OAR News
OAR’s Conference Day Two Looks at Education and Life in the Community
OAR will host its eighth annual Applied Autism Research and Intervention Conference on Friday, October 29, and Saturday, October 30, 2010 at the Sheraton Crystal City in Arlington, Va. For these two days, 24 leading autism professionals, researchers, and experts will come together to present the latest research and evidence-based interventions regarding autism spectrum disorders. During the course of the event, attendees will be able to choose from 16 presentations in the following four topics: OAR-Sponsored Research, Research to Practice, Education and School-Age Learners, and Transition and Life in the Community.
Day Two
Saturday’s featured tracks are Education and School-Age Learners, which focuses on teaching important skills to children with autism, and Transition and Life in the Community, which focuses on older individuals who are in the process of becoming independent members of the community. Attendees can go to sessions from either track throughout the day.
Paul Shattuck, Ph.D., kicks off the Saturday with his keynote address titled “Outcomes after Leaving High School.” Dr. Shattuck is an assistant professor at the George Warren Brown School of Social Work at Washington University in St. Louis. In his presentation, he will discuss what happens as adolescents with autism exit high school and age into young adulthood. His research attempts to answer much-needed questions such as: Where do they live? Are they employed? And how does poverty impact service use and related outcomes?
Education and School-Age Learners
Immediately following Dr. Shattuck’s keynote speech, attendees can choose sessions from one of the two tracks. The first presentation on the Education and School-Age Learners track is “Teaching Emotion Recognition and Expression to Students with Autism to Improve Social Competence,” by Ethan Long, Ph.D., BCBA; Peggy Halliday, M.Ed., BCBA; and Rorie Hutter, M.S., Ed. All three speakers are from the Virginia Institute of Autism (VIA) where Dr. Long is the executive director, Halliday is the director of outreach services, and Hutter is the director of education. Their presentation will discuss the issues that arise due to the difficulties many individuals with autism face identifying and expressing a variety of emotions. In addition, they will describe several techniques to teach emotional awareness and expression.
Christina Whalen, Ph.D., BCBA-D, is the founder, president, and chief science officer of TeachTown, a company creating innovative technology-based intervention solutions for special needs students. After the lunch break, she will present the next session on this track, “Increasing Student Motivation and Skill Acquisition via Computer-Assisted Instruction.” Dr. Whalen will describe TeachTown: Basics, an evidence-based program designed to meet the needs of children with special needs, which has been shown to be effective in improving language, cognitive, academic, and social skills. This presentation will also feature an overview of several research studies on motivation and skill acquisition.
The last session on this track, “Evidence-based Practice of Medication Treatment of Autism Spectrum Disorder: Myths and Facts,” will be presented by Luke Tsai, MD, FAACAP. Dr. Tsai is visiting professor at Oakland University’s School of Education and Human Services and also serves on OAR’s Scientific Council. In this session, Dr. Tsai will discuss the increasing use of psychotropic medications to treat ASD. He will introduce a new system to assess the effectiveness of the most commonly used psychotropic medications in order to provide some helpful guidelines for caregivers.
Transition and Life in the Community
Saturday’s second track, Transition and Life in the Community, runs parallel to the first track. The first presentation after the opening keynote is entitled “Supporting Adults with ASD in the Workplace Using Behavior Support,” by Carol Schall, Ph.D., director of the Virginia Autism Resource Center at Virginia Commonwealth University. She will present a review of Positive Behavior Support (PBS) practices that assist individuals with ASD to become independent at work. She also plans to include implementation considerations and several case studies exemplifying the provisions of PBS in a work setting.
Lawrence Sutton, Ph.D., a psychologist and manager of the Western Region Office of the Bureau of Autism in the Commonwealth of Pennsylvania, will present at the session directly after lunch. In his presentation, “When Young Adults with ASD Interact with the Criminal Justice System - Needs and Emerging Interventions,” he will provide several case studies of individuals who have been convicted of crimes. Attendees will learn more about existing literature on how to address issues leading up to arrest and convictions and will examine a model program that attempts to bridge some of the gaps in knowledge.
The track concludes with a presentation by Toli Anastassiou, MA, BCBA, and Carrie Hennessy, BA, titled “Preparing Your Young Adult with Autism for a Successful Transition to an Adult Day Program.” Anastassiou is the program director for Quest Autism Programs and Hennessy serves as the clinical director. They will describe the key skills that are necessary in preparing a young adult with ASD for transition to an adult day program. Preparing for success in lower staffing ratios, teaching endurance to sustain employment and addressing functional community-based skills are among the examples this duo will review.
Stephen Shore, Ed.D., and Zosia Zaks, MS, M.Ed. will close the conference with a special keynote address entitled, “Dating on the Autism Spectrum.” Both of these successful professionals have diagnoses on the autism spectrum, and will draw from personal experience as they discuss issues of importance for those interested in dating. Participants will learn strategies for coping with loneliness, dating successfully, maintaining safe and healthy relationships, and increasing communication and closeness with loved ones.
Read the overview of Friday’s conference events in last month’s issue of The OARacle. [link] Please visit the conference section of OAR’s Web site at www.researchautism.org/news/conference to register or view a detailed schedule, complete list of speakers, and full presentation summaries. To get more information, contact Alyssa Kruszyna at 703-243-9717 or akruszyna@researchautism.org.
AFAA Holds First Congressional Briefing
On Thursday, July 15, Advancing Futures for Adults with Autism (AFAA) held the first formal congressional briefing on the employment, residential, community living, and personal needs of adults with autism. The culmination of a two-year process by the partner agencies that comprise AFAA (of which OAR is one), the briefing brought together federal legislators, national policymakers, and advocates for adults with autism, including individuals who have autism. Their purpose was to discuss priorities for action in the public and private sectors that address the increasing and unmet demand for effective services for adolescents and adults with the disorder.
Senator Robert Menendez (N.J.) and Congressman Mike Doyle (Pa.) served as honorary co-chairs of the briefing and both offered remarks affirming their commitment to supporting adults on the spectrum to live lives of quality and purpose.
The briefing included an overview of autism and the array of needs of adults on the spectrum. A stakeholder panel, chaired by Linda Walder Fiddle of the Daniel Jordan Fiddle Foundation and featuring a diverse range of adults on the autism spectrum and family members, shed light on the strengths, challenges, complexities, and humanity of those most intimately affected by the condition.
Other panel topics included community life (chaired by OAR’s Peter Gerhardt, Ed.D.), residential supports (chaired by Mardie Oakes of Hallmark Community Solutions), employment (chaired by Ilene Lainer of the New York Center for Autism), and a closing panel (chaired by Cyndy Hayes of Global Communities of Support) on cross-cutting, also known as interrelated issues, such as systems, challenges, importance of public/private partnerships, staff retention, etc., that impact adults with autism and their families.
“Working together, we have made incredible strides toward creating a focused agenda for improving access to services for adults with autism,” says Peter Bell, AFAA co-chair and executive vice president of Autism Speaks. “The congressional briefing is an important next step as we seek to engage our elected leaders and key figures in the private sector and compel them to act in support of creating better futures for our loved ones with autism.”
AFAA Presents a Public Policy Agenda
The primary goal of Advancing Futures for Adults with Autism (AFAA) is to advocate for change that will enable adults living with autism to lead independent and productive lives. This change must occur in public policy and in partnership with the private sector. Developed during an earlier AFAA Think Tank and National Town Hall, the National Public Policy Agenda is one outcome of the AFAA effort. These are its recommendations to federal public policymakers:
1. Adults with autism need access to services and supports to develop skills to live safe, independent, and successful lives. AFAA urges federal policy makers to:
- Amend the Individuals with Disabilities Education Act (IDEA) to include life skills/social skills training as part of individualized education programs (IEPs).
- Enact the Frank Melville Supportive Housing Investment Act to design and develop new residential models.
- Expand the capacity of Community Development Financial Institutions.
- Expand the implementation and enforcement of the Americans with Disabilities Act (ADA) and Olmstead decisions to ensure the least restrictive and most appropriate housing for adults with autism.
- Expand the Workforce Investment Act (WIA) and Developmental Disabilities Assistance and Bill of Rights Act (DD Act) to encourage public/private collaborations that create meaningful and diverse vocational opportunities for adults with autism.
- Expand Medicaid to include ongoing residential, vocational, and community living supports.
- Create/expand federal incentives to encourage investment in housing options for adults with autism.
- Establish a new priority within the DD Act to provide appropriate and ongoing vocational supports for adults with autism.
2. Adults with autism need access to skilled direct care personnel. AFAA urges federal policy makers to:
- Prioritize the training of direct care workers to provide vocational and residential assistance to adults living with autism.
- Expand the Combating Autism Act (CAA) to include training demonstration projects to teach service providers to work effectively with adults with autism.
3. Adults with autism need access to and choice within the funding of services. AFAA urges federal policy makers to:
- Change existing and establish new funding streams so that financial assistance follows the person and can be used to meet unique and evolving needs.
- Expand both public and private funding for residential, vocational, and community integration services for adults with autism. Funding should follow the individual and be person centered to meet the varying and unique needs of adults with autism.
- Enact the Achieving a Better Life Experience (ABLE) Act.
- Increase the amount and flexibility of funding allowing individuals with autism and their families to make the most effective decisions.
- Develop a cost-effective process that allows cross-state portability and uniformity of person-centered funding.
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OAR Chairman Continues to Raise the Bar
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OAR Chairman, Jim Sack |
OAR Chairman Jim Sack gathered together friends and business associates for the ninth annual Chairman’s Dinner on June 7 and shattered all previous attendance and fundraising marks. Almost 150 people turned out at The Palm in Tyson’s Corner, Va., for an evening of great food, wine, and camaraderie, which reached its high point when Sack once again took on the role of auctioneer. By the time he was through and counting ticket proceeds and donations, the dinner raised more than $94,000 for autism research, besting the previous high by more than $12,000.
“Seeing my friends, family, and colleagues respond this way each year is humbling and gratifying,” observes Sack. “This year they have taken their generosity to a new level.”
Assuming his now traditional role of auctioneer, Sack cajoled increasingly higher bids from his friends, keeping up his humorous banter and refusing to let a challenging sound system deter him. The impressive array of auction prizes included: a unique NASCAR weekend package; a ticket and dinner package to a New York Yankees game in Yankee Stadium; tickets, dinner, and team gear for this year’s Navy vs. Duke game; a wine dinner for six; and two delicious barbeque prizes: a North Carolina smoked barbeque supper for 30 people and a Cajun turkey feast for 10 to 20 guests. The final prize was a personal caricature to be drawn on the wall at The Palm restaurant.
With this year’s record-breaking success, the Chairman’s Dinner has now raised more than $600,000 for autism research since 2002. Proceeds from this event support OAR’s research and autism information programs.
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Spotlight On Conference Keynote Addresses
Conference Speaker Dennis Reid Will Discuss Evidence-Based Practice in Staff Training and Retention
Evidence-based procedures are critical not only in working with and teaching people with autism, says Dennis Reid, Ph.D., BCBA. It’s also a critical component in training and supervising the staff who work with people with autism. That is one point he wants audience members at OAR’s eighth annual Applied Annual Applied Autism Research and Intervention Conference to take away from his keynote address on Friday, October 29.
The other is that staff training and supervision has a critical effect on the quality of supports and services provided for people with autism and, subsequently, their quality of life.
Currently the director of the Carolina Behavior Analysis & Support Center, Dr. Reid will talk about the importance of staff training and retention in a field where burnout is frequent and job skills are in demand. His presentation will explain what current evidence-based research has shown to be effective in enhancing work enjoyment and promoting job retention. He will provide an example of staff training based in large part on a summary of his 2008 OAR-funded research project. This research focused on assessing and improving teaching proficiency among staff that work in a one-to-one capacity with individuals with autism.
“Staff training is important because how well support staff provide needed services for people who have autism is heavily determined by the quality of skills staff possess. On-the-job training is a primary means of providing proficient job skills for staff, and particularly for paraprofessional personnel who often begin their human service jobs with no formal, prior training in relevant job skills,” he explains.
Training all by itself, however, is not a magic solution that creates a productive and satisfied staff. Employers must also think about how to keep that staff in their jobs, he says. “Retention is important because one of the biggest obstacles to providing quality services for people with autism on a consistent basis within human service agencies is the high rate of staff turnover. One factor that tends to reduce staff turnover is when staff enjoy their work situation. How staff are trained (and supervised) can significantly affect their day-to-day work enjoyment.”
When OAR asked him to present at the conference and include a summary of the outcomes of the research study that it funded, Dr. Reid was happy to say yes. His company, located in Morganton, N.C., has employed adults with severe autism in a supported work capacity for the last 15 years.
This presentation is important to him, he notes, because he strongly supports the mission and goals of OAR, and especially its focus on research with an applied focus that can have truly meaningful outcomes for people with autism. Also, he says, he attended a previous OAR conference and found it “inspiring, informative, and enjoyable.”
His 2008 project, “Training Paraprofessional Staff to Provide Proactive Support for Individuals with Severe Autism in Inclusive Settings,” focused on assessing and improving the teaching proficiency of support staff employed to work in public schools with students with autism in a one-to-one capacity (such staff are often referred to as “shadows,” personal instructors or PIs, or simply “one-to-ones”). Co-conducted with Wendy Fitch and Marsha Parsons, the study’s initial assessment found that the teaching proficiency of 17 PIs in nine public school systems indicated the most frequent obstacle to effective teaching and student learning was incorrect use of a least-to-most assistive prompting strategy to help students respond correctly to instructional trials.
Subsequently, the researchers demonstrated a brief yet systematic on-the-job means of training seven PIs in proficient prompting. “Results indicated that following the training (along with on-the-job feedback), their teaching proficiency improved to criterion standards and student compliance to instruction likewise improved,” explains Dr. Reid. “These results maintained during follow-up observations, including periods of up to 49 weeks across two school years.” The project has been summarized in manuscript format and just submitted for consideration for publication in a peer-reviewed journal.
Dr. Reid has more than 35 years experience in working with developmental disabilities, as a manager, clinician, and consultant in educational services; training and managing staff; treating challenging behavior; providing support services for people with severe disabilities; and teaching functional skills to people with severe disabilities. He has published more than 100 applied research journal articles and book chapters focusing on applied behavior analysis in developmental disabilities and staff management, and he has published seven books.
His interest in autism stems from the work he did in graduate school, he says. Dr. Reid received his doctorate in psychology, with a specialization in applied behavior analysis and school psychology, from Florida State University. After working for a short time as a school psychologist, he started working with agencies that worked with people with disabilities, including autism. “I became particularly interested in autism because my ABA orientation seemed to be very effective with people with autism,” he says. It was particularly gratifying to see that ABA instruction could not only help people with autism to learn quickly but also enjoy their lives more, he adds.
When the day is done, what Dr. Reid finds most rewarding about the applied research he does is that the results actually have an impact on people’s lives. “We do a lot of problem-solving with the applied research, and we can then disseminate the results to people who need it.”
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News from the RUN FOR AUTISM
Spring Toward the NYC Half
Remember the spring days of 50- and 60-degree mornings, limited humidity, and flowers beginning to bloom? The New York Road Runners know that spring will come again and are all set for perfect race conditions for the 2011 New York City Half Marathon, set for Sunday, March 20.
On June 2, the NYRR opened the lottery for the 2011 half marathon and the club has also selected OAR as an official charity partner. Already planning ahead for next year, OAR is excited to have even larger team than in 2010, which was comprised of 53 runners raising just short of $86,000. “Making the Half Marathon a spring event was the best thing the NYRR could have done for that race,” says RUN Director Lily Matusiak. “The NYC Half Marathon must be one of the best half marathon courses in the country. Now that the word is out about its success as a spring race, I wouldn’t be surprised if it becomes one of 2011’s most popular half marathons.”
With the lottery opening earlier than ever, entries to this race prove to be in high demand. OAR is excited to participate in the event for the fifth year, receiving reserved charity entries for our increasingly impressive runners and fundraisers.
OAR hopes to have its biggest NYC Half Marathon team ever in 2011. If you want to be part of it, ensure your spot today, because OAR has a limited number of charity entries. Per New York Road Runner guidelines for participating charities, charity runners in this race must raise at least $1,000. For more information on the RUN FOR AUTISM-New York, please go to www.runforautism.org or email run@researchautism.org.
Before the Laffy Taffy, Treat Yourself to a 10K for OAR
Before you hit the pavement decked out in your Halloween costume and ready to trick-or-treat this October 31, hit the pavement with the RUN FOR AUTISM-Marine Corps Marathon 10K team. That’s right, as you may have heard, this year’s Marine Corps Marathon and 10K are taking place on Halloween morning, giving you an extra incentive to burn a few calories before partaking in Kit Kat Bars, Snickers, and Laffy Taffy later that evening.
Even better, you can join OAR Executive Director Mike Maloney and Scientific Council Chairman Peter Gerhardt, Ed.D. as they take on the 10K’s 6.2 mile course.
It’s sure to be a fantastic and fun race, so why not share it with others? Recruit a team of your friends, colleagues, and family to run/walk and fundraise together!
All OAR runners receive a custom race shirt and t-shirt, training and fundraising guide, personal fundraising webpage, invitation to the Runner’s Recognition Dinner, and staff support.
Those who raise $250 or more also receive a free registration for the Eighth Annual Applied Autism Research and Intervention Conference on October 29-30.
For more information or to register and join the team, please go to OAR’s Web site at www.runforautism.org or e-mail run@researchautism.org.
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Focus on OAR Research
Using a Direct Observation Assessment Battery to Assess the Outcome of Early Intensive Behavioral Intervention
 Two OAR-funded researchers, Rebecca MacDonald, Ph.D., BCBA, and William Ahearn, Ph.D., BCBA, are studying the benefits of using direct observation to assess the outcome of early intensive behavioral intervention (EIBI) for children with autism. Specifically, they are looking at play, joint attention, stereotypy, and cognitive skills.
Intensive behavioral intervention for young children diagnosed with autism spectrum disorders (ASD) can produce large gains in social, cognitive, and language development. When compared to other groups of children with ASD receiving non-behavioral intervention treatment or minimal treatment, groups receiving behavioral intervention achieved greater gains. These changes in performance are usually measured with standardized testing.
Few studies have reported direct observational measures of change. Appropriate play, joint attention skills, and standard measures of cognitive functioning, such as imitation skills and instruction following, have all been identified as important instructional targets for children with autism. Some researchers have used them as criteria for determining outcome, although often in the form of indirect testing and questionnaires.
The researchers, who are both program directors at the New England Center for Children (NECC), will use direct observation to study both typically developing children and children with ASD. In addition, they will analyze new data samples and data from a 10-year longitudinal sample of performance of young children with ASD.
While they will compare typically developing children and children with ASD of the same age, they also intend to look at within-group variables that may influence outcome such as age at intake, length of intervention, and initial performance on a direct assessment battery and free play sample.
As they write in their proposal, they also hope to draw comparisons “between children with ASD and their typically developing age-matched peers, as well as direct measure comparisons for the children with ASD at entry and following 1 and 2 years of treatment. Additional knowledge regarding potential predictors of treatment outcome will be invaluable to practitioners in the field. Second, we would like to extend research in this area by including assessment and outcome data for 1-year-olds diagnosed with ASD. Comparisons will also be made between performance for this group and their typical age-matched peers.”
How the Project Will Work
The first component includes increasing their pool of assessment data for both children with ASD and typically developing children. Data has been collected over the past six to seven years using the Early Skills Assessment (ESA) for both typically developing children and those diagnosed with ASD spectrum disorders. All children entering the NECC Intensive Instruction Program Preschool and Home-based programs are tested using the ESA. They are then tested one and two years after entry, or upon exiting the program. The data for 1- and 2-year olds is limited for the children with ASD and particularly limited for typically developing children.
They plan to continue data collection for all students with ASD currently enrolled in the preschool, along with age-matched typically developing peers, with a focus on increasing their sample pool of the 1- and 2-year-olds.
The second component will include analyzing all ESA data, both those data collected over the previous six years and data collected during the course of the study. ESA data will be collected for approximately 30 typically developing children and 15 children diagnosed with ASD. Assessments of children with ASD will include both initial assessments upon entry into the EIBI program and follow-up assessments, after 1 or 2 years of treatment.
About This Researcher
William Ahearn, Ph.D., BCBA, and Rebecca MacDonald, Ph.D., BCBA, are currently program directors at the New England Center for Children. They have both been behavior analysts for over 20 years and have published extensively in the field of applied behavior analysis. Dr. MacDonald received her doctorate in clinical and child psychology at the University of Kansas and is a licensed psychologist.
In addition to his role at the New England Center for Children, Dr. Ahearn is also a clinical assistant professor in Northeastern University's master's program in applied behavior analysis. Dr. Ahearn's research interests include assessment and treatment of severe problem behavior, resistance to change, behavioral economics, and pediatric feeding difficulties. His work has been published in a number of journals and he recently published a book chapter inMaking a Difference: Behavioral Intervention for Autism. Dr. Ahearn is currently on the editorial boards for the Journal of Applied Behavior Analysis and Behavioral Interventions. |
All children will range in age between 1 and 5 years old. All children with ASD aged 3 to 5 will be enrolled in a preschool that provides 30 hours per week of EIBI services, using individualized programming based in the principles of applied behavior analysis. All children with ASD aged 1 to 3 will be enrolled in a home-based program that provides EIBI services 18 to 24 hours per week.
The typically developing children aged 3 to 5 will be enrolled in an on-site integrated preschool classroom, consisting of 15 typically developing preschool age children, and the typically developing children aged 1 to 3 will be enrolled in an on-site day care.
Outcomes and Practical Relevance
Through this study, Drs. Ahearn and MacDonald will evaluate the Early Skills Assessment to see if it is a useful determinant of performance in children with ASD. As a direct observation tool, the ESA offers a way to measure the behavior of children who are often untestable using standardized measures. The test can be run quickly (30-45 minutes) with minimal additional materials needed.
What remains to be seen is the test’s sensitivity in measuring changes in the behavior of children with autism over time. The researchers will assess both changes in individual children’s behavior following EIBI and differences in ESA scores for children with ASD and their typically developing age-matched peers.
If the ESA proves a valid measure for examining changes in skill acquisition and social behavior in children with ASD, and differences in the performance of typically developing children and children with autism, it could become a valuable tool to practitioners working with ASD. A direct measurement tool that quickly and effectively evaluates performance on core deficits in children with autism would be a welcome addition to a field that generally relies on indirect assessment measures.
They will also evaluate changes in children’s performance as measured by blind observers watching a play sample. If these data also indicate significant changes in performance following one to two years of treatment, this will provide social validation for EIBI as an intervention that produces observable changes in social behavior and the ESA as a valid tool for measuring performance.
This study will also examine the potential predictors of positive outcome for children with autism enrolled in EIBI services. This is a natural extension of research conducted at NECC over the past several years. This research has begun to examine how differences between children with ASD and typically developing children can be operationally defined and systematically measured longitudinally. The current study will extend this research to include additional direct observations measures that may be useful in identifying early predictors of outcome following diagnosis as well as measuring changes in performance over time as compared to a typically developing sample.
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HOW TO…TEACH SELF-HELP SKILLS
By
Stephen Anderson, Ph.D.
Dressing for Success: How Self-Help Skills Can Help Individuals with Autism
Stephen Anderson, Ph.D., is the chief executive officer of Summit Educational Resources, which provides educational and therapeutic services to children with autism in Buffalo, New York. A child psychologist, Dr. Anderson is a national expert in the education and treatment of children with autism and related developmental disabilities. He has worked in the field of developmental disabilities for more than 25 years. Dr. Anderson holds appointments as adjunct assistant professor at the University of Kansas and the State University of New York at Buffalo and an adjunct with the Exceptional Education Department at Buffalo State College.
With much of the current emphasis on early intensive intervention and recovery, parents and teachers of young children with autism do not spend a lot of time talking about deficits in self-help skills. Most are more concerned with the child’s development of functional communication and early cognitive skills. Often, it is simpler to dress the child than it is to teach the child to dress him/herself. But dressing and the development of other basic self-help skills are important to success at school and work, making friends, and living independently.
As an individual develops self-care skills, her/his ability to live and function independently across multiple environments increases, and it influences the level of supports an individual will need. Vine and Hamilton (2005) examined the individual characteristics associated with community integration for 37 individuals of with developmental disabilities. Scores on daily living scales were found to correlate with objective aspects of quality of life such as community access, daily routines, and choice opportunities.
Uniqueness of Individuals With Autism
Self-help skills are part of a larger group of behaviors called “adaptive skills,” a collection of practical skills that enable individuals to function in everyday life. Adaptive skills include communication, community self-sufficiency, socialization, behavior, and activities of daily living (ADL). The basic skills of eating and drinking, dressing and undressing, toileting, and personal hygiene all fall within ADL.
Individuals with autism often experience a gap between intellectual functioning and adaptive functioning that is not evident in individuals with developmental disabilities without autism. Studies have also shown that children with autism often display poorer adaptive skills (including ADL) and significantly more maladaptive behaviors than a comparison group of individuals with developmental delays without autism. Because individuals with Asperger’s have intellectual abilities within the normal range, one might quickly conclude that this group would not present delays in ADL. However, at least one study showed that individuals with Asperger Syndrome also demonstrated moderate deficits in most adaptive skills, including ADL, in spite of their advanced vocabulary and normal IQ scores.
Core Features of Autism and Implications for Instruction
One of the challenges in working with individuals with autism is that it is a very diverse group. At one end of the autism spectrum are individuals with significant intellectual delays and at the other end are individuals with intellectual abilities within the normal range. It is fairly safe to assume that profiles of communication, social, and intellectual deficits may present broad challenges for teaching new skills. Specifically, deficits in attention, imitation, and symbolic play are very likely to impact the individual’s learning and the instructor’s choice of instructional strategies. Likewise, behavioral issues such as an interest in consistent routines, stereotypical behavior, and aggression may present unique challenges.
Imitation and Observational Learning. Little research exists to explain how typical children learn self-help skills. Children appear to learn largely from their parents’ coaching, demonstration, and frequent reminders. Simply showing and telling seems to be enough for most children without ASD. Through imitation, children learn a variety of basic and complex skills within a short period of time. Whether it is the reward of matching or the praise they receive from parents and teachers, the motivation to imitate is present very early. Many children with autism, however, do not learn to imitate naturally and are not likely to learn by simply observing their parents or listening to their parents’ instructions.
Communication. Communication, particularly the ability to understand and integrate information, is important for typical development. Once again, many children with autism experience significant delays in both the understanding and production of speech. As a result, methods that rely on verbal instructions and explanation may not work very well.
Adherence to Rituals and Routines. Individuals with ASD sometimes exhibit adherence to specific routines and stereotypic mannerisms (e.g., hand flapping). These behaviors can be particularly challenging because they may interfere with getting and sustaining the learner’s attention when teaching new skills.
Sensory and Motor Issues. Finally, a variety of sensory and motor concerns may interfere with learning self-help skills. These issues may be present at a very early age for some otherwise typically developing children but rarely persist beyond the first three or four years of life. In contrast, children with autism may have ongoing sensory and motor issues, such as an extreme sensitivity to the texture of toothpaste or a struggle with the fine motor skills needed for buttoning.
Arguably, deficits and excesses in these areas will make teaching and learning self-help skills more challenging; but there is no evidence that their absence predicts failure for the development of self-help skills. However, the instructor must find another way to teach and for children to learn. Many learners require an approach that relies heavily on breaking the target skills into very small steps and directly teaching the skill one step at a time – often accompanied by direct physical prompts for desired responses that later must be faded. Similarly, adherence to routines and sensory and motor deficits will make teaching more challenging and may extend the time it takes to learn a new skill; however, it does not mean that instruction will be unsuccessful.
Proven Teaching Methods
Over the last 25 years of research, instructional strategies have emerged for teaching self-help skills. The general approach for teaching self-help skills has included various combinations of behaviorally based principles that include stimulus control procedures, task analysis, chaining, reinforcement, and prompting.
Stimulus Control Procedures. One of the first questions to consider when beginning instruction is: What stimuli should control the learner’s behavior? For example, the stimuli that control washing hands should be the presence of noticeably dirty hands or learned sequences such as washing hands before you eat. For a preschool child, a verbal instruction from the teacher or parent to wash their hands before eating is normal. When a prompt is still necessary when the individual reaches adolescence or young adulthood, it is no longer normal.
Chaining and Task Analysis. A behavior chain is a sequence of discrete behaviors that make up more complex behavior. A chain allows the simplification of complex behaviors into a series of steps for learning. Examples of chaining are plentiful, such as chaining together simple steps to form the skill of “putting on a t-shirt.” Once learned, this simple skill can be combined with all other articles of clothing to form the act of dressing (an even longer chain). The job of breaking down complex behaviors into a series of teachable steps is called a task analysis.
Prompting. Because many individuals with autism may not have any of the component steps of the task analysis, the instructor often must rely on prompting to occasion the behavior so that it can be reinforced. There are three basic ways to prompt desired behavior: verbal, model, and physical guidance.
Verbal prompts involve specific instructions (e.g., “get dressed”) to help the child begin or continue the target task. Modeling involves demonstrating the desired behavior while the child observes. It may be effective for learners who can imitate and who have some of the component skills prior to instruction. Physical guidance prompts are often used with children with severe disabilities. Physical guidance may involve the instructor fully guiding the learner or partial prompts such as touching the learner’s elbow to encourage picking up a toothbrush.
Prompts, although very effective for teaching new skills and maximizing the instructional time, present a risk that the learner may become dependent on them. Thus, the instructor or parent must introduce prompts only if absolutely needed, then fade them quickly and systematically. One of the most common approaches to using prompts systematically is most-to-least prompting. When most-to-least prompting is applied, the instructor provides physical guidance at the level where the child is likely to correctly perform the step. Over trials or sessions, the instructor slowly reduces the amount of help as the child begins to independently perform the task (e.g., reducing the amount of effort needed to guide the child).
Other Strategies. A variety of creative visual and tactile strategies have been employed to minimize dependence on adults and to maximize the strengths of learners with autism. For example, the use of pictures, activity schedules, and videotape has all been reported. Visually cued instruction in the form of activity schedules and video modeling have been used to teach a variety of skills and hold great promise for teaching self-help skills. Tactile prompts such as the use of a beeper’s vibrating function also have been used to cue learners to respond without an adult verbal or physical prompt.
The Role of Parents and Schools
Given the pace of today’s society, asking parents to do much more seems daunting. The good news is that as individuals acquire skills, it means independence for the parents as well as the learners. In most cases, parents will be able to build on things they are doing already. For example, instead of taking the time to dress her son each day, a mother can use that time to introduce a program to teach him to dress himself. It may take a little more time initially, but eventually both gain greater freedom.
Whether a child is in a general or special education setting in a public or private school, school personnel also have a responsibility to provide a comprehensive program that addresses all areas of development, including self-help (Individuals with Disabilities Education Improvement Act – Revised, 2006). But if a child with autism is in a general education classroom, most teachers are focused on teaching required academic curricula and testing them on content – not teaching self-help skills. At a minimum, school district personnel should be involved to ensure transfer of skills from home to school. If your child attends a special education classroom for some or all of the day, the school district should be directly teaching self-help skills and these activities should be written into the child’s Individual Education Plan.
In summary, the acquisition of self-help skills is critical for individuals with ASD. Research has shown that children with autism often experience moderate to significant deficits in this area regardless of their intellectual abilities. Deficits in daily living skills have been demonstrated to significantly impact on quality of life related to community integration, work, and personal choices. Fortunately, there exists a body of scientifically proven methods for teaching self-help skills to individuals with ASD. When applied systematically, most individuals with autism can learn to be more independent and achieve a lifetime of greater success.
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GOOD READS
Teaching Social Communication to Children with Autism
OAR-funded researcher Brooke Ingersoll, Ph.D., recently published Teaching Social Communication to Children with Autism, a two-book package and DVD, co-written with Anna Dvortcsak, MS, CCC-SLP. The package, which includes a practitioner’s guide to parent training and a manual for parents, presents a parent-training approach that is accessible, evidence based, and highly practical. Using developmental and behavioral research, the practitioner’s guide offers guidelines for conducting parent training individually or in groups. The guide breaks down proven techniques for promoting social-communication skills of young children into simple, effective steps so parents can learn how to do them.
The DVD features video clips of parents implementing the techniques with their children and a PowerPoint presentation. The practitioner's guide also features 30 reproducible handouts and forms.
The companion manual for parents helps parents master the techniques and use them at home with their child during daily routines and activities. Copies of the parent manualare also sold separately.
The package is compatible with the STAR Program and other ABA-based methodologies.
Dr. Ingersoll is a psychologist and board-certified behavior analyst with a doctoral degree in experimental psychology from the University of California, San Diego. While co-director of the Autism Treatment and Research Program at the Hearing and Speech Institute (now known as the Artz Center), she conducted a study on teaching imitation and the spontaneous use of gestures using a naturalistic behavioral intervention that was funded by OAR in 2003. Dr. Ingersoll is currently an assistant professor of psychology at Michigan State University, East Lansing. She has conducted training for practitioners on early intervention strategies for children with autism spectrum disorders both nationally and internationally.
Dvortcsak, MS, CCC-SLP, is a speech-language pathologist in private practice in Portland, Oregon. Dvortcsak provides training to families with children with autism and individualized speech and language services. She specializes in training professionals in conducting parent training for young children with autism spectrum disorders. Prior to starting her own practice, Dvortcsak was co-director of the Autism Treatment and Research Program at the Hearing and Speech Institute (now known as the Artz Center) in Portland.
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