How to Use Evidence-Based Practices to Help Children with Autism in Unknown or Uncomfortable Settings

How to Use Evidence-Based Practices to Help Children with Autism in Unknown or Uncomfortable Settings

Christy Roybal, M.S.

1 in 88 Children have an Autism Spectrum Disorder (CDC)

Individuals and families affected by Autism Spectrum Disorders are part of every community. 2

National Survey – Autism prevalence at 1 in 50 school-age children

What is Autism?

A developmental disorder of neurobiological origin

– Developmental - Evidence of the disorder sometime in the developmental period – typically before 3

– Neurobiological – of or related to the nervous system

– Lifelong – individuals will not “grow out of” or be cured of autism

3

What are the Core Deficits of Autism?

Committee on Educational Interventions for Children with Autism, National Research Council, Educating young children with autism,

2001

Communication• Joint Attention• Symbol Use

Social Development• Adults• Peers

Cognitive Development• Includes executive function (planning)

4

Core Deficits of Autism (continued)

Sensory & Motor Development• Motor abilities• Atypical sensory responses• Motor stereotypies• Sensory/Arousal modulation

Adaptive Behaviors• Social responsibility • Independent performance of daily activities

Problem Behaviors

5

Characteristics: Communication

• Language difficult to produce and understand• Limited facial expressions and use of gestures• Literal and concrete thinking and interpreting• Unusual “melody” of speech• Difficulty imitating sounds and actions• Repeats (echoes) words and phrases

Characteristics: Communication• “Children and adults on

the autism spectrum have taught me that it is imperative to communicate most clearly about things that are the most difficult to understand.”

• Understanding Death and Illness and What They Teach about Life: An Interactive Guide for Individuals with Autism or Asperger's and their Loved Ones

• by Catherine Faherty

Characteristics: Communication“ When Bernard was told that he was scheduled for a CAT scan in

one hour, he became elated. Bernard loved cats and brought many of his favorite cat books with him to the hospital. He had even made a sign for the door to his room, writing his name in cat letters….Realizing what she had said, the nurse explained to Bernard that a CAT scan, now referring to it as a CT scan. Was like a big x-ray, and that it had nothing to do with real cats. They decided that it was a funny name for an x-ray and that Bernard would be allowed to bring his favorite cat book with him to hold and look at while he was having his scan.”

Prescription for Success: Supporting Children with Autism Spectrum Disorders in the Medical Environment• by Jill Hudson

Communication

What helps• Keep language simple• Use concrete, literal

language• Use visuals to support your

communication (visual prompts)

• Give instructions and/or ask questions one time only

• Use gestures, facial expressions, tone of voice

What gets in the way• More than one person

giving instructions or asking questions

• Repeating instructions louder

• Repeating instructions many times

Characteristics: Social

• Difficulty in relating to people • Difficulty in understanding/using social

cues• Greater focus on objects• Lacks understanding of the perspective of

other people• May appear to be inflexible,

argumentative, stubborn

Social

What helps• Use social stories• Give cues (visual,

demonstration) to help the child understand what to do

What gets in the way• Trying to get the child

to “look at me.”• Trying to get the child

to use polite language – “please, thank you, excuse me”

• Taking the child’s behavior personally – it’s not about you

Characteristics:Cognitive Development

• Delayed executive functioning

Planning

Organizing

Breaking down complex activities/requests

• Transitions can be difficult• Difficulty generalizing skills• Difficulty with Theory of Mind

Cognitive DevelopmentWhat helps

• Provide information that can be seen, is organized and as specific as possible

• Pre-teaching activities• Visual strategies –

schedules, mini schedules, cue cards

• Easy-to-understand maps of the hospital

What gets in the way• Not preparing the child• Rushing the child through

the process• Using words/symbols the

child does not know

Characteristics: Sensory and Motor Development

• Restricted interests• Non-functional routines• Stereotyped and repetitive motor mannerisms• Delayed motor skills• May be very sensitive or unaware of sensory

input (noise, smells, visual stimulus, movement, touch)

• May explore by licking, smelling, etc.• Often overwhelmed by sensory experiences• May seek or avoid sensory experiences

Sensory and Motor Development

What helps• Use special interests for motivation

/reinforcement• Allowing the child to keep special

items or talk about special interests when he/she is stressed

• Keeping things as quiet as possible• Consider head phones to block out

sound or with music• Notice what helps the individual to

be calm and alert• Something in the mouth (that is safe)• Something in the hands (that is safe)• Thinking about alternatives to what

the child wants to do and can’t.

Example: Child wants to fling a stethoscope around – is there a kid stethoscope or other things that they can use?

What gets in the way• Trying to take away items of

special interest (as long as they are safe)

• Not addressing their sensory needs

• Over/under simulating environment

• Be patient when children are navigating around– they may feel unsteady on shiny floors, steps, etc.

• Lots of things that you can’t control (smells, noise, unexpected changes in the environment)

Characteristics: Adaptive Behaviors

• Difficulty with executive functioning• May need direct instruction in

– self-care– leisure activities – functioning in the community– Self advocacy

Characteristics: Problem Behaviors

• Using inappropriate behaviors as a means of communication

• Behavior may result from fear, sensory overwhelm, anxiety or illness

• Behavior may be related to ritualistic and/or stereotypical behavior

• Behavior can be related to social difficulties

Characteristics: Problem Behaviors

• Why do they do what they do?Functions of Behavior

1. Escape – from a person, place or activity

2. Tangible – desire for a thing or activity

3. Sensory – feels good or meets a sensory need

4. Attention – desire for attention from peers or adults

Mark V. Durand, 1990

Problem Behavior

What helps• Don’t take it

personally – it is not about you

• Always consider communication, visual supports, antecedents and consequences

What gets in the way• Talking a lot to the

child– Reasoning– Telling the child what

he/she shouldn’t do

How do you change it?Positive Behavior Supports

• Token Economy• Video modeling• Timer• Boundaries defined• Labels• Reinforce, reinforce, reinforce• Help them to understand what is being asked and what comes next• Use few words supported by pictures/written words• Say/show what you want, not what you don’t want• Each activity has its own expectation – make sure the child understands

what they are being asked to do• Expectations should be modeled, practiced & reinforced

Behavior – Effective Interventions• Interventions should use highly supportive

and structured environments.• Interventions should utilize predictability and

routine.• Interventions focus on easing transitions

between activities.• Interventions need to involve the family in

planning and implementation if possible.* Adapted from Dawson & Osterling, 1997.

Evidence Based Practices

• Prompting• Time delay• Reinforcement• Task analysis and chaining• Shaping• Differential reinforcement of other/alternative behaviors• Discrete trial training• Extinction• Functional behavior assessment • Positive behavior supports• Response interruption/redirection• Self-management

Evidence Based Practices Continued

• Computer-assisted instruction• Functional communication training• Independent work systems• Naturalistic interventions• Parent training• Peer-mediated instruction/intervention• Pivotal Response Training• Social skills groups• Social stories • Video modeling• Visual supports• Voice output communication aids/speech generating

devices• Stimulus control & environmental modification

http://autismpdc.fpg.unc.edu/content/evidence-based-practices

Components of an Evidence-Based Practice Brief

• Overview: A general description of the practice and how it can be used with learners with autism spectrum disorders.

• Step-by-Step Instructions for Implementation: Explicit step-by-step directions detailing exactly how to implement a practice, based on the research articles identified in the evidence base.

• Implementation Checklist: The implementation checklist offers a way to document the degree to which practitioners are following the step-by-step directions for implementation, which are based on the research articles identified in the evidence base

Components of an Evidence-Based Practice Brief

• Evidence Base: The list of references that demonstrate that the practice is efficacious and meets the National Professional Development Center’s criteria for being identified as an evidence-based practice.

• Briefs found here - http://autismpdc.fpg.unc.edu/content/briefs

• Modules found here - http://www.autisminternetmodules.org/

It’s time for an activity!• Develop a social story for a typical routine at

the hospital.

and/or• Develop a mini-schedule for an common

activity /procedure at the hospital.

ReferencesBehavioral Intervention for Young Children with Autism, Catherine Maurice (1996) Pro-ed

Choosing Outcomes and Accommodations for Children Michael Giangreco (2011) Brookes Publishing

Prescription for Success: Supporting Children with Autism Spectrum Disorders in the Medical Environment, Jill Hudson (2006) Autism Asperger Publishing Co

Thinking about You Thinking about Me, Michelle Garcia Winner (2007) Think Social Publishing

Understanding Death and Illness and What They Teach about Life: An Interactive Guide for Individuals with Autism or Asperger's and their Loved Ones, Catherine Faherty (2008) Future Horizons Inc.

Thank You!