1 Educating Students with AutismPaul Livelli, Ph.D. Mountain Creek Farms Universtiy of Maryland

2 Objectives Understanding Autism Setting up classrooms and schoolsBehavioral Programming Teaching Strategies/Instruction Communication Programming Vocational Programming Questions and hopefully answers

3 Paul Livelli The Story of Roger

4 Who are you? Group exercise

5 What is Autism

6 Group Activity Break into small groupsLabel all the characteristics of students with autism on large sheet of paper Group them into categories (hopefully 3 or 4) Present to larger group

7 Autism characteristicsSocial Communication Motor Sensory

8 How Autism Looks People different and remoteIncapable of understanding others thoughts/feeling (Theory of Mind) Language and intelligence impaired Repetitive behaviors Sensory sensitivity

9 Children with Autism Don’t follow typical patterns of development18 – 36 months of age changes occur Rejection of others, strange behaviors, lose language, lose social skills

10 Typical Parent Fears Lack of communication/connectionFeelings of being ignored Embarrassment of public displays of behavior Lack of hopes and dreams

11 Autism Statistics Found in every country of the worldFound in all racial, ethnic, religious, and economic backgrounds Affects 1 or 2 people for every thousand Three to four times more likely in boys

12 What is Autism?

13 Communication Infant w/Autism NormalAvoid eye contact Seem deaf Start developing language, then abruptly stop talking Study mother’s face Easily stimulated by sounds Keep adding to vocabulary and expanding grammatical usage

14 Social Relationships Infant w/Autism NormalAct as if unaware of the coming and going of others Physically attack and injure others w/out provocation Inaccessible, as if in shell Cry when mother leaves the room and are anxious with strangers Get upset when hungry or frustrated Recognize familiar faces and smile

15 Exploration of Environment Infant w/Autism NormalRemain fixated on a single item or activity Practice strange actions Sniff or lick toys Show no sensitivity to pain, engage in self-mutilation Move from one engrossing object or activity to another Use body to purposefully reach/acquire objects Explore and play with toys Seek pleasure and avoid pain

16 Social Symptoms Difficulty with give and exchangePreference of being alone Resist attention Seldom seek comfort/attention Difficulty interpreting – don’t read body language “Come here” example Aggression as communication

17 Language DifficultiesAbout ½ of children with autism stay mute Some infants do coo and babble during first 6 months Some develop language 5 to 8 years Speech is not always meaningful Echolalia Confusion of pronouns

18 Story of Temple Grandin“Thinking in Pictures”

19 Repetitive behaviors and obsessionsStereotypies/Self stimulation Repetition of tasks – lining up pretzels Fixations/obsessions Demand consistency Order and sameness may provide sensory stability Imaginative play is limited

20 Sensory symptoms Sensory integration – difficulty organizingPainful sensitivities – sound, light, texture, smells Oblivious to cold or pain Senses sometimes scrambled – gag when touching a certain texture

21 Unusual Abilities Artistic talentCapacity for complicated mathematical concepts Puzzles Play instruments w/out lessons Savant skills

22 Autism Diagnosis

23 How is Autism Diagnosed?Parents first to notice Changes in regular development NO medical test/rule out other disorders Psychiatrist/Psychologist with training can recognize disorder Standardized scales Rett’s/Aspergers

24 Diagnostic Criteria Poor or limited social relationshipsUnderdeveloped communication skills Repetitive behaviors, interests, and activities

25 What Causes Autism? Abnormalities in brain structure/functionThe Lymbic System Amygdala – regulation of social and emotional behavior Serotonin (neurotransmitter) – higher levels Still not sure with the current research available

26 Factors Affecting Brain Development

27 Heredity Studies of twins suggest higher likelihood of brain dysfunction Identical more likely than fraternal to have autism Parents with one child more likely to have another with autism Autism does not appear to be due to one gene

28 Inheritance Irregular segment of genetic codeCluster of 3 to 6 unstable genes Certain conditions unstable genes interact and interfere with brain development In some families siblings have minor language difficulties but not full autism reinforcing the “conditions theory”

29 Pregnancy and Other ProblemsViral infections like rubella Lack of oxygen No clear links yet

30 Accompanying DisordersMental retardation – 15-20% have IQ below 35, 75-80% have MR, more than 10% have above average IQ Seizures – about 1/3 of people with autism, most cases can be controlled with meds Fragile X – 10% of those with autism, defective piece of X chromosone

31 Intervention/Aproaches

32 Developmental Environment building on skills and interestsConsistency and structure Predictable schedules Classroom activity areas Activities to meet sensory needs Adaptation of materials

33 Behavioral Reward for appropriate behaviorTime intensive, highly structured, repetitive sequences Opportunities for practice Reinforcement, reinforcement, reinforcement

34 Medications Treat anxiety and depression, serotonin levels (Prozac, Luvox, Zoloft, Anafranil) OCD meds Hyperactivity meds Sensory research to block endorphins Meds to treat psychiatric disorders – now unpopular in use

35 Practice Teaching

36 Making and managing the classroomInstructional Design Making and managing the classroom

37 Classroom Activities Group instruction Discrete trail deliverySocial and play areas Technology

38 Group Instruction Delivered by the teacher Support by aide(s)Dynamic movement Repetition and practice Generalization of skills

39 Discrete-trial DeliveryDelivered by aide(s) Supported by the teacher Static instruction Repetition and practice Not for generalization except across instructors

40 Social and Play Areas Space for movement Table tops for gamesAccess to leisure materials Design for comfort and relaxation Outside play areas

41 Technology Located in the classroomAvailable both to staff and students Proximate to group instruction areas Designed for generalization of skills Introduction to technological age

42 Design your classroom setupSmall Group Project Design your classroom setup

43 Maximizing learning while maintaining staff and student energyThe Instructional Day Maximizing learning while maintaining staff and student energy

44 The Instructional Day Reading, writing, math, communication, social skills Mix of high energy and low energy activities Pyramid instructional design

45 The Schedule Morning Group Writing/Reading InstructionMath Instruction Recess/Leisure Activities Snacks/Lunch Social Skills Activities Other Academics Afternoon Group

46 The Schedule as a Behavioral ToolPosted in easily understood format Redirect students after each activity Provide adequate warning Manipulate schedule as tasks are finished Written word, PECs, Actual pictures (digital camera)

47 The Instructional ProgramInstructional Area that relates to the overall plan Specific instructions for implementation of the program Materials needed for the program Data collection to be used Specification of how often to take data

48 Write an Instructional Program for identifying colorsSmall Group Project Write an Instructional Program for identifying colors

49 Practice Teaching

50 Students with HFA and Aspergers Syndrome: Understanding and Increasing BehaviorPaul Livelli, PhD Student Services Coordinator College Living Experience

51 Brainstorm Activity What motivates people? ?????????????

52 A Powerful Motivator / / -

53 Sorry; this is it / - /

54 Sorry; this is the really powerful motivator/ - \ Don’t you see it?

55 This is really it…

56 The really powerful motivatorDoes it apply to the students we serve?

57 The Nature of MotivationMotivation is not dichotomous Little utility in thinking a student “is” or “is not” motivated Motivation is dynamic and continuous It is a probability that an individual will engage in and maintain a certain activity. Motivation is therefore subject to numerous factors People (instructors/parents) have no affect on some factors but may have significant affects on other factors

58 Characteristics of Asperger’s Syndrome:May move into the personal space of others, not recognizing body language, facial and verbal cues that he/she has transgressed May not make direct eye contact Lack of emotional reciprocity or empathy Rigid and inflexible adherence to specific routines or rituals Stereotyped and repetitive motor movements Persistent preoccupation with parts of objects Friends and new acquaintances may be acknowledged with tight and enthusiastic hugs instead of formal greetings like “Hi, how are you?” May begin to talk about the latest topic of concern which is of interest only to themselves (e.g., train schedules), may be age inappropriate or boring but the person does not pick up on looks of disinterest or snickers from the group. Speech and language peculiarities such as:  stilted and formal language, voice too loud or monotone or hyperverbal. Hypersensitivity to noises or smells Cognitive abilities which are average or above average (They are often known as “little professors”) Difficulties with subjects that require inferential reasoning, abstract concepts, problem solving, extensive calculations or social judgements. Fine motor problems which lead to poor penmanship and low writing motivation Gross motor clumsiness which leads to poor skills in competitive sports and physical activities Depression, frequent school absences, low school motivation due to being socially vulnerable and easy targets for teasing and bullying

59 Social Interactions: - wanting to be left alone at times - trouble with back and forth social interactions - little sense of other people’s boundaries - inappropriate use of eye contact, avoidance or extended staring - poor use of nonverbal gestures - not accepting touching unless self-initiated  

60 Interest and Activities:- repeatedly watching videos or video segments - lining up and or/ ordering objects - strong attachment to inanimate objects - pacing or running back and forth, round and round - very sensitive to sounds - resisting change - difficulty waiting - history of eating  problems - defensive to touch which isn’t self initiated - lack of fear or real danger

61 Qualitative Impairments in Communication:- problem with getting the order of words in sentences correct - problem understanding jokes - problems answering questions - problems with reciprocal conversations - problems using speed, tone and volume appropriately - difficulty understanding abstract concepts

62 Learning Characteristics:- well developed long term memory - good visual skills - hyperactivity - delayed response time - needs help to problem solve - short attention span to some activities and not others - problems organizing

63 Environmental Challenges that Lower Ability to Function CompetentlyMajor Changes: - alterations in school, work, home, community - time changes - staff or teacher absent - cancellation of event or activity - having to wait too long Environmental Confusion: - crowds - noise - not having enough space - losing things of value - surrounded by too much movement - surrounded by too much visual stimuli Relationships: - being corrected - being denied - being late - being ignored - being left out - being teased - being scolded

64 Effective Behavior Interventions of Problem BehaviorsWhat makes us do what we do?         Biological Influences         Instructional/ Reinforcement History         Setting /Events         Stimulus Events

65 A Simple Way to Break it DownImportance How important is doing well? How important is doing the work? How important is the class/the activity? Essentially “Why would I want to do this?” Confidence Self-efficacy for material Self-efficacy for evaluation procedures

66 1. Hypothesize the function of the behaviorSocial Attention Escape/ avoidance Wants tangible item or activity Sensory Feedback

67 Types of Motivation Extrinsic IntrinsicEngaging in behavior to attain a reward or to avoid a punishment from an external source. Intrinsic Engaging in behavior out of curiosity, sense challenge and an internal sense of gratification.

68 2. Gather Information a. Antecedent : Does the behavior occur……     - When  you are attending to other people in the room?     - Following a request to perform a difficult task?     - When a request for an item or activity is denied?     - Repeatedly, in the same way, for long periods of time, even when no on is around? b.   Consequence: When the behavior occurs, do others….     - Attend to the student?     - Leave the student alone?     - Negotiate or give the desired item/activity     - Allow the student to engage in inappropriate behavior?  

69 3. Plan an Intervention a. Based on information gathered, are environmental changes needed?    - Limit materials available to student.     - Remove distracters. b. Based on information gathered, determine how people should react to the challenging behavior each time it occurs.     - Plan to ignore.     - Plan to attend.     - Plan to have privileges earned.     - Plan to redirect.  

70 4. Identify a Replacement Behaviora. What appropriate behavior is “functionally equivalent” to the challenging behavior?     - Manipulating a stress ball or twist pen to replace inappropriate hand movements     - Teaching the student to ask if he can use the computer later to replace tantrum behavior     - Teaching student to raise his hand to replace attention-seeking behaviors     - Teaching the student to communicate his wants appropriately to replace escape/ avoidance behaviors b. Complete replacement behavior planning guide with team     -Which behavior is the team going to target for replacement?     1.What functionally equivalent behavior is the team going to train in place of the problem behavior?     2. In what situations will training occur?     3. Who will be responsible for conducting the training sessions?     4. What motivation system will be implemented during training?     5. Describe how the team will evaluate if and how the student uses the new response.  

71 Some Points of InterventionStyle – the walking M n M Content, context, and meaning Extrinsic reward structure When the individual comes to talk with you every interaction has the potential to reinforce behavior

72 Our Style Create a context where you relate to them do not force them to relate to you Hold high but realistic expectations Use concrete language Tell students what they need to do in order to be successful Be enthusiastic Use humor

73 Extrinsic Rewards Give students feedback as quickly as possibleReward behaviors that you desire Attention for desired behaviors

74 Take Home Message Show and share your interestThink in terms of importance and confidence Use but do not over-use extrinsic rewards Individualize as much as possible Listen as much as possible It’s your agenda through their eyes Why would they want to do that?????