowing that other people think differently
• Ability to take another’s perspective
• Understanding people have had different
experiences than our own
THEORY OF MIND
• Realize everyone has own opinions,
thoughts, desires and ideas
• Being able to “read” audience and
change behavior accordingly
• Thinking about the consequences of a
statement/action BEFORE doing
• Putting other’s feelings before our own
• Developing empathy
THEORY OF MIND & ASPERGER’S
DISORDER
• Insensitivity to other people’s feelings
• Cannot take into account what other people
know
• Inability to negotiate friendships by reading
and responding to intentions
• Unable to detect a speaker’s intended
meaning
• Cannot interpret listener’s level of interest
THEORY OF MIND & ASPERGER’S
DISORDER
• Inability to anticipate what other’s
might think of your actions
• Does not understand misunderstandings
• Cannot deceive/understand deception
• Inability to understand the reason
behind other’s actions
THEORY OF MIND & ASPERGER’S
DISORDER
• Inability to understand “unwritten
rules” or conventions
• Difficulty developing empathy
• Difficulty determining other’s
motivation
• Inability to predict other’s behavior
• Off-topic remarks
• Perseverative language
THEORY OF MIND & ASPERGER’S
DISORDER
• Thus, theory of mind deficits can effect
every aspect of a person with ASD’s every
day functioning
• It effects academic, social, behavioral and
emotional functioning
• Whenever you are designing an intervention,
you have to question whether part of the
problem is a ToM deficit
• If so, always teach to the deficit
THEORY OF MIND DEFICITS & THE
IMPACT ON LEARNING
• Once a student enters 2nd grade, social
thinking comes into play in many CA State
Standards:
• Language Arts
―Comprehension, inferencing, alternative endings
• Writing
―Creative writing, persuasive writing, expository
text
• Social Studies/Science
– Inferencing, drawing conclusions, connecting
knowledge, evaluating evidence/information
GENERAL GUIDELINES FOR
IMPROVING THEORY OF MIND
• Make sure students understand eye gaze
(this is different than making eye contact)
• Can they “read” other people’s eyes?
• Do they use their eye gaze appropriately
with peers?
• Do they use and read body language
effectively?
• Can they do perspective taking?
GENERAL THEORY OF MIND
• Beginning: how do you know/ who would
know?
• Always ask what clues they are using
• Must understand own thinking before you
can reflect on other’s
• Pair eye gaze in stories with thoughts/
interests
• Thought bubbles (Zeebu)
WHAT’S IN MY THOUGHT BUBBLE?
WHAT’S IN MY THOUGHT BUBBLE?
MORE TEACHING STRATEGIES
• Always reference social thinking in
curriculum materials
• Optical illusions
• Perspective taking (Piagetian tasks)
• Watch movies/read books & discuss what
characters may be thinking- how actions
effect consequences
– Example: Willy Wonka and the Chocolate Factory
Character
Type of Person
What They Did
How They Felt
What Happened
to Them
AUGUSTUS
Rude, piggy, greedy,
Drank out of
chocolate river
when told not to
Didn’t care, wanted
to eat all the
chocolate
regardless of what
happens
Nearly drown, got
sucked into pipes,
got nothing
VIOLET
Wants to always win,
doesn’t play fair
Stole gum and
turned into
blueberry
Happy that she
chewed gum,
sad/angry at getting
fat
Had to be “juiced”didn’t get the gum,
didn’t beat record
VERUCA
Spoiled, whiny, rich, only
wants her way
Demands own
squirrel, shoved
down garbage
shoot
Kept demanding to
get what she
wanted
Covered in
garbage, didn’t get
squirrel, got
nothing
MIKE
Asks too many questions,
obsessed with TV,
violence, impulsive, doesn’t
listen
Tried to get on
Chocolate TV
against advice
Only cared about
being on TV
Shrunken,
stretched out,
didn’t get to be on
TV, didn’t get any
chocolate
CHARLIE
Respectful, caring, thinks
of others first
Drank forbidden
soda
Guilty, sorry, told
truth
Won the
Chocolate Factory,
got the world
MORE TEACHING STRATEGIES
• Always provide rationales
• Use the “social feedback loop”
• Students see how their behavior effects
others and feeds into how they will treat
them back:
– “When you walk down the hallway with a
scowl on your face, other’s think you’re
angry or mean. They won’t want to chat
with you and may ignore you when you try.”
MORE TEACHING STRATEGIES
• Make sure students know EXPECTED
from UNEXPECTED behaviors
• These include understanding
– When to talk
– What to say
– What to do with your face and body
– Proxemics
– Tone of voice
– Common “teenage” behaviors
BEGINNING SOCIAL INTERACTION
• A few things to remember:
– We can’t teach a child to be a social
butterfly who has little/no motivation
– “I don’t want friends” is often code for
“I’ve failed every time so why bother”
– You don’t go from 0 friends to popularity
– You don’t have to have a lot of friends to
get by in life
– You don’t start by being “best friends”
FRIENDSHIP PEER-A-MID
(adapted from Garcia Winner)
LEVEL 6: CLOSE FRIEND
Very close friend with whom you share special
thoughts, feelings, dreams and secrets
LEVEL 5: BONDED FRIEND
Spend lots of time together; look out for one another. Plan time
to be together often in different places
LEVEL 4: EVOLVING FRIENDSHIP
Both make effort; are interested in being together; arrange to hang
out during times outside of school.
LEVEL 3: POSSIBLE FRIENDSHIP
Someone you agree to meet up with at a later time, but only in the setting
you know them- requires little effort
LEVEL 2: ACQUAINTANCE
Someone you to talk to because they are in the same place
(not pre-arranged)
LEVEL 1: FRIENDLY GREETINGS
Short interactions (“hi, how are you?”) that are friendly. Do to lots of people many
times a day, every day
BEGINNING SOCIAL INTERACTION
• Understanding pragmatics is SUPER
important
• Goals of how many conversational
turns one will take are rarely effective
• Better to focus on “rules” of a
conversation and reasons to carry one
out
• Initial focus for “quiet” kids should be
on chit chat and not long conversation
LET’S JUST CHIT CHAT!
• What the heck does this mean? Starts
with just saying a few words
• Makes you look “friendly” and
“interested in what’s around you”
• Doesn’t oblige you to talk for long
periods
• Lots of opportunity for practice
LET’S JUST CHIT CHAT!
• Common chit chat
topics:
Weather
TV/movies
News
Sports
Common experience
(tests, teachers)
– Short thoughts
–
–
–
–
–
• Uncommon chit
chat topics:
Your life story
Science, math
Personal information
Unsolicited opinions
Overly esoteric
information
– Long thoughts
–
–
–
–
–
PRAGMATIC LANGUAGE
• What is a CONVERSATION?
• Two or more people talking to
other about the same thing
each
• A conversation MUST build upon what
the other people are saying
• A conversation is not just words, but
also eye gaze, body language, tone of
voice…
EXECUTIVE FUNCTIONING
• As an adolescent, expectations to
multi-task increase dramatically
• Goes beyond listening, taking notes,
following in the book…
• A core deficit in the AS population,
despite high IQ’s
• Remember, it really does not dawn on
students that you have to take your
book home to do your homework!
EXECUTIVE FUNCTIONING
• Need to teach student organized searching
• Model the structure you want to see
• Slowly transfer expectations to student
• Provide organizational structure
– Homework organizers with checklists
– Blue stickers on math book, math class door, math
materials
– List of expectations per class (color coded)
– Self-monitoring checklist (Did I do what I needed to)
– Time lines for assignments
– Rationales!!!
SELF-ADVOCACY
• “Deficits” related to:
– Theory of mind
– Executive functioning
– Multi-modal processing
– Learned helplessness
– Social skills
– Anxiety
HOW TO HELP
• Always question if it is a theory of mind
deficit
• Remember motivation to be independent
may be lacking
• Knowing when you need help involves
multi-modal processing
― Motivation may be there, but understanding
the steps to achieving independence may not
• Know your student’s cognitive strengths
and weaknesses
HOW TO HELP
• Many students with ASD cannot tell you
what they need to accomplish something
― You will have to break down the steps
― Introduce/master one step at a time
• Student’s cannot always “produce:” they
talk a good game, but don’t do!
• Remember, they may be able to perform
in one setting, but not another
HOW TO HELP
• Asking for help is often seen as
admitting “stupidity” or “failure”
• Praising effort over accuracy
• “Successful people know when they
need help and who to ask for help”
• When a student can’t answer, avoid
saying, “But you know this…” At that
moment, they don’t know it
HOW TO HELP
• Provide peer assistance when possible
• Give students appropriate rationale for
why they must behave in expected ways
• Answer questions honestly
• Remember in college, ONLY the student
can approach and get “disabled student”
services/accommodations
• Most accommodations are the same, but
not modifications
BEHAVIOR MODIFICATION
PRINCIPLES
• A Reinforcer always INCREASES the
likelihood of a behavior reoccurring
– If behavior isn’t increasing it is not that behavior
modification doesn’t work, it is that your
reinforcer doesn’t work
• Punishment always DECREASES the
likelihood of a behavior reoccurring
– Again, if behavior doesn’t decrease, you aren’t
actually punishing it
BEHAVIOR MODIFICATION
PRINCIPLES
• One reason people do not believe that behavior
modification works is because the are unaware of
the EXTINCTION BURST!
– When you first try to change a behavior, it will not just
disappear overnight- it gets worse!
– If a student has been reinforced for something, and the
reinforcement goes away, they will “up the ante” trying to
continue to be reinforced
– Soda machine example
WHEN DO BEHAVIOR PROBLEMS
OCCUR?
• Unpredictable settings (assemblies, start
of new academic task)
• Unstructured or down time
• Responses from others have been
inconsistent- the strongest behaviors are
those that are intermittently reinforced!!
• Over-stimulating activities
• Situations that underscore their deficits
WHEN DO BEHAVIOR PROBLEMS
OCCUR?
• Change in routine/transition time
• Too much language is used
• Verbal exchanges are not understood conceptually
• Child lacks the appropriate coping strategy
• Child cannot express/solve the problem
• Physiologic factors
– Medication side effects
– Lack of sleep, hunger
– Anxiety levels increasing
WHEN DO BEHAVIOR PROBLEMS
OCCUR?
• Tasks that involve organization
• During large group activities
• Lack of attention/not enough
reinforcement
• Tasks are too easy, too difficult
EFFECTIVE BEHAVIOR TOOLS
• The first thing you must do it figure out what the
function of the behavior is
• Research has identified the following as the 4
most common/likely functions:
– Sensory needs (handling change, emotions,
dysregulation)
– Escape from situation (avoidance)
– Attention (from teacher, peers)
– Tangible: Gain a desired item (computer time,
book)
ADDITIONAL POSSIBLE
FUNCTIONS
• Excitement- sometimes a child is just excited
• Frustration- may lead to escape behaviors
• Neurological/Medical- remember a lot of your
ASD students may be on medication and it all has
side effects
• Misinterpretation- the child does not understand
others behavior (thinks child purposely hit them
when child was accidentally bumped into)
• Normal child behavior- some of what your
students display is simply developmentally
appropriate behavior!
GOLDEN RULES
• Reinforce! Reinforce! Reinforce!
• T.I.P.S.
• Use “DO” statements, avoid “DON’T”
statements
• Begin where child will achieve success
• Give time for child to generate alternative
responses
• Remember to work on relaxation skills
• Provide an appropriate rationale for expectations
WHEN TO INTERVENE
• During “breakdown” child is in a high arousal state
• Do NOT “reason”/“discuss” event when child is
aroused
– A common way to escalate a child’s behavior is to try to
talk to them when they are in the throes of a “meltdown”
• Be sure the student/other students are safe
• Initially you just want to help the student calm
down
• Intervene on a positive note
– “Thank you for calming down.”
– “I’m happy to see you are ready to talk”
REDUCING BEHAVIORS
• Set the environment to meet student’s needs,
then slowly tailor the environment
• Supportively move student beyond comfort
levels to handle more distressing situations
• We cannot eliminate all situations where a
student may have difficulty (e.g. unexpected
change)
• Prepare the student to handle these
situations
REDUCING BEHAVIORS
• Ask yourself if the behavior you are trying to teach
IS NECESSARY for the child’s overall well-being
• Be specific! SAY WHAT YOU WANT THEM TO
DO- NOT WHAT YOU DON’T WANT THEM TO
DO
• Be Consistent! Follow through with demands/
commands
• Work toward removing triggers- but only those that
“make sense”-– If student will only use pink erasers, give her pink erasers
(proactively removing trigger)
– But, if a child gets upset when told “no” this is not a trigger you can
or should remove
REDUCING BEHAVIORS
• Avoid power struggles
• Avoid threats of withdrawing powerful
reinforcers
• Learn to detect warning signs
• Teach calming techniques
• Be willing to change your behavior
plan if it isn’t working
REDUCING BEHAVIORS
• Be a constant source of reinforcement!
• Model the behavior you want to see demonstrated
• Use what’s reinforcing- even if it seems odd
– If the student wants to work to read the dictionary, let
them!
• Depersonalize issues
• Children with ASD may be good at saying the right
thing… But often they CANNOT do it!!
• Remember: Most Behavior is NOT
Manipulative- It is Communicative