Autism and Deafness Best Practices

1. Autism and DeafnessBest Practices Katie Nunn

2. 1 out of 150 will be diagnosed with Autism. • http://www.autism-society.org/site/PageServer?pagename=FactsStats

3. Autism and Deafness • Autism has no single cause and no known cause • There is no data about the number of children with autism and deafness

4. Diagnosing Autism Evaluations and Testing • While there is no one behavioral or communication test that can detect autism, there are screening checklists that are now used. • Autism Treatment Evaluation Checklist (ATEC) Internet Scoring Program, • Childhood Autism Rating Scale (CARS), • Childhood Autism Test (CHAT), • Most of these test are done by a physician, psychologist, psychiatrist and the parents • http://www.autismeducation.net/diagnosing.htm

5. Autism Treatment Evaluation Checklist (ATEC) Internet Scoring Program • This checklist was designed to help parents, researchers, and physicians determine if a specific kind of treatment is being successful for the child. • 1 page document, free, can download online, rating scale, can be scored on the internet • http://www.autism.com/ari/atec/atec-online.htm

6. Child Autism Rating Scale (CARS) • This test was designed to help differentiate between autism and other cognitive impairments. • The test helps to identify and diagnose autism in individuals ages 3 through 22 years and to estimate the severity of the disorder • Combines parent reports and direct observation by the professional • The child is rated, a final score can indicate, non autistic, mild to moderately autistic, or severely autistic. • The scale is used to observe 15 items, relationship to people, imitation, emotional response, body use, object use, adaptation to change, visual response, listening response, taste-smell-touch response and use, fear and nervousness, verbal communication, non-verbal communication, activity level, level and consistency of intellectual response, and general impressions. • This scale can be completed by a clinician or teacher or parent, based on observations of the child's behavior. • http://www.autism-world.com/index.php/2007/03/27/childhood-autism-rating-scalecars/

7. CHAT • The CHAT is a screening tool developed for pediatricians to use at the 18-month checkup for children. • Clinicians complete 5 items based on observation and ask parents to answer yes/no to an additional 9 items. Each section takes an average of 5 minutes to complete. • If a child fails, they should be given another CHAT a month later

8. Intervention Strategies for Behavior Modification

9. Applied Behavioral Analysis (ABA) • What is it: a systematic approach to the assessment and evaluation of behavior, and the application of interventions that alter behavior. • Goal: To evaluate and modify one’s behavior in ways such as: • teach new skills • generalize or to transfer behavior from one situation to another (e.g., from communicating with caregivers in the home, to interacting with classmates at school); • modify conditions under which interfering behaviors occur (e.g., changing the learning environment so as to foster attention to the instructor); • reduce inappropriate behaviors (e.g., self injury or stereotypy). • http://www.centerforautism.com/aba/whatisaba.asp

10. Example of ABA… • Andy, a mainstreamed 1st grader diagnosed with hearing loss and PDD tendencies, would constantly raise his hands straight up into the air. This caused negative attention towards him from his peers. Andy raised his hands as a self- stimulating activity. The teacher evaluated his behavior and then created an intervention where she would touch Andy’s arms and tell him to put his hands down when he raised them inappropriately. Within 7 days Andy’s targeted behavior began to decline. The teacher decided to change the intervention to make it semiprivate. She gave Andy a meaningful look when she wanted the target behavior to stop. Andy’s target behavior continued to decline. Within 13 days of the intervention taking place Andy’s behavior had been modified. This target behavior was no longer a distraction for Andy and his classmates. • Easterbrooks, S, & Handley, C.M. (2005-06). Behavior Change in A Student with a Dual Diagnosis of Deafness and Pervasive Developmental Disorder: A Case Study. American Annuals of the Deaf. 150, 401-407.

11. Sensory Integration Therapy • What is it: A type of therapy that focuses on improving abilities to take in sensory information and process the information productively. • Goal: Sensory integration therapy is designed to help the child develop more appropriate sensory input processing and responses and lessen self- stimulating behaviors or other sensory related awkward behaviors. • http://autism.healingthresholds.com/glossary#term1890

12. Example of Sensory Integration (SI) Therapy • During sensory integration therapy, the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory input with motion. Examples of such activities include: • swinging in a hammock (movement through space); • dancing to music (sound); • playing in boxes filled with beans (touch); • crawling through tunnels (touch and movement through space); • hitting swinging balls (eye-hand coordination); and • balancing on a beam (balance). • http://autism.healingthresholds.com/therapy/sensory-integration

13. Intervention Strategies to Promote Language

14. PECS • What is it: PECS: Picture Exchange Communication System • Picture boards, cue cards, photos, drawings • All of this can be used to help a child communicate effectively and easily • Inexpensive • Appropriate for all ages • Easily used in many different locations (school, home) • Can be taught with little training to family and other care givers • However, may be cumbersome to transport multiple pictures to various locations (ex. Vacation, forgot to bring hamburger picture! ) • http://www.pyramidproducts.com/PicsforPECS2008Sample.pdf • Goal: to help nonverbal children or children with language difficulties to access communication

15. PECS: Stepping Stones • Start with wants and needs • Cookie, bathroom • Build up to sentences • I want a hamburger. • Questions and answers • Do you like milk? • No, I do not like milk.

16. Example of PECS • Johnny wants the fish crackers. He is trying to pull them off the counter. The teacher sees this and walks over. Johnny looks at the teacher. The teacher waits 30 sec. The child does not respond. “Johnny, what do you want?” the teacher asks. Johnny points to the crackers. “What is that?” The child still does not respond. “Johnny, you want the orange fish crackers? Go get your picture off your board.” If the child does not do this, get the PECS picture of the fish crackers off the velcro board. Have the fish crackers in one hand and the PECS picture in the other. Place the PECS picture in the hands of the student. Tell the student to give the PECS picture back and then they will get the crackers. If the student is unable to do this, model it with another adult. Once the student has given you the PECS picture immediately reward them with the crackers and praise the child. “Good job. You wanted the orange fish crackers and you gave me the card. Now you have the crackers.”

17. Floor Time • What is it: A technique designed to help a child address their developmental challenges in a child centered way • Goal: To strengthen a child’s cognitive, emotional, social, and physical development with an emphasis on two way communication, expression of feelings, and develop of logical thought. • It comes from the DIR Model: Developmental, Individual Difference, Relationship-based approach. There are six developmental levels. These stages are:1. Self-regulation and interest in the world (3+ months)2. Forming relationships, attachment and engagement (intimacy) (5+ months)3. Two-Way Communication (9+ months)4. Complex Communication (12-18+ months)5. Emotional Ideas (24-30+ months)6. Emotional Thinking (34+ months)

18. What it looks like… • 2-3 objectives can be worked on at a time • Caregiver uses a calm voice or signer uses exaggerated signs in a slow, flow like way with gentle looks • Follow the child’s lead • No direct instruction • Use Floor Time as a daily activity • Toys and other activities can be used to encourage interaction • Length of play will increase as appropriate

19. Example of Floor Time • A caregiver and a 9 month old are sitting on a blanket on the floor. The baby reaches for a toy. The child can not get the toy. The caregiver says, “Do you want the toy? Can you reach the toy?” The child slaps his hands on his legs and begins to babble, but does not reach for the toy. The caregiver moves the toy closer to the child. “Do you want the toy still? Are you going to reach for the toy?” The child touches the toy but does not pick it up. The caregiver picks up the toy and places it in the eyesight of the baby. “Do you want to play with this toy? I do you want to see what the toy can do?” The caregiver pushes the toy and the toy begins to light up. The child is interested and reaches for the toy. “Do you know what the toy can do? The toy can light up. Can you push the button on the toy?” The baby babbles some more and puts the toy in their mouth. The caregiver pulls the toy out and places it on the blanket. The baby reaches for it again and while doing so pushes the button and the toy lights up. “Very good! You made the toy light up. Can you do that again?” The toy is placed on the blanket and the baby reaches for it and touches the button. The caregiver gives praise to the child and the child slaps his hands on his legs and smiles.

20. Incidental Teaching… • What is it: Provides structured learning experiences in everyday activities and natural environments. • Goal: Designed to increase language and social responses by using positive reinforcement and by following child’s interests.

21. What it looks like… • Must be preplanned- (ex. Going to the store, zoo, mall, restaurant, special toys, activity ect.) • Have objectives-(ex. Today I will establish 3-4 teachable moments and use them to work on Johnny giving me two word responses.) • Elaborate- “motherese” support the child to give more of a response.

22. Elaboration: Level of prompts … • Prompts to help make the child successful: • Level 1: This prompt involves waiting 30 sec. when a child shows an interest in an object ect. This delay is to encourage the student to give some kind of initiative towards the object. • Level 2: After 30 sec., if the child has not asked for the item, then prompt the child appropriately ex. What do you want? • Level 3: If the child still does not respond, provide the student with a more specific prompt with gestures ect. Ex. What is that? • Level 4: This is the most supported level. Prompt the child to imitate the correct response that is being modeled for the child. Ex. That is the car. I want the red car. • The goal is to use the least amount of prompts to get the student to respond correctly.

23. Example of Incidental Teaching • Johnny wants the fish crackers. He is trying to pull them off the counter. The teacher sees this and walks over. Johnny looks at the teacher. The teacher waits 30 sec. The child does not respond. “Johnny, what do you want?” the teacher asks. Johnny points to the crackers. “What is that?” The child still does not respond. “Johnny, you want the orange fish crackers?” Show the child the crackers and prompt the student to model “ I want crackers.”

24. TEACCH • What is it: The Treatment and Education of Autistic and related Communication handicapped Children is a division of the Dept. of Psychiatry of the School of Medicine at the University of North Carolina at Chapel Hill. Provides evaluations, individualized curriculum, social skill training, vocational training, parent counseling and training. • Goal: To develop individual plans to help people with autism and their families to live together more effectively by decreasing the autistic like tendencies that limit the quality of life. • Parts of their curriculum have been copied.

25. What TEACCH looks like…. • Emphasis placed on individual needs, goals, curriculum and classroom are made for that child to reduce autistic tendencies • Well organized space, designated areas, labels, ect. • Color coding: for each child, or materials, or areas of the room • Use pictures: child’s place, destination, daily schedule, reminders or desired behaviors, where things belong, tasks and activities • Lists: what to take home, bring back to school, what to get, what needs to be completed, various jobs in the classroom ect. • Colored tape: transition paths, line up places, personal space • Dividers: personal space, comfort, to mask stimuli, provide as obstacles for running away • Schedules posted (written, PECS, icons) • Direct instruction: Directions need to be given with prompts, pictures, visual cues, hand movements (sign language) • Well organized • Repeat and review • Positive reinforcement

26. Social Stories • What is it: Short stories that explain common occurrences with matching social cues and what and why the situation happens. • Goal: These stories are designed to prepare an individual with information, strategies and a well thought out process of how to deal effectively with an event. • Gray, C. (1993). Social stories:Improving responses of students with autism with accurate social information. Focus on Autistic Behavior, 8, 1-10. • Gray, C. (1996). Teaching children with autism to "read" social situations. In K. Quill (Ed.), Teaching students with autism: Methods to enhance learning, communication, and socialization (pp. 219-242). New York, NY: Delmar Publishers.

27. What it looks like… • Describes where the situation occurs, who is involved, what they are doing and why, how they feel and how they react. • Provides sequential steps for an everyday event and how to accomplish it. • The desired behavior is clear and stated in positive ways by the characters in the story • Describes ways to help the child remember the social story and how to work through that particular event.

28. How it is used… • Select a behavior that would increase a positive social interaction for that child. • Match a social story with the target behavior. • Help the child generalize the story across many situation with various activities • Reread the story • Gradually fade the story out after the you have seen the child’s behavior change

29. Facilitating Reading Comprehension for Students on the Autism SpectrumSusan E. Gately • Children with Autism have difficulty with: • Reading comprehension • Poorer silent reading skills • Inferencing • Can decode well above age, but can not comprehend passage called Hyperlexia • Difficulty understanding setting (social context), characters (actions, motives, goals, emotions)

30. Strategies to help with Reading Comprehension • Build background knowledge and preteach • Picture Walks • Graphic Organizers • Think alouds, reciprocal thinking • Preteach narrative text structure • Goal structure mapping (who, did what) • Emotional thermometers • Social Stories • Gately, Susan (2008).Facilitating Reading Comprehension for Students on the. Teaching Exceptional Children. 40, 40-45.

31. References and Resources • http://www.autismeducation.net/diagnosing.htm (evaluations) • http://www.centerforautism.com/aba/whatisaba.asp (ABA) • http://autism.healingthresholds.com/therapy/sensory-integration (SI) • http://www.mcesa.k12.mi.us/AutismTips.htm • Gately, Susan (2008).Facilitating Reading Comprehension for Students on the. Teaching Exceptional Children. 40, 40-45. • Easterbrooks, S, & Handley, C.M. (2005-06). Behavior Change in A Student with a Dual Diagnosis of Deafness and Pervasive Developmental Disorder: A Case Study. American Annuals of the Deaf. 150, 401-407.