CLDDV 173 Autism Overview and Treatment Chapter 4

CLDDV 173: Autism: Overview and Treatment Chapter 4: Environmental Arrangement to Prevent Contextually Inappropriate Behavior Prepared by Debbie Laffranchini, Professor From Autism Spectrum Disorders (Boutot and Myles)

Behavior O All behavior is meaningful O All behaviors communicate a need or desire O Behaviors communicate our understanding of a situation and what is okay to do O The context that behavior occurs (the environment, the situation) determines the appropriateness or inappropriateness of the behavior

Behavior in Context Appropriate Inappropriate

Behavior in Context Appropriate Inappropriate

If it’s not working, change the environment to support appropriate behavior! Don’t suppress the behavior!

Creating Sustainable and Meaningful Behavior Change O Comprehensive approach requires: O Understanding how factors in the environment impact and explain behavior O Understanding context of behavior O Understanding importance of motivation O Awareness and skills to prevent inappropriate behavior

Strategies for Compliance O Rewards O Punishment O Consequences O Motivation

Problems with Current Strategies O Rewards, reinforcers O Problem: must constantly seek new reinforcers, because item/activity used as a reward loses value O Punishment O Problem: creates resentment and mistrust O Consequences O Problem: availability of consequences O Motivation O Problem: in order to motivate, must deny the child first

Antecedent-based Intervention O Look at antecedents O Problem: seem inconsistent because conditions change O May require completion of a functional behavior assessment O Informs development of plan O Informs implementation of plan O Informs evaluation of plan

Functional Assessment and Behavior Support Planning O Functional behavior assessment (FBA) is evidence-based practice to determine purpose of a behavior in order to develop a behavior support plan

Functional Behavioral Assessment Process O Establish a team O Identify and define O O O behaviors to be assessed Initial data collection Development of hypothesis of why behavior occurs Test hypothesis Develop intervention plan Plan monitoring and evaluation

Embedded Requests to Increase Appropriate Behaviors O Embed requests in activities rather than work on one skill at a time O For example, responding to name during circle time, small group, clean up, departure

Inappropriate Behavior: Possible Causes O Child is in pain or discomfort O Child is ill or beginning to become ill O Hunger O What to do: O Provide access to nutritious food O Check for pain, discomfort, illness O Check mouth for dental causes

Challenges for Individuals with Autism Spectrum Disorders O Social Interaction O Repetitive and stereotyped patterns of behavior O Impaired verbal and/or nonverbal communication O Sensory processing difficulties

Challenge: Social Interaction O Difficulty with nonverbal behaviors O O Eye contact Facial expressions O Nonverbal behaviors also challenging: O Body posture O Inflexible movement O Awkward physical movement O Lack emotional expression O Difficulty taking turns, asking questions or exchanging ideas O Prefer visual or tangible objects O What you can do: O Prompt frequently O Provide visual supports for successful social interactions

Challenge: Repetitive and Stereotyped Patterns of Behavior Demonstrate varying levels of intensity in focusing on particular objects Preoccupation with restricted patterns of behaviors or activities

Challenge: Repetitive and Stereotyped Patterns of Behavior Routine-driven characteristics that involve little functional importance

Challenge: Repetitive and Stereotyped Patterns of Behavior O Problems that arise: O Change in routine O Change in food O Change in physical arrangement O Changes may result in behavioral outbursts or anxiety

Challenge: Repetitive and Stereotyped Patterns of Behavior • Self-stimulation is common • • • Spinning Rocking Moving objects repetitively

What You Can Do for Repetitive and Stereotypical Patterns of Behavior O Meet the unmet sensory need O Could be movement O Could be pressure O Could be providing earbuds or earphones O Reduce stress O Slowly introduce changes O Transition with announcing ahead of time

Challenge: Impaired Verbal and/or Nonverbal Communication Challenge initiating or maintaining conversation with social meaning or functional intention

Challenge: Impaired Verbal and/or Nonverbal Communication • • • Echolalia Language comprehension difficulties May articulate well when telling a story • But don’t understand theme or underlying meaning

Challenge: Impaired Verbal and/or Nonverbal Communication O Challenge: joint attention O Ability to pay attention to a topic or object in the same social situation O Group work may be difficult O What you can do: O Support speechlanguage pathology services O Provide communicative supports across settings O Prompts on playground for conversational initiatives

Challenge: Sensory Processing Difficulties O Atypical response to sensory stimuli O Sensory processing difficulties are common O Some stereotyped behaviors or social responses are results of sensory processing difficulties

Challenge: Sensory Processing Difficulties O Sensory processing difficulties can look like: O Auditory hypersensitivity O Tactile defensiveness O Sensorimotor differences

Challenge: Sensory Processing Difficulties O Child can be hyposensitive O Child can be hypersensitive O Child can be mixed O O Noise Light Touch Smell O Varies from individual to individual O Varies from setting to setting

Challenge: Sensory Processing Difficulties Use of visual stimuli is the most effective way to catch and maintain the attention of individuals with ASD

What You Can Do for Sensory Processing Difficulties O Provide “fidget” materials O Provide spaces to get inside O Use calming materials

Strategies for Creating a Supportive Environment Modifications of the Physical Environment O Environment is best when well-organized O Environment is best when predictable

Strategies for Creating a Supportive Environment O Learning space O Classroom layout O Where materials are placed O Predictable O Accessibility of materials and resources O Promotes independence and autonomy O Color code materials

Strategies for Creating a Supportive Environment Assessing Individual Needs: • Are materials placed sequentially? • Are learning and leisure spaces clearly defined? • • • Independent work Group work Leisure/break Transition Relaxing space

Strategies for Creating a Supportive Classroom O Schedules O Visual supports O Visual cues, materials that organize O Priming O Information in advance to prepare O Social narratives O Write stories about how to cope O Checklists

Strategies for Creating a Supportive Environment O Visual supports O Visual schedules O Choice boards O Boundary markers O Maps O Labeling

Strategies for Creating a Supportive Classroom O Schedules O Visual schedules tend to be helpful O Helps with predictability O Unexpected changes or routines are typically difficult O Social Stories and other social narrative strategies can help

Strategies for Creating a Supportive Classroom: Opportunities to Make Choices O Materials to use during task O Time at task O Food choices O Leisure activities O Choices create sense of satisfaction and empowerment

Strategies for Creating a Supportive Environment Modifying Physical Environment: O Seating O Learning space O Space for relaxation

Strategies for Creating a Supportive Environment Modifying the Environment: Sensory Considerations O Atypical sensory seeking or avoiding O Lighting O Sounds O Smells O Temperature Lighting O Use soft lights O Screening bright windows

Strategies for Creating a Supportive Environment Modifying the Environment: Sensory Considerations O Sounds: O Using earphones or ear plugs O Smells O Wear minimal perfume O Temperature O Be aware of proper room temperature

Strategies for Creating a Supportive Environment Light: Blinds and curtains, soft Visual: Free of bright colors and patterns

Strategies for Creating a Supportive Environment Modifying the Physical Environment O Child’s level of comfort O Touch O Feel O Texture O Smells

Strategies for Creating a Supportive Environment O Assessing Individual Needs O Home layout O Planning classroom O No one solution fits all children O Consider family needs O Consider cultural differences

Strategies for Creating a Supportive Environment • Assessing individual needs: What aspects of child’s behavior affects their interaction in the environment • • • Sensory Anxiety Restrictive and repetitive pattern of behavior Level of understanding visual and written cues Level of communication

Strategies for Creating a Supportive Environment O School environment: O Seating O Away from bright windows, posters, door, hallways O Front row may be helpful O Cover chair legs with tennis balls O Carpet squares with inner seats O Alternative seating O Therapy balls O T-stools O Learning space O Classroom layout O Accessibility O Space for relaxation

Strategies for Creating a Supportive Environment Assessing Individual Needs: • What is the appropriate seating accommodation? • • • Seating device? Able to support self in seating? Cushion to reduce sensory overload? Light Fresh air Distractions Personal space Traffic pattern

Strategies for Creating a Supportive Environment Assessing Individual Needs: • Where can the student store books, materials, and equipment? Are they easily accessible?

Strategies for Creating a Supportive Environment O Assessing Individual Needs: • Will visual cues be provided appropriately? • Pictures, icons, symbols • Labeling • Color coding

Strategies for Creating a Supportive Environment O Research supports the effectiveness of therapy balls in in-seat behavior and maintained engagement O Substantial improvements O Decrease in oppositional behavior of refusal to follow routine teacher request O Positive classroom behavior

Strategies for Creating a Supportive Environment O Space for relaxation O Need a “home base” O Quiet, separate place O Defined area in the classroom O Helps them to restore calm and relax O Get away from light, sounds, people

Strategies for Creating a Supportive Environment O Visual Supports O Individuals with ASD tend to be strong visual processors and learners O Objects O Photographs O Pictures O Symbols O Signs O Written words O Visual supports increase comprehension of language O Visual supports increase comprehension of environmental expectations O Visual supports provide structure and predictability

Creating a Supportive Environment Using Functionally Relevant Instruction O Important for child to learn a relevant skill instead of responding to a prompt O Child can then generalize to other situations O Use natural situations to teach skills

Qualities of Instruction, Reduces Inappropriate Behavior O Avoid mundane, menial tasks O Understand child interests and preferences and respond to them O Not too easy; not too difficult O Gradual increase in difficulty O Don’t stay too long at a task or activity O Rate of instruction

Create Positive Atmosphere O Kind and caring demeanor of teacher and ALL support staff O Negative interactions can elicit inappropriate behaviors O Negative moods of adults can be antecedents for inappropriate behavior

Strategies for Creating a Supportive Environment O Environmental Planning in Schools O O Learn who your children are Make the classroom work for all students O Classroom should be well O O organized Areas increase predictability for students (centers, stations) Areas for skill development Areas for general activities Areas for type of instruction O One on one Small group Whole class

Strategies for Creating a Supportive Environment O Creating a successful learning environment O Support children’s learning O Method of presentation and delivery of learning materials will determine the effectiveness O Children with ASD process best through combination of clear verbal instruction and explicit visual prompts O Interactive social environment

Strategies for Creating a Supportive Environment in the Home/Community O Fire, electrical safety O Cover electrical outlets and wiring O Electrical appliances out of child’s reach O Use warning signs such a bold X

Strategies for Creating a Supportive Environment in the Home/Community O Doors and windows O Child may have little or no awareness of danger O Appropriate locks on doors O Consider Plexiglass windows

Strategies for Creating a Supportive Environment O Creating a safe environment for youngest children O Safety is a significant concern O Gates O Covering outlets O Childproof locks

Strategies for Creating a Supportive Environment O Environmental modifications: O Furniture arrangement O Storage of materials O Use safety locks for chemicals, medicine O Safeguard windows and stairs O Cover outlets and knobs on appliances O Organize to keep cleaning supplies out of child’s reach O Alternative seating devices O Use visual supports O Plan fire and evacuation procedures