Autism Spectrum Disorders: Strategies and Interventions

1. Autism Spectrum Disorders: Strategies and Interventions Adrianne Da Silva, M.A. Erin Milhem

2. Cognitive Deficits • Executive Functioning • Storage and Retrieval of Information of salient information • Processing Speed • Discrepancies between verbal and nonverbal reasoning skills • Abstract thinking and inferencing

3. Executive Functioning • What is it? • An umbrella term that includes a collection of related functions that are responsible for goal- directed and problem solving behavior.

4. Executive Functioning • The invisible disability

5. Inhibit Inability to stop behaviors or impulses • Blurting out answers before being called on • Difficulty taking turns • Careless mistakes in schoolwork • Distraction from task at hand • Beginning task without listening to full instructions • Answering questions without thinking the question through • Difficulty following rules • Lack of personal safety and space

6. Shift/Cognitive Flexibility Difficulty changing from one activity to another • Make transitions • Problem solve flexibly • Switch attention • Change focus from one topic to another

7. Initiate Difficulties with starting a task, activity, and independently generating ideas, response, or problem solving strategies. • Want to succeed at tasks but trouble getting started • Need lots of prompts to begin • Overwhelmed by large assignments

8. Working Memory Problems with holding information in the mind for purpose of completing tasks. Trouble remembering things Losing track of what they are doing Difficulty following directions

9. Plan/Organize Difficulty with managing current and future tasks. Anticipate future events Set goals, and develop steps to carry out. Sequencing a series of steps Finishing Tasks Getting lost in the details Difficulty sorting and classifying information from the concrete to the conceptual level.

10. Organization of Materials Problems organizing personal space. • Messy desks, backpacks, bedrooms, lockers, etc. • Trouble cleaning up after self • Keeping track of possessions

11. Monitor Problems with personal monitoring. • Rushing through work • Careless mistakes • Failing to check work • Failure to notice if things bother other people • Tracking and modifying behaviors and mood states

12. Emotion Regulation Ability to identify, monitor, and inhibit emotional responses and implement appropriate coping strategies • Emotional outbursts • Yelling, screaming, swearing • Tantrums, Meltdowns, and Rages • Physical Aggression and property destruction • Low Frustration Tolerance • Depression and withdrawal • Inability to implement appropriate coping strategies

13. Common Triggers • Losing a game • Changes in routine • When other students don’t follow the rules • When he or she doesn’t get his/her own way • When the student gets excited and can’t wind down • Misunderstanding directions • Thinking that their work is not as good as another student

14. Deficits that can contribute to Difficulty with Emotion Regulation • Difficulty communicating • Social difficulties • Motor challenges • Cognitive challenges • Neuropsychological factors (hyperactivity, hypo-activity)

15. Why is emotion regulation important ? • Extreme positive and negative emotions can effect: • Communication • Attention • Problem Solving

16. Skills Required for Successful ER • Awareness of emotions • Read and interpret nonverbal expressions of emotions • Ability to understand and monitor emotional triggers • Clearly and appropriately express the emotion • Regulate the intensity and timing of the expressed emotion

17. Steps for Independent emotion regulation • Recognizing the “rumbling” – early warnings signs that the student is starting to escalate • Making plans for coping with emotional events or triggers • Implementing the plan in an appropriate manner

18. Recognizing the “Rumbling” • As the teacher begin to recognize the signs that the student is beginning to escalate • Increased pacing • Increased talking or noise making • Silly or goofy behaviors • restlessness • At first, we may have to recognize for them and help them choose a calming strategy • Begin teaching the students how to notice their signs

19. Teaching the Skill • Make it as concrete as possible • Write it down – make it visual • Often children need to be taught that there are degrees of emotions • Can be represented with a thermometer or a scale • Coordinate with home plans!

20. The Incredible 5 Point Scale • Helps individuals rate the emotional state • 1 – I am happy and calm • 2 – I am a little upset • 3 – I am definitely upset • 4 – I’m feel like I getting to the point when I can not control my behavior • 5 – I’m unable to control my behavior

21. Types of Emotion Regulation Strategies • Behavioral Strategies • motor actions • sensory motor strategies • Language Strategies • Self talk • Picture communication devices • Advanced Strategies • Problem solving • Self reflection • Perspective taking

22. The Emotional Toolbox (Attwood, 2004) Helps students identify tools to use that can help “fix” certain feelings Physical Tools Relaxation Tools Thinking Tools Social Tools

23. Physical Tools • Going for a walk or run • Playing wall ball • Ride a bike • Play an instrument • Play a sport • Stretching

24. Relaxation Tools • Drawing • Reading • Listening to music • Finding a quiet safe place • Organizing • Using fidget items

25. Thinking Tools • Using self-talk (“things will be ok” “it will go better next time” ) • Create a personal antidote that can encourage positive thoughts – write it down – (I can ask for help) • Help put the event in perspective for the student • Have the student engage in academic work that he or she excels in

26. Teach and Practice Skills • Start out with NEUTRAL situations • Role play • Social stories • Video modeling • Develop situations to practice skills – warn the student ahead of time

27. Reinforce the Use of Appropriate Strategies • Reinforce in both practice and real life situations • When approaching a high probability situation, rehearse with the student and remind about reinforcer • Reinforce immediately • Use behavior specific praise, emphasizing language you are teaching the student

28. Interventions

29. Response InhibitionEnvironmental modifications Increase external controls, restrict access to settings or situations in which the child can get in trouble or distracted. Provide external structure by teaching rules that can be applied and generalized to a variety of situations. Increase supervision/physical proximity and offer support to bolster the “stop” function. Implement ways to cue when to control impulses. Dawson & Guare, 2010

30. Response InhibitionTeaching the Skill • Walk the child through the process, having them practice the skills using a contrived situation, teaching example, or visual aides. • Teach alternative to negative behaviors. • Reinforce the child immediately for using the skill • Teach them repair strategies • Work with the child on identifying the skill being addressed and your understanding of the intent of the behavior. • Dawson & Guare, 2010

31. Shifting/Cognitive Flexibility Environmental modifications • Create a consistent, predictable environment as much as possible. • Create Visual Cues for routines and schedules. • Highlight changes to the routine and help the child build a bridge from the familiar to the unfamiliar. • Allow additional time to adjust to changes in routine • Provide additional support during transitions. • Provide external reinforcers

32. Shifting/Cognitive Flexibility Teaching the Skills • Teach the child to walk through new situations. This includes self-talk (e.g. “this is different but doesn’t mean it is bad). • How/when to ask for help. • Teach to use a calendar/schedule • Model multiple ways of approaching a task or situation • Teaching ways to self reinforce • Meltzer, 2007

33. Initiation • Provide external structure in the form of general guidelines, cues, and support • Develop schedules and routines. • Use technology • Begin task with the child • Reward completion of tasks • Small groups or peer work • Self-understanding/Reflection • Meltzer, 2010

34. Working Memory Visual schedules and check in with schedule throughout the day Verbal cues or prompting Timers Work boxes Develop structured systems for organization (i.e. worksheets, checklists, etc.) Written and verbal reminders Environmental Modifications • Meltzer, 2010

35. Working Memory Teaching the Skills • How to attend to details • Repetition, rehearsal, and review • Attaching meaning • Editing/Chunking information • Meltzer, 2010 • Dawson & Guare, 2010

36. Plan/Organizing Provide a plan or schedule Break projects into clearly defined subtasks and attach deadlines to each subtask Avoid asking opening ended questions or random questions in class or group setting Create a templates Offer examples of previously finished projects Environmental Modifications. • Dawson & Guare, 2010

37. Planning/Organizing Teaching the Skill • Developing an accurate understand of time • Strategy notebooks • Ability to assess and breakdown tasks • Prioritizing Tasks • Obligation • Aspiration • Negotiation • Monitoring Progress • Meltzer, 2010

38. Organization of materials • Help develop a system for organizing a backpack • System for organizing schoolwork and homework • Coming up with a system for organizing room • Work to help child understand the negative and positive consequence of material management

39. Physical Structure • Clear physical and visual boundaries. • Boundaries help to understand where each area begins and ends. • Boundaries help establish context and segments the environment. • Minimize visual and auditory distractions. • Establish behavioral expectations

40. Routines • Use the need for routine in a positive way by teaching and building productive and functional routines that individual’s with ASD will use now and in the future • Characteristics: generalizes, go throughout the lifespan, promotes independence.

41. Routines • First work, then play. • Concept of finished. • Top to bottom. • Left to right. • Check schedule. • Follow directions / instructions.

42. Schedules / Transition Systems • Visually communicates what activities will occur and in what sequence. • The concrete reference to the schedule helps promote flexibility. • Individualized at the individuals most independent level of understanding. • Needs to be used by the individual.

43. Schedule / Transition Systems • Assess visual level of understanding (functional vs. representational objects, pictures, photos, words, etc..). • Assess an amount of visual information to be used in schedule (one at a time, part day, full day, etc..). • Select a process for using the schedule (how to sequence and concept of finished).

44. Work Systems • Gives the individual 4 pieces of information in a visual format: • What work/activity? • How much work/activity? • When finished? • What’s next? – reinforcement • Cause / effect

45. Work Systems • Identify: • Types of routines - left to right, top to bottom. • Symbols to be used - letters, numbers, color, written, etc.. • Concept of finished – box, shelf, drawer, file folder, etc… • Reward or motivator.

46. Visual Structure • Visually communicates information on how to complete the activity or direction. • Helps to combine and organize a series of elements to obtain a desired outcome.

47. Visual Structure • Teaches flexibility. • Promotes generalization of skills. • Promotes meaningfulness within activities. • Examples: objects; pictures; written instructions; jigs; product samples, etc.. • Visually communicates information on how to complete the activity or direction. • Helps to combine and organize a series of elements to obtain a desired outcome.

48. Visual Structure

49. The 5 Point Scale

50. How Does Your Engine Run • System for monitoring arousal levels in young children • High • Just right • Low