13 Elements that Influence Behavior (and should be in an IEP) Michael J. Weiss, Ph.D.

1. 13 Elements that Influence Behavior (and should be in an IEP) Michael J. Weiss, Ph.D. Director, ADA Therapy Fairfield University

2. 13 Elements that – together – influence behavior • Definitions & Data • Medical team evaluation • Relationships and finding my child’s (and my) voice • Communication • Sensory & movement issues • Multimodal channels of information • Intensity, diversity, generalization • Assume competence: offering a wide academic window • Inclusion in the world • Make plans do-able • Understand your belief-systems • Dynamic behavior (“parenting”) plan • Medical management

3. Element 1: Definitions & data: be evidence based • Have you defined the behaviors, educational and therapeutic targets of concern? • Factually note: what, where, when, who • What happened before and after events • Indicate “antecedents” and “consequences” or environmental factors • Record frequency and duration of events?

4. But, beware of “data-ists” • You know… racist, sexist, dataist…. • The “big data lie” – “there is no data…” • Beware of statements like, “the literature indicates…” • “no data” is interpreted to mean “no truth” • Concerning most therapies, what should be said is that “it hasn’t been appropriately studied yet” • Assessing issues in clinical settings is time consuming, costly, hard-to-control & contrary to providing services “right now” • That doesn’t mean intuition should be ignored • Nor, does it mean that we should NOT collect information “An absence of evidence is not evidence of absence (Dr. Carl Sagan) ”

5. Element 2: Medical team evaluations Pervasiveness of medical issues that follow our kids, i.e., Neurological, Gastrointestinal anomalies • See Tim Buie in Bauman & Kemper (2004) Neurobiology of Autism • Who is the total team that is sharing information • Neurologist, Geneticist, Endocrinologist, ENT, Urologist, Immunologist, Orthopedist, GI, Dentist, & more…. • Psychopharmocology  generally, put in place non-medical interventions of behavioral development first – use of medications should routinely “go last”

6. Element 3: Recognizing the PERSON: Finding your child’s “voice” • What does your child like to do? What do they gravitate toward? • Consider the who, what, where, when of actions in terms of “why” • go beyond the facts and make guesses about motives and desires • Yet, recognize the fallibility of guessing! • Enlist your child on his/her terms • Join in (Floor time/Relationship Development Interv.) • Offer age-appropriate options, choices & autonomy • Create therapeutic opportunities for self-expression • Have you asked the child/student/patient “why” they do what they do or how they feel about what is going on?

7. Element 4: Communication • Communication occurs ALL DAY • Not “two times 30-minutes” • Should NOT require a Speech & Language Pathologist • Training staff is the life blood of all-day communication • Total Communication systems • Verbal behavior programs • Gestures & Sign • Picture-symbol-systems • Augmentative and Alternative Communication (AAC) • Schedules, aided Language boards & use of “visuals” • MUSIC • Teaching THE ALPHABET!! • Have you given the child a means of saying what they might like to say? • “None of the above” • “More string to ‘stim’ with please” • “Drop dead you jack-ass”

8. Element 4: Communication • Discussions of feelings, thoughts, desires • Social-affective-emotional vocabulary • Social curricula with instruction in pragmatics • “Social grammar:” turn-taking, reading cues, etc. • Learn how to anticipate what others’ are saying • Learn how to interpret others’ feelings about what they are saying • Use commercially available curricula as instructional/therapeutic guide • Age-typical partners: don’t let your child’s only communication partners be adults and other children with developmental concerns • Rehearsal of social communication • Social stories • Social scripts • Video models and video self-monitoring

9. Social script rehearsal for “Maine” conversations Pam: Do you ever go skiing in the mountains? Megan: Yes, I go skiing in the mountains. Pam: What else can you do in the mountains? Megan: I can go sledding. I can go hiking up a mountain path. Pam: What else? Megan: I can climb rocks. Pam: What do mountains look like? Megan: Mountains are tall. Mountain peaks are pointed. Sometimes snow is on the mountain peak, even in the summer. Pam: When there is a lot of snow in the driveway what do you need to do? Megan: I need to shovel the snow to clear the way.

12. Element 4: Communication • Using music & reading to access speech & language

13. Element 5: Sensory & Movement realities • Recognizing autism (and a wide host of other developmental disorders) as a “sensory-movement disorder” • Consider what types of therapies influence movement regulation in others’ that share the diagnosis of ASD • Consider other forms of movement disorders (i.e., issues related to cerebellum or basal ganglia; Parkinson’s; stroke patients, etc.) and what therapies help these individuals

14. The Neurobiology of Movement Disorders & Autism (Bauman, 2008; Bauman & Kemper, 2005; Courchesne & Allen, 1997; Hollander, et al., 2005) • The embryological early anomalies to effect development: • Brainstem/Inferior Olive • Cranial nerve development • Somatosensory information • Cerebellum • Regulates all movement • Regulates sensory processes • Motor, language & cognitive planning, sequencing, timing & organization • Basal Ganglia • Enlarged aspects (right caudate/total putamen volume) correlates with uncontrolled or perseverative movement

18. Autism is a movement disorder! What might they have in common? • Correlations among aberrant movement patterns in: • Speech • Ballistic/Aberrant & repetitive movements • Throwing • Grasp/hand use • Lip Closure • Gait • Reaching/Crossing midline • Kneeling & standing • Disassociation of movement of different body parts • Difficulties in core strength, idiosyncratic weakness and/or hypotonia • Balance and coordination dysregulation • Cerebellum and Basal Ganglia regulation?

19. Element 5: Sensory & Movement realities • Recognizing environmental “contributions” (“noise” in any sensory modality) • Again, therapies are ALL DAY • “Sensory Diets”: managing arousal cycles • Oral-motor programming and daily carry-over • Real movement opportunities • Movement/expressive therapies (music/dance/art) • Break-a-sweat exercise • Use “incidental” exercise: sitting on a stool • Organize when movement is and is not encouraged

20. Element 6: Considering multimodal channels of information • Which modalities of taking in information goes with the least distress (seeing, hearing, touching??) • How to systematically combine modalities: • Play with modalities one at a time • Systematically add, subtract, mix modalities • Use behavior as an index of too many or too few? • Most common “good combination?” • Use visual information more • Talk at children less • Incorporation of touch that suits the child

21. Element 7: Understanding Intensity, diversity & generalization strategies • Intensity means: • hundreds of repetitions daily to further responsiveness • long periods of time dedicated • “early intervention” for 3-hours/week exemplifies “non-intensity” • Diversity of experiences effects attention • Moderate novelty in activities associated with alerting • Redundancy is associated with inattention (i.e., habituation) • Teach with intensity and diversity promotes generalization – systematically put in long hours with several differing: • Ways of presenting materials • People • Locations • Orders of activities • Repetition of activities through the day (rather than all at once)

22. Intensity-diversity-generalization of exposure to curricula • Communication systems are an all day requirement • Assistive technologies are omnipresent (verbal behavior; aided language boards; software; communication devices; picture-symbol systems) • Expansion into the “personal world” of interest-reality themes • Expansion into the social world (social scripts; social stories; functionality in the real world) • Table-top activities in support of real-world activities (how instruction traverses different methodologies) • Taught through diverse medium/methods (i.e., learning to read music) • Taught in a generalized manner; learned for generalize application

23. Element 8: Assuming competence: offering the dignity of age-appropriate curricula • The “retardation assumption” • Performance is a measure of competence? Ask a person diagnosed with Cerebral Palsy if they agree • Work at the child’s “developmental level?” Which is….? Fallacy of IQ or Developmental Quotients as global indicators • Discussions that the child can hear (but, shouldn’t) “stick of furniture” phenomenon • Assuming high level of performance is a “splinter skill” or an “odd” behavior is the death of developing person-specific abilities/skills

24. Element 8: Assuming competence: offering the dignity of age-appropriate interactions and curricula So…what should be our guide? • Have a great teacher as one of our guides! • Do use a tracking device (i.e., Activities of Basic Learning & Language Scales (ABLLS)) or other measurable data systems • Avoid “linear programming” and “mastery criteria” as only mechanism of change • Select a developmentally “wide window” of activities concurrently • Vary extent of supports v. level of independence as a function of task complexity, i.e., high-level activity with “errorless” supports • Select activities that lend themselves to age appropriate modifications • What is an age-appropriate version of the child’s obsessions or preoccupations?

26. iPad Apps worth knowing about Examples of APPs relevant to AAC: • First-Then • Click & talk • Sounding Board • Grace • WordPower 24 • iCommunicate • Pictello • OneVoice • Proloquo2go Speech/Articulation • A, B, C Phonics • ArtikPix • PhonopixFull • Articulate It • Smart Oral Motor • VAST Autism 1 – Core • “Talking” Tom & Friends Literacy/Verbal Communication • First Words Deluxe • Read & Write • VAST Autism 1 – Core • “Builder” Apps (Language, Sentence, Story or Question Builder) • Miss Spider’s Tea party • Read & Write, Letters, Sounds & Combinations • Word Slapps • Fun Farm Patterning • Logic • Shape-O! • AlphaWriter • Sight Words • Fill the Gap • AssistiveChat • Speech with Milo Prepositions/Verbs • Spark! HD: Spark Story Starters • All of the Dr. Seuss books

27. iPad Apps worth knowing about Occupational Therapy • 1, 2, 3, Color HD • A Bee Sees • Alphabet Tracing • iWriteWords • Talking Gina the Giraffe • Katy Perry • Labyrinth 2 • Marble Mixer • Pattern Search • Tangrams • Tozzle • Dexteria Executive Function and Analytical Skills: • Little Things • Quibble kids • Pattern Search • My first Slider • Hanoi • Build a train • Cover Orange • Playtime Theatre

28. Simple Sentence Structure EER: Plurals EER: Prepositions First Categories Adjectives & Opposites Words & Concepts II Words & Concepts III Concentrate! I Follow Directions: 1 & 2 Level Commands Micro-LADS 3: Prepositions Micro-LADS 4: Pronouns Micro-LADS 7: Prepositions II Sentence Master 1, 2, & 3 Number Maze Dollars and Cents Picture Sentence Key 1 Picture Sentence Key 2 Pix Writer Clicker 5 First Keys to Literacy All My Words Write: Out Loud Simon Sounds It Out 2 Visual Voice Typing Quick and Easy Black Beauty Element 8: Assuming competence: offering the dignity of age-appropriate curriculaAcademic computer software offering a “wide window” of intellectual opportunity (without the “social distractions”)

29. Software companies that you should know about • Don Johnston • Laureate Learning Systems • Crick Software

30. Element 9: “Inclusion” in the world • Real relationships: friends, loved ones and being a legitimate member of our community • Modeling and “regression toward the mean” • Organizing and generalizing our day-to-day conduct – don’t avoid going out • Catch-22 irony: why aren’t our kids included? Usually related to complicated behavior. Why is behavior complicated? Partly because we aren’t included in the world. • Going out IS HARD TO DO! • Promoting behavior in the world? Don’t want to “make a scene”

31. Element 10: Make plans Do-able • Figuring out how much you can realistically do • “Prep time” for all involved • REAL training and consultation of teaching staff and family (not “15-minutes per week consult”) • Team meeting opportunities • Formalizing fun time together • Formalizing fun time apart • Getting a babysitter • In-home services • Insistence on sufficient staffing

32. Element 11: Beliefs about childrearing and my child • Wanting change is not mutually exclusive with accepting people for who they are • People diagnosed with a developmental difference are still children, adolescents, adults • Interact with each individual according to both developmental status and chronological age • Yet, at no point across development is harming yourself or others acceptable behavior • Beliefs about competence translates into levels of expectations • Expectations establish comfort zone for what we will insist of our children • Young man in Westport, CT diagnosed with Asperger’s who drives himself to University • “I (teacher/parent/therapist) am entitled to respect and deference from my child/student/client, just as I owe them respect and deference”

33. Element 12: A flexible & dynamic behavior (“parenting”) plan • Predicated on concepts from the study of social development (i.e., children benefit from “authoritative” parenting), not from animal models of learning • Children do well in a climate combining unconditional love & support, with high standards & expectations • Understanding basic principals of Operant Theory is extremely useful in understanding how you are parenting/teaching a child • Know the definition of (i) positive reinforcement; (ii) negative reinforcement; (iii) punishment; & (iv) extinction • Principal focus of contingencies should revolve around “self-determination” (or the restrictions there of) • “Naturally occurring” consequences of doing what you want if you are comporting yourself appropriately… or not.

34. Element 13: Data-driven medical management • Going in “the right order”: points 1 through 12 above go first whenever possible • Obvious medical exceptions i.e., seizure activity, medical illness, disease, conditions, etc. (see point #2)) • Find a physician who: (i) you like!; (ii) returns your phone calls; (iii) is data driven; (iv) who asks about the educational/therapeutic programs; (v) is willing to try a diverse set of approaches • Back to point #1: define what you are doing and collect data • Be able to define what you are treating • If medical treatment isn’t working… CHANGE OR STOP!! • Identify “blind evaluators” in the data collection process

35. Proactive elements that influence PEACE • Definitions & Data • Medical team evaluation • Relationships and finding my child’s (and my) voice • Communication • Sensory & movement issues • Multimodal channels of information • Intensity, diversity, generalization • Assume competence: offering a wide academic window • Inclusion in the world • Make plans do-able • Understand your belief-systems • Dynamic behavior (“parenting”) plan • Medical management