Case Study--Autism Spectrum Disorder--

Student ProfileName: Lily

Age: 12

Academic Strengths: Lily enjoys reading and does well in Language Arts and in some aspects of History. She has developed a strong interest in several specific areas of History, especially early American history, and often checks out and reads books about the subject matter in her free time. Her teacher has expressed concern that her interest in history could be indicative of a preoccupation or fixation related to her having ASD but it has been determined that it is not detrimental to her academic success at this time. In the past she has excelled at projects related to history when she has a lot of creative freedom with the assignment. She has also shown an interest and strong ability in art and enjoys drawing and water color painting. Last semester she began taking art as an elective and has excelled in the class. She has shown a preference for academic activities that involve reading, drawing or painting, or creating things with her hands.

Social Strengths: Until recently, Lily has preferred to spend most of her time alone, and was often perceived by her peers as being extremely shy and quiet, or withdrawn. She has been making considerable progress, however, with meeting her social goals of interacting with her peers and participating in group activities. With prompting she is now able to join a group of her peers at a table during lunchtime and will even occasionally speak up during collaborative activities in the classroom.

Behavior Strengths: Though tentative and extremely quiet, Lily is friendly and respectful to her teachers and peers. She is currently working on limiting her engagement in self-stimulatory behaviors when she feels overwhelmed.

An example of one of Lily’s paintings from her art class last semester.

Student Profile - Continued

Academic Needs: Lily is currently performing below grade level in Science and Math and also struggles in History/Social Studies, even though she has shown a strong interest in it, because she has a hard time completing assignments on time and per the teachers instructions. Currently she is struggling the most, however, in math.

Social Needs: Lily has made significant improvement recently in the area of social skills, responding to most prompts and questions asked of her, but continues to struggle to make friends. She participates only occasionally in group projects or discussions and avoids most social interactions unless she is prompted to participate by a teacher or other adult. She currently lacks the ability to engage in spontaneous conversation, a skill that is crucial to her being able to interact with her peers.

Behavior Needs:Lily has few behavior issues that would be considered to be excessively disruptive but often struggles to follow instructions in relation to completing specific tasks or assignments, and engages in self stimulatory behaviors when she feels overwhelmed, primarily rocking back and forth or twirling an object such as her pen. Sometimes, when she feels overwhelmed by what is being asked of her, or does not understand how to do an assignment, she will “shut down” and will sit for an entire class period, twirling her pen or another similar object, without completing any of her work. She has also demonstrated a need for a sense of sameness and a tendency for inflexibility. She struggles the most when new types of activities are introduced or if expectations are changed suddenly.

Language/Communication Goals

• Goal I

• Lily will overcome deficits in using communication for social purposes and will learn how to change communication to match context or the needs of the listener. Specifically, she will learn how to engage in spontaneous conversation with her peers and/or teachers or other adults. She will learn how to determine what types of conversations are appropriate for different situations and/or different listeners and be able to use them accordingly.

• Goal II

• Lily will learn how to understand meaning when it is not explicitly stated and will learn nonliteral or ambiguous meanings of language such as sarcasm.

Social/Behavioral Goals

• Goal I • Lily will learn to ask for help

when she feels overwhelmed or does not understand how to do an assignment rather than “shutting down” or engaging in self-stimulatory behaviors.

• Goal II• Lily will learn coping

strategies to help her deal with changes that normally cause her anxiety, such as when new types of activities are introduced or if expectations are changed suddenly.

Direct Behavioral Observation

• The Functional Behavior Analysis (FBA) for the behavior goals outlined previously should include direct behavioral observation. Direct behavioral observation involves measuring the frequency, duration, and intensity, etc. of student actions, usually with non-interactive methods in the student’s natural classroom environment. It should also include an analysis of the data from the observations, which will be used to determine the function of each behavior. Once the function of a behavior is identified, a replacement behavior can be identified and a plan can be implemented to reduce the undesirable behavior. A replacement behavior is an appropriate behavior that replaces the inappropriate behavior. In order for a replacement behavior to work it must be efficient, effective, and meet the same function as the target behavior.

Intervention I - Language/Communication

Intervention: Social Scripting will be used to teach Lily how to engage in spontaneous conversations. Research has demonstrated that many children with autism who receive science based intervention learn to talk. According to Patricia Krantz and Lynne McClanahan, in their article Social Interaction Skills for Children with Autism: A Script-Fading Procedure for Beginning Readers, however, “many youngsters who have acquired complex verbal repertoires nevertheless fail to engage in language that is not evoked by verbal cues Although they dependably respond to adults’ questions or prompts, they do not spontaneously initiate or continue interactions that do not produce preferred items or activities”. Their research on Social Scripting and Script-Fading demonstrated that “the script-fading procedure enabled children with autism to converse with adults, to benefit from adults’ language models, and to engage in language practice that contributes to fluency”. They also found that even after the initial teaching, the unscripted interactions not only continued but also generalized to different activities that had not been the topic of teaching.

Procedure and Opportunities for Learning: A learning opportunity will be created by first providing Lily with a Social Script that deals with a typical conversations that her peers (middle school aged students) would be likely to engage in during free time in the classroom or at lunch. First Lily will be taught to repeat a script in that would be appropriate for that specific social situation. As she learns to use the scripts, it will begin to be faded, one word at a time, from end to beginning until she is able to recite the whole script without help. Over time, different topics of typical conversations likely to be encountered will be covered, and Lily will be given the chance to act out various conversations with her teacher and later with her classroom peers on a one to one basis. As her skills progress she will be encouraged to join a group of her peers during lunch and engage in spontaneous conversations on her own. She will be asked to self-monitor the experience and report back to the teacher on how successful she felt she was and/or any difficulties she encountered.

Goal: Lily will learn how to engage in spontaneous conversation with her peers and/or teachers or other adults. She will learn how to determine what types of conversations are appropriate for different situations and/or different listeners and be able to use them accordingly.

ABC Diagram of Teaching Strategy

• Antecedent – Lily will be taught a social script. She will then be given the appropriate prompt for whatever level she is currently working at on the script (as she learns to use the script, it will begin to be faded, one word at a time, from end to beginning).

• Behavior – Lily will respond appropriately to the prompt that she is given by reciting whatever part of the social script that she has memorized thus far.

• Consequence – Each time Lily responds correctly she will be given verbal praise. Upon completing each full social script she will be allowed to choose one art supply as a reward for her hard work.

ABC Diagram – Strategy Implications

Before Intervention:• Antecedent – Lily sits down with a group of her

peers at lunch who are engaging in a conversation.

• Behavior – Lily speaks at an inappropriate time, talking about something that is off topic and about a subject matter that is only of interest to herself.

• Consequence – Lily’s peers have a hard time relating to the subject that Lily is speaking about and consequently are not able to respond appropriately to her. The conversation is stalled and Lily is possibly ostracized.

After Intervention:• Antecedent – Lily sits down with a group of her

peers at lunch who are engaging in a conversation.

• Behavior – Lily gauges the topic of the conversation, waits to speak at the appropriate time and using cues from one of the social scripts that she has learned, responds to one of her peers in an appropriate fashion.

• Consequence – Lily’s peers respond to her input into the conversation in a positive manner, making Lily feel validated and socially accepted.

Intervention II – Social/Behavioral Goal: Lily will learn to ask for help when she feels overwhelmed or does not understand how to do an assignment rather than “shutting down” or engaging in self-stimulating behaviors.

Intervention: Applied Behavior Analysis (ABA) techniques will be used to teach Lily to ask for help and to refrain from undesirable (self-stimulating) behaviors. According to the recommendations of the organization Autism Speaks, her day will be structured to provide many opportunities (both planned and naturally occurring) to acquire and practice skills in both structured and unstructured situations. She will receive positive reinforcement for demonstrating the appropriate behaviors of completing her work and asking for help when needed and will receive no reinforcement for the inappropriate (self-stimulating) behaviors that prevent her learning. (Autism Speaks). Research has shown that “ABA principles and techniques can foster basic skills such as looking, listening and imitating, as well as complex skills such as reading, conversing and understanding another person’s perspective” and it has been “endorsed by a number of state and federal agencies, including the U.S. Surgeon General and the New York State Department of Health” (Autism Speaks).Procedure and Opportunities for Learning: Lily will receive positive reinforcement for demonstrating the appropriate behaviors of completing her work and asking for help when needed. She will be given multiple learning opportunities throughout her day to complete an assignment independently, such as during her Language Arts period where students are asked to complete a journal about an assigned topic, or in her math period where students are given a series of problems out of their math books that they are asked to complete. Each class period where Lily completes her assigned work, asks for help if needed and does not engage in a self-stimulating behavior, she will be given a checkmark by that respective teacher on a form that has been supplied to her. If she does not finish her work due to “shutting down” or engaging in a self-stimulating behavior then she will not receive a checkmark for that class period. At the end of each week she will be allowed to turn in the form to her resource teacher in exchange for various levels of prizes that depend on the number of check marks she has earned. Since Lily has a strong interest in art, the prizes will be a variety of art materials that she will be allowed to choose from.

ABC Diagram of Teaching Strategy

• Antecedent – Lily will be asked to complete an assignment independently.

• Behavior – If Lily becomes frustrated she will ask for help from the teacher rather than “shutting down” or engaging in a self-stimulating behavior.

• Consequence – Lily will receive a check mark from the teacher at the end of the class period if she successfully completed her assignment, asked for help if needed, and refrained from “shutting down” or engaging in a self-stimulating behavior. Then, at the end of the week, she will be given the opportunity to exchange the checkmarks for prizes.

ABC Diagram – Strategy Implications

Before Intervention:• Antecedent – Lily becomes frustrated

by an assignment that she doe not understand how to do.

• Behavior – Lily “shuts down” or engages in a self-stimulating behavior.

• Consequence – Lily fails to complete her assignment causing her grades to suffer.

After Intervention:• Antecedent – Lily becomes frustrated by

an assignment that she does not understand how to do.

• Behavior – Lily asks the teacher for help with the assignment in lieu of “shutting down” or engaging in self-stimulating behaviors.

• Consequence – Lily is able to successfully complete the assignment and her grades rise.

Parent and General Education Teacher Support

Teacher Support: I would support Lily’s general education teachers in programming her for success by creating comprehensive guidelines for the interventions discussed earlier, for her teachers to follow. I would also encourage her teachers to promote normalization for Lily in the classroom. Normalization “occurs when the activities, materials, and settings in which a person engages are the same as those in which persons without disabilities of the same age, gender, and culture are engaged” and is crucial because it “helps those with significant disabilities “fit in” with those without disabilities” (pp). I would also encourage the teacher to help Lily develop the skills to become more “self-determined” which include making choices, making decisions about her actions, setting goals for herself, recognizing her own abilities including her strengths and needs, and advocating for herself. Opportunities to practice these skills should be made available to Lily as often as possible in each of her classes.

Parent Support: I would include Lily’s parents in programming her for success by encouraging them to help her practice the skills that she is working on at school, at home as well. For example, for her Language/Communication goal of learning to engage in spontaneous conversation, her parents could practice her social scripts with her and present her with opportunities outside of school to talk to various people such as neighbors or family friends, etc. To help her work on her Social/Behavioral goal of asking for help when frustrated instead of engaging in self-stimulating behaviors, her parents could use a similar reward system at home to the one being used at school which I could provide for them. I believe that communication between home and school is vital, and one of the most valuable ways that student success can be supported. I would encourage Lily’s parents to come to me with any questions, concerns, or suggestions that they might have and would work alongside them as a team to help Lily succeed in learning the necessary skills for her to do well and improve.

Transition to 8th GradeTo help Lily transition to the next grade successfully I would first identify all of the members of her support team and collaborate in order to identify the areas where she is likely to need extra support. Research has shown that “the establishment of a unified, collaborative approach to a student’s support can be the difference between being effective or ineffective and, in our experience, the commitment is well worth it” (pp). One strategy for laying a “foundation for positive behavior support” is through Person Centered Planning (Kincaid/Dunlap). Person Centered Planning, which is usually used for transitioning from secondary education to post-secondary life, involves creating a framework by which a person is helped to “identify their dream for the future, including all the ideas, values, people and things that are important to them”. I believe this same person-centered approach can be used to help Lily prepare for the next grade level by giving her choices and ultimately control over her own life and education. As part of the planning, her primary school activities should be identified and her IEP goals and yearly progress should be re-evaluated in order to determine what worked for her and what did not work the previous year. It is essential that her IEP goals for the following year are appropriate and will continue the progress that she has made over the past year. Because individuals with ASD often have a difficult time transitioning and adjusting to new schedules, I would also spend time working with Lily to acquaint her with her new schedule (through use of a visual schedule) and teaching her (through social stories etc.) what changes to expect. It is vital to do everything possible to alleviate the anxieties that she may feel towards transitioning to the next school year so that her anxieties don’t trigger unwanted behaviors (such as those addressed previously), or impede her learning.

Works Cited

Autism Speaks. (www.autismspeaks.org)

Kincaid, Don, and Dunlap, Glen. Laying the Foundation for Positive Behavior Support through Person-Centered Planning. Volume 2, Issue 1. (class resource)

Krantz, Patricia J., and McClanahan, Lynne. Social Interaction Skills for Children with Autism: A Script-Fading Procedure for Beginning Readers. Journal of Applied Behavior Analysis, 31, 191-202. 1998. Princeton Child Development Institute. Retrieved April 2015. Web.