Strategies for Sustainable Behavior Change in Autism Treatment

1. CLDDV 173: Autism: Overview and Treatment Chapter 4: Environmental Arrangement to Prevent Contextually Inappropriate Behavior Prepared by Debbie Laffranchini, Professor From Autism Spectrum Disorders (Boutot and Myles)

2. Behavior • All behavior is meaningful • All behaviors communicate a need or desire • Behaviors communicate our understanding of a situation and what is okay to do • The context that behavior occurs (the environment, the situation) determines the appropriateness or inappropriateness of the behavior

3. Behavior in Context Inappropriate Appropriate

4. Behavior in Context Inappropriate Appropriate

5. If it’s not working, change the environment to support appropriate behavior! Don’t suppress the behavior!

6. Creating Sustainable and Meaningful Behavior Change • Comprehensive approach requires: • Understanding how factors in the environment impact and explain behavior • Understanding context of behavior • Understanding importance of motivation • Awareness and skills to prevent inappropriate behavior

7. Strategies for Compliance • Rewards • Punishment • Consequences • Motivation

8. Problems with Current Strategies • Rewards, reinforcers • Problem: must constantly seek new reinforcers, because item/activity used as a reward loses value • Punishment • Problem: creates resentment and mistrust • Consequences • Problem: availability of consequences • Motivation • Problem: in order to motivate, must deny the child first

9. Antecedent-based Intervention • Look at antecedents • Problem: seem inconsistent because conditions change • May require completion of a functional behavior assessment • Informs development of plan • Informs implementation of plan • Informs evaluation of plan

10. Functional Assessment and Behavior Support Planning • Functional behavior assessment (FBA) is evidence-based practice to determine purpose of a behavior in order to develop a behavior support plan

11. Functional Behavioral Assessment Process • Establish a team • Identify and define behaviors to be assessed • Initial data collection • Development of hypothesis of why behavior occurs • Test hypothesis • Develop intervention plan • Plan monitoring and evaluation

13. Embedded Requests to Increase Appropriate Behaviors • Embed requests in activities rather than work on one skill at a time • For example, responding to name during circle time, small group, clean up, departure

14. Inappropriate Behavior: Possible Causes • Child is in pain or discomfort • Child is ill or beginning to become ill • Hunger • What to do: • Provide access to nutritious food • Check for pain, discomfort, illness • Check mouth for dental causes

15. Challenges for Individuals with Autism Spectrum Disorders • Social Interaction • Repetitive and stereotyped patterns of behavior • Impaired verbal and/or nonverbal communication • Sensory processing difficulties

16. Challenge: Social Interaction • Difficulty with nonverbal behaviors • Eye contact • Facial expressions • Nonverbal behaviors also challenging: • Body posture • Inflexible movement • Awkward physical movement • Lack emotional expression • Difficulty taking turns, asking questions or exchanging ideas • Prefer visual or tangible objects • What you can do: • Prompt frequently • Provide visual supports for successful social interactions

17. Challenge: Repetitive and Stereotyped Patterns of Behavior Demonstrate varying levels of intensity in focusing on particular objects Preoccupation with restricted patterns of behaviors or activities

18. Challenge: Repetitive and Stereotyped Patterns of Behavior Routine-driven characteristics that involve little functional importance

19. Challenge: Repetitive and Stereotyped Patterns of Behavior • Problems that arise: • Change in routine • Change in food • Change in physical arrangement • Changes may result in behavioral outbursts or anxiety

20. Challenge: Repetitive and Stereotyped Patterns of Behavior Self-stimulation is common Spinning Rocking Moving objects repetitively

21. What You Can Do for Repetitive and Stereotypical Patterns of Behavior • Meet the unmet sensory need • Could be movement • Could be pressure • Could be providing earbuds or earphones • Reduce stress • Slowly introduce changes • Transition with announcing ahead of time

22. Challenge: Impaired Verbal and/or Nonverbal Communication Challenge initiating or maintaining conversation with social meaning or functional intention

23. Challenge: Impaired Verbal and/or Nonverbal Communication Echolalia Language comprehension difficulties May articulate well when telling a story But don’t understand the theme or underlying meaning

24. Challenge: Impaired Verbal and/or Nonverbal Communication • Challenge: joint attention • Ability to pay attention to a topic or object in the same social situation • Group work may be difficult • What you can do: • Support speech-language pathology services • Provide communicative supports across settings • Prompts on playground for conversational initiatives

25. Challenge: Sensory Processing Difficulties • Atypical response to sensory stimuli • Sensory processing difficulties are common • Some stereotyped behaviors or social responses are results of sensory processing difficulties

26. Challenge: Sensory Processing Difficulties • Sensory processing difficulties can look like: • Auditory hypersensitivity • Tactile defensiveness • Sensorimotor differences

27. Challenge: Sensory Processing Difficulties • Child can be hyposensitive • Child can be hypersensitive • Child can be mixed • Noise • Light • Touch • Smell • Varies from individual to individual • Varies from setting to setting

28. Challenge: Sensory Processing Difficulties Use of visual stimuli is the most effective way to catch and maintain the attention of individuals with ASD

29. What You Can Do for Sensory Processing Difficulties • Provide “fidget” materials • Provide spaces to get inside • Use calming materials

30. Strategies for Creating a Supportive Environment Modifications of the Physical Environment Environment is best when well-organized Environment is best when predictable

31. Strategies for Creating a Supportive Environment • Learning space • Classroom layout • Where materials are placed • Predictable • Accessibility of materials and resources • Promotes independence and autonomy • Color code materials

32. Strategies for Creating a Supportive Environment Assessing Individual Needs: Are materials placed sequentially? Are learning and leisure spaces clearly defined? Independent work Group work Leisure/break Transition Relaxing space

33. Strategies for Creating a Supportive Classroom • Schedules • Visual supports • Visual cues, materials that organize • Priming • Information in advance to prepare • Social narratives • Write stories about how to cope • Checklists

34. Strategies for Creating a Supportive Environment • Visual supports • Visual schedules • Choice boards • Boundary markers • Maps • Labeling

35. Strategies for Creating a Supportive Classroom • Schedules • Visual schedules tend to be helpful • Helps with predictability • Unexpected changes or routines are typically difficult • Social Stories and other social narrative strategies can help

36. Strategies for Creating a Supportive Classroom: Opportunities to Make Choices • Materials to use during task • Time at task • Food choices • Leisure activities • Choices create sense of satisfaction and empowerment

37. Strategies for Creating a Supportive Environment Seating Learning space Space for relaxation Modifying Physical Environment:

38. Strategies for Creating a Supportive Environment Lighting Atypical sensory seeking or avoiding Lighting Sounds Smells Temperature Use soft lights Screening bright windows Modifying the Environment: Sensory Considerations

39. Strategies for Creating a Supportive Environment Sounds: Using earphones or ear plugs Smells Wear minimal perfume Temperature Be aware of proper room temperature Modifying the Environment: Sensory Considerations

40. Strategies for Creating a Supportive Environment Visual: Free of bright colors and patterns Light: Blinds and curtains, soft

41. Strategies for Creating a Supportive Environment Child’s level of comfort Touch Feel Texture Smells Modifying the Physical Environment

42. Strategies for Creating a Supportive Environment • Assessing Individual Needs • Home layout • Planning classroom • No one solution fits all children • Consider family needs • Consider cultural differences

43. Strategies for Creating a Supportive Environment Assessing individual needs: What aspects of child’s behavior affects their interaction in the environment Sensory Anxiety Restrictive and repetitive pattern of behavior Level of understanding visual and written cues Level of communication

44. Strategies for Creating a Supportive Environment • School environment: • Seating • Away from bright windows, posters, door, hallways • Front row may be helpful • Cover chair legs with tennis balls • Carpet squares with inner seats • Alternative seating • Therapy balls • T-stools • Learning space • Classroom layout • Accessibility • Space for relaxation

45. Strategies for Creating a Supportive Environment Assessing Individual Needs: What is the appropriate seating accommodation? Seating device? Able to support self in seating? Cushion to reduce sensory overload? Light Fresh air Distractions Personal space Traffic pattern

46. Strategies for Creating a Supportive Environment Assessing Individual Needs: Where can the student store books, materials, and equipment? Are they easily accessible?

47. Strategies for Creating a Supportive Environment • Assessing Individual Needs: • Will visual cues be provided appropriately? • Pictures, icons, symbols • Labeling • Color coding

48. Strategies for Creating a Supportive Environment • Research supports the effectiveness of therapy balls in in-seat behavior and maintained engagement • Substantial improvements • Decrease in oppositional behavior of refusal to follow routine teacher request • Positive classroom behavior

49. Strategies for Creating a Supportive Environment • Space for relaxation • Need a “home base” • Quiet, separate place • Defined area in the classroom • Helps them to restore calm and relax • Get away from light, sounds, people

50. Strategies for Creating a Supportive Environment • Visual Supports • Individuals with ASD tend to be strong visual processors and learners • Objects • Photographs • Pictures • Symbols • Signs • Written words • Visual supports increase comprehension of language • Visual supports increase comprehension of environmental expectations • Visual supports provide structure and predictability