8

Supporting Individuals

on the

Autism Spectrum:

Common Sense Systematically Applied





Tim Feeney, Ph.D.

Clinical Director

School and Community Support Services

600 Franklin Street

Suite 110

Schenectady, NY 12305 USA

(518) 372-2026

tfeeney@scssconsulting.com

www.scssconsulting.com

Our Tasks:

Me:

1. Present a framework for supporting individuals

with a variety of needs to regulate themselves

and their learning to the greatest extent

possible while being respectful of your

knowledge and expertise in this area.



2. Leave everyone with a least 3 strategies

to use upon return to their classes.



You:

1. Listen

2. Ask questions

3. Stay awake

4. Make plans

Staking Out the Turf

Applied Behavior

Analysis

Baer, Wolf, Risley, 1987; Kantor, 1959;

Skinner, 1953; Tharp & Wetzel, 1963



Functional Behavior Assessment Setting Events &

Carr & Durand, 1995; Iwata et al., 1994 Establishing Operations

Fox & Conroy, 1995; Michael, 1982;1993





Positive Behavior Supports Communication-Based

Carr et al, 2002; Horner et al., 1990 Intervention

Carr et al., 1996; Durand, 1990;

Reichle & Wacker, 1993



Daily Routines/

Picture Routines Generalization &

Bondy, 1995 ; Koegel & Koegel, 1997; Maintenance

Wetzel & Hoschouer, 1984 Carr et al., 1990; Dunlap, 1996





CONTEXT-BASED INTERVENTION

Planning

Friedman & Scholnick, 1998 Apprenticeship in

Thinking

Rogoff, 1990

Socially Co-constructed

Narratives Dynamic Assessment

Hudson & Fivush, 1993

Feurerstein, 1979



Socially Mediated Learning

Vygotsky, 1932; 1987

Grandma Masse’s Rules for Success:



“The smart guys are the guys who learn

from the other guys. Don’t get all caught up

in one thing; everyone believes their thing is

the best thing and they’re usually wrong.

So, shut-up and listen and learn and change.”





In order to be successful

you’ve got to be eclectic.

AN ADMITTEDLY INCOMPLETE VERSION OF THE AUTISM SPECTRUM

Primary Indicators of AspergerÕ Syndrome

s Primary Indicators of Autism

(in school aged children)









Childhood Disintegrative



AUTISM SPECTRUM DISORDER

SOME ARGUE IT IS NOT AN Difficulties relating to peers and reading nonverbal cues

 Often have a hard time reading body-space  Generally impaired language development with difficulty expressing needs verbally

 Difficulties with transitions or changes  Often develop unusual patterns of speech: lacking intonation and expression repeating









Disorder

 Often obsessive about topics of interest words or phrases repetitively (called echolalia). Some children with autism learn to

 Sensory sensitivities read.

 Typically score very high on standardized tests  Often do not express interest in other people and often prefer to be alone Š limited eye

 Na•ve about relationships and interactions with strangers contact.

 Often have difficulty with language pragmatics and prosody  Typically very resistant to changes in routine

 Often have difficulty with fine and gross motor skills  Often unusual attachments to objects

 Often recognized/diagnosed in later childhood  Often avoid ing touching or physical proximity of others and over or undersensitivity

to pain



Pervas ive Deve lopmental Disorders Š Not Otherwise Specified (PDD-NOS)

LEAST MOST

SEVERE  Delays in the development of social skills SEVERE

DISABILITIES  Delays in the development of communication skills. DISABILITIES

AUTISM SPECTRUM DISORDER









Primary Indicators of Nonverbal Learning Disabilities Primary Indicators of High Functioning Autism

MANY ARGUE IT IS NOT AN









s!)

(it looks a lot like AspergerÕ

 Difficulties relating to peers and reading nonverbal cues

 Often have an excellent vocabulary and verbal expressionŹ  Often have a hard time reading body-space

 Good rote memory skills are commonŹ  Difficulties with transitions or changes

 Often focused attention to detail, but the individual often missing the big picture.Ź  Often obsessive about topics of interest

 General difficulty with reading comprehension beginning in the upper elementary  Sensory sensitivities

grades, especially for novel material.  Typically score very high on standardized tests

 Difficulties in math are common, especially in the areas of computation, word  Na•ve about relationships and interactions with strangers

problems, and abstract applications  Often have difficulty with language pragmatics and prosody

 Concept formation and abstract reasoning are often significantly impaired.  Often have relatively good fine and gross motor skills

 Are usually very concrete and interpret information literally.  Often recognized/diagnosed in earlier childhood

 Generally poor social skills.

Tim Feeney, Ph.D.

Wildwood Institute

Asperger’s

Syndrome









Autism

Childhood

Disintegrative

Disorder





Rett Syndrome









from Lord & Risi, 2000

Four Domains of Behavior

Characteristics Associated

with Autism Spectrum Disorders





• Communication (especially functional communication)



• Social Interaction



• Behavior (unusual interests in activities that are

restricted, repetitive, and/or stereotypic)



• Sensory Information (unusual sensory responses and

interests)

Chuck’s autism is different than Connor’s

autism is different than Sarah’s autism is

different than Devan’s autism





While there are common traits,

everyone’s autism manifests itself

differently, so any intervention

strategies will need to be tailored

to address these differences.

UNIFORMITY

is not necessarily a good

quality in intervention



There is no single “right”

solution - sometimes the best

you can do is keep trying



Plan A



Plan B



Plan C



Sometimes what works today

won’t work tomorrow!

Common Sense Premises

for Supporting Students

on the Autism Spectrum

“Intelligence is not just a gift-

it’s a choice”

-George Shaffner The Arithmetic of Life









Success results from using

what you’ve got

- not from what you’ve got!

You are an opportunity;

whether or not people

take advantage of that

opportunity is up to them

There is a time for

everything,

and a season for every

activity under heaven.

- Ecclesiastes 3:1

Not:



“How can people motivate others?”



Rather:



“How can people create the

conditions within which others will

motivate themselves?”

- E.L. Deci

Successful intervention is

about establishing a

respectful relationship

with someone who’s

doing his or her best to

tick you off

Sow your seed in the morning,

and in the evening let not your

hands be idle,

for you do not know which will

succeed,

whether this or that or whether

both will do equally well.



-Ecclesiastes 11:6

Don’t fall victim to

the tyranny

of the clock

You can make people

do things that they

just don’t want to do

but the price for doing

so will be high

Poodle

An impulse



is not



a choice

Functional Conceptions of Choice:

• Free choice



• Fixed choice



• Forced choice



• Feeling the natural and logical results of

actions in the environment

Understand

the Negotiables

and

Non-negotiables



(most stuff is negotiable)

The glass ain’t half empty,

it’s half full!



and





You can teach 1/2 empty

people to become 1/2 full people



(it’s hard to teach 1/2 empties to

become 1/2 fulls)

“ A coach gets guys to do the things

they don’t want to do so they

can become the players that

they want to be.”

- Walt Harris





“We’re all coaches”



A good coach:



• Alters his/her coaching to

reflect the needs of the player

and conditions of the context.



• Never tries to play the game

him or herself.

SETTING

SD B C



EVENTS

Functional Support Means

Moving from:





A B C

To





A B C

Interventions that Focus on the App licat ion

of Consequences are D epe nde nt Up on:



HIGH REASON

( In te llec t – “ co o l”)



 “Cho o sing t h e b e st o p ti o n ”



 Lo g ic a l appl ica t io n o f le a rn e d

o ut co m e s





or

F the Most Part ,

We Live in the Som at ic World:



VISCERAL RESPONSES

( Gut feeli n g s – “h o t ”)





 “I do n’ t kn o w w h y! I j us t did .”



 Im pl ici t a ppli ca t io n o f ex p eri e n ce s

Success via Learning from

Consequences

Presupposes:

Reasonable intactness of the neural networks

responsible for connecting:



Memory for the factual aspects of past behavior



and/or



Memory for the “Somatic Markers”, or the feeling states

associated with the consequences of those behaviors





Without these connections in memory,

past rewards and punishments

lack the power to drive future

behavior

A Qu ick Ove rvi ew o f Cur re n t

Ap pr o a ches t o In t er ve n t io n fo r

Stud en t s on t h e A ut ism S p ec tru m

“ABA”

Disc re t e Tri a l Tra in in g / The ra py

( Lo vaas )





 In t e n s iv e in s t r u c t i o n

 In t e n s iv e in s t r u c t i o n



 D i s c r e t e t r ia ls :

 D is c r e t e t r ia ls :



St im u lu s – “ Sa y „H e llo ‟”

St im u lu s – “ Sa y „H e llo ‟”

Re sp o n se – St u d e n t s a ys „He llo ‟”

Re sp o n se – St u d e n t s a ys „He llo ‟”

Re in f o rce r – St u d e n t r e i n fo r c e d

Re in f o rce r – St u d e n t r e i n fo r c e d



 O n e -t o -O n e i n s t r u c t io n d o n e i n a

 O n e -t o -O n e i n s t r u c t io n d o n e i n a

h i e r a r c h ic a l m a n n e r :

h i e r a r c h ic a l m a n n e r :



 Pre -la n g u a g e sk ills ( m a t c h i n g a n d

 Pre -la n g u a g e sk ills ( m a t c h i n g a n d

im it a t io n )

im it a t io n )



 Be h a v io ra l sk ills ( a t t e n t io n a n d fo c u s )

 Be h a v io ra l sk ills ( a t t e n t io n a n d fo c u s )



 So cia l sk ills ( im it a t ive p la y a n d t u r n -

 So cia l sk ills ( im it a t ive p la y a n d t u r n -

t a k in g )

t a k in g )

“ AVB”

Ana lys is o f Ve rb a l Be h av io r

( Ca rbo n e )





 D isc rete tri a l i ns tr u ctio n o f a n i mit a tive

repe rtoi re

 Mim eti c – mot o r i m it a tio n ( s ig n in g)

 E choi c – ver ba l imit a ti o n





 E choi c – ver ba l be ha vio r w h o se for m is

c o nt roll e d b y s om e o n e el se’ s ve rb a l

be ha vi o r w it h “ po i nt -to-p o in t

c o rres p o n de n ce”







- Te ach e r sa ys “ m o m my”

- St u d e n t sa ys “ m om m y”

- Te ach e r r e in fo rc e s st ud e n t ( t yp ica lly wi t h

pri m a r y re in fo r ce rs t h en se cond a ry)





 Ma nd s – ver ba l be ha vio rs w h o s e fo rm

is co n t rolle d b y s t a tes o f de p ri va t io n

a n d a ve rsio n.

 Th e fu n cti o n o f a m an d i s to requ e st

o r o b ta in wha t is wan ted .



 A de ma n d or com m a n d .



 Int e rv e nti o n is focu sed o n

de live rin g t h e ite m th a t is m an ded .



- De sired i te m s (“I wan t s o me cand y”)

- In for m at io n (“Wh e re‟ s m o mm y?”)

- Assist anc e (“H e lp m e p le a se .”)

- Act ion s (“Play wi t h me .”)

- Missin g it ems (“ I n e e d a sp o on. ”)

- Atte n t io n (“Loo k at wh at I did !”)



 Requi rin g t h e n ece ssary se t tin g

eve n t s/e st a bli sh in g o p er a ti o n s

 Tacts – ver ba l be ha vio r tha t is un de r th e

co nt rol o f t h e n o n ve rbal e n viro n me n t

and in clu d es n o u ns, acti o ns, adje ctive s,

pro n ou ns , and re lat io n s.

 A labe l of som e thi ng in th e

e n viro n me n t; a voc ab ul ary



 A t act d oe s no t s p eci fy it ’s rei n fo rce r,

rei n fo rce tact s w ith g e n er alized

rei n fo rce rs

 Whe n te ach in g tact s th ere sh oul d be

lo w SE/ EOs

PECS

Pict u re Exc h an ge Co m mu n ic a ti o n Syst em

( Bo n dy )





 Au g me n t a tive a lte rna tive

co mmu n ic a ti o n sy st em w it h th e foc u s

o n t h e i n iti a ti o n o f c o mmu n ic a ti o n by

t h e stude n t



 Exc ha n g e a pi c tu re of a d esi red item

w it h a n a d u lt w h o imme d ia tel y h o n or s

t h e reque st



 Rein fo rceme n t o f co m mu n ic a ti o n

be ha vi o r.



 An e n vir o n m e n ta lly b a se d a pp ro a ch

t ha t e n h an ce s t h e op p o rtu n itie s to

co mmu n ic a te



 Hig h frequ e nc y, co n text u al SD s fo r

co mmu n ic a ti o n

BASIC CONCEPTS OF APPLIED

SIS

BEHAVIOR ANALY THAT ARE OFTEN

MISUNDERSTOOD



Po sit ive Re in for ceme n t :

The co n ting e n t p re sen tat io n of a sti m u lus (o r

ev e n t ) imme diat el y fol lowi ng a b eh avior that

increa ses th e probab ility of t h at b eh avior in si m ilar

sit u ati ons





Neg a t ive Re in for ceme n t :

The co n ting e n t remo va l of an u n p leasan t

(a vers ive ) st im u lu s o r eve n t imm e d iat el y

fo llow in g a b eh avio r, t her eb y increa sing the

probabi lity of that b ehavi or in sim ilar situ ati on s.





Pu n is hme n t :

A con ti nge n t s ti m u lu s or ev e n t t h at decreases the

probabi lity t h at b eh avio r wi ll o ccu r in si m ilar

sit u ati ons .

REINFORCEMENT AND

PUNISHMENT ARE DEFINED BY THE

Y

EFFECT THE HAVE ON BEHAVIOR!

BASIC CONCEPTS OF APPLIED

BEHAVIOR ANALYSIS THAT ARE

N

OFTE MISUNDERSTOOD







D i s c r i m i n a t i v e St i m u l u s ( SD )

D



An a n tte c e d e n tt e ve n tt tth a tt s e r v e s a s a c u e fo r a

An a n e c e d e n e ve n h a s e r v e s a s a c u e fo r a

r e s p o n s e tth a tt w iillll r e s u lltt iin r e iin fo r c e m e n tt..

r e s p o n s e h a w r e s u n r e n fo r c e m e n







Se t t i n g Ev e n t s ( SEs ) / Es t a b l i s h i n g

Op e r a t i o n s ( EOs )

An tte c e d e n tt e ve n tts tth a tt iin c r e a s e tth e p o tte n c y

An e c e d e n e ve n s h a n c r e a s e h e p o e n c y

o f a r e iin fo r c e r a n d iin c r e a s e s tth e p r o b a b iilliitty

o f a r e n fo r c e r a n d n c r e a s e s h e p r o b a b y

o f tth e o c c u r r e n c e o f p a r ttiic u lla r b e h a viio r ..

o f h e o ccu r r e n ce o f p a r cu a r b e h a v o r

Th e s e a r e n o tt iim m e d iia tte a n tte c e d e n tts ,, tth e y

Th e s e a r e n o m m e d a e a n e c e d e n s h e y

a r e o ftte n tte m p o r a lllly d iis tta n tt a n d p e r s iis tt o v e r

a r e o f e n e m p o r a y d s a n a n d p e r s s o ve r

ttiim e

me

Social Stories

(Gray)



• A short story that describes a situation, concept or social

skill using a format that is meaningful



• Often in response to a troubling situation and also when

trying to describe a skill that is typically successful and

problem free.



• Descriptive Sentences: Statements of fact

• Perspective Sentences: Statements describing internal states

• Directive Sentences: Identify a suggested response

• Affirmative Sentences: Express commonly shared value/opinion

• Partial Sentences: Encourage guesses about next steps

• Control Sentences: Identify methods of recalling information

• Cooperative Sentences: Identify how others will help





PICTURE

GATHER TAILOR THE TEACH WITH

THE

INFORMATION TEXT THE TITLE

GOAL

TEACCH

Treatment and Education of Autistic and related Communication

Handicapped Children

(Schopler & Mesibov)









• Structured Teaching: Arranging the classroom and the

methods of teaching in an organized pattern



• Physical Organization



• Work areas



• Scheduling



• Giving Direction

SCERTS

(Prizant & Wetherby)



• Social Communication

• Accepting communication intent

• Directing communication to assure behavioral

regulation, social interaction and joint attention

• Presymbolic to symbolic communication

• From echolalia to creative language

• From unconventional to conventional language





• Emotional Regulation

• Self-regulation

• Mutual/interactive regulation





• Transactional Supports

• Outcomes that are the result of interplay between

child and context over time

• Family-mediated interactions

• Peer-mediated interactions

Floortime/DIR

Developmental Individual-Difference, Relationship-Based

(Greenspan)

6 Emotional Milestones



• Self-regulation and Interest in the World: The ability to take an

interest in the sights, sounds, and sensations of the world and

to calm oneself down



• Intimacy: The ability to engage in relationships with other people



• Two-way Communication: The ability to engage in two-way

communication



• Complex Communication: The ability to create complex gestures

and to string together a series of actions into an elaborate and

deliberate problem-solving sequence



• Emotional Ideas: The ability to create ideas



• Emotional Thinking: The ability to build bridges between ideas

to make them reality-based and logical

Common Themes of

All These Approaches

• Intervention must be delivered early and

intensively, through established routines,

and focus on the development of

self-regulation and problem-solving

strategies in context.



• In absence of meaningful engagement in chosen

life activities all interventions will ultimately

fail.



• Long term, flexible, and frequently adjusted

supports may be needed to prevent behavior

problems and to facilitate social development.

Communication









Cognition Behavior

Behavioral

Control

Academic

Growth

Social

Competence

Creating Supports

Our Behavior Affects the Lives of the People

We Support o

 Optimism & Hope. Evident in the problems that are

targeted and the language that is used when

describing the individual and when interacting with

the individual.



 Appreciating the Influences of Contextual Factors on

Behavior. Requiring an understanding of the setting

events, the distant (and uncontrolled) and

uncontrolled events on an individual’s behavior.



 Applied Pragmatism. Recognizing that there is no

single “right” solution; moving away from the notion

of “consistent” use of a prescribed intervention

strategy to “concordance” on the part of all

involved.

It’s important to have fun

with and create opportunities

for fun and to laugh a lot

even in the face of

significant challenges

Context Relevancy:

How does this stuff apply to

the bigger world?

adapted from Sailor, 1999



• Useful: Do the outcomes that we’re targeting produce

something useful to the individual in long run?



• Desirable: Does the individual choose the outcomes for

him/herself when given the choice?



• Social: Do the outcomes result in behaviors that will

increase or imporve interactions with persons

other than paid staff?



• Practical: Will the behavior be used in real contexts

without staff support?



•Adaptable: Is there a focus on developing skills that

can/will be used in a number of situations and without

staff?

A CONTINUUM OF STAFF SUPPORTS





Intensive Specific Periodic Independent

Requiring direct and Requiring direct Requiring direct Requiring little

constant interaction of support of staff in support of staff in support to participate

staff to participate in, order to participate in, order to learn new/ in the typical elements

and benefit from program and benefit from specific difficult elements of of the program

(and defined) elements the program

of the program









Most Least

Intense Intense







Specialized Modified Adapted Typical

A specific environment An environment Environmental and No environmental

designed to assist developed to assist time modifications modifications are needed

individuals to learn the individuals learn developed to augment for the individual to

majority of skills specific (and defined) typical classroom to acquire new skills

skills routines and maintain already

learned skills









A CONTINUUM OF ENVIRONMENTAL SUPPORTS

PERSON



Motor Cognition Language Emotion Volition Behavior

SKills









Human beings are a collection of

relatively independent structures,

processes, and systems

John’s Cognition

Attention Perception Memory Organization Reasoning EF







Arousal Encode/Store/Retrieve Sequence Inductive

Select Episodic/Semantic Categorize Deductive

Direct/ Explicit/Implicit Associate Analogical

Filter Declarative/Procedural Analyze Divergent

Maintain Involuntary/Strategic Synthesize Convergent

Divide Working Memory/

Shift Knowledge Base

Remote/Recent

Pro/retrospective

Iconic



Goals for John - John will:

1. Increase duration of maintained attention

2. Increase prospective memory from 3 to 5 minutes

3. Increase category naming from 3 to 5 members per category

John’s Language

Phonology Syntax Morphology Semantics Pragmatics







Receptive vs. Receptive vs. Receptive vs.

Expressive Expressive Expressive

Phrase Structure Lexicon Speech-act

Rules Semantic Competence

Etc. Relations Conversational

Discourse Competence

Structures Socio-linguistic

Competence

Goals for John: John will

1. Decrease mean naming latencies from 3 to 2 seconds

2. Include 5 basic story grammar elements in retellings

3. Use politeness markers in greeting people: 90%

John’s Behavior

John is the totality of his behaviors and

the systematic relationships among them

John







b1 b3 b12 b4 b1 b7 b62 b17 b17 b17 b4 b6 b9 b17 b12 b3 b8 b8 b5 b6 b17









Goals for John: John will

1. Increase frequency of b3 and b12

2. Decrease frequency of b17

Alternative Understanding of Human Beings

Sarah

Pursuing personally meaningful goals

While participating in culturally

valued activities

In social, cultural, and historical

contexts

Mediated as necessary by individuals

with greater expertise in that domain

Using cultural tools, such as

language, category schemes,

mathematics, organizational supports,

“And the rest domain-specific strategies

is abstraction”

In the presence of varied

context facilitators and barriers

Intervention Goals

Sarah will successfully complete ___ meaningful task, with

___ supports, possibly using ___ “tools/strategies”, in

___ context (setting, people, activities), in order to

achieve ___ goal.



Possibly focusing intervention attention on some specific

aspects of cognition, communication, social skills,

behavioral self-regulation, or educational/vocational

skills – aspects that are either particularly weak or

particularly important for Sarah.

The

Three Big

Things

“When we think of your child at 22 years old

we need to think about the 3 most important

things to work on; the things that, if s/he

achieves, s/he’ll have a meaningful life.”





The 3 Things tend to cluster around these areas:



• Behavioral regulation/self-regulation



• Friendships/social-interaction



• Vocational skills/meaningful engagement



• Self-help skills

EFFECTIVE SUPPORT PLANS



Identify the “3 Big Things”

(Remember: Program 1st, Place Emerges)









ONGOING ASSESSMENT &

ADJUSTMENT

Identify Initial Social/Behavioral

Goals and Objectives

Ideally small range of goals and objectives









Create a Flexible System of Support

People

Places

Events









Create a Plan for Supports

Circumstances for increases & decreases

FLEXIBLE SUPPORT PLANS



PLAN A

• Setting Events/Conditions

• Student Expectations

• Environmental Changes

• Staff Expectations





PLAN B

• Setting Events/Conditions

• Student Expectations

• Environmental Changes

• Staff Expectations







PLAN C

• Setting Events/Conditions

• Student Expectations

• Environmental Changes

• Staff Expectations

EXECUTIVE FUNCTIONS

“… those mental capacities necessary for

formulating goals, planning how to

achieve them, and carrying out the plans

effectively” (Lezak, 1982)

“…ability to maintain an appropriate

problem-solving set for attainment of a

future goal.” (Welsh & Pennington, 1988)

EXECUTIVE FUNCTIONS

“… the executive functions serve as an

integrated directive system exerting

regulatory control over the basic domain-

specific neuropsychological functions

(e.g., language, visuospatial functions,

memory, emotional experience, motor

skills) in the service of reaching an

intended goal.”

Gioia & Isquith, 2003

EXECUTIVE FUNCTIONS

Organizing and controlling action, thought,

and emotion in a way that is (1) not

determined by immediate environmental

events, (2) not determined by immediate

impulse or states of the body, (3) not

determined by the control of others, (4)

directed toward personal goals, (5) while

taking into account the goals and

intentions of others

EXECUTIVE FUNCTIONS



• Routine, habitual, easy

Versus

• Non-routine, novel, hard, effortful

– Strategic thinking demands

– Working memory demands

– Inhibition of pre-potent response demands

– Maintenance of goal-directed behavior

EXECUTIVE FUNCTIONS

• Self-regulation

• Self-determination

• Self-control

• Self-management

• Self-direction

• Maturation

Bottom Line

(Vygotsky in 80 words or less)



Development/maturation of language, cognition, volition,

and behavioral self-regulation is based on goal-directed

supported participation in authentic cultural activities,

mediated by social interaction with more mature

members of the culture, with meaningful practice in the

use of cultural “tools” (including compensatory

strategies), and with demands on the “apprentice”

within the “Zone of Proximal Development”.





This is apprenticeship teaching and applies to child

development generally, to regular education, to

professional and vocational training, and to teaching

individuals with disability.

EF: UNORGANIZED LIST

• Setting and managing goals • Flexible shifting

• Planning • Deliberately controlling any

• Organizing cognitive function

• Initiating • Working memory

• Inhibiting • Social perception

• Self-monitoring • Controlling emotions

• Strategic thinking • Learning from consequences

• Problem solving • Organized sense of self

NEUROPATHOLOGY OF EF

DISORDERS

• Congenital or acquired

• Structural or metabolic

• Focal or diffuse

• Focal:

– Prefrontal structures

– Prefrontal-striatal-cerebellar systems

• Diffuse:

– Perhaps disruption of widely distributed complex

neural systems can cause EF dysfunction

EF SYMPTOMS

• impulsiveness • ineffective planning

• poor social judgment • decreased flexibility/ shifting

• social disinhibition • slowed processing

• egocentrism • diminished divergent

• difficulty interpreting the thinking

behavior of others • concrete thinking

• perseveration • immature problem solving

• poorly regulated attention • weak self-monitoring

• disorganization (in • inefficient responses to

thinking, talking, and feedback/ consequences

acting) • reduced initiation

• weak goal formulation • dulled emotional responses

EF: FUNCTIONAL DEFINITION

Based on analysis of strategic action

• Self-awareness of strengths and limitations (what’s hard to

do; what’s easy to do)

• Goal setting

• Planning/organizing

• Initiating

• Inhibiting

• Self-monitoring and evaluating

• Strategic thinking

• Flexible shifting, adjusting, benefiting from feedback

OTHER ASPECTS OF EF

• Transfer from learning context to

application context

• Think abstractly and flexibly

• Assume a non-egocentric

perspective (“theory of mind”)

METACOGNITION

• STATIC: Knowledge/awareness of one’s cognitive and

academic processes and skills, and of procedures

(“strategies”) that enhance performance



• DYNAMIC: Executive control over cognitive and academic

processes in everyday learning and problem solving: Doing

something special to overcome obstacles and succeed with

difficult tasks

SELF-DETERMINATION

• AUTONOMY: Act independently, free from undue

external influence

• SELF-REGULATION: Formulate, enact, and

evaluate plans of action, with revisions as

necessary

• PSYCHOLOGICAL EMPOWERMENT: Act on the

belief that one can influence important outcomes

• SELF-REALIZATION: Capitalize in a beneficial

way on a reasonably accurate knowledge of self

Michael Wehmeyer and colleagues

Sense of Self







Executive Functions





Basic Developmental Acquisitions:

Physical, Linguistic, Academic,Vocational Social, etc.

General Orientation

to Intervention

(within this framework)



1. Include individuals with and without disability in

culturally valued activities

2. Focus on strengths (versus impairment)

3. Prevent secondary disability caused by lack of

meaningful participation (“Matthew effect”)

4. Facilitate effective, individualized

compensations within culturally valued

participation, with expert mediation of learning

tasks

5. Ensure adequate practice and systematic

reduction of supports

IMPORTANCE OF EF

CRITICAL FACTOR IN:

• Social success

• Academic success

• Vocational success

• Independent living

EF DEVELOPMENT

Themes

• Start early

• Develop slowly

• Continue into adulthood

• Influenced by biologic and environmental factors

• Variability: Context (person, setting and task),

motivation, culture

EF DEVELOPMENT:

The Role of Experience

Individuals are more likely to develop effective self-

regulation if they:

• Experience adequate social attachment

• Experience an organized and predictable world

• Receive “authoritative/apprenticeship” parenting,

including effective modeling and verbal mediation

• Are rewarded for appropriate self-regulation and control

by adults who value self-regulation and autonomy

INFLUENCES ON COMPETENT PLANNING

adapted from Friedman & Scholnick, 1997



Environment Task

• Resource Availability •Complexity

• Predictability •Supports

• Culture •Familiarity

•Coherence





Internal

•Self-beliefs •Stress • Goals

•Memory Capacity •Attention • Self-regulation

•Sequencing •Processing Capacity









Planning Sequence

•Problem Representation

•Goal setting

•Decision to Plan

•Strategy Construction

•Monitoring & Adjusting

Helping People Choose to Plan



• DO NOT plan on planning in situations that have historical

impulsive routines in place



• Help individuals to “connect the dots”; the outcomes

associated with planning explicit and the likely outcomes

associated with not planning equally explicit



• Show the positive effects of planning for the individual in the

short term and long term



• Help the individual to make small/brief plans with immediate

outcomes



• Create a culture of planning early and often



• Plan with the person, not for the person

DYNAMIC ASSESSMENT

ONGOING

CONTEXTUALIZED

COLLABORATIVE

HYPOTHESIS-TESTING

ASSESSMENT

WHY TEST HYPOTHESES?

• Failure on any complex task is

multiply interpretable

• Complex students can be supported

in a variety of ways

• Test results do not necessarily

indicate how best to achieve success

on specific tasks

WHY COLLABORATE?

• Increase observations and

experiments

• Increase compliance

• Educate family, staff, others

• EF training for student

• Show respect

WHY IN REAL CONTEXTS?

• Inconsistency

• Validity problems of standardized testing

• Impact of setting, person, activity

• Impact of stress

• Observe real-world initiation, inhibition,

self-monitoring, problem solving

• Observe effects of real-world supports

and routines

• Observe support behaviors of others

Ongoing Contextualized Collaborative

Hypothesis-Testing

What’s the problem?

(Using the two strangers in the doorway rule)









Hypothesis Formulation

(Why is s/he doing this?)







Hypothesis Selection

(Begin with easiest to test

or most obvious)







Hypothesis Testing

(Protocol for experimentation

Plan A - Plan B - Plan C

Testing time line)

CCH-TA PROCESS

• Define problem

• Identify need for dynamic assessment

• Generate hypotheses

• Choose which (combination) to test

• Create “experiments”

• Implement (collaborate in context)

• Interpret

• Proceed to intervention or another test

• Continue to monitor and adjust

Some Useful Screening Tools



For Autism:



• Autism Screening Instrument for Educational Planning (ASIEP)



• Childhood Autism Rating Scale (CARS)



• Autism Behavior Checklist



• Pervasive Developmental Disorder Screening Test (PDDST)





For Asperger Syndrome:



• Asperger Syndrome Diagnostic Scale (ASDS)



• Krug Asperger’s Disorder Index (KADI)



• Australian Scale for Asperger’s Syndrome

Problem Behavior



Primary Secondary

Symptomatic - Organic Functional - Learned





Neurophysiological Escape/Avoid

Limbic Kindling

Perceptual Disturbances Attention

Qualitative Aspects

Electrophysiological

Seizure Disorders Acquisition



Psychiatric Sensation

Mood Disturbances Automatic SR+

PTSD

Control

Physiological

Metabolic Tolerance

Pain

Potential Influences on Behavior

Environmental Vulnerability

Life

Behavior Problems

Events

Communication Problems



Neurological/

Psychiatric Impairments

Setting

Cognitive/Academic/Vocational

Events Failure



Physical/Health Problems





Environmental Rigidity



Us Decontextualized Intervention

WE MAKE PEOPLE

CRAZY! Focus on External Control

WHY NOT FOCUS ON EXTERNALLY

MEDIATED PUNISHMENTS

OR REWARDS?

adapted from Boggiano; Deci; Schwartz



• A “consequence” is often a euphemism for punishment.



• Much of the punishments that are provided by staff pale in

comparison to that which individuals experience in their

everyday lives.



• Rewards are often given inconsistently and are typically

effective only as long as they are used.



• Learned helplessness and learned dependence are the typical

result of situations in which the day-to-day behaviors of

individuals are managed by someone else.



• We cannot “motivate” individuals- motivation is an internal

event, no matter how we try to motivate - carrots or sticks - the

reality is that all we’re really doing is providing an

opportunity

FACTORS TO CONSIDER WH EN

DESIGNING SUP PORTS





For m a l Tea chi n g In fo r m a l

S tr uc tu re









Mo r e S tu den t Less

S u ppo rt s









Lea rn in g

Sta ge







Acqu is it io n Flu e n cy Ge n er a liz a t ion Ma in t e n a n ce

Goal

Plan



Predict



Do

Review

PLANNING TO TEACH N EW SKILLS





• De fine skills a nd i d en t ify t he co n di ti ons

u nde r whi ch t he y wi ll be u sed / needed



• Asse ss t he c u rren t l eve l o f pe rfo rm a nce

a cro ss mod al iti es



• Pla n t he leve l o f p romp ti ng a nd

id en t ify t he i m po rt a n t e leme n t s fo r t he

stu den t t o a t t e n d t o (e .g. , SD) in t he

co n t e xt s in whi ch s/ h e wi ll u se t he

skills



• Pla n t he ty pe a nd freq u enc y o f

re in fo rcemen t



• Pla n when a nd h ow o ft en t o t ea ch . . .

who w ill t eac h . . . w h ere t o t e a ch

Acti vit y-Bas ed Te a ch in g





• Ins tr u ction w it hi n t he con t e xt of a

fu n ct ion al d a ily ro u t in e. The m at erials

and setting for tea ching ar e de fine d by

the context.



• Provide CRITICAL MOMENTS for

in st ru ct io n (e .g ., t he ti mes whe n th e

st im u lu s a nd re sponse in for m ati on

cru cia l t o le a rn in g a beh a vior a re

p resen t )



• The GOAL: Per fo rmi n g t he be h avio r in

t he n at u ra l con t ex t e it her

in depen d en t ly o r w ith neces sary

a dap tat io n s.

PROMOTING N ATURAL CUES





• Ma t ch t he p romp t t o t he a ctu a l/ n a tu ral

t er m in o lo g y a n d beh a vior s use d in t he

co n t e xt



• Emph a size t he ty pe if p rom p t m os t

p rev al en t in t h e n a t u ral se tt in g



• Wh en a ste p is m issed or sk ipped , cal l

a t t e n t ion t o t he PRIOR st ep t o a ssu re

t he s tu den t at te n ds t o p rev al en t

n at u ra l cu es a nd a sk “w h a t ‟s n ex t? ”



• Use n a tu ral pro m p t s a n d co rrec ti on

d u ring flu enc y, m a in t en a nce , a n d

ge n er al iza ti on



• Tea ch s t u d en t s t o ASK FOR HELP!

Some Rules of Thumb for the

Development of Successful

Interventions



 Interventions must be doable in context.





 Interventions must be doable with available resources.





 Interventions must be sustainable over time.





 Interventions must be constituency owned and operated.





 Interventions must be intuitively appealing.

Designing Contextual Supports



Develop a Vision for the Future



 THE “THREE BIG THINGS” 







Identify Contexts Embedded Skills





Priority Environments





Priority Activities





Priority Skills

Key Concepts in Antecedent-Focused

Skill Development





• Prevention of undesireable behavior by

eliminating provocation.

For everybody at all ages, there are provocations

that overwhelm self-control. For people with

disabilities that threshold is often lowered.





• Positive communication from partners.

A key component of prevention is the communication

style of communication partners.



• Positive setting events (behavioral momentum).

People are more likely to engage in effective

interaction when they have a background of success.

• Choice and control.

People are more likely to engage in effective interaction

if they have reasonable control over the tasks, activities,

and routines of life.



• Interesting, meaningful, do-able tasks



• Positive roles and scripts

People are more likely to engage in effective interaction if

they have meaningful roles in their lives.

GOOD INSTRUCTIONAL PRACTICE:

SELF-REGULATION

From M. Pressley: More about the Development of Self-regulation: Complex, Long-term,

and Thoroughly Social Educational Psychology, 1995, 30(4), 207-212





1. Instruction matched to students’ “zones of proximal

development”



2. Extensive modeling and explanation



3. Massive practice within interesting and authentic tasks



4. Adult and peer scaffolding to minimize frustration and

maximize success (apprenticeship procedures; support)



5. Ongoing for at least many years

Collaborative/Elaborative

Interaction



Creating socially co-constructed

narratives of life as we live it

Intent

• Sharing Information

• Communicating understanding

of partner’s intent

• Invites evaluation of

contribution

• Confirms contribution

• Shows enthusiasm for

contribution

• Equal leadership roles

Cognitive Support



• Give information when needed

• Makes memory and organizational supports available

• Give cues in a conversational manner

• Responds to errors by giving correct information in a

non-threatening manner



Emotional Support



• Communicating respect for other’s concerns

• Explicitly acknowledging difficulty of the task

• Questions in a non-demanding and supportive manner

Elaborative Support



• Working on topics of interest

• Maintain topic for many turns

• Makes connections when topics change

• Makes connections among day-to-day themes

• Adds explanations in a conversational manner

• Invites explanations for events

• Invites discussions of problems and potential

solutions

• Reflects on the physical and psychological status of

others

To Assure Long Term Success Individuals Need to:



 Know that an event or activity will be difficult.



 Establish reasonable goals (in some cases these might

be immediate).



 Formulate a plan to achieve the goal (or

understand the plan).



 Initiate goal-directed behavior.



 Refrain from actions that interfere with the

successful achievement of goals.



 Attend to and evaluate how well they are doing.



 Try another plan or strategy if things are not

going well.

Teaching People to Think

 Think out loud.



 Think out loud a lot.



 Think out loud with the person: reflect, plan, problem-

solve, observe, organize, evaluate, remember, review,

create, etc.



 Make use of external supports when thinking: diagrams,

photos, written routines, day planners, notes, etc.



 Present yourself as an image of thoughtfulness. Help the

individual to embrace the notion that being thoughtful is a

good and great thing.



 Think out loud in a way that shows that you are fun and

flexible and experimental in your own thoughts.



 Think out loud in a way that captures metaphors,

analogies, similarities, history, etc.

ROUTINES

• Repetition creating temporal structure to

improve memory about relevant past events



• Cognitive predictions about what happens next



• Natural occasions for promoting cognitive

growth



• An impetus for improvisation when trying to

avoid a negative outcome

are a necessary

prerequisite for



Planning

Essential Properties of Routines:

Predictable



Portable



Personal



Essential Effects of Routines:

Develop positive behavioral momentum



Increase opportunities for non-contingent

positive feedback



Increase the ability to predict events



A natural framework for planning



A natural framework for evaluating

Steps to Organize Routines of Everyday Life

1. Identify successful and unsuccessful routines of everyday life.

What’s working, what’s not working?



2. Identify changes that have the potential to transform

unsuccessful routines into successful routines (including

changes in the environment and the behaviors of others.)



3. Identify how changes in routines include activities that are

motivating to the individual and everyday people.



4. Implement needed supports to organize routines so that the

individual experiences success and receives intensive practice in

context.



5. Systematically withdraw supports and expand contexts as

much as possible.

Concrete Interaction

Routines Routines

• Picture Routines • Language Routines

• Written Routines • Activity Sequencing

Key “Executive System”

Concepts That Help Individuals

Learn Self-Regulation





Hard - Easy



Big Deal - Little Deal



Ready - Not Ready



Scary - Not Scary



Like - Don’t Like



Choice - No Choice

Interaction Scripts for Routines



Making Decisions

About the Goal



• “What’re you going to do?”



• “What are we here for?”



• “How will we know we’re done?”



• “We’ll know we’re done when

it looks like this . . . “

Making Plans



• “OK, so what’s the plan?”



• “What’ll you need to get this done?”



• “How will you and I know you’ll

need help?”



• “What will help look like?”



• “Don’t tell me what you don’t

want, tell me what you do want.”



• “OK, so what do you want me to do?”

Making Decisions About Ease or

Difficulty Before Beginning



• “Do you think this will be hard or easy?”



• “If it’s hard, then what’ll you need?”



• “Have you ever done this before?

What happened?



• “I don’t think I could do this! How do

you know that you can?”



• “Whaddaya think? Big deal or little deal?”

Coaching Through Problems



• “You look upset, is there anything

I can do?”



• “OK, you’re not ready. No problem;

just let me know when you’re ready.



• “I’ll know you’re ready when you

look like this . . .”



• “I’ll wait.”



• “You know we’ve gotta figure this

out, let’s try . . . “



• “I know it’s hard, but we’ve got

to do this.”

Coaching in Context



• “So, how’s it going?”



• “Is that helping you? Not helping?”



• “Is there anything else you can do?”



• “Is there anything I can do to help you?”



• “So when are you going to start?”

Review What Occurred

• “So how’d it go?”



• “How’d you do?”



• “Tell me exactly what happened . . .

and then what?”



• “What do you think other people

thought?”



• “What were you thinking when you . . .”



• “Next time you do this, what’ll you do

differently? The same?”



• “What helped?



• “What didn’t help?”

Beha vi or Ra t ing Ke y

DAILY ROUTINE Pro m pt Rat ing Ke y

St ud e n t: ________________

1 = Hea lth /S afet y Risk 1 = Tot al H a nd Ove r Ha nd

2 = Signi fica nt P rob le m 2 = Ph ysical P romp t

3 = Mod erat e Pro b lem

Dat e : ____________ 3 = Mod eling /G estu rin g

4 = Slig h t Prob lem 4 = Verb a l Prom p t

5 = No Pro b lem 5 = In d ep en d en t







Routi ne Activity: Specific Tasks: Evalua tion:



Beha vior

_________________

1 2 3 4 5

 _____________ _________________

Prom pt



_________________ 1 2 3 4 5







Beha vior

_________________

1 2 3 4 5

 _____________ _________________

Prom pt



_________________ 1 2 3 4 5







Beha vior

_________________

1 2 3 4 5

 _____________ _________________

Prom pt



_________________ 1 2 3 4 5







Beha vior

_________________

1 2 3 4 5

 _____________ _________________

Prom pt



_________________ 1 2 3 4 5

ACTIVITY PLAN-DO-REVIEW SHEET

St ud e n t: ________________



Dat e : ____________







Routi ne Activity: ________________________





I thi nk th a t t h is w ill be : HARD EASY





I THINK I CAN DO THIS MUCH ON MY OWN: ________________________









THE THINGS I NEED TO DO TO GET THIS DONE:





__________________ _____________________





________________________________________





OR P D

ASK F HEL IF I NEE IT







I NEEDED THIS MUCH HELP:





1 2 3 4 5

A Little A lot









I DID THIS MUCH: __________________________________

My Plan





LISTEN



GET MY MATERIALS READY



IS IT HARD OR EASY?

____

____

____

MAKE A PLAN



JUST DO IT!



LOOK IT OVER



HOW DID I DO?

Mrs. Johnson’s 1st Grade



Today is:





__________________________________________________________







I HAD A    DAY





I LIKED TO:





_____________________________________________________________





_____________________________________________________________







  

LISTENING SOME HELP LOTS OF HELP





PLAYE D NICE SOME HELP LOTS OF HELP





TOOK TURNS SOME HELP LOTS OF HELP





WAITED SOME HELP LOTS OF HELP

Problem-Solving Routines:





Students Who are Verbal: Students who are Non-verbal:



1. Define the problem 1. Identify/experience

the problem

2. Generate alternatives

2. Try alternatives

3. Choose an action

3. Experience effect

4. Self-evaluate



5. Self-reinforce

A Decision Matrix for Dealing with Difficult Situations



• Mental Health

• Substance Abuse Health/Safety Risk

• Environment

• Behavior

• Other NO YES



Short Term Interventions

People • Inpatient

Provoking events • Alternative

Environment Program

• Staffing

Long Term Interventions



Support Factors

Internal Factors

Control

Motivation Environmental Interpersonal

Roles Places Network

Routines Events Staffing

Goals Activities Coaching

Engagement Practice in

Staffing

Activity Context

Ma na ging Crises Man a ge m en t:

Est ab lish ing A Pr o t oc o l fo r Pr o bl em s

Befo re Th ey Oc cu r





 W h o w ill in t e r ve ne fir st?

 How w ill s/h e g et h e lp ?

Pla n s  How w ill o t h e rs re sp o nd t o

fo r re q u e st s fo r h e lp ? ( “ I n e e d h e lp. ”

“I n e e d h e lp n ow. ”)

Pe o pl e

 How w ill w e re pl a ce a p e rson

w h o ‟s “ d o ne ”?





 Iden t ify idio syncr a ti c sig na ls

Pla n s o f im p e ndin g t r o u bl e .

fo r  Iden t ify hi e ra r ch y o f

In t e rrup t io n re dir e ct io n ( e. g ., proxi m ity , a

an d br e a k, h um or, et c. ) .

 Iden t ify m e t h o ds o f r ed u ci n g

De- e sca la ti on

e m ot iona lit y of situ a t ion





 Mana g ing t h e e n vir o n m en t .

Pla n s  Mana g ing /m ovi n g o t h e rs.

fo r  Havin g a pr e d e t e rm in e d

Pro t ec ti o n p lac e t o re m o ve t h e

indi vidu a l, i f n e ces sa ry.

A Cris i s

An e ve n t t h a t r e su lts in

di sr u p t ion o f r o u t in e e ve n t s

and r eq u ir es ac t ion s t ha t ar e

a ty pica l for st a ff and o t h e rs







Ma na geab le Unm a n age a ble

Cris is Cris is



 Requi r ing a chan g e in  Resu lts in h e a lt h and

t h e ro ut ine a ct ivit ie s. sa fe t y risk t o sel f o r

 Disr u pti ve of pe e r o t h e r s.

ro u t in es .  Requi r e s t h e a t te n t ion

 Requi r ing t h e a tt en t io n o f m o r e t ha n o n e st a ff.

o f st a ff t o t he d et rime n t  Resu lts in b e ha viora l

o f p ee rs . co n t agi o n e ffe ct .

 Ma y r eq u ir e ch a ng e in  Requi r e s s igni fican t

t h e en viro n m e n t . ch a ng e in e nvi r on m e n t .







Fam ily

Re sp o n se

P la n 91 1

P la n

 Mean ingful executive fu nc tio n routi nes

General Crisis  Sust ained p os it ive per sonal re lationsh ip s

Prevention  Coac hing/ appr en ticesh ip opportu nities f or indiv idu als a nd

staff

Needs  A definition of m anagea ble and un m anage ab le c rises and a

we ll understood plan for res po nding to t hese cris es









 Staff tr aine d i n c ris is interven tio n appro ac hes

 Identifica tio n of trigger s (by ind ividu als a nd staff a like)

Crisis Response  Identifica tio n of solut ion s t hat are desi red b y the ind ivid ua l

Needs  Identifica tio n of en viron me nt al m anagem ent st ra te gies

 De velopm ent of a crisis response pr oto col (for th e ent ire

or ga nizatio n)

Preven t ing It F a

rom Hitt ing t he F n:

A Sc ript f or Re s po n di ng Wh e n a n

In d ivid u a l is Beg i n n in g t o En ga ge

in P ro blem Be ha vio rs







“Wha t a re yo u do ing?” ( Offe red i n a non -

co n fro n t a ti ve voic e t on e . Th e ide a is t o b e gi n

t o a ss is t t h e individ u a l t o r ef le ct on h is/ h e r

cu rr e n t ac t io n s) .



“Is it hel ping yo u t o ge t wh at you

w a nt/ nee d?” ( Ag a in wi t h po sit ive a ffe ct ,

t h e ne xt st ep i n se lf-re fle c ti o n, inc r e a sin g t h e

o r ie n t a ti o n t o a d e sir ed o u t co m e) .



“Wha t c a n yo u do instea d?” (Co n t inui n g

po sit ive prob le m so lvin g and a su b t le

r e dir e ct io n to a n a lt e r n a t ive ac t ivity) .



“When w ill you sta rt ( t o d o t he

a lterna tive) ?” ( A fina l n u dg e in t he r igh t

dir e ct io n)

The Job:



Help people to learn to develop,

and tell



THE STORY



Not simply report the news.

Four Lessons to Live by:



• Hope is an essential part of

any successful plan of support.



• Form follows function. Think

about what the individual needs

and then create a way for that

to happen in a flexible manner.



• The more you try to force something

or someone to change, the more

it (or he or she) changes you.



• When all else fails, a sense of joy

and a sense of humor can get you

through a whole lot!