neurologically-fragile students: supporting access and participation geni moots plotnick 11/07

NEUROLOGICALLY-FRAGILE STUDENTS:NEUROLOGICALLY-FRAGILE STUDENTS:SUPPORTING ACCESS AND PARTICIPATIONSUPPORTING ACCESS AND PARTICIPATION

Geni Moots PlotnickGeni Moots Plotnick

11/0711/07

Knock KnockKnock Knock

Who’s there?Who’s there?

Expanding Gene PoolsExpanding Gene PoolsEnvironmental NeurotoxinsEnvironmental Neurotoxins

BEHAVIORBEHAVIOR

Neurotypical Neurotypical

Issues of Conduct:Issues of Conduct:

CHOICE REFLECTIVE CHOICE REFLECTIVE OF MORAL OF MORAL SELECTIONSELECTION

Neuroatypical Neuroatypical

Survival:Survival:

MANIFESTATION OFMANIFESTATION OF

UNDERLYINGUNDERLYING

BIOLOGICALBIOLOGICAL

PREDISPOSITIONPREDISPOSITION

NEUROTYPICAL v NEUROTYPICAL v NEUROATYPICALNEUROATYPICAL

1) Escape/Avoid1) Escape/Avoid-peer judgment-peer judgment-failure-failure

2)Obtain2)Obtain-peer or adult attention-peer or adult attention

1)Escape/Avoid1)Escape/Avoid--sensationsensation-social/interaction-social/interaction-external control-external control-failure-failure

2)Obtain 2)Obtain --reduce or increasereduce or increasesensation / stimulationsensation / stimulation

INTERESTING THINGS…INTERESTING THINGS…

Resistance to instruction (and to Resistance to instruction (and to ‘multiple‘multiple

bosses’) is so common for ASD bosses’) is so common for ASD students students

that in some states this is part of their that in some states this is part of their

eligibility criteria checklist.eligibility criteria checklist.

ASD Neuropathy:ASD Neuropathy:

• Easy to Easy to habituatehabituate and prone to anxiety. and prone to anxiety.

• If a negative event sequence has If a negative event sequence has occurred occurred

twice the likelihood of it happening again twice the likelihood of it happening again is exponential.is exponential.

• Have difficulty with sequencing and Have difficulty with sequencing and cause-effectcause-effect

• Knowledge does NOT mean Performance!Knowledge does NOT mean Performance!

If we keep doing what we have If we keep doing what we have done we will ‘fer sure’ get done we will ‘fer sure’ get more of what we have gotten.more of what we have gotten.

• If the individual is repeating a If the individual is repeating a problem behavior, the consequence problem behavior, the consequence of the behavior has been reinforced of the behavior has been reinforced for that individual in the past !!!for that individual in the past !!!

If we keep doing what we have If we keep doing what we have done we will ‘fer sure’ get more of done we will ‘fer sure’ get more of what we have gotten.what we have gotten.

ExplainExplain

ArgueArgue

CajoleCajole

NegotiateNegotiate

ThreatThreat

IsolateIsolate

• Analyze (ABC)Analyze (ABC)

• HypothesizeHypothesize

• Target most impactingTarget most impacting

skillskill

• Train all staffTrain all staff

• Create static supports Create static supports

• Choose reinforcersChoose reinforcers

• Train/rehearse w/childTrain/rehearse w/child

• Collect dataCollect data

INTERVENTIONS…INTERVENTIONS…

……should address the characteristics should address the characteristics that underlie autism spectrum that underlie autism spectrum disorder itself.disorder itself.

Ziggurat ModelZiggurat Model by Dr. Ruth Aspy and Dr. Barry by Dr. Ruth Aspy and Dr. Barry

GrossmanGrossman• SKILLSSKILLS

• TASK DEMANDSTASK DEMANDS

• STRUCTURE AND VISUAL SUPPORTSSTRUCTURE AND VISUAL SUPPORTS

•REINFORCEMENTREINFORCEMENT

•SENSORY DIFFERENCES SENSORY DIFFERENCES

AND BIOLOGICAL NEEDSAND BIOLOGICAL NEEDS

CRITICAL CRITICAL considerations considerations ==

SENSORY DIFFERENCES SENSORY DIFFERENCES

ANDAND

BIOLOGICAL NEEDSBIOLOGICAL NEEDS

ORDER OF SUSPITION AND ORDER OF SUSPITION AND INVESTIGATIONINVESTIGATION

1.1. BIOLOGICAL FACTORS (ill, tired, BIOLOGICAL FACTORS (ill, tired,

change in medication)change in medication)

2. OUTSIDE FACTORS ? (event, routine 2. OUTSIDE FACTORS ? (event, routine or family change) or family change)

3. SKILL DEFICITS3. SKILL DEFICITS

4. ANTECEDENTS / CONSEQUENCES4. ANTECEDENTS / CONSEQUENCES

CHOOSING CHOOSING [battles][battles] BASKETS BASKETS

• Harmful to self or Harmful to self or others?others?

• Destructive?Destructive?

• Disruptive orDisruptive or

distracting?distracting?

• Interfere with self or Interfere with self or other learning?other learning?

• Is it socially approp?Is it socially approp?

• ELIMINATE ?ELIMINATE ?

• REDUCE ?REDUCE ?

• REPLACE ?REPLACE ?

• IGNORE ?IGNORE ?

Biological Needs and Biological Needs and FrailtiesFrailties

ANTEDEDENT INTERVENTIONSANTEDEDENT INTERVENTIONS

Opportunities created by the Opportunities created by the interventionist rather thaninterventionist rather than

by the behavior !by the behavior !-demand -demand (level, amount, objects, place, adult, (level, amount, objects, place, adult,

time)time)

-sensory setting-sensory setting-task or task format-task or task format-adult communication and proximity-adult communication and proximity-sensory-motor breaks-sensory-motor breaks-motivators-motivators

SENSORY DIFFERENCES AND SENSORY DIFFERENCES AND BIOLOGICAL NEEDSBIOLOGICAL NEEDS

• Address Address environmental environmental stressorsstressors

• Provide a sensory Provide a sensory dietdiet

(sound, light,proximity,(sound, light,proximity,

textures, movement textures, movement

needs)needs)

• Monitor and Monitor and AddressAddress

-appetite/hunger-appetite/hunger

-fatigue-fatigue

-medical needs-medical needs

REINFORCEMENTREINFORCEMENT

-success-assured -success-assured rehearsalrehearsal

generalized and generalized and expandedexpanded

in small incrementsin small increments

-consistent -consistent

-train initially w/satiation-train initially w/satiation

-self-selected-self-selected

-contingent upon desired -contingent upon desired behaviorbehavior

-concrete, activities, -concrete, activities,

privilegesprivileges

-use of restricted -use of restricted interestsinterests

or desired sensationsor desired sensations

-pair social with tangible-pair social with tangible

ReinforcersReinforcers

• -primary (food/drink)-primary (food/drink)

• -activity (favored stim, look at book, -activity (favored stim, look at book, build)build)

• -social (praise, hug, high 5)-social (praise, hug, high 5)

• -material (objects)-material (objects)

• -token-token

Special, Preferred InterestsSpecial, Preferred Interests

Signs that Reinforcement has Signs that Reinforcement has not been appropriately not been appropriately addressed…addressed…-helplessness / low self-esteem-helplessness / low self-esteem

-no increase in desired behavior-no increase in desired behavior

-high frustration level-high frustration level

-escape behaviors-escape behaviors

-failure to frequently earn reinforcers-failure to frequently earn reinforcers

STRUCTURE AND VISUAL STRUCTURE AND VISUAL SUPPORTSUPPORT

PREDICTABILITYPREDICTABILITY

-Use visual, -Use visual, environmental environmental

-Model physically-Model physically

-Rehearse physically-Rehearse physically

-”Oops” (‘silly us’) if -”Oops” (‘silly us’) if need to repairneed to repair

VISUALSVISUALS

-photos-photos

-personalized cards, -personalized cards, plans, cartoons, plans, cartoons, mapsmaps

-graphic organizers-graphic organizers

-power cards-power cards

-5-pt scales-5-pt scales

Indicators that Structure / Indicators that Structure / Visual support need Visual support need readjustment…readjustment…-increase in behaviors-increase in behaviors

-repetitive questioning-repetitive questioning

-increased anxiety-increased anxiety

-increase in anger/rage-increase in anger/rage

Task demands too big if…Task demands too big if…

-failure at task-failure at task

-quit before completion-quit before completion

-express overwhelm-express overwhelm

-meltdown-meltdown

-see increased isolation and peer rejection-see increased isolation and peer rejection

Not taught? Too hard? Not enough support?Not taught? Too hard? Not enough support?

Indicators that Skills to TeachIndicators that Skills to Teachlevel is not appropriate…level is not appropriate…

-lack of goal progress-lack of goal progress-overdependence on -overdependence on

assistance/promptingassistance/prompting

If s/he is UNable to exhibit the desired If s/he is UNable to exhibit the desired behavior CONSISTENTLY even with behavior CONSISTENTLY even with boosted motivators and refined boosted motivators and refined environments, distress, agitation environments, distress, agitation

and worsening are likely.and worsening are likely.

TASK DEMANDSTASK DEMANDSSkill Skill DeficitsDeficits

RestrictedRestricted

PatternsPatternsCommuni-Communi-cationcation

SensorySensory ?? ?? ??

CognitiveCognitive ?? ?? ??

MotorMotor ?? ?? ??

EmotionalEmotional ?? ?? ??

SCENARIOS………SCENARIOS………

• S scooches about to poke and push S scooches about to poke and push peers with hands and feet during peers with hands and feet during circle timescircle times

• S asks for help then comes unglued S asks for help then comes unglued and loud when I come and try to helpand loud when I come and try to help

• S puts his head on the desk and S puts his head on the desk and refuses to do any work during math refuses to do any work during math even though he’s a math genius even though he’s a math genius

• S asks for a break during read-aloud S asks for a break during read-aloud but does not return to his seat w/out but does not return to his seat w/out promptingprompting• S pushes peers hard when playing tag S pushes peers hard when playing tag

on the playgroundon the playground

• S will not come in w/her class from S will not come in w/her class from recessrecess

• S does Edmark fine w/Ms. Y but shutsS does Edmark fine w/Ms. Y but shuts

down w/Ms. Zdown w/Ms. Z

• S taps his pencil loudly during S taps his pencil loudly during workbook mathworkbook math

PRIMING and REHEARSALPRIMING and REHEARSAL