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105 Cards in this Set

  • Front
  • Back

Prematureand misleading to claim that any one __________ is better than another for ASD

treatment

Intervention should be individualized to match a child's... (2)

o Currentdevelopment level


o Profileof learning strengths and weaknesses (from assessment)

Intervention should directly address these 3 core characteristics of ASD

o Communication


o Socialinteraction


o Restrictedpattern of interest

Approaches should be derived from a variety of sources (2)

o Clinicaland educational practice


o Empiricalresearch

Most interventions fit into the following categories (2)

1. Traditional Behavioral Interventions


2. Social-Pragmatic Developmental Interventions

Traditional Behavioral Interventions are very...

structured

Pros of Traditional behavioral interventions (4)

· Cleargoal in mind


· Easydata collection/predetermined outcome


· Easy toteach skill


· Parentsappreciate ABA for a while

Cons of Traditional behavioral interventions (4)

· Contextdriven


· Limiting(you can only look for prescribed thing)


· May behard for language/social skills


· Kids endup looking like robots

Social-Pragmatic Developmental Interventions are less...

structured

Social Prag Dev intervention follow...

child's lead

Pros of Social-Pragmatic Developmental interventions (2)

· Betterfor language skills


· Can be usedafter traditional behavioral therapy

Cons of Social-Pragmatic Developmental interventions (6)

· Subjectiveright/wrong responses


· Hard towrite goals around pragmatics· Followingchild’s lead requires the child to do something/can get out of control


· Learnedhelplessness


· Doesn’tlook like therapy


· Requireslots of skills to naturally integrate goal

AAC (in general)

An areaof clinical practice that attempts to compensate either temporarily orpermanently for the impairment and disability patterns of individuals withsevere and expressive communication disorders

AAC is used with client who...

have complexcommunication needs (multiple handicaps)

AAC system is...

o Anintegrated group of 4 components including symbols, aids, strategies, andtechniques


o Used byindividuals to enhance communication

Effective communication is multi...

modal

AAC is not used to replace communication, but to...

supplement current communication

Low tech

o Non-electrical


o Communicationboards/books


o Scheduleboards


o Eye gazeboards


o Containssome form of symbols

High tech

o Electronicor battery required


o Usuallyhas voice output


o May haveprint output


o Containssome type of symbols

VOCA

voice outputcommunication aid>Ji$r

SGD

speech generatingdevice

o iPad vs.Dedicated Speech Device

§ iPad pros/cons = looks normal, affordable,easier to make changes, uses multiple apps, distractibility with games,insurance will not cover costs, good for screener, no research to support




§ DSD pros/cons = compatible with technology,grow with communication level and child, you design it for what you want, longprocess to get

______% of kids with ASD are non-verbal

50

3 goals should be the focus for AAC and ASD

1. Teachthe child to become a better communication partner


2. Createan environment that lessens the child’s communication, behavioral, and socialdifficulties


3. Developskills that support participation

AAC - Teachthe child to become a better communication partner (4)

- Pragmatic challenge (don’t understand conceptof communication partner)


- Initiate, maintain and end conversations


- Include pauses, eye contact, prosody deficits


- Focus on visual strengths (always use visualrepresentations in breakdowns)

AAC - Createan environment that lessens the child’s communication, behavioral, and socialdifficulties (2)

- Much like hearing impairment – what iseffective forum?


- The more predictable you can make theenvironment, the better

AAC - Develop skills thatsupport participation (1)

- Use of big mack or pictures to participate instory time

Goals of AAC Assessment (3)

o Identifythe current unmet communication needs of the individual


o Identifyand predict the future unmet communication needs of an individual


o Come up with plan to address those needs

Iconcity - 3 levels

Level 1= transparent (easily distinguished between symbol and referent)




Level 2= translucent (not as easily recognizable but still somewhat close to referent)




Level 3= Opaque (even with explanation, difficult to see how symbol stands forreferent)

Advantages of Manual signs (4)

- Iconic-signs typically “look like” what theystand for


- Easy to teach and prompt (ease of modeling, notcomprehension)


- Takes advantages of visual strengths (eliminates frustration with auditory)


- No aid for the child to keep up with

Disadvantages of Manual signs (3)

- Requires solid imitation skills (usually not astrength with this population)


- Everyone doesn’t know signs (limitscommunication partners)


- Requires pretty good gross and fine motorskills (not a strength- clumsy)

Practical Application of Manual Signs (5)

· Modelthe target sign consistently


· Use handover hand modeling when needed


· Reinforcethe behavior


· Uselanguage bombardment just like you would with spoken language


· How longdo we teach single words vs word combinations?

Advantages of Graphic Symbols (3)

- Visually processed


- Can easily adapt symbols


- Iconicity for user and partner (does not limitconversation partners)

Disadvantages of Graphic Symbols (2)

- Can become cumbersome (too many to organize)


- Iconicity for partner and user

Practical application of Graphic Symbols (5)

- Use symbols for schedule boards


- Communication notebooks


- Choice making – most frequent use of graphicsymbols


- Input and output


- Consider the language skills to determinesingle words vs word combinations

Advantages of Speech Generating Devices (4)

- Provides a voice


- Technological abilities


- No longer requires good motor skills to access(can even set latency for touch)


- Environmental controls (lights, MP3, TV channels)

Disadvantages of Speech Generating Devices (4)

- Requires extensive training for user and family(intimidating)


- Technology doesn’t always work for when we needit (tech support)


- Often not adequate in noisy situations


- Cost

Practical Application of Speech Generating Devices (6)

- Begin by pairing device with known reinforcers during meaningful interactions


- Model the target icon consistently


- Use hand over had modeling when needed


- Reinforce the behavior


- Use language bombardment just like you wouldwith spoken language


- Use for input and output

Gesture dictionary

Documentstraditional and untraditional gestures of an individual

Gesture dictionary good for anyone with...

severespeech/language issues

Why CLD considerations with AAC?

- Differentcultures view individuals with disabilities differently


- Differentcultures view technology differently


- Symbolsneeded may not be adequate for bilingual individuals


- Somecultures may see pictures as offensive

Behavior Learning Theories - Focus

how the environmentimpacts an individual’s behavior and how that individual responds to stimuli inthe environment (you are a blank slate that the environment impacts)

General Assumptions of Behaviorist Theories (6)

· Principlesof learning imply equally to different behaviors and to different species ofanimals (learning is universal)


· Learningprocesses can be studied most objectively when the focus of the study is onstimuli and responses (outward behaviors)· Internalcognitive processes are largely excluded from scientific study


· Organismsare born as blank slates


· Learningis largely the result of environmental events


· Aculturally universal theory

General Implications of Behaviorist Theories

· Emphasis on behavior


- Individuals are active respondents that aremost likely to learn when they have a chance to behave (you can’t learn withoutopportunities to show you’ve learned)


· Only measurable behavior changes can confirmlearning has taken place


· Drill and practice


- Repetition of stimulus-response habitsstrengthen those habits


· Breaking habits


- Satiation vs. extinction


= Satiation breaks reinforcement of habit (notmotivated anymore)


· Rewards


- Important to reinforce learning

Contingencies

the relationshipbetween a behavior and the preceding and following environmental events thatinfluence a behavior

Basic Components of Behavioral Contingencies

- Antecedent = the stimulus that precedes thebehavior


- Behavior = the behavior emitted in response tothe stimulus


- Consequence = the positive or negativeconsequence of the behavior

Four possible functions of behavior: (EATS)

o Escape


o Attention (good or bad)


o Tangible seeking


o Sensory seeking

DiscreteTrial Training (DTT) commonly used within...

Applied Behavior Analysis (ABA)

ABA is...

a discipline devotedto using principles of learning theory to address socially important problems

In the beginning stages of ABA, DTT is the mainintervention procedures (4)

- One to one interaction in a distraction-freeenvironment (allows them to focus)


- Clear and concise instructions


- Highly specific procedures for prompting andfading


- Immediate reinforcement

Targets of DTT (4)

- Learning skills


- Language skills


- Social skills


- Cognitive skills

Steps of DTT (5)

1. Antecedent


2. Prompt (verbal, gestural, etc.)


3. Response (behavior of child)


4. Consequence for a correct response/incorrectresponse (reinforcement)


5. Inter-trail interval (break)

DTT is common treatment for...

for individualsimpacted by severe ASD who display self-injury and aggressions

DTT - Types of Trials

o Full Gestural Trials (most intrusive)


- Teacher places one red and one blue card on thetable and says “point to red” (antecedent)


- Teacher then immediately points to the red card(full gestural prompt)


- Child responds by pointing to red (response)


- Teacher says “That’s right! Good Job!”(consequence)


- There would be a very short pause before a newDTT would begin


o Partial Gestural Trials


- Same as above, but teacher gestures halfwaytoward the red card


o Independent Trials


- No prompts given

Benefits of DTT (8)

o Scientifically based instruction


o Can be individually tailored (motivators,breakdown of steps, etc.)


o Increases functional behavioral responseo Decreases nonfunctional behavioral response


o Repetitive instruction builds up individual’sbehavioral and skill repertoire


o Gives predictable structure to the learningenvironment


o Creates a large number of learningopportunities


o Can be conducted in many different settings

Disadvantages of DTT (5)

o Time commitment


- EBP = 60 hrs per week


o Very expensive (need ABA specialist)


o Lack of resources/availability


o Contrived treatment situation (notnaturalistic)


o Generalization to other environmental contextsmore difficult to achieve

Shaping

- Reinforcement of successive approximation tobehaviors


- Primary reinforcers then social reinforcers

PivotalResponse Treatment (PRT)

· Another behavioral treatment intervention basedon the principles of ABA (not part of ABA, just influenced by it)


· Provides a guideline for teaching skills andhas been most successful for language, play, and social interaction skills inchildren with ASD

PRT is loosely...

structured andnaturalistic

What are pivotalbehaviors?

o Behaviorsthat are central to a wide range of a child’s functioning, and when supported,are believed to produce improvement in many targeted and non-targeted behaviors

4 pivotal behaviors

- Motivation


- Responsivity to multiple cues


- Self-management


- Child self-initiations

PRT Steps for Implementation (4)

- Motivation


- Respondingto multiple cues


- Self-Managementto increase positive behaviors


- Promotingself-initiations

Main components of PRT (6)

- Choice


Shared control to increase motivation


- Clear and uninterrupted instructions or opportunities


Help sustain attention


- Reinforcement of approximations/attempts


- Reinforcement has a specific relationship to the desired behavior is through natural reinforcement


- Instruction should be developmentally appropriate, sometimes challenging the child and sometimes asking for something the child understands


- Include multiple components when appropriate


Using two different objects that may elicit same verbal response

Benefits of PRT (2)

- Children who are less impaired can have benefit


- PRT can continue to be relevant acrossdevelopmental trajectories (can be tailored easily)

Similaritiesof DTT and PRT(6)

Both treatments


- Are rooted in behavioral theory


- Can be individualized


- Focus on individual’s response to theenvironment


- Require specialized, skilled trainers


- Are expensive and time consuming


- Are very challenging approaches

Behaviors targeted with Social Stories (3)

- Any behavior that requires an increasedknowledge of social expectations


- Reducing disruptive behaviors such as tantrums,aggression, echolalia, and self-injury


- Increasing social behaviors such as initiatingbehaviors, engagement with peers, appropriate play

3 parts of social story

· Title


· Intro that explicitly identifies the targetbehavior


· Conclusion that summarizes and reinforces theidea

Sentence types (6)

1.Descriptive = gives basic or background information


2.Directive = gives the child direction (gives another way)


3.Perspective = provides insight to others’ feelings and reactions


4.Affirmative = expresses commonly shared beliefs (generally speaking, ex.“people nod when they talk”)


5.Control = help the student recall information (reminders)


6.Cooperative = identify how others will help

Sentence Ratio

BasicRatio = 2-5 descriptive, perspective, and/or affirmative for every 0-1directive




CompleteRatio = 2-5 descriptive, perspective, and/or cooperative for every 0-1directive or control

Advantages of social stories (6)

- Developed specifically to address ASD socialdeficits


- Tailored to individual and specific needs


- Is time and cost efficient/flexible


- Plays to the child’s visual strengths


- Less invasive than other interventions


- Said to address deficit in theory of mind

Concerns with social stories (2)

- Supportive data is anecdotal rather thanempirical


§ Limitations of studies due to individualization




- Benefit depends on skill of writer and writer’sunderstanding of ASD, as well as the writer’s ability to take an autisticperspective

Social stories - errors to avoid (5)

- Including too many directive sentences inproportion to perspective and descriptive sentences


- Stating directive sentences in inflexible terms(use “I will try to”)


- Writing above the person’s cognitive/developmental age


- Not being thorough enough in describing eitherthe situation or the desired behavioral response


- Too many behaviors in story

Sexual Education - Social stories

- Sex ed lacks concrete teaching methods andusually uses abstract talking


- Must be planned and systematic for ASD


- Necessary to help prevent sexual abuse, STDs,and unwanted pregnancies

3 Major components sex ed

- Health and hygiene (every day and sexual)


- Relationships(feelings and expressions, friendship and intimacy)


- Self-protection/advocacy (personal rights,protection against abuse)

Cartooning/comic stripping - colors

Green = happy


Red = anger


Blue = sad


Purple = proud

6 Phases of PECS

- Phase I: Teaching the Physically Assisted Exchange


- Phase II: Expandingspontaneity


- Phase III: Simultaneous Discrimination


- Phase IV: Building Sentence Structure


- Phase V: Responding to “what do you want?”


- Phase VI: Commenting in response to questions

PictureExchange Communication (PECS)

ABA based system that teaches children toinitiate communication and respond to the communication of others

Goals of PECS

- Helps the child spontaneously initiatecommunicative interaction (picture exchanges usually focus on responses)


- Helps the child understand the function ofcommunication (everyone has a role)


- Develops communicative competency (not justresponse, but initiation and commenting)

Advantages of PECS (6)

- Helps to jump start language


- Addresses both the communicative and socialdeficits of ASD


- Well-suited for pre-verbal and non-verbalchildren (different language levels)


- Semantics of PECS more like spoken languagethan signing


- There is a picture for each word


- Iconic/easily understandable

Errors to avoid for PECS (3)

- Failing to strictly adhere to the teachingprinciples in phase I (requires lots of patience/persistence)


- Tendency to rush through phase I


- Inconsistent implementation in classroom and athome

VideoModeling

Predetermined skill or behavior is developed asa result of watching images of someone demonstrate the skill/behavior

Characteristics - Video Modeling (4)

1. Peer, adult, character as model (self-modelingindividual serves as model)


2. Behaviors demonstrated always positive


- Not everyone agrees (benefits also in showingnegative behavior)


3. Evidence to support its use across all agesabove 2 ½ and all severity levels


4. May not be as effective for severe cognitivedelays

3 main types of video modeling

1. Adult/peer


2. Self-modeling


3. Point of view modeling

Adult/peer VM

§ Adults and age matched peers or siblings asmodels


§ Models demonstrate a desired skill/behavior


§ Strong research for evidence of peer modeling


§ Adults provide more appropriate model, but canrelate to peers more


§ Not always, but usually social situation (eyecontact, non-verbal communication, etc.)


§ Easier to demonstrate social skills (definitestart/end)


§ Demonstrated via natural interaction orscripted role play

Self-modeling VM

§ Observer is the model


§ Child must be demonstrating appropriatebehavior, which often requires editing (for younger ones)


§ Can be obtained by scripted role play


§ Often scripts and preparation are needed


§ Can be demonstration of new skill or refiningold skill

Point of view modeling VM

§ Video instructions given from perspective ofthe viewer


§ Camera held at eye level of the viewer


§ Doesn’t require editing or preparing anyone tobe filmed

How to do video modeling

- Behavior must first be identified


- Type of modeling that will be used isidentified


- Depending on type of modeling, preparationsmust be made to shoot the video


- The video is then edited if needed


- The clinician and the child view the video

crucial element invideo modeling

teachingwhile/after viewing the video (talk about antecedent, behavior, consequence)-left

Important for ASD children to... (3 main things)

o Gain independence


o Become his own thinking


o Make connections and associations

· We know that ASD children tend to be (3)

o Reliant on others


o Responders


o Lacking in imitation skills

· Operant conditioning

Theuse of consequences to modify the occurrence and form of behavior




- Intentionally set up environment foropportunity to initiate


- Reinforcement increases the likelihood of thebehavior occurring again

NoBiggie

§ Don’t sweat the small stuff or the stuff youcan live with


§ Is it actually important right now?

Yeses

§ The more the merrier


§ “Yes, you can XX, as soon as you finish these 3things”

Choices

Alwaysmake your choice legitimate

Choicesfor turn

· You pick one book, I’ll pick one-

Choicesfor order

· Which do you want to do first?

Choicesthat are irrelevant to you

· Do you want red or blue?

Choicesto look like he’s getting something special

· Do you want Thomas or paper?

Choicesfor quantity

· Do you want to do 6 or 10?

Link memory with...

emotion

Organization is...

key

ASD kids and environment (4)

- Need interest and novelty


- Something to talk about


- Work areas need to be cleared of excess


- Time to go

Sometimes you need to stick your ground

- When a child really wants something


- When it’s a reasonable task


- When it’s the step to the new skill


- When it’s part of a specific behavioral plan

Your plan won’t work every time

- Step one: keep your eyes open


- Step two: start with a wait


- Step three: plan the “out

How to plan the out - possibilities

- Maybe provide a choice ( so you’ve modeled) - Maybe play the guessing game (you’ve reducedthe skill needed)


- Maybe give permission (I need you to take thisone)


- Maybe hand over hand (but do it fast, and thankthe child for the good work)


- Maybe get something out of his system (so youcan both move on)