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Using Boundary Markers to Support Students with Autism in Classroom Settings

Boundary settings are a type of environmental support for students with ASD. Basic boundary markers which establish physical space for specific activities such as break time areas, and reading areas help students differentiate expectations across settings, especially when one area is used for different activities (this is very common in classrooms around the world). For example, if two or more tasks must be completed at the same work space or work area, using a colored tablecloth can help distinguish one activity from another. Reading could take place at the table and then it could be covered with an orange tablecloth when it is time for math. Additionally, sectioning off an area on the floor with colored tape, rugs, or anything else that would indicate where a student is expected to be during any given activity is an effective environmental support. This type of marking or labeling is simple and seems to be a minor modification, but in fact, it is highly effective for working with students with ASD. These modifications can reduce students’ confusion and increase clarity by identifying expectations.

It is important to note that simply applying these types of environmental supports without explicitly demonstrating them to the student and explaining what they are intended for will likely not result in the desired outcome. It is almost always necessary to show the student how they are intended to be followed for the markers and boundaries to be effective. Often times, showing or demonstrating to the students how the boundaries and markers are to be followed needs to be done repeatedly and over time.

Finally, when boundaries and markers begin to show effectiveness with students with ASD, rewards for appropriately following the supports should be utilized. That is, when a student correctly follows them they should be provided with social praise or other types of rewards.

What Constitutes Effective Intervention for Individuals with Autism? The National Research Council’s report on Effective Treatments for Autism Still Stands True

In 2001, the National Research Council published findings effective treatments on Educational Interventions for Children with Autism from birth to age 8. The committee set out with the question “What are the characteristics of effective interventions in educational programs for young children with autism spectrum disorders?” The findings were published in a comprehensive book titled, “Educating children with autism.”

In answering the above question, the committee recognized that there were numerous articles written on autism treatment and that there were numerous treatment programs across the country claiming to be effective in helping children with autism. Treatments ranging from ABA-based programs to developmentally-based programs to diet-based programs or more idiosyncratic programs such as sensory integration. In order to base their recommendations on clear evidence of effectiveness, the committee ruled out treatment that did not base their statements on some form of data regarding the outcome of the children.

They took a look at over 900 articles written on the treatment of autism and also enlisted the assistance of ‘model’ programs currently in place for the treatment of autism.  These model or state-of-the-art programs were typically university or research ran programs who that enlisted the services of highly qualified professionals. Of the ten model programs selected, seven were from an applied behavior analysis framework, one was from a developmental framework, one was purely parent training, and the last was a combination of behavioral and developmental frameworks.

The committee listed key features seen as variables of effective programs in an effort to use this information from these state-of-the-art programs and translate it to publicly funded early education programs across the country and to begin some quality control.

The first characteristic identified as a key feature of an effective treatment program is that of early entry into a program.  When reviewing the information from these model programs and based on findings from the literature, the committee saw that the earlier a child is placed in treatment the better their chances of making gains.  Therefore, their first recommendation was that educational services begin as soon as a child is suspected of having an autism spectrum disorder highlighting the importance of early intervention. Early detection and treatment are key phrases often heard in the medical field and this is the exact same case when it comes to the treatment of autism.  So, early entry is recommendation number one.

Next, the committee looked at the intensity of these programs and what has been shown in the literature  to be an effective level of intensity. Their conclusion upon review of the information was that educational services include a minimum of 25 hours a week, 5 days a week, 12 months a year during which time a child is actively engaged. The word minimum in this recommendation is key as some children may need more than this minimum of hours given the severity of their symptoms or their resistance to treatment.

Additionally, the notion of active engagement is very important as the recommended number of treatment hours is not merely the number of hours recommended for a child to be placed in a treatment program, but the number of hours to child is actively learning while in the program.  This means that the child should not be just physically present in a treatment program, but that each and every hour of that program is designed in a way in which the child will learn for a minimum of 25 hours per week.

Another way of looking at this is if it was recommended that a child attend a special education program 30 hours a week, one would initially think that the recommendation for a minimum number of hours has been met. However, if, within these 30 hours, the child spends at least two hours a day playing alone in the playground, one hour a day eating lunch, a few hours a day in unstructured and unsupervised solitary play activities, and only two hours of actual teaching occurs within the school day, a child is left with only a 10-hour a week treatment program. And while play time is extremely important for any child, if a child does not yet have the skills to know how to play, how can the child be expected to interact with other children during these free play times without specific structured teaching?  So, it is important to look beyond the number of hours and actually look at what each hour of the treatment program will entail whether that be an ABA program, school-based program, or any type of recommended treatment program.  It’s imperative that a child be placed in a program where they can access the curriculum and where the teachers or therapists are actively engaging the child so as to capture each and every teaching opportunity and make it a worthwhile experience. There needs to be intensive teaching and learning occurring during a child’s time in an intervention program.

The committee actually described intensity as a “large numbers of functionally, developmentally relevant, and high-interest opportunities to respond actively.”  In other words, a child’s time spent in a treatment program should result in high levels of learning when it comes to the matter of reaching their educational goals. So, the higher the level of active engagement, the higher the intensity, the higher the change rate for steady gains.

Next on the list of key characteristics was the child to teacher ratio. The committee recommended that programs consist of sufficient amounts of adult attention in order for a child to meet their educational goals, either learning with one-to-one or very small group instruction. The decision of student-to-teacher ratio should be made, depending on the learning ability of the child rather than depending on the staffing needs of the program.  Therefore, if a child can learn in a small group of maybe two children and one teacher, then that should suffice; however, as is the case for many young children with autism, if the child cannot occupy their own free time in a constructive manner, redirect their attention when asked, or learn via observation of a peer, then the teaching instruction should be in a one-to-one manner, that is one teacher with one child.

The committee recognized the need for well-trained personnel.  The committee noted that all the model programs they reviewed were developed by persons with Ph.D.’s in autism-related fields and the programs were directed and implemented by teams of professionals who had extensive training and experience in autism spectrum disorders. It is so important that the person designing a treatment program for a child with autism has extensive knowledge not only in the field of autism, but hands on experience in designing effective programs.

Next, the committee recognized the notion of individualization. A key characteristic of these model programs was that of comprehensive, individualized treatment goals based on the needs of each individual child rather than a one-size-fits-all curriculum for all the children in the program. The curriculum or individualized plan developed for each child should be based on their own personal strengths and weaknesses.  The goals for each child should also focus on the development of a child’s social and cognitive abilities, their verbal and non-verbal communication skills, adaptive or self-help skills, and the reduction of behavioral difficulties using more positive behavioral approaches rather than punitive approaches.

The second part of this recommendation, that “goals “are frequently adjusted,” cannot be emphasized enough. While the initial curriculum and targets developed for a child may be individualized at the onset of a treatment program, it is critical that these goals and targets be reviewed routinely and adjustments be made when necessary.

And lastly, the committee recognized the important role parents have when it comes to the effectiveness of treatment programs. A key characteristic amongst all model programs was their emphasis on parental training and involvement in the program. The involvement of parents is a very valuable tool in the treatment of autism because children spend most of their time with their parents; therefore, parents must play an active part in the treatment team so as to continue where the formal treatment sessions end. With parents as active participants of the program, a child will always be in a consistent environment where their skills can be generalization generalized and maintained.

What are the Changes to the Diagnosis of Autism with the DSM-V?

The first change with the new edition of the DSM is to combine the formerly separate diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not-otherwise-specified into one group with the name of Autism Spectrum Disorder. The stated reason for this was that of reliability and validity. That is, the DSM IV could, to the satisfaction of the committee, distinguish individuals with autism from typically developing individuals. Further, the committee stated that because autism is described by a common set of behaviors that it is best represented as a single disorder. Finally, the committee stated that a single spectrum disorder represents the current state of knowledge regarding the disorder and how it appears clinically to clinicians.

The second change is the combining of the three domains that appeared in DSM-IV (Qualitative impairments in social interaction, Qualitative impairments in communication, and restricted repetitive stereotyped patterns of behavior) into two domains (Social Communication Deficits and Fixed Interests and Repetitive Behaviors). The following rationale were provided: 1) deficits in communication and social behaviors are inseparable and; 2) delays in language are neither unique to autism (i.e., they appear in other disorders), nor are they universal (i.e., not all individuals with autism have them); 3) The changes improved specificity of the diagnosis while not compromising the sensitivity; 4) Increased sensitivity across severity levels of autism; 5) Secondary analyses of data sets support the combination of categories.

The third change is a change in the criteria within the social/communication domain were merged and streamlined to clarify diagnostic requirements. The following rationale was provided. In the previous version of the DSM several criteria measured the same symptom thus giving greater importance to that symptom (social/communication) and the merging of these criteria requires a new approach to them. Secondary data analyses were conducted to determine the most sensitive and specific symptom clusters to facilitate diagnosis for a range of ages and language levels.

Next, there is a new requirement of two symptoms from repetitive behavior and fixated interests be identified. It was also proposed that this change will increase specificity while not decreasing sensitivity. In addition, there is a requirement for multiple sources of information (clinical observations and parent/caregiver report).

These changes represent the current iteration of the DSM-V diagnosis of autism.

How to teach your child to wait and what you could do before and after telling your child “no”

Two common difficulties that we encounter when working with families over the years are regarding waiting and when a child is told no.  These two scenarios can be overwhelming as they are often accompanied by the most intense challenging behaviors.  We will go over these on this this post.

First off, the skill of requesting appropriately must be well-established already.  If this skill is not yet in your child’s repertoire then it must be taught first. If the skill is already there, but it’s not as fluent as we’d need it to be, then work on that first.

Let’s say your child can already ask for a cookie—this is great, but what can you do if for some reason, you child has to be told to wait?   If your first thought given that question you just read is along the lines of “oh…” then do consider the following.  There is this passage of time that happens between being asked to wait for something and finally getting that something.  The key here is working on that gap.  Depending on how your child “understands” that concept—time—you may have to be more hands-on when helping out your child go through it.   Instead of simply saying “wait,”  try giving your child something that he likes to “kill time.” This is not something out of the ordinary. Case in point: look at long lines of people at a grocery store, a theme park ride, at a bank, et cetera.  It is very rare to see a long line of people, waiting, just starting blankly at the back of the head of the person in front of them (unless you’re in the military or something similar) and just “wait” for their turn.  Perhaps you’ll notice a handful dealing with waiting in not-so-positive ways but for the most part, people will do something to pass time.  From being on their phones, talking to someone whom they are with, looking around, reading a book—we, again, most of us, can handle waiting because we fill that gap with something else.  And that is something that you can try out—offer your child something that they will not mind doing while they wait.  The more reinforcing that activity the better. When starting to teach your child to wait while engaged in something, make sure to keep the wait-time very short. How short?  It depends on each child really, but a good rule of thumb is to end the wait when your child is still behaving well (i.e., before your child starts that path to a full-blown tantrum). Let’s say that time is around one minute—great. Keep it around that time limit and systematically increase the time just a bit and stay on that higher limit (e.g., from one minute to about two minutes) until your child gets used to it.  From there, you can once again increase the limit to say three minutes.  This does not happen without any difficulty—the key here is you being consistent.  Also, avoid a situation wherein the wait time had been too long that your child “forgets” about whatever it is he or she is waiting for.  You need your child’s motivation for whatever it is he or she is waiting for for the learning process to “click.”  Once that motivation goes away, the teachable opportunity is lost so it is best to be realistic on how long you really want your child to wait.

Again, teach waiting only if they can truly have that cookie, but at a later time (or after a number of activities).  If they cannot have that cookie, then don’t say wait (after which they do) then tell them no in the end. Hence, the next topic: what can you do when you are about to tell your child no (i.e., denial).

True: a no is a no and that is something our children must learn; however, before we get to that lesson, let’s take a few steps back.  If you know that your child cannot have that cookie, give your child’s behaviors a chance to not escalate.  Offer your child something she likes instead of whatever that is she wants at the moment.  The key here is you offering an alternative that she truly wants—whatever that is given that moment.  If your child accepts the alternative—great!  If your child does not like your attempts to compromise—and if your child is capable—ask her to choose her own alternative item/food/activity.  Be prepared to honor her choice.  If your child accepts that scenario—great!   If not, time to roll up your sleeves—it’s time to teach your child that no means no.  There is no going around this.  You have offered her alternatives. You have also given her a chance to choose her own alternative.  If those fail, you have done your job but despite your efforts to teach alternatives, the tantrums will happen. As those behaviors are happening, the worst thing that you can do is give in—no.  Don’t give in as that will only reinforce all those not-so-nice behaviors.  It will be difficult, but a no is a no.

When your child’s behaviors start to de-escalate, it is still possible to offer her alternative and/or giving her a chance to select her own, but never give in.

If your child already engages in the most extreme challenging behaviors such as self-injurious behaviors or property destruction or any other behaviors that compromise the safety of others during times when he or she is denied access to something, we highly recommend that you immediately seek assistance from a trained professional.

How to Make a Visit to the Grocery Store a Learning Opportunity for Your Child with Autism

A visit to the grocery store for parents with a child with autism can be quite stressful. On the other hand, it can also be a wonderful learning experience if parents take the time to follow a few simple strategies.

Before the shopping experience begins, it may be beneficial to state what is expected from your child, approximately how long it will take, and what can be expected afterwards. A method to increase motivation may be to state a clear if/then contingency. For example, “Johnny, if you stay next to mom/dad, help pick out your items, then after shopping we can get visit a nearby store you like.”

Make a list of items, either drawn out, printed out, or cut out from advertisements that your child can keep track of during the shopping trip. These can be items they prefer and would be interested in tracking and finding. Ask your child to cross out the items or put the picture in an envelope when you both find the item, signifying one step closer to being done with the shopping experience. Give your child a shortened list without all the items you need to get on it. Save the last item that you get for his list so that he can directly see when the last item is crossed out, you are done!

Have a back-up enjoyable activity that your child can engage in while you are completing the remaining part of the shopping trip that is not on his list. A small coloring book, games on your phone, a squishy toy, or some music through headphones may work to keep him engaged.

Use the experience to teach language skills. Grab a green and a red apple and ask your child to identify which one is red. Grab a big and a small can of tomatoes and ask your child to identify which one is bigger. Ask your child to label items that you grab from the shelves, especially preferable items. Based on how advanced your child’s speech is, tailor what you ask of them to their level.

Last, if your child has difficulties walking through an entire shopping experience, allow your child to catch a ride on the shopping cart only if he has walked and helped for a certain amount of time, or when all of his grocery list is completed. If you base it on time, be sure to have a visual chart (e.g., have 5 boxes, each representing 2 minutes) or timer for him to know how much time he has left of walking.

Hopefully these strategies will aid in creating a productive and enjoyable grocery shopping experience for you and your child!

When You Start an ABA program, What Should You Reasonably Expect from Your Service Provider?

The following are things that you should expect as a parent when you begin treatment for your child with Autism.

You and your child have a right to a therapeutic environment.  This means that the teaching environment set up to help your child is one in which socially significant learning occurs.  As a client, your child also has the right to services from an agency in which their number one goal is the personal welfare of your child (e.g., safety, treatment efficacy, advocacy). This means that all energy put into the program is to help your child become more independent and lead a better life.

It is also your child’s right to have a treatment program supervised by a competent behavior analyst. Unfortunately, as the rates of autism have increased, so have the number of treatment programs allegedly providing assistance to children with autism.  Furthermore, in many locations, the demand presently outweighs the supply for trained, experienced behavior analysts. It is imperative that the credentials and qualifications of your service provider be credible.

Your child has a right to be provided with a program that teaches functional skills. Functional skills are skills that a child can use in their everyday life and that furthers their independence (tying shoes, initiating conversation, engaging in cooperative play, etc.). There is little benefit in taking the time and dedication to teach a child something that cannot be incorporated or used in their everyday life.

Assessment and ongoing evaluation are crucial components of any ABA program, and should be expected.  This includes setting up a program based on the individual needs of a child and continuing a program based on the ongoing needs of a child. These needs will continually change, therefore ongoing assessments and modifications are imperative, necessary, and a right.

Parent and caregiver trainings should be included in the ABA program. These typically include meetings between parents or caregivers and their service provider in which valuable ABA strategies are discussed, demonstrated, and implemented. The focus of these meetings is to educate parents about various but individualized ABA based techniques they can implement with their child to address challenging behaviors, reinforce desirable behaviors, and promote generalization of progress.

Lastly, and perhaps most importantly, a child with autism has the right to the most effective treatment procedures available. In this case – scientifically validated treatment programs which today have only been shown to be based on ABA principles and techniques.