promoting independence in individuals with disabilities

By Karen Umstead, M.Ed. Board Certified Behavior AnalystBeautiful Minds of Princeton

www.beautifulmindsofprinceton.com

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A bit of data collection Who are you

Administrators Direct Support Staff Behavior Analysts Parents

Population served Adolescent Adult

Disabilities Autism/Developmental Disabilities Multiple Disabilities Mental Illness SLD Other

Areas you work in: Employment/Vocational Day Programs Supported living (supervised apartments, group homes) Community

Familiar with applied behavior analysis (ABA)

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Reality Independence is a critical skill, especially in the

home, community, and in employmentMost individuals with disabilities are unable to

perform skills when professional support fades.*Even if the skill is mastered independently, often

times it is not generalized or carried over to new people objects, and settings. *

Independence should be lifetime goal.


* (Hume, Loftin, & Lantz,2009, p. 1329)

For Your ConsiderationAs you grew up, did you always want to live at home?Did you want to be able to go the mall or out to eat

without an adult watching over you?Did you want to get a job? Doing something you

liked? Or at least in a place that you liked?When you started to do these things, how did you

feel?


Survivor: Independence IndonesiaDropped by yourself in a non-motored boat and

cannot see landYou have assorted items in your boatEverything is working and ok to use for activity For now you cannot see anyone else

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Barriers to IndependenceCommunicationInitiation*Generalization*Prompt Dependence*Behavior



Consider your ClientTake time now to pick out a client that you want to

increase his/her independenceAs we go throughout this workshop, consider each

area and how it may applyBy the end of the workshop, you should have an idea

on something to try next with your client


CommunicationExpressive abilities ArticulationDelays in processingReceptive understanding


InitiationPlanning

Motor-preparing for/anticipating movementPlanning steps of activity or appropriate response

Processing SpeedAttention to relevant environmental cues/stimuliMotivation-is it worth it to try and initiate?Unclear expectationsNeed to specifically teach, prompt, & reinforce this skill


* (Hume, Loftin, & Lantz,2009, p. 1330-31)

GeneralizationTrain and HopeOvergeneralize

Take one skill and apply it to inappropriate circumstances

Client learns hand motion for round and round and starts to do that in other settings/times that it is not appropriate

Faulty stimulus controlTarget behavior comes under the restricted control of

an irrelevant antecedent stimulusClient says red when he says a card with a bent edge


(Cooper, Heron, Heward, 2007)

Prompt DependenceOver-reliance or dependence on adult supportCan be especially difficult when having 1:1 supportClient may not exhibit the behavior without some

form of a promptIn some cases, clients will guide adults to prompt

them indicating the client considers it part of the response

Also be aware of the client relying on adults for reinforcement rather than delivering it themselves


Behavior Inappropriate behaviorLack of appropriate behavior

Can overlap with other barriersMore of a positivity or lack of desired behavior (e.g. not

typically inappropriate, but not greeting others at job)Little to no motivation


Consider your ClientConsider the following and write it on your paperWhat barriers to independence might be affecting

your client?What specific elements of the barrier(s) exist?


Finding the Balance


Staff Support Independence

CommunicationNever to old to start teaching/shaping

communicationLook at latency- teach to fluency (quick & correct)Use of visual supports to communicate or understandFinding means to communicate receptively Can work on articulation goals or consider teaching a

way to ask people if they understand or a way to augment communication with gestures/visuals

Technology can be very useful in facilitating all this


Self-MonitoringAspect of self-managementMark down the occurrence or not occurrence of

behaviorMay improve behavior by increasing self-focus on

behavior or aspects of one’s behavior


Target Behavior # of times

Asked someone if they needed help

1111 1111 1111 111

Self-MonitoringConsists of four steps

Choosing and defining target behavior (operational)Deciding on system of self-monitoringIdentifying reinforcementTeaching individual system of self-monitoringTeaching self-management independence

Initially you may want to consider adding a bonus and/or have individual check-in with adult

Gradually release to individual



Video Modeling (VM)VM involves watching a video demonstration and then imitating the

behavior of the model Models can be:

Self (video self-modeling) Positive self-review (PSR)

Edit video clips to show client engaging in appropriate behavior

Edit video clips to show client showing inappropriate behavior Video feedforward

takes skills client possesses and sequences them correctly takes skills client can do with prompts, and edit out the

promptsPeer, Adult, Point of View modeling (seeing through someone’s

eyes)

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Video Modeling Greetings


Video Modeling Toothbrush


Video Modeling Towels


Video Modeling POV


Integrated Work SystemsComponent of the TEACCH programVisually organized space Individuals independently practice skills that have been

previously mastered under the direct supervision of an adult.

A work system visually communicates at least four pieces of information to the client:

1. The tasks the client is supposed to do2. How much work there is to be completed3. How the client knows he/she is finished/progress4. What to do he/she is finished?


Integrated Work Systems


Integrated Work SystemsSimilar to activity schedules but…Work systems do not require matching or

sequencing skillsInstead, work systems may use a ‘‘left-to-right’’ format

where clients complete all activities placed to their left (in any order), and move them to ‘‘finished’’ location on the right

Strong emphasis of teaching concept of finished as a motivational tool

Requires well-organized and structured work space with few distractions that compete for a client’s attention.


Some Research Results


Increase in on-task behavior (including generalization not just during integrated work systems)

Decrease in adult promptingGeneralization of skills from special education to

general educationReducing latency between instruction

Strategy UseIssues of planning, problem-solving, goal settingWork on not only what but HOWStrategies to consider teaching

Goal settingProblem-solving (including what to do if 1st try fails)Self-advocacy


Time/Prompting AidsTime Timer

Visual representation of timeWith and without beepStand alone or watch

Motivaider Stand alone or clip on

Vibralite Vibrating WatchSmartphones


Motivador

Stand-alone or clip on Vibrating Can be set for intervals

(seconds or minutes)Fixed or Variable schedulesDuration and intensity of

vibration can be customized


Guidelines to Facilitate GeneralizationTeach target behavior in natural settingTrain across individualsTrain in variety of settingsQuickly shift between artificial cues and

reinforcers to natural cues and reinforcersTransition from CRF to intermittent

reinforcementIncrease delays in delivery of reinforcementReinforce generalization

(Zirpoli & Melloy, 1993)(Alberto & Troutman, 2009)

Generalization This is not an exhaustive list and there are more

strategies to considerIntroduce to Natural Maintaining ContingenciesProgram common stimuli

Including typical features of the generalization setting into the instructional setting

Teach looselyRandomly varying noncritical aspects of the

instructional setting within and across teaching sessions


(Alberto & Troutman, 2009; Cooper, Heron & Heward, 2007)

Training for GeneralizationTrain Sufficient Exemplars

General Case Programming: emphasizes using sufficient members of a class of stimuli to ensure that clients will be able to perform the task on any member of the class of stimuli

Using Multiple Settings, Teachers, and Activities: evidence that training in a variety of settings generalizes the skills taught to novel settings

Teaching the learner to respond to a subset of all of the possible stimulus & response examples then assessing the learner’s performance on untrained examples (referred to as a generalization probe)


Training for GeneralizationUse Indiscriminable Contingencies

Employ thin intermittent schedules of reinforcement

Make it difficult for the client to determine when contingencies of reinforcement are to occur.

Train to Generalize: Increase probability by reinforcing

generalization as a response class Lag schedule of reinforcement – teacher

provides reinforcement only for responses that are different from the previous response


Needs to ConsiderInadvertent prompts

Eye gazeSlight gestures (hands, head)Body language (orientation, leaning)

Over-preparing the environment (stimulus prompts)Getting everything out for individualPutting everything away for individual

Too helpful (time delays)Jumping in immediately


PromptingIn this case we are discussing prompts given after an incorrect

response is madeThis different than an Sd (usually a verbal command)When initially teaching a skill, it may be appropriate to use a

most-to-prompting strategy. With a client with prompt dependency issues, least to most is

recommendedLeast-to-Most

Written/VisualGestural (e.g. pointing)Model (show the individual what to do)Faded Physical Physical


Verbal PromptingIn general, verbal prompts should only be used when

a verbal response is required. Least-to-most

Written/VisualGestural (facial cues or expressions, tapping lips)Faded verbal first soundFaded verbal wordsVerbal prompt


Three Term ContingencyAntecedent: what happens before the behavior

Ex: teacher calls on student, demand (come here) is made, peer pushes

Behavior: ALWAYS describe in specifics (like you’re telling a blind person), only in observable termsNO: mean look YES: stared directly in other students eyes for 10

seconds with facial muscles tensedConsequence: what happens after a behavior

Ex: Student sent to office, Para says do your work, student laughs

41© BMOP 2011 www.beautifulmindsofprinceton.com

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Function of BehaviorLook at the function (why the behavior is occurring)Four main functions

AttentionEscape/AvoidanceSensoryTangible (wants to get an item)

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Competing BehaviorsBuild plan around hypothesis statementIdentify desired and alternative behaviorsWork to make behavior

Irrelevant (antecedent) Inefficient (teaching new skills)Ineffective (consequence)

A way to brainstorm strategies to address the problem behavior at different stages


Build a Competing Behavior Pathway

MaintainingConsequence

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Setting EventTriggeringAntecedent

Desired Behavior

Problem Behavior

MaintainingConsequence

ReplacementBehavior

Other ConsiderationsReinforcement- needs to be individualized and

appropriateAllow for choice-making whenever possibleConsider individual preferences when appropriateTake into account strengths and weaknessesFind a way to measure if the intervention/plan is

working. Can’t just rely on anecdotal info


ReferencesAlberto P. A, Troutman A. C. (2008) Applied behavior

analysis for teachers. 8th ed. Upper Saddle River, NJ: Prentice Hall.

Cooper J.O, Heron T.E, Heward W.L. (2007) Applied behavior analysis (2nd ed.) Upper Saddle River, NJ: Merrill/Prentice Hall.

Hume, K., Loftin, R., & Lantz, J. (2009). Increasing independence in Autism Spectrum Disorders: A review of three focused interventions. Journal of Autism and Developmental Disorders, 39, 1329-1338. Doi: 10.1007/s10803-009-0751-2


promoting independence in individuals with disabilities

Education

client bmop

independence indonesiadropped

applied behavior analysis

critical skill

professional support

group homescommunityfamiliar

supervised apartments

abilities articulationdelays