Starting Strong 2015Understanding Autism Spectrum Disorders and An Introduction to Applied Behavior Analysis

Robin Talley, M.Ed., BCBAUW Autism Center

Presentation Overview

• Overview of Autism Spectrum Disorders (ASD) and How Symptoms Manifest

• Diagnostic Criteria of Autism Spectrum Disorders

• Introduction to Applied Behavior Analysis

• Components of a Teaching Loop

AUTISM SPECTRUM DISORDERS

Autism Spectrum Disorder (ASD)• ASD is a neurodevelopmental

disorder1

• The collection of symptoms vary from individual to individual2

• Prevalence: 1 in 68; 1 in 42 boys to 1 in 189 girls

• Prevalence ranges from 1 in 175 in Alabama to 1 in 45 in New Jersey

• Infants with an older sibling with a diagnosis of ASD, are at an elevated risk for ASD and ASD symptoms

http://www.cdc.gov/ncbddd/autism/index.html1 DSM-V, 2013; 2 Siegel, 1996

DSM-IV to DSM-5Core Areas of Impairment

Qualitative Impairment

in Social Interaction

Qualitative Impairments in Communication

Restricted, Repetitive and

Stereotyped Patterns of Behavior

Persistent Deficits in Social Communication

and Social Interaction

Restricted, Repetitive Patterns of Behavior

Social Communication/Social Interaction

• Deficits in social-emotional reciprocity• Atypical social approach

• Difficulty in back-and-forth conversation

• Reduced sharing of interests, emotions or affect

• Difficulty initiating or responding to social interactions

• Deficits in nonverbal communicative behaviors• Poorly integrated verbal and non-verbal

communication

• Differences in eye contact and body language

• Deficits in understanding and use of gestures

• Lack of or reduced facial expressions and nonverbal communicationDSM-V, 2013

Social Communication/Social Interaction

• Deficits in developing, maintaining and understanding relationships

• Difficulties adjusting behavior to suit various social contexts

• Difficulties in making friends

• Reduced interest in peers

DSM-V, 2013

Restricted/Repetitive Patterns of Behavior

• Stereotyped or repetitive motor movements, use of objects or speech• Repetitive motor movements

• Lining up toys or flipping objects

• Echolalia

• Scripted words or phrases

• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior • Extreme distress at small changes

• Difficulties with transitions

• Rigid thinking patterns

• Greeting rituals

• Need to take same route or eat same food every dayDSM-V, 2013

Restricted/Repetitive Patterns of Behavior

• Highly restricted, fixated interests that are abnormal in intensity or focus

• Strong attachment to or preoccupation with unusual objects

• Unusual interests or interests of extreme intensity

• Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment

• Apparent indifference to pain/temperature

• Adverse response to specific sounds or textures

• Excessive smelling or touching of objects

• Visual fascination with lights or movement

DSM-V, 2013

Behaviors Observed

Symptoms of ASD

Adapted from Division TEACCH; University of North Carolina at Chapel Hill

Understanding Individuals with ASD

Adapted from Division TEACCH; University of North Carolina at Chapel Hill

Understanding Individuals with ASD

• Reduced sharing of interests, emotions or affect

• Difficulty initiating or responding to social interactions

• Differences in eye contact and body language• Deficits in understanding and use of non-verbal

communication

• Does not engage in typical play with peers• Ignores others when greeted• Looks away when someone is talking to him• Stands too close to others in line

Behaviors Observed

Symptoms of ASD

Adapted from Division TEACCH; University of North Carolina at Chapel Hill

Understanding Individuals with ASD

• Difficulties adjusting behavior to suit various social contexts

• Extreme distress at small changes• Difficulties with transitions

• Speaks too loud at inappropriate times• Has a meltdown when mom drives to school

a different way than usual• Does not want to move from one activity to

the next, resulting in challenging behaviors

Behaviors Observed

Symptoms of ASD

1. Group Activity: How does autism impact participation?

• Consider how the characteristics of ASD impact an individual's participation in one of the following activities and how this behavior could be misinterpreted

1. Making a choice in the lunch line

2. Riding on the bus with peers

3. “Hangin” on the playground

4. A situation that you are experiencing with your student/son/daughter

• Be prepared to share

DIAGNOSIS OF ASD

What is important about an ASD diagnostic evaluation?

• Clarify individual’s behavioral and developmental difficulties

• Psycho-education about Autism Spectrum Disorders (ASD)

• Access to services

• Information about next steps (e.g., treatment recommendations)

• board eligible neurologists (M.D.),

• board eligible psychiatrists (M.D.),

• licensed psychologists(Ph.D., Psy.D.),

• board certified developmental and behavioral pediatricians (M.D.)

• Medical diagnosis of ASD

• Special education eligibility as a student with autism

Who can diagnose ASD in Washington State?

Screening vs. Diagnosis

• Screener Tools:

• Modified Checklist for Autism in Toddlers (M-CHAT-R)

• Screening Tool for Autism (STAT)

• Where and when are they given?

• When is a referral for a full evaluation needed?

A positive screener does NOT guarantee an ASD diagnosis!

An ASD evaluation does NOTautomatically = ASD diagnosis

Interdisciplinary vs. Multi-Disciplinary vs.

Single Discipline ASD Evaluations

• Single Discipline – one type of professional conducts the diagnostic evaluation

• Multi-Disciplinary – more than one type of professional doing evaluations, not necessarily contributing to one diagnostic formulation

• Inter-disciplinary – more than one type of professional (for example, Psychologist, Neurologist, Speech Language Pathologist) involved in the diagnostic process

UWAC Clinic Diagnostic Evaluation Model

• Four sessions• Intake interview

• Two assessment sessions

• Feedback session

• Use of multiple respondents, standardized assessments, observational data, and review of school and medical records

• Final written report and follow-up call to review results and next steps

INTERVENTIONS FOR ASD

Overview of Interventions

• Autism Speaks – 100 Day Toolkit

• Description of treatment for ASD

• https://www.autismspeaks.org/sites/default/files/docs/treatment.pdf

Evidence-Based Practices

• National Standards Project, Phase 2 (2015)

• http://www.nationalautismcenter.org/national-standards-project/results-reports/

• Evidence-based practices for individuals with autism across the lifespan that include ABA-based intervention strategies (ages 0-22+ years)

• Behavioral interventions: ages 3-22+ years

• Comprehensive Behavioral Treatment for Young Children: ages 0-9 years

APPLIED BEHAVIOR ANALYSIS

Applied Behavior Analysis (ABA)

The science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for behavior change

What is Applied Behavior Analysis?

• Scientific approach to understanding behavior and how it is affected by the environment

• The use of behavior analytic methods and research findings to change socially important behaviors in meaningful ways

• Consumer confusion…

Cooper, J. O., Heron, T. E., and Heward, W. L. (2006). Applied behavior analysis (2nd ed.)

The “Umbrella” of ABA

Discrete Trial Training

Reciprocal Imitation Training

Incidental Teaching

Pivotal Response Training

Early Start Denver Model

C

Consequence

Events that occur

immediately AFTER the

behavior

Can increase or

decrease the likelihood

that the person will

display the behavior

again

B

Behavior

*Wolery, M., Bailey, D.B., & Sugai, G.M. (1988). Effective teaching: Principles and procedures of applied behavior

analysis with exceptional students. Boston, MA: Allyn and Bacon, Inc.

Events that occur

immediately BEFORE

the behavior

Can be altered to

increase or decrease

the occurrence of the

behavior

Response to the

things and events

around us at any

given time.

A-B-C Model of Behavior

A

Antecedent

ABA Program Features

• A-B-C model of behavior• Comprehensive or specific programs• Blend of teaching strategies (DTT and naturalistic)• Individualized• Intensive

• Repeated practice• Embedded learning opportunities• Quality of learning trials

• Data-driven decisions• Builds on the child's interests and actively engages the child• Teaches tasks as a series of simple steps• Use of reinforcement to teach new behaviors• Generalization of skills targeted

National Research Council (2001). Educating Children with Autism.

BasicABA

Outcomes

Increase desirable

behaviors

Decrease undesirable

behaviors

Teach new skills

Promote generalization of

skills

TEACHING LOOP

Teaching Loop

A

B

C

Prompt(if necessary)

Prompt(if necessary)

Cue

Behavior

Feedback

Teaching Loop

Target Behavior

Request bubbles by giving paired with eye contact

Cue Bubbles with lid closed tightly

Prompt None

Behavior Give bubbles paired with eye contact

Feedback Blow bubbles

Incorrect Teaching Loop

Target Behavior

Receptive color identification

Cue “Can you give me red?”

Prompt Gesture (tap card)

Response Shakes head “no” and picks up orange card

Feedback None, continues to give cue

Teaching Loop: Cue

Cue

Prompt

(if necessary)

Behavior

Feedback

• Also called instruction, antecedent, or SD

• Lets the child know when to respond (question, command, presence of a peer, bell ringing)

• Remember…it’s not always a verbal instruction

Cue: Things to Remember

• Must be clear and concise

• Consistent instructions should be used across team members

• Avoid repeating instructions

• Follow through with every cue given…modifying is okay

• Use cue/instruction that is familiar to the child

• Be sure that the child is interested in the materials being used

Teaching Loop: Prompt

Cue

Prompt

(if necessary)

Behavior

Feedback

• Something that occurs before the response and increases the likelihood of a correct response

• Prompt prior to a response minimizes errors

Types of Prompts

• Physical (Full and Partial): When teaching clapping, adult brings the child's hands together and claps or brings them close together and lets the child complete the action

• Verbal: When teaching expressive label “cup” Adult asks “what is it?” “cup”, “c…”

• Gestural: When teaching functions of objects “what do you drink with?”, Adult holds his/her hand to his/her mouth shaping it like a cup

• Model: Adult models the whole/partial action of clapping while teaching the receptive instruction “ clap hands”

• Visual: When teaching receptive instruction “clap hands”, picture of someone clapping is shown in addition to the auditory direction

Why Prompt?

• To reward child

• To minimize errors

• Frequent errors:

• Tend to be repeated

• Decrease opportunities for praise or positive feedback

• May impact motivation

• Lead to challenging behaviors

Prompt Fading

Target Behavior

Asking a social question

*Any prompt added must be faded

Prompt FadingTarget Behavior

Request “swing” by putting planet in Dad’s hand

Trial #1 Gesture (hand) = PROBE SKILL

Trial #2 Full physical (sit)Full physical (give)Gesture (hand)

Trial #3 Full physical (sit)Partial physical (give)Gesture (hand)

Trial #4 Full physical (sit)Proximity/Environmental (give)Gesture (hand)

Trial #5 Environmental

Prompt: Things to Remember

• Plan ahead for how prompts will be used

• Use the least amount of prompting necessary to ensure a correct response – Goldilocks Rule

• Only give an instruction if you know you can prompt the child to complete the task

• A prompt is only considered effective if it results in the child’s correct response

Teaching Loop: Behavior

Cue

Prompt

(if necessary)

Behavior

Feedback

• Demonstrated by the child

• Result of given cue

• Allow time for the student to respond

Teaching Loop: Feedback

Cue

Prompt

(if necessary)

Behavior

Feedback

• Also called consequence

• Follows any response given by the child

• Provides feedback to the child regarding the response

Types of Feedback

• Correct response = reinforcement

• Positive reinforcement

• Negative reinforcement

• Incorrect response = corrective feedback

• “Try again”

• “I didn’t hear you”

• “No”

Feedback: Things to Remember

• Reinforce frequently when first teaching a skill

• Follow the “Goldilocks rule” to determine the right amount of reinforcement to give following a behavior

• Reinforcers should be paired with social praise

• Use behavior specific praise, let the child know what they did correctly

• If you can’t identify a reinforcer…there should be NO instruction

Questions??

Robin Talley: rtalley@uw.edu