The Institute for Behavior Change
Understanding
Autism Spectrum Disorders
and successful approaches to treatment
© 2007 The Institute for Behavior Change, Inc.
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Training Schedule
Day 1: Basic Concepts
Overview of Autism Spectrum Disorders (ASD)
Overview of BHRS, Treatment Planning and ABA principles
Overview of Treatment Outcome measurement
parental assessment of progress
staff data collection methods
Day 2: Basic Skills
Functional Behavior Assessment (FBA) methods
Improving Communication skills
Improving Social Skills, reducing frustration & expanding options
Working effectively with families and schools
Autism across the lifespan
© 2007 The Institute for Behavior Change, Inc.
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Training Objectives
Participants in this training will:
•
•
•
•
•
© 2007 The Institute for Behavior Change, Inc.
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Acquire a working knowledge of the Autism Spectrum Disorders (ASD)
•
How to identify the symptoms of ASD
•
Understand that symptom presentation varies from child to child
•
How to create effective treatment plans
Learn how to use Behavioral Health Rehabilitation (BHR) services to
deliver effective treatment to children with ASD
Understand why ongoing treatment outcome measurement is essential
Learn how to measure treatment outcomes effective and efficiently
•
To facilitate rapid responses to changing child behavior
•
To facilitate continued funding for necessary treatment
Learn how children with ASD can be supported throughout the lifespan
•
Early childhood, School, and Employment settings
•
Socialization and training for maximum independence
Diagnosing Autism
DSM-IV TR
Diagnostic and Statistical Manual of Mental Disorders
of the American Psychiatric Association, 4th Edition
(Text Revision) © 2000 American Psychiatric Association
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•
Establishes criteria for the diagnosis of ASD as a psychiatric
disorder (Axis I diagnosis).
•
Used by psychologists, psychiatrists and other medical
doctors to classify symptoms so that treatment services
can be funded by insurance.
•
Code 299.00
Diagnosing Autism Spectrum Disorders
Autistic Disorder
Asperger’s Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Pervasive Developmental Disorder
Pervasive Developmental Disorder, NOS*
299.00
299.80
299.80
299.10
299.80
299.80
The designation abbreviated NOS can be used when
the mental disorder appears to fall within the larger
category but does not meet the criteria of any specific
disorder within that category.
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Autistic Disorder (Autism)
299.00
In children with this Pervasive Developmental Disorder there is substantial delay in
communication and social interaction associated with development of "restricted,
repetitive and stereotyped" behavior, interests, and activities.
Diagnostic criteria for Autistic Disorder
A. At least six items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
(d) lack of social or emotional reciprocity
(2) qualitative impairments in communication as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an
attempt to compensate through alternative modes of communication such as gesture or
mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain
a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to
developmental level
(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as
manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of
interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or
complex whole-body movements)
(d) persistent preoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3
years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or
imaginative play.
C. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.
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Asperger’s Disorder
299.80
In children with this Pervasive Development Disorder language, curiosity, and cognitive
development proceed normally while there is substantial delay in social interaction and
development of restricted, repetitive patterns of behavior, interests, and activities.
Diagnostic criteria for Asperger's Disorder
A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other
people)
(4) lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as
manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of
interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other
important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single words used by age 2
years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity
about the environment in childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
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Rett's Disorder
299.80
Children with this Pervasive Developmental Disorder appear to develop normally at first, but their head
growth slows, they lose social "engagement" and hand skills, and they develop stereotyped
movements of the hands and poorly coordinated gait or trunk movements. There is also psychomotor
retardation and impairment of language development.
Diagnostic criteria for Rett’s Disorder
A. All of the following:
(1) apparently normal prenatal and perinatal development
(2) apparently normal psychomotor development through the
first 5 months after birth
(3) normal head circumference at birth
B. Onset of all of the following after the period of normal development:
(1) deceleration of head growth between ages 5 and 48 months
(2) loss of previously acquired purposeful hand skills between
ages 5 and 30 months with the subsequent development
of stereotyped hand movements (e.g., hand-wringing or
hand washing)
(3) loss of social engagement early in the course (although often
social interaction develops later)
(4) appearance of poorly coordinated gait or trunk movements
(5) severely impaired expressive and receptive language
development with severe psychomotor retardation
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Childhood Disintegrative Disorder
299.10
Children with this Pervasive Developmental Disorder appear to develop normally for the
first two years of life, but then lose skills in areas such as language, play, and bowel
control and manifest impaired social interaction and communication associated with
restrictive, repetitive, stereotyped behavior.
Diagnostic criteria for 299.10 Childhood Disintegrative Disorder
A. Apparently normal development for at least the first 2 years after birth as
manifested by the presence of age-appropriate verbal and nonverbal
communication, social relationships, play, and adaptive behavior.
B. Clinically significant loss of previously acquired skills (before age 10 years) in
at least two of the following areas:
(1) expressive or receptive language
(2) social skills or adaptive behavior
(3) bowel or bladder control
(4) play
(5) motor skills
C. Abnormalities of functioning in at least two of the following areas:
(1) qualitative impairment in social interaction (e.g., impairment in nonverbal
behaviors, failure to develop peer relationships, lack of social or
emotional reciprocity)
(2) qualitative impairments in communication (e.g., delay or lack of spoken
language, inability to initiate or sustain a conversation, stereotyped and
repetitive use of language, lack of varied make-believe play)
(3) restricted, repetitive, and stereotyped patterns of behavior, interests, and
activities, including motor stereotypies and mannerisms
D. The disturbance is not better accounted for by another specific Pervasive
Developmental Disorder or by Schizophrenia.
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Autism Syndrome
2-4 times more common in boys
Occurring at an increasing rate since 1990
Socially self-stigmatizing
Hypersensitive to stimulation
Self-stimulating behavior
Inattentive to directives
Intolerant of redirection
Escape-Avoidance responses
Uncommunicative & easily frustrated
Difficulty with self-regulation
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Asperger’s Syndrome
2-4 times more common in boys
Occurring at an increasing rate since 1990
Socially self-stigmatizing
No significant delay in language
Uses words by age 2 & phrases by age 3
Deep interest in relatively arcane subjects
Many children with Asperger’s Disorder
have a “rule book” with 10,000 entries
-- and have memorized all of them.
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PDD Syndrome
2-4 times more common in boys
Occurring at an increasing rate since 1990
Socially self-stigmatizing
Severe impairment in at least 3 major domains
Expressive or Receptive Language
Gross Motor or Fine Motor Coordination
Cognitive Processing
Socialization
Under-responsive to stimulation
Difficulty with self-regulation & easily frustrated
Inattentive to directives & intolerant of redirection
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Not an ASD
Reactive Attachment Disorder
313.89
Diagnostic criteria for Reactive Attachment Disorder of Infancy or Early Childhood
A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning
before age 5 years, as evidenced by either (1) or (2):
(1) persistent failure to initiate or respond in a developmentally appropriate fashion to most
social interactions, as manifest by excessively inhibited, hypervigilant, or highly ambivalent
and contradictory responses (e.g., the child may respond to caregivers with a mixture of
approach, avoidance, and resistance to comforting, or may exhibit frozen watchfulness)
(2) diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit
appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack
of selectivity in choice of attachment figures)
B. The disturbance in Criterion A is not accounted for solely by developmental delay (as in mental
retardation) and does not meet criteria for a Pervasive Developmental Disorder.
C. Pathogenic care as evidenced by at least one of the following:
(1) persistent disregard of the child's basic emotional needs for comfort, stimulation, and
affection
(2) persistent disregard of the child's basic physical needs
(3) repeated changes of primary caregiver that prevent formation of stable attachments (e.g.,
frequent changes in foster care)
D. There is a presumption that the care in Criterion C is responsible for the disturbed behavior in
Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
Inhibited Type: if Criterion A1 predominates in the clinical presentation
Disinhibited Type: if Criterion A2 predominates in the clinical presentation
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Not an ASD
ADHD (hyperactive, impulsive, combined type) 314.0x
Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder
A. Either (1) or (2):
(1) inattention: six (or more) of the following symptoms of inattention have persisted for at
least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish school work,
chores, or duties in the workplace (not due to oppositional behavior or failure to
understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental
effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments,
pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivityimpulsivity have persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:
E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder,
Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental
disorder.
Code based on type:
314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the
past 6 months
314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but
Criterion A2 is not met for the past 6 months
314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion
A2 is met but Criterion A1 is not met for the past 6 months
Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no
longer meet full criteria, "In Partial Remission" should be specified.
© 2007 The Institute for Behavior Change, Inc.
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© 2007 The Institute for Behavior Change, Inc.
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What causes Autism?
Refrigerator Mothers.
It’s Genetic.
Mold.
Vaccinations.
(For every expert, there is an equal and opposite expert.)
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Causes of Autism Spectrum Disorders
Children with Autism are all…
“All” doesn’t apply to any group of human beings, except when
you want to classify, categorize and/or isolate them.
Some children with Autism Spectrum Disorders (ASD)…
Have genetic abnormalities
Were adversely effected by vaccination contents
Have mothers who are intimidated by their lack of response
Are unusually sensitive to environmental stimuli, including molds
Can be classified as children with mental retardation
Are just “late bloomers”
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Characteristics of children
with ASD
Children with ASD are all…
“All” doesn’t apply to any group of human beings, except when
you want to classify, categorize and/or isolate them.
Some children with ASD are highly…
Creative
Intelligent
Sensitive to sound, light, vibration, smell or taste
Sensitive to vitamin deficiencies and chemicals
Precocious in specific talents or abilities
Normal in every way, then regress
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Myths about Autism
BHRS wasn’t
made to treat
children with
Autism!
If that’s true (it’s not) then why are you here?
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Behavioral Health Rehabilitation
Services
Individualized
Intensive
Behavioral
Treatment
Measuring Outcomes
and ameliorating identified problems.
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What does “Ameliorating” mean?
The identified problems are
Getting Better.
If the identified problems (“target behaviors”) are reducing
over time, the treatment program is “ameliorating” the
identified problems and continued funding of the child’s
treatment program is possible.
Insurance companies can’t deprive a child under the age of 21
of Medicaid funding for treatment that is ameliorating the
child’s identified problems.
That’s federal law.
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HOW to help children
with challenging behavior
1.
2.
3.
4.
5.
6.
Establish a hierarchy.
Locate the child on the hierarchy.
Decide how to move the child to the
“next level” on the hierarchy.
Get treatment team permission to
implement the plan, then do it.
Monitor the results.
Re-write your plan based on the results,
then begin again at #4.
Helping children with ASD
Most children with ASD need help to:
1. Communicate effectively
2. Socialize age-appropriately
3. Respond adaptively to frustration
4. Expand their range of experiences
5. Behave safely
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Communicate effectively
Hierarchy of communication problems
Most problematic
No intentional communicative behavior (not even pointing)
No vocalizations (no sounds)
Perseverative vocalizations (repeating the same sounds)
No speech (no words)
Echolalia (repeating what was just heard)
Perseverative speech (repeating the same word or words)
Minimal speech (for need gratification only)
No reciprocity (no give-and-take in social conversation)
Least problematic
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Communicate Effectively
Communication skills that may need to be developed
Expressive  Manding (requesting toys, activities, edibles, assistance,
breaks)
 Greetings
 Saying “yes,” “no,” and indicating preferences
 Reciprocal communication (responsive and spontaneous)
Receptive –
 Orients to speaker
 Understanding vocal directions and gestures
 Following pictorial and/or written directions and
schedules
 Tolerating delay
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Socialize age-appropriately
Hierarchy of Socialization problems
Most problematic
Aversion to socialization (active avoidance of others)
No interest in socialization (passive avoidance of others)
Perseverative Play (repeated, inappropriate use of toys)
Tolerates playful interruption of Perseverative Play
Parallel Play (appropriate use of objects)
Successful Structured Play episodes (adult direction)
Successful Structured Play episodes (adult assistance)
Successful peer play (still requires adult supervision)
Least problematic
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Socialize age-appropriately
Socialization skills that may need to be developed
Tolerance for the presence of one other child in the area
Tolerance for redirection to socialization for brief periods
Tolerance for redirection to alternative social activities
Tolerance for playful interruption of perseverative play
Replacement of Parallel Play with collaborative play
Responsiveness to adult direction
Responsiveness to adult assistance
Responsiveness to peers in social situations
Appropriate appeal to adult authorities when frustrated
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Respond adaptively to frustration
Hierarchy of maladaptive frustration problems
Most problematic
Physical aggression (violence against other people)
Self-injurious behavior (violence against self)
Severely stigmatizing social behavior (screaming, soiling)
Property destruction (violence against objects)
Frustration is addressed after behavior explodes
Frustration is addressed during behavior explosion
Frustration is addressed before behavior explodes
Frustration is excessive but behavior doesn’t explode
Least problematic
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Respond adaptively to frustration
Frustration management skills that may need to be
developed:
Relaxed breathing
Counting
Appropriate Ignoring (separating self from sources of
frustration)
Tolerance for redirection and delay (1-2-3 Magic, etc)
Tolerance for time-out procedures
Generalization of limit-setting tolerance from one adult to
others
Seeking adult intervention appropriately
Seeking adult intervention when necessary
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Expand their range of experiences
Hierarchy of experiential problems
Most problematic
Aversion to new experiences (refusal to think about them)
Cooperates with learning about new experience only
Aversion to new experiences (active refusal to attend)
Cooperates with Behavioral Rehearsal of attendance only
Accompanies adult to new activity (passively attends)
Accompanies adult to new activity (minimal participation)
Accompanies adult to new activity (reasonable participation)
Accompanies peer to new activity (reasonable participation)
Least problematic
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Expand their range of experiences
Tolerance for new and different experiences may be needed
Shaping tolerance for new experiences (foods, toileting, etc)
Opening & Expanding “circles of communication” (DIR model)
Tolerating new performance expectations in school
Tolerating new performance expectations at home
Tolerating new performance expectations in the community
Learning alternative means of communicating with PECS
Learning alternative means of communicating with sign
language
Learning alternative means of communicating with speech
skills
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Behave safely
Hierarchy of safety problems
Most problematic
Risk-taking for sensory stimulation (falling, self-cutting)
No awareness of environmental danger in any setting
Unsafe indoors (climbing, electricity, stove, etc)
Unsafe outdoors (motor vehicles, elopement, getting lost)
Unsafe on trips to public places (mall, store, playground)
Unaware of stranger safety (avoidance, nonadmittance)
Unaware of community safety resources (police, teachers)
Least problematic
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Behave safely
Learning new safety precautions may be needed
Inhibition of impulses for dangerous self-stimulatory activity
Acquiring awareness of indoor environmental dangers
Acquiring awareness of outdoor environmental dangers
Acquiring awareness of motor vehicle dangers
Acquiring safe travel skills in malls, stores, playgrounds, etc
Acquiring safe stranger skills (avoidance, nonadmittance)
Acquiring understanding of community safety resources (police,
teachers) – PremiseAlert program to increase community safety
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Therapeutic Staff Support
In-Service Training
Practical & Applied Skills
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Sensitivity to the Client’s Family
Building a Relationship with the
Client’s Family
RESPECT


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Respect is an ATTITUDE of Acknowledging
the Feelings, values and interests of the
family in a Therapeutic Relationship
Affording your Client’s Family Respect, you
are not Passing Judgment on the Manner
that they live, OR Interact, OR the Values
that they Hold
Rapport
 Is one of the Most Important Features or
Characteristics of Unconscious Human Interaction
 The Ability to enter the Family’s World View
 It is Commonality of Perspective, being in “sync”, being
on the same wavelength as the person you are talking to
 Positive Communication Skills
Trust
 The basic Foundation of every Relationship: Honesty,
Caring, Integrity
Compliance Boundary
 Setting up Parent and Teacher Boundaries- Allowing
Intervening Caregiver to Finish Intervention before
Approaching unless asked by the Attendee ( Teacher,
Parent, TSS) Talk to BSC first, then Deal with it
Appropriately
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Sensitivity to the School and
School Environment
Building a Positive Working
Relationship with the
Teachers
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

Positive Communication Skills


Respecting the Rules of the School
Respecting the Role of the
Teacher with your Client
Discussing with the Teacher the
need for pairing with Child
Restraining Clients
PA Laws Pertaining to Restraint of Children



Personal Restraint is the Application of Physical Force on a
Person’s Body without the use of any Device for the Purpose
of Restricting the Free Movement of a Person’s Body.
The Term Personal Restraint does not include Briefly holding
without Undue Force a Person in Order to Calm or Comfort
him or her, or Holding to Safely Escort a Person from One
area to Another.
BHRS staff may not be involved in the Application of a
Restraint Procedure under Any Circumstances even if they
have been trained within the past year.
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Physical Assistance and Guidance

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What are the Limitations?
Physical Assistance and
guidance is an intervention
that is utilized when a client
puts him/herself at risk for
harming self and/or others.

Physical Assistance is NEVER
utilized as a general
intervention.

Examples of “do’s” and
“don'ts” of physical guidance.
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Restraint Cont.

Exclusion (Federal term: "exclusionary time out")
is the removal of a child from the child's
immediate environment and restricting the child
alone to a room or area. (See 55 Pa. Code
§3800.212). PERMITTED

Exclusion is similar to the Federal "time-out"
which is the restriction of a person for a period
of time to a designated area from which the
person is not physically prevented from leaving,
for the purpose of providing the person an
opportunity to regain self control. (See 42 CFR
§483.352 and .368). PERMITTED

Seclusion is NOT PERMITTED by PA State law
(55 Pa Code §3800.206), in that the person
cannot be confined to the room by any form of
locking the room, blocking egress by standing in
the doorway, or otherwise preventing a person
from leaving the area.
Professionalism on the Job
Keeping Personal Distance
What are your Personal Boundaries when Working with a Family
 Disclosure
 Gifts
 Mealtime
 In the Community
TSS Role Limitations
What are the Limitations to your Role as a TSS Provider?
 You are a Direct Provider of Services to the Client
 You may make suggestions as to the Course of Treatment,
However, any suggestion must be Discussed with the BSC
before the Intervention is Implemented.
 You may be in Direct Contact with the Parent, However,
there are Limitations to what you may be in Direct Contact
about:
Check with your BSC
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What is this packet the BSC gave me?
The Psychological Evaluation
The Client’s Full History







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Client’s Demographic Information
Psychiatric evaluation and Diagnosis
Who the treatment team is
History of medication
Allergies and Sensitivities (sensory issues)
Past Services
Current Services
The Importance of the
Diagnosis



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What is your Client’s Diagnosis?
Why is it Important to Understand your
Client’s Diagnosis?
How the Diagnosis affects the Manner in
which you Work with your Clients
Understanding the Medication your Client
is Taking
Increasing your Knowledge of
your Client’s Diagnosis,
Treatment, and Appropriate
Interventions


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Accessing Resources: Resources are available at
the Office, Talk to your BSC, Internet, Parent,
other TSS providers, Teachers, PT/OT, Speech,
etc.
It is Important to keep the Lines of
Communication going to ensure that All
Treatment Team Members are on the Same Page
Regarding the Client’s Progress
Client Treatment Outside of BHR
Services
• What treatment has your Client had in the
past?
• Has the treatment outside of BHRS been
successful or unsuccessful? Why?
• What treatment outside of BHRS does your
client receive at the current time and how
does it affect the work you do with the
client?
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The Treatment Plan

Working Treatment Plan
Goals for the Client

What are the short-term and long-term goals for the
client?
 Always positive and always focus on increasing the client’s skills
and abilities for positive behavior

Target and Replacement Behavior



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Target Behavior– negative behavior you are targeting to
assist the client to reduce
Replacement Behavior – a preferred behavior that replaces
the target behavior
Methods of Achieving the Goals

The interventions that you are expected to utilize when
working with the client to achieve the short-term and longterm goals
If Your Goal is to Document Behavior…..
You first have to
Understand Behavior
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

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What is Behavior?
Technically Speaking….
Behavior is defined as any Observable
and Measurable act of an Individual
Behavior always has an Antecedent and a
Consequence (A-B-C which will be
explained later)
Behavior is also a Response to what is
Occurring in the Environment at any
given Time, and that response will
determine future behavior
There is Positive and Negative BehaviorHow you Handle the Behavior will
Determine what will Reinforce that
Behavior
Analyzing the Behavior
How is the Behavior Analyzed?
There are several different methods to
analyzing behavior…. The method most
often utilized is through direct
observation and documentation…
1. Functional Behavior Analysis



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The process of gathering information about the
antecedent and consequence that are functionally
related to a problem behavior and teach alternative
behavior instead of suppressing the behavior using
punishment
A Functional Behavior Analysis helps to assess how the
client learned the behavior and how it has been
maintained
The data collected during a Functional Behavior
Analysis is used to select interventions that will assist
the child in replacing the problem behavior
How we Assess the Problem Behavior
Through Direct Observation in the Child’s
Environment, We:
Identify the Problem Behavior


Define the Behavior in Concrete Terms

Create a Hypothesis about the function of the
Behavior
Identify the contributing Factors to the
Behavior
The Contributing Factors are discovered through an AB-C analysis
(Antecedent-Behavior-Consequence)
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A-B-C
Antecedent

The event that happens before behavior occurs

What the Client says and does

The event that occurs directly after the Behavior
Behavior
Consequence
The use of the A-B-C chart will
assist you in determining what
preconditions are causing the
behavior and what
interventions could be applied
to prevent the behavior from
reoccurring.
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Antecedent
• The setting or event that occurs
before the behavior happens
• Examples:
– People that are present in the
environment
– Time of day
– The activity the child is doing or
asked to do
– Physical and medical variables
(hunger, tired, medications)
– The instructor/parent tone of voice
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Behavior: Form
• Anything observable that the child
does – it should be specific and
concrete
• What the TSS actually observes
not your opinion
– If you were talking on the phone to
your BSC how would you explain what
the child did
– A behavior should be described
without opinion: not that the child had
a “bad attitude”, but the child “pushed
his paper on the floor and said no”
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Behavior: Function
• Behavior occurs due to 2 functions:
– To get: attention, activities, objects,
sensory stimulus
– To escape or avoid: attention, activities,
objects, sensory stimulus
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Consequences
• Any event that follows a behavior
• This will either increase or
decrease the behavior
• Examples:
– Verbal praise
– Redirect to a replacement behavior
– Attention or the lack of attention to
the behavior
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What Creates Behavior?
Reinforcement Creates Behavior
Reinforcement is the key to learning
“ everything you have learned is a result of reinforcement”

Definition of Reinforcement
Any event that INCREASE the likelihood of that specific
behavior in the future


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Positive Reinforcement
In an attempt to increase the likelihood of a
Behavior Occurring in the Future, a preferred
stimulus is ADDED to the environment
Negative Reinforcement
In an attempt to increase the likelihood of a
Behavior Occurring in the Future, an aversive
stimulus is REMOVED from the environment
The Importance of Using
Reinforcement
Negative Reinforcement- Why Does it Happen?
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•
Escape has occurred when behavior has led to a reduction
of the aversiveness of the present environment. In other
words, something unpleasant is currently going on, and the
person does something to terminate or lessen it.
•
Avoidance has occurred when behavior has prevented the
•
Escape and avoidance are both instances of behavior
leading to an improvement in the environment (hence
reinforcement) by removing some amount of the
aversiveness of the environment (therefore negative). As
is always the case with reinforcement, life is better for
the behavior having occurred, therefore increasing the
probability of the behavior in the future under similar
circumstances.
onset of an impending increase in the aversiveness of the
environment.
Reinforcement Cont.
You should:
Identify Reinforcers that will work with your Client
1. Reevaluate Reinforcers daily
3. Apply on a variable schedule
4. BE PREPARED-Reinforcers will change constantly
(reevaluate reinforcers daily)
****VERY IMPORTANT****
The Reinforcers should be given to the Client
WITHIN 3 SECONDS After the Appropriate
Behavior Occurs. The Client will then begin to
Associate the Reinforcer with the
Appropriate Behavior.
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Reinforcement Cont.
Example of positive reinforcement of
cooperative play:
Martha was a five-year-old girl who attended
preschool. She seldom played with the other children.
Workers at the preschool began praising and admiring
Martha when she engaged in cooperative play with
other children. As a result of this procedure Martha's
level of cooperative play with the other children
increased.
Example of positive reinforcement of
disruptive classroom behavior:
Research was conducted in elementary school
classrooms to study the effects of teacher behavior
on student behavior. During one phase of the study,
the teacher began disapproving of the students'
disruptive behaviors when they occurred. This
resulted in an increase in the level of disruptive
behaviors.
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Reinforcement Cont.
The Nudist
Decide if the following item is an example
of positive reinforcement. Focus on
the highlighted target behavior to
determine if it was positively
reinforced. Provide a reason for your
answer.
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Martha had a three-year old son named Noah. For
reasons that Martha could not understand,
Noah would sometimes take all his clothes off
and run about the house. Every time Noah did
this, Martha gave Noah a stern lecture telling
him about the dangers of not wearing enough
clothing. As a result of this, Noah took his
clothes off and ran about the house more often
than he had previously.
Reinforcement Cont.
Analysis of Noah and his need to be naked:
This is an example of positive reinforcement
because the lectures were consequences
dependent upon removing the clothes and
because this caused clothing removal to
become more frequent.
As illustrated in this example, sometimes stimuli
that are painful and seemingly unpleasant
can act as positive reinforcers.
When a child is being lectured, that child is also
receiving attention, and especially among
attention-deprived children lectures of this
kind can function as reinforcers.
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Importance of Reinforcement

It is Difficult to Apply the Treatment Plan
with a Client Until you Know what is
Reinforcing to that Client

Understanding What is Reinforcing could
take Time. Be Patient and Learn in order to
Pair Yourself with the Reinforcer

Using a Reinforcer Checklist
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Schedules of
Reinforcement
• Fixed Ratio: A reinforcer given
after a fixed number of responses
• Fixed Interval: The first correct
response after a set amount of time
has passed is reinforced
• Variable Ratio: A reinforcer is given
after a varying set of correct
responses
• Variable Interval : The first correct
response after a varying amount of
time has passed is reinforced
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End of Day 1
Tomorrow, we’ll explore
treatment methods,
strategies and tactics that
are especially relevant for
children with Autism
Spectrum Disorders.
We’ll start on time, so
please don’t be late, so you
can receive full credit for
the program.
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Pairing
Positive Pairing is one of the Most
Important Interventions that the
therapist will Utilize.
If the therapist Does Not create a
Positive Relationship with the
client, the Client may not Respond to
the therapist or the interventions.
The Result of not pairing Positively
with the Client is Potential for
Refusal to Engage with the
therapist in order to Reduce the
Target Behavior.
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Pairing Continued
Definition of Pairing
Building Positive Rapport with the Client:


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Pairing begins with Noncontingent
Reinforcement, first Reinforced without
having Demands placed on the Client
Once the Client is taking Reinforcers
from the Therapist, they can gradually
introduce demands
Once paired , everything associated with
the Therapist will become Reinforcing.
Pairing with Reinforcement
The Goal of Pairing with Reinforcement

“Become the M&M”
Steps for Pairing with the Client
Identify the Reinforcers:
Identify Objects, food items and Activities that are
Reinforcing to the Client
 Approach the Client with Something Fun:
Approach the Client with a Reinforcer in an Outstretched hand
Make it Obvious that you are Approaching with something
Fun
 Make sure that what you have is More Desirable:
Don’t interrupt the Client’s fun to do an Activity that is Less
Reinforcing
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Pairing with Reinforcement Cont.

Make Activities More Fun:
When the Client is Playing with a Toy or Engaging in an
Activity, do things that make it more Enjoyable
 Pair your Voice with Reinforcement:
While Pairing with the Client’s Reinforcers, say the
Client’s name and use Short Phrases to Describe what
you are doing
You will Pair not only Yourself but also your Voice with the
Reinforcement
 Limit the Availability and Visibility of other
Reinforcers:
Every time a Fun Item Appears, it Appears Because you
make it Available, Therefore Making you more
Valuable
Pairing is an ongoing Process
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Interventions
 How to help your client change non-preferred
behavior to PREFERRED behavior utilizing
effective intervention techniques
 The Intervention must be “Least
Restrictive/Least Intrusive”
 The interventions that you Utilize are
documented in the treatment plan.
 Communicate with the Treatment Team for
appropriate Implementation of all
Interventions
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Interventions Continued
The Hierarchy of Prompts
Why Use Prompts?


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When teaching, we Usually want to
prompt because we want to be able
to Reinforce the Behavior
-However-
We also want to be able to get rid
of prompts (fade prompts) because
we want the Client to learn to
Demonstrate the behavior without
help
Prompts
Continued
1. Full Physical Prompt
Hand over Hand assistance to complete the
Targeted Response.

Hand over Hand is typically used when the
Target Response is motor in nature.


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For Example, a full Physical assist Might
entail putting your hand on the Client’s hand
and moving the Client’s hand through the
action of writing his or her name OR
If the Client is learning to Jump up and
down, Providing a full Physical Assist would
mean Physically lifting the client up and
down in a jumping motion.
Prompts
Continued
2. Partial Physical Assist (PPA)
As the name Suggests, a partial Physical assist is
less intense or Intrusive than a full Physical
Assist.
If full physical Assist is hand over hand, the
Partial Physical assist can be visualized as
providing minimal supportive GuidanceFor example - touching the Wrist to Stabilize
handwriting or encouraging the Client to
jump without actually lifting his or her body
off the ground
If the Client doesn’t need hand over
hand assistance, Start here.
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Prompts
Continued
3. Direct Verbal (DV) Prompt:
This is a direct Statement of what we expect the Client to do or say.
Example: “come here.” “Put the glass on the counter.” This level of
Prompt requires that the Client be able to follow your Direction.
4. Indirect Verbal (IV) Prompt
An Indirect Verbal Prompt tells the Client that something is expected
but not Exactly what.
Example: “What Next?” “Now What?”
5. Independent
The Client is able to perform the Task on his or her own with no
Prompts or Assistance from you.
Prompt levels can change form moment to moment when Teaching.
Prompt if necessary to keep the Response Effort low and
Reduce Frustration.
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Interventions
Continued
Modeling
Modeling is simply showing the Client what you want him
or her to do.
You do not Physically touch the Client.
In order for modeling to work, the Client must Know
how to Imitate another person’s actions.
If a Client has good imitation skills, start here.
Gestures
Pointing, Facial expression, Mouthing words silently or
otherwise indicating with a motion what you want the
Client to do.
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Interventions
Continued
Redirection
Providing Client alternative choices and redirect the client away from inappropriate
Behavior to the preferred behavior
Backstep
Taking the Client back to the original place that
they last followed direction.
Overcorrection/Positive Practice
Procedures involve having the client engage in repetitive behavior as a penalty for
having displayed inappropriate action
Social Stories
Presents Appropriate Social Behaviors in the form of a story
If the client is capable of helping to write the story, then he/she does so.
If the client is not capable, the parent or TSS writes the story with the client’s
involvement.
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Interventions
Continued
Planned Ignoring
A variation of timeout in which social proximity and attention are consistently
withheld for a specific length of time immediately contingent on a
client’s undesirable behavior.
Contingency Contracting
A Contingency Contract is based on an “if…then” statement.
Token Economy
A token economy is based on delayed reinforcement. A system of behavior
management in which tangible or token reinforcers such as points,
plastic chips, metal washers, poker chips, or play money are given as
rewards and later exchanged for back-up reinforcers that have value in
themselves (e.g., food, trinkets, play time, books); a miniature economic
system used to foster desirable behavior
Goal Charts
Visual Reward of a delayed reinforcement which allows the client to see
his/her progress
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Interventions
Continued
Behavioral Rehearsal/Role Modeling
Rehearsing the requested behavior before the Client is
exposed to the Social Situation. ( TSS model the
behavior with Parents).
Walk and Peel (Home Version)
Walk - Disengaging from the client – walking away when the
disruptive behavior occurs
Peel - if the Client tries to grab you.
Peel him/her as soon as possible.
Before you leave the area, make sure the client is safe
from danger and no property has the potential to be
destroyed.
Once the behavior has stopped (about one minute), then
redirect Client to an activity.
If the problem occurs again then, reroute through the
above procedure.
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Intervention
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

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Continued
Walk and Peel (Non Home Version)
This behavior should be handled differently in
school or public as compared to home which is
described previously.
If problem behavior occurs, tell Client “No” and
provide a SHORT rational. If Client accepts,
reinforce Immediately but not with the item
you just refused.
If the client is still displaying disruptive
behavior, Immediately place a demand on them
to do something else. Example: “Walk with me,
sit in this Chair, etc.”
At this point the client should complete the
demand placed on them without further
behavior.
Once the Client has completed the demand
without disruptive behavior, allow them to
continue what they were doing before behavior
or redirect to the next activity.
Interventions
Continued
Counting Procedure

A distracter from inappropriate behavior
Utilizing Time- Out and Chill- Out


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Time-out/ Chill outA procedure for the reduction of inappropriate
behavior whereby the child is denied access,
for a fixed period of time, to the opportunity
to receive reinforcement
Seclusion – is different from time- out and is
not permitted by TSS providers
Interventions
continued
Shaping
A Behavior change process in which a new or unfamiliar behavior is
taught through reinforcing successive approximations of the
behavior, progressing step-by-step toward a terminal objective
Forward Chaining
 Forward Chaining is a Procedure that begins with the first element
of the chain and progresses to the last element. (A to Z)
 In this procedure you start with the first task in the chain. You
Do Not move on until the Client can perform the element
Satisfactory.
 Each element of the chain is performed in this manner until it is
completed in its entirety
Backward (Reverse) Chaining
 A Chaining procedure that begins with the last element in the
chain and proceeds to the first element.
 As in Forward Chaining, Do Not move on until the Client can
perform the element Satisfactorily.
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Differential Reinforcement
•
Differential reinforcement of alternate behavior (DRA). A procedure
in which reinforcement is delivered for behaviors that are alternatives
to the target behavior
•
Differential reinforcement of incompatible behavior (DRI).
Systematically reinforcing a response that is topographically
incompatible with a behavior targeted for reduction
•
Differential reinforcement of low rates of behavior (DRL). A
procedure in which reinforcement is delivered when the number of
responses in a specified period of time is less than or equal to a
prescribed limit; encourages maintenance of a behavior at a
predetermined rate lower than the baseline or naturally occurring rate
•
Differential reinforcement of other behavior (DRO). A procedure in
which reinforcement is delivered when the target behavior is not emitted
for a specified period of time; behaviors other than the target behaviors
are specifically reinforced; also referred to as differential
reinforcement of the omission of behavior.
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Applied Behavior Analysis




Definition of Applied Behavior Analysis (ABA)
ABA is the Study of human Behavior, the
pattern of a Client’s Behavior to understand and
Predict the Client’s Future Behavior
ABA Utilizes Specific and Comprehensive
Theories of human learning, Operant learning, or
Learning Theory to Change Behavior
ABA Enhances the Development, Abilities, and
Self direction skills of Clients with Disabilities,
and to enhance the Productivity and Abilities of
the Client in Regular Education
Implementation of ABA will Produce practical
Behavior change in the Client.
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WHAT!!!!!! Ahh… can someone please Explain what was just said…..
Simply put:
 ABA is a Behavior-modification-type
Approach to learning based on the work
of Dr. B. F. Skinner
 This Approach is based on:
1. Careful study (analysis) of each
behavior.
2. Breaking down each problem Behavior
into even smaller Behaviors (Task
Analysis).
3. Gradually teaching each small desired
Behavior one at a time, using Rewards in
Specific ways (shaping).
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Applied Behavior Analysis Continued
While uniquely adapted to each child, ABA is a
highly structured, rigorous, systematic and
consistent teaching Approach throughout
all of the client’s environments which is
organized around:
1. The Specific way a Request is made of the
Child (antecedent)
2. The Child’s response to Requests
(Target Behavior)
3. How Adults React to the Child’s
Correct/Incorrect Responses
(Consequence)
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How to help children with ASD
The following interventions
were designed specifically
for helping children with
Autism Spectrum Disorders
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Verbal Behavior (VB)
What is Verbal Behavior?

Verbal Behavior is Programming Based on the Principles of Applied
Behavior Analysis incorporating B.F. Skinner’s Analysis of Verbal
Behavior

ABA/VB in this context Addresses difficulties in the Development of
Communication seen in most individuals with Autism and other related
Disabilities, in part by emphasizing Functional language and tying it to
Motivational Variables

Verbal Behavior is Based on Language

The Focus is teaching Verbal Behavior to children with Autism within
a program of Applied Behavior Analysis (ABA).

It is the study of functions of language over its forms, and numerous
Verbal Operants, or units of language.
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The VB Curriculum
• Based on B.F. Skinner’s book VERBAL BEHAVIOR
(1957) which proposes that language is a
behavior, which is influenced primarily through
reinforcement, and on establishing and
maintaining the motivation to learn.
• Emphasis is on teaching the function of language.
Teaching procedures focus on transferring the
child’s ability to respond across all functional
categories. A “word” is not considered “learned”
until it can be used across all functions.
• Intensive one-on-one therapy immerses the child
in a “language-learning environment”.
The Mariposa School 2006
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VB continued - Teaching Manding
What is Manding?


The request of an Item, Event, Information or
Removal of an Aversive; response is Specific to
Motivative Operation
The Request is made through Sign, PEC’s, or
Verbalization
Please note that our goal is to assist the child to
become as verbal as possible and to reduce or
eliminate the need for PECs
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



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Why Mand?
Manding is what teaches the
Client that Talking or Signing is
Useful
It helps Clients avoid Frustration
in Communicating their needs and
wants
It is Relatively easy to do because
you Are using the Clients own
Motivation as a tool
The Mand is usually the First
Form of Verbal Behavior to be
Acquired since it may produce
Immediate and the Specific
Reinforcement Requested
Teaching how to Mand
What do they want?
Label the item
give them the item
Say the name of the item
Try to have them repeat
use sign, PECS, vocalization
If the item is really reinforcing they will try to request for it again!
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Manding
***Manding only works if the item is highly reinforcing
to the client ***



How do we know what is Reinforcing?
Through Motivative Operation
How motivating is the item?
Find out through direct Exploration with the child
Reinforcer Inventory

Differential Reinforcement-
Reinforcement of one form of Behavior and Not another, or
the Reinforcement of a Response under one condition,
but Not Another.
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Natural Environment Training (NET)


Unstructured teaching that
uses the learner’s
motivation and not teacher
selected set of materials
as a basis for learning
NET aides in the
development of functional
and generalized
communication
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Natural Environment
Training
•
•
•
•
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Characteristics of NET
Learner initiated activities
Tasks and activities vary
frequently
Preferred items /activities
chosen by child
Serves as basis for learnerteacher interaction
Early Learner NET
• Put very few demands on the learner and pair
yourself with reinforcers
• Have learners take reinforcers from you
• Gradually increase response requirement
• Begin errorless teaching of mands with full
complement of prompts and then fade prompts
• Intersperse a few instructional demands for
easy tasks to develop compliance
• Fill in the blank intraverbals with songs,
nursery rhymes and other fun activities
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Intermediate Learner
NET
• Teach within the context of
the activities which are
reinforcing and motivating for
the child
• Teach mands, simple tacts,
receptive, and simple
intraverbals
• Transfer across operants
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Advanced Learner NET
• Teach within the context of the
reinforcing or motivational
activities of the learner
• Complex VB modules that are
conversations within non-verbal
contexts
• Include answers to “WH ”questions
(Intraverbals) as well as manding
for information (asking “WH”
questions)
• Have similar but less complex
conversations in the intensive
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The DIR Model
The DIR Model is :


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An integrated Understanding of
Human Development
A more Advanced intervention than
Past Models that looked only at
surface Behaviors and isolated
Cognitive Skills
The DIR Model
continued
Three Areas of Insight:
D- Functional Developmental Level
 Where is the child at in his/her Development?
I- Individual Differences in Processing
 What is the Processing Profile of the child?
*Auditory
*Visual
*Spatial
*Sensory
*Motor
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The DIR Model
continued
R- Relationships
 What are Relationships Like?
 What is the interactive use of
Affect in the family Now?
 What are the Ideal Patterns to
Support enhanced
Development?
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What is Floor Time?

Time set aside for Unstructured Play with
Child ( 20-30 Minutes)


Spontaneous Play on the Floor led by child

Sessions should happen 6-8 times a day
Encourages two-way interaction while
Continuing to let Child Lead the Play
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What is the Purpose of Floor Time?
 The Purpose of Floor
Time is to Assist a
Child in Climbing the
Developmental Ladder
and to Achieve the Six
emotional milestones of
Communication
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Six Emotional Milestones of
Communication
1. Self Regulation, Shared Attention,
and Interest in the World
 Take interest in the World and not Be

Overwhelmed
Shared Attention is the most important
component
2. Intimacy
 Child Gains the Ability to engage with other
3. Two-way Communication
 Beginning of Communication Through non

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verbal gestures to Create Dialog
Opening and closing circles of Communication
Increased affect
6 Emotional Milestones Cont.
4. Complex Communication
 Creating complex gestures
 Child now has a means of expressing needs
 Problem Solving Patterns( i.e. Child takes mom by hand,
knocks on fridge and points to juice)
5. Emotional Ideas
 Formation of Ideas and Language acquisition begin
 Child puts stories together with toys
 Emotional Themes are Played out by the Child with a
Momentarily desired Toy
 Begins to understand Symbols stand for things
 Imaginary play begins to take place
6. Emotional Thinking
 Building bridges Between ideas as a basis for Logical Thought
 Ideas are Linked together in a Logical Sequence of Play
 Symbolic level of Thinking
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The Five Steps of Floor Time
Step 1: Observation
Facial Expressions
Tone of Voice
Gestures
Body Posture
Verbal Ability
Step 2: Approach
 Open Circles of Communication using Gestures
 Expand on Interests of the child
Step 3: Follow the Child’s Lead


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Be a Supportive Play Partner
Assist the child as he/she Leads Play
Floor Time
Continued
Step 4: Extend and Expand Play
 Expand Themes of Play while Continuing to let
the child Lead the Play
 Making Supportive Comments about the Play
 Ask Questions to Stimulate Creative thinking
Step 5: Child Closes the Circle of Communication
 Adult opens the Circle of Communication
Through a Gesture
 Child closes Circle of Communication by
Building on that Gesture and in turn providing
one of his/her own
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Documentation
Documentation of BHR Service delivery must be:
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
© 2007 The Institute for Behavior Change, Inc.
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A thorough, accurate & complete record, in ink, of
service delivery (with date and start & stop times)
Contemporaneous (completed in written form within
24 hours after services were rendered)
Legible, including the signature of the provider, with
the provider’s
Signed by the provider
Signed by the parent, guardian or teacher who was
responsible for the child while the provider delivered
services
Handed-in promptly after work has been performed
Documenting the Client’s Behavior
The Purpose of Documentation
– To record the client’s target and
replacement behavior throughout your shift
– To document any new behavior that might
shift the focus of treatment
– To provide data that will determine if any
changes are necessary with regards to the
treatment plan that will increase your
client’s chances for success
– To monitor the progress or lack thereof
that your client has made throughout the
authorization period
– For legal purposes
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Do’s and Don’t(s) of Documentation

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


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
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Do
Document on CRF in the Notes Section any Missed Hours with
the Client and explain fully why the hours were not utilized.
Turn in the CRF each Week, Whether or not you saw the client.
Turn in your progress notes and CRF for the days that you did
see the client
Use AM and PM when Writing Time, write your degree.
Have Parent, Caregiver or Teacher sign CRF and Progress
Notes DAILY
Establish with BSC how Tick Marks Should be Documented
according to the Client’s Behavior and make sure Tick Marks on
Page one of Progress Notes Match Page Two
Ensure Interventions Match with Target Behavior
Use Quotation Marks if you are Quoting someone else
Document who else was with with your Client that Day
Write in third person (“TSS used verbal praise when Johnny
independently used replacement behavior”)
DOCUMENT EVERYTHING
Documentation of the Client’s Behavior




© 2007 The Institute for Behavior Change, Inc.
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Do Not
Do Not Write in Start and
Stop Times if you did not
Work with the Client
Do Not Leave any blank Lines
or Spaces
Do Not Write your Opinions in
your Notes
Do Not Use “I” or “We”
© 2007 The Institute for Behavior Change, Inc.
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© 2007 The Institute for Behavior Change, Inc.
All Rights Reserved. Unauthorized duplication is a violation of applicable laws.
© 2007 The Institute for Behavior Change, Inc.
All Rights Reserved. Unauthorized duplication is a violation of applicable laws.
Developing Interventions
The Communi-Teen program offers clients an
opportunity to join community social groups
and expand their range of opportunities for
socialization and inclusion in the community.
A teen volunteer facilitates the client’s
entry into and participation in various
community activities. The client is
accompanied by his/her TSS provider to
provide behavior support as necessary.
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Other Interventions
COLLAGE provides socialization groups
and opportunities for clients to
acquire new social skills.
Devereux CARES offers training in the
Picture Exchange Communication
System (PECS).
SibShops offers sibling assistance.
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Support for Teens and
Young Adults with ASD
Adolescence (13 to 17 Years)
• Family and Community Issues
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– Peer rejection, reducing social
isolation
– New parental roles in education
planning
– Transition planning in school for
employment at the end of High
School
– Emerging sexuality
– Estate/Trust planning (how to find
Support for Teens and
Young Adults with ASD
Adolescence (13 to 17 Years)
• Educational Focus
–
–
–
–
–
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Academic achievement
Vocational training
Domestic skill acquisition
Self-care skills in the home
Expanding community awareness
(the Communi-Teen program, for
example)
– Improving reading & writing skills
– Social Skills with siblings and
Support for Teens and
Young Adults with ASD
Late Adolescence (17 to 21 Years)
• Family Issues
– Adjusting emotionally to having an
adult son/daughter with special
needs
– Developing advocacy skills for adults
– Financial and guardianship planning
– Residential issues
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Support for Teens and
Young Adults with ASD
Late Adolescence (17 to 21 Years)
• Educational Focus
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– Vocational education and work
support
– Domestic skills training for
independence
– Self-care skills training for
independence
– Expanding awareness of community
– Communication skill enhancement
– Social Skills enhancement
– Expanding recreation opportunities
– Functional reading, writing & math
Hands-On Training


© 2007 The Institute for Behavior Change, Inc.
All Rights Reserved. Unauthorized duplication is a violation of applicable laws.
SCENARIO
You will be given a specific scenario
Expectations: Utilize the specific
interventions that you have been given.
What intervention did you choose? Why
did you choose that intervention? Detail
your reasoning for utilizing that
specific intervention.
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