Seeing is Believing

Editor’s Note – The following article was written by Amy F. Hobbs, Training Coordinator with the Autism Society of North Carolina.

Research shows that video modeling is an effective strategy to use with individuals with Autism Spectrum Disorder to improve social and communication skills. As a trainer, I frequently emphasize the importance of showing children with autism what you want them to do as opposed to just telling them. Verbal directions are typically difficult for individuals with autism to process as their visual processing skills are more advanced than their auditory processing skills. Video modeling or the process of instructing through watching a model therefore provides an excellent opportunity for students to actually see the behavior or the skill that is requested and therefore better understand it.

Not only is video modeling time and cost effective, but it can be rehearsed and rerecorded until the exact skill or behavior desired is captured. This is a much cleaner method than live modeling and can be watched repeatedly until the skill is learned as well as used as a tool for maintaining the skill. In fact, video modeling is a practical method of instruction for teachers that can be used with multiple individuals needing practice on the same skill.

As with computer screens, video modeling takes away the interpersonal component present in 1:1 teaching that makes learning more challenging for individuals with autism. It offers instead a mode of instruction that is highly motivating and fosters independence.

Video modeling has been used to teach many different social, academic, behavioral or functional skills from iPod use to how to give a compliment. Many studies show the success of video modeling in teaching challenging social skills such as recognition of emotions, perspective taking, social initiations, eye contact, social greeting, sharing and engagement in social conversation. My goal here is to demonstrate the simplicity of the video modeling process by giving some basic steps to follow.

1. Determine if the child has the perquisite skills needed to ensure success. These include basic imitation skills, normal visual and hearing acuity, and the ability to attend to a video for at least one minute.
2. Teach a skill that can be easily modeled and observed. An ideal target skill is one that the child is able to do with prompting.
3. Decide who to use as models in the video. Peers, siblings or other children of a similar age are good choices. Once the skill or behavior is learned, videotape the child with autism displaying the target skill or behavior (video self-modeling). This can be a powerful tool for increasing the child’s self-efficacy (Bray & Kehle, 1996) as well as reinforcing the maintenance of the skill.
4. Write the script for the models and keep it short. Three to five minutes is recommended, but it can be shorter.
5. Video the models making sure that the important actions are clearly visible and that the audio is clear and free of distracting sounds. Keep it simple.
6. Intervention includes:
   a. Showing the video model to the child with autism several times and then
   b. Providing a time and place to practice the skill.
   c. Monitoring and keeping data on the child’s progress.
   d. Testing to see if skills generalize to other settings and people.

Often video modeling instruction is paired with another method of teaching such as peer mentoring, social skills groups, self-management, reinforcement, role modeling and other applied behavior analysis techniques to ensure success. Below is a list of research articles that demonstrate success using video modeling.

References:

• Bray, M., & Kehle, T. (1996). Self-modeling as an intervention for stuttering. School Psychology Review, 25, 358-369.
• Other research:
• Bellini, S., Akullian, J., & Hopf, A. (2007). Increasing Social Engagement in Young Children with Autism Spectrum Disorders Using Video Self-Modeling. School Psychology Review: Volume 36, Issue No. 1.
• Charlop-Christy, M.H., & Daneshvar, S. (2003). Using Video Modeling to Teach Perspective Taking to Children with Autism. Journal of Positive Behavior Interventions: Volume 5, Issue No. 1, pp. 12-21.
• Charlop-Christy, M.H., Le, L., & Freeman, K.A. (2000). A Comparison of Video Modeling with In Vivo Modeling for Teaching Children with Autism. Journal of Autism and Developmental Disorders: Volume 30, Issue No. 6, pp. 537-552.
• Corbett, B.A. (2003). Video Modeling: A Window into the World of Autism. The Behavior Analyst Today: Volume 4, Issue No. 3.
• Corbett, B.A. & Abdullah, M. (2005) Video Modeling: Why Does It Work for Children with Autism? Journal of Early and Intensive Behavior Intervention: Volume 2, Issue No. 1, pp. 2-8.
• D’Ateno, P., Mangiapanello, K., & Taylor, B. A. (2003). Using Video Modeling to Teach Complex Play Sequences to a Preschooler with Autism. Journal of Positive Behavior Interventions: Volume 5, Issue No. 1, pp. 5-11.
• Goldsmith, T.R. & LeBlanc, L.A. (2004) Use of Technology in Interventions for Children with Autism. Journal of Early and Intensive Behavioral Intervention:Volume 1, Issue No. 2, pp. 166-178.
• Hine, J.F. & Wolery, M. (2006). Using Point-of-View Video Modeling to Teach Play to Preschoolers with Autism. Topics in Early Childhood Special Education: Volume 26, Issue No. 2, pp. 83–93.
• Hine, J.F. & Wolery, M. (2006). Using Point-of-View Video Modeling to Teach Play to Preschoolers with Autism. Topics in Early Childhood Special Education: Volume 26, Issue No. 2, pp. 83–93.
• Smith, C., Williamson, R. & Siegel-Robertson, J. (2005). Implementing Technology to Teach Social Skills to Students with Multiple High-Incidence Disabilities. Unpublished University of Memphis research study, 11 pp.
• Wert, B. Y., & Neisworth, J. T. (2003). Effects of Video Self-Modeling on Spontaneous Requesting in Children with Autism. Journal of Positive Behavior Interventions: Volume 5, Issue No. 1, pp. 30-34.
• Williams, C., Wright, B., Callaghan, G., & Coughlan, B. (2002). Do Children with Autism Learn to Read More Readily by Computer Assisted Instruction or Traditional Book Methods? Journal of Autism and Developmental Disabilities, Volume 6, pp. 71-91

Amy can be reached via email at ahobbs@autismsociety-nc.org or by phone at 828-236-1547.

A New Year, A New Approach to Challenging Behaviors

Editor’s Note – The following post was written by Louise Buchholz Southern, M.Ed., BCBA, Training Specialist for the Autism Society of North Carolina (ASNC).

As professionals working in the field of Autism Spectrum Disorder (ASD) intervention and as parents of individuals with ASD, it’s likely that we have all experienced challenging and persistent behaviors. These behaviors come in many forms including aggression, property destruction, non-compliance, and self-injurious behavior, to name a few. When we experience these behaviors in an individual with ASD, one of the first questions we should ask ourselves is, “What is the individual trying to communicate with this behavior?” What want, need, confusion, or fear is the individual trying to express? As one individual with ASD stated, “You can’t not communicate. Everything you say and do or don’t say and don’t do sends a message to others.”

Some behaviors take us by surprise, and seem to appear without any cause. However, if we operate under the assumption that there is always a reason for the behavior, we are more likely to take the action necessary to change behavior. Changing someone else’s behavior always requires a change in our own behavior first. So as the New Year begins and as we continue to face challenging behaviors, let’s assume that behavior is always meaningful and let’s ask ourselves these questions:

• Does the individual have a way to communicate his/her wants, needs, and choices all of the time and across contexts? In order to teach an individual the power of communication, we cannot compartmentalize their communication to certain parts of the day or to certain locations (e.g. only when the instructor directs the individual to a choice board that is affixed to the wall).
• Even if the individual is “verbal,” does s/he functionally communicate? For example, some individuals script from TV shows, or they repeat back what they hear rather than responding. Some individuals are nonresponsive to anyone other than people with whom they are very familiar. Some individuals use language that does not seem to make sense given the context. Some individuals label everything, but don’t use language to express wants or needs, or to respond to questions and statements. In all of these examples, while the individual is “verbal,” we need to explicitly teach and reinforce functional communication.
• Note: ASNC’s Training Department is preparing to launch a functional communication training workshop this spring. In addition, the Autism Internet Modules website http://www.autisminternetmodules.org offers a range of free trainings on evidence-based practices such as functional communication training and the Picture Exchange Communication System (PECS).
• Have we identified a behavior that we can teach and reinforce to replace the behavior that we don’t want to see?
• Are we effectively reinforcing those behaviors that we want to see? Are we applying consequences that are actually reinforcing /motivating to the individual? Are we reinforcing the appropriate behavior consistently, and are we making sure that the individual understands the connection between behavior and consequence (reinforcer)? Are we attending to (and reinforcing) those behaviors that we want to increase significantly MORE than we are attending to those behaviors that we want to reduce? Are we missing opportunities to reinforce the individual when s/he is doing what is expected?
• Are we delivering instructions/information in a way that the individual with ASD can understand?
• Are we visually structuring academic, leisure, and work activities so that the individual understands what to do, how much to do, when finished, and what next? Many individuals with ASD experience significant anxiety and frustration when they don’t understand the expectations, the “rules” of the game, or when the activity will be finished.
• Has there been a change to the routine or has something unexpected occurred? How can we better prepare the individual for these inevitable events?
• Does the individual have a strategy in place to regulate his/ her sensory needs? What self-calming activities do we need to explicitly teach? How does the individual indicate that he needs a break?

For more information about support services available to individuals, families and professionals through the ASNC Training Department contact Louise via email at lsouthern@autismsociety-nc.org.

For titles related to challenging behavior please visit the Autism Society of North Carolina Bookstore located at www.autismbookstore.com.

Structure – an Important Teaching Tool

Editor’s Note – This article was written by Amy Hobbs, Training Coordinator for the Autism Society of North Carolina. To read Amy’s bio click here.

It was Sunday and a new group of campers had arrived in the afternoon. I was called to the old dining hall to assist a counselor who was having trouble getting a young camper back to the group lodge to take a shower and get ready for bed. The four-year old camper who I’ll call Alex was at Mountain Adventure Camp for the first time. It was Alex’s, first time ever spending the night away from his home. Alex did not speak and to communicate his needs he typically cried, flopped to the floor and banged his head. Lucky for Alex, he was attending a camp that was specifically designed for individuals with autism.

Alex was wandering aimlessly around the dining hall, but every time his counselor tried to direct him towards the door, he flopped to the floor. Alex did not understand the pictures that the counselor was showing him that represented the Group Lodge nor did he understand the words used to explain that it was time to take a shower.

The old dining hall had lots of tables and chairs and also lots of doors leading to the outside. When Alex flopped to the floor the next time, we opened the nearest door and simply pulled chairs in around him making a corral with the only opening being a door to the outside. It took Alex about 30 seconds to stand up, look around and then walk straight out the open door.

I remember the look of amazement on that counselor’s face as he watched Alex walk out the door. He never forgot that example of using physical structure and how it helped Alex to understand what we wanted him to do.

Sometimes when students with autism are in inclusion settings, they have trouble attending to their work because of all the distractions in the room such as other students talking or moving around or people coming in and out of the door. Planning seating arrangements for these students to optimize their success in the mainstreamed setting is crucial. It might be that sitting on the front row or away from the main door will be enough to reduce the distractions. Another student might benefit from having a desk that faces the wall to help them concentrate on the work in front of them.

The simplicity of using the physical structure in the environment to address behavioral challenges is sometimes overlooked. However, the first step to addressing a behavior problem or instructional challenge is to make sure that the individual with autism understands the expectations. Often when the demands are clarified through moving the furniture or adding visual supports, then the behavior challenge dissipates.

The training department offers training on using a structured approach to teaching individuals with autism. For more information on this and other available trainings, click here.

Amy Hobbs can be contacted via email at ahobbs@autismsociety-nc.org or by telephone at 828-236-1547 or 800-442-2762, ext. 1501.

Avoiding Power Struggles

Editor’s Note – This week’s article is provided by Amy Hobbs, Training Coordinator, for the Autism Society of North Carolina. Amy works out of the ASNC Asheville office and can be reached via email at ahobbs@autismsociety-nc.org or via phone at 828-236-1547.

Despite the welcomed summer break, after a few weeks without the structure of school many children with autism spectrum disorder (ASD) begin to get restless. Too much unstructured time can result in kids spending endless hours on the internet, watching movies, playing video games, or engaging in other favorite activities. This in turn can cause them to have a more difficult time and sometimes a struggle leaving or ending those activities to do other necessary things like chores, exercise, hygiene, outings, etc. Creating consistent routines, making plans, giving choices, using visuals and maintaining a positive attitude with individuals with (ASD) are important strategies that help avoid these types of power struggles.

Developing consistent summer routines can help individuals with autism complete daily chores as well as understand and accept new activities and demands. Start by creating a daily routine that stays the same as much as possible Monday through Friday. Keep roughly the same schedule on Saturdays and Sundays as during the school year. Within the M-F routine, establish set times for chores, hygiene, meals, exercise, work, skill maintenance, social opportunities and preferred activities. Whenever possible, include the individual with ASD in making choices within the schedule and be sure there is consistency with the times and activities that are planned. To incorporate new or different things there can be a time each day for “something new”. The individual can choose whether to try a new game, outing, food, exercise, park, etc. The favorite activities can certainly be a part of the day too. By scheduling them after other mandatory chores have been completed and for specific amounts of time with a clear ending time (like 4:00 or when the bell rings for example) will help with the transition away from the activity.

Remember that “seeing is believing” and making it visual helps the individual with ASD better understand and accept the expectations. Creating a chore chart is one way to give a visual representation and structure to completing chores. The chart could have 4 or so chores that need to be completed every day, 4 or so that need to be completed twice a week, and some on Saturday. The individual can choose the order in which they do specific chores for each day, the times that they do them, what days they do them, etc. Giving choices increases the individual’s sense of autonomy and control as well as their motivation for completion or follow through.

Having a “break time or nap time” after lunch can provide an individual with autism a much-needed respite in his/her room or another calm area of the house with low stimulation. Particularly with the heat that we are experiencing this summer, remember to encourage individuals to drink lots of water and plan activities that help them stay cool. Some ideas to consider are a community pool, a backyard pool or sprinkler, a mountain stream, air-conditioned library or book stores and walking at the mall. Another idea is to take a cool leisure bath during the day for an individual who likes water. You might add some bubble bath, low lighting or soft music depending on the person’s preferences.

The more thought out the plan, the better when it comes to avoiding power struggles. First, it’s important to make sure that the individual with autism understands the plan. Typically, using visual supports (whether written, pictures, or objects) can help ensure that the expectations are clear. Next consider how much of a notice the individual needs before introducing a new activity, vacation, trip, change in schedule, etc. The amount of time needed for processing a change or new plan varies a lot between individuals. Some do better if they know pretty far in advance so they have time to adjust to the idea whereas others will only become anxious and obsessive if given too much of a heads up.

Anticipate what may be hard about this new activity and think of what you can do to make it easier. For example, keep some favorite items like stress balls, dinosaurs, cars, music box, slinky, bubbles, and other soothing items close at hand in your back pack and bring them out when needed to help distract, redirect or calm.

If you are experiencing a recurring power struggle and you respond in the same manner each time, it is most likely time to change your response to the behavior. The power struggle has become a routine and it will be up to you to change it. Keep in mind that if the function of the behavior is to gain attention, it might be that even negative attention such as arguing may be rewarding. Think of an alternative response that will redirect the individual to another topic or another activity. If there are certain topics or situations that bring on power struggles, try to steer away from them.

Remember that the challenging behavior is most likely a result of the individual’s autism and it’s important to maintain a calm and clear response. People with ASD have difficulty communicating and understanding social interactions. They also have difficulties with self-regulation and can become overstimulated easily by factors in the environment that we may not even be aware of. Our job as parents, professionals or friends is to support them by keeping a positive attitude.

By thinking ahead and making a structured plan for the upcoming days left in the summer, you can prevent many challenging behaviors from occurring.

School is out for summer. What to do?

Editor’s Note: This week’s Blog contribution is from Leica Anzaldo, Training Manager for the Autism Society of North Carolina’s Training Department.

School is out and while many of us have been anxiously awaiting this day, for others it is a time of anxiety. Summer for children with autism and their families can be a particularly difficult time. Schedules are different, the places they are accustomed to going to each day are closed, the people they rely on seeing each day aren’t there, and many are at home with their parents who now have to scramble to structure an entire day and make it predictable enough to survive until tomorrow. Then the cycle repeats the next day. While this may be stressful, remember that summer can provide an opportunity for new enjoyable experiences that make great impact on the child’s future.

Many summer camps now offer inclusive programs or part-day inclusive programs that can support children on the autism spectrum effectively based on their abilities. Often however, families are fearful of revealing diagnosis because of a history of their child being turned away from day camp. Asking to speak directly to the program coordinator can help. Provide the camp staff with as much information about your child as possible including what systems and structure work best for them at school and at home. Have them meet your child so they don’t jump to their own assumptions about his/her diagnosis. Offering to provide staff with training on what works best for your child and most likely other children on the autism spectrum is another benefit you could extend to the program that may increase their comfort and ability to serve not only your child but others. Of course ask lots of questions. Some camps unfortunately say they support children with special needs but struggle to do so. Ask the camp coordinator to see the camp environment. If your child is going to be indoors for long periods of the day make sure they are in a room that is large enough to accommodate the noise level, crowd and activities of the busy campers. Ask how they prepare campers for transitions from one environment or activity to another. Does this coincide with what your child needs for successful transition? What kind of structure is used in the room, are there centers with boundaries that will make sense to your child? Is there an area you’re your child can access when he/she needs a break? How will they handle behavioral issues, reminding them of course that other children in this age group may also have behavioral issues even in the absence of a diagnosis. What type of training are staff provided, does it go beyond basic first aid and CPR? And, of possible meet the camp staff. Talk with them about the needs of your child then ask yourself “does your intuition tell you that they will be patient, compassionate and nurturing?”

There are also other great community options for families. Depending on where you live your local YMCA may have a day camp option for you. There are several around the state that have wonderful model day camp options that include partial inclusion or full inclusion. In Wake County the YMCA works very hard to make sure they are an option families can count on for support. Another place to look is within your Parks and Recreation Department. Several Parks and Rec. programs have reached out to the Autism Society of NC for training for their camp staff as well as afterschool and regular program staff. Several after school programs also run day camps in the summer. If your child is already utilizing this service during the school year it may be a natural choice for summer. Museums are another great place to research. Do you have a children’s museum in your area that offers summer camp options? How about natural history, art or science an area that your child may already be interested in and thrive in? If your child is interested in sports many sports programs provide the structure and support needed for a successful day. Check with your local soccer, baseball, basketball or hockey complex.

If you think your child may be ready for the overnight experience, consider Camp Royall for next year. Camp Royall is the Autism Society of North Carolina’s summer camp program and it offers a unique experience to individuals on the autism spectrum of all ages and ability levels. Camp staff receive extensive training and are there because they love supporting individuals on the spectrum. Each year I provide support to camp staff during training week and am consistently blown away by their compassion, drive and dedication. Sending your child away for a week may seem unreachable to many however almost all the campers have the time of their lives and can’t wait to go again next year. There are other camps like this in different parts of the state as well, check out camp Lakey Gap in Black Mountain.

If your child will be at home for the summer it is important to prepare them. Start with developing a schedule that includes expectations at home as well as transitions to activities and events in the community. Make sure your schedule is set up in a way that your child understands. When developing the schedule ask yourself these four questions:

1. What type of visual cue should I use? (objects, photos, pictures, line drawings, or words)
2. How long should the schedule be? (how much info. can your child process and use at a time)
3. Does it go with the person or is it stationary? (is it on a clipboard, wallet, in iTouch)
4. How does the person manipulate the schedule? (cross out, put cards in finished pocket, take card to area, flip over)

Answers to these questions depend on the individual and his present level of performance.

Also, have a “First, Then schedule” handy for those moments of stress when your child may only be able to process two steps and make sure the Then, represents a preferred activity. The schedule will also allow you to prepare the child for new activities and changes in routine. I highly recommend using it in this way. Prepare your child for vacations, new activities, visitors or the unexpected. The schedule should tell them four things; the activities and their sequence, where to go and it visually represents time.

In addition you may want to set up “centers” around the home that will engage your child and give you much needed time to do other things. For example, set up a water play area outside with a sprinkler, water table with different cups, watering cans and pool toys. You may consider placing this in a shaded area if your child is sensitive to light and/or heat. Inside have a sensory area in the ready. A bean bag chair, exercise ball, and bin of sensory toys that you know your child will enjoy. Much of this can be found at the dollar store. Other stations may include a Lego station, craft station, puzzle station, video game station but make sure you include these in the schedule so that there is some structure to the day that your child will most likely be looking for. If you know you are heading out for the day and this may be difficult make sure you start the day with a preferred activity and end the day with a preferred activity and that this is included in the schedule. Seeing that he/she will get to do some favorite things may alleviate some of the anxiety around the unknown of going out into the community.

When trying something new in the community start with small doses. For example, if you want to try the community pool but aren’t sure how your child will do start by going to the pool and having your child take a look at it before actually going in. Try this in the evening before the day of the event then place it on the schedule for the next day. Also, use calendars that your child will understand to show when school will start again, when you are going on vacation, to visit family, or are having visitors. Just like with the schedule use materials that your child understands.

Also, try scheduling play dates. Try inviting kids over that your child may know from school or the neighborhood. The other parents will be more than grateful and hopefully will reciprocate. It may be that you grow your network of support this way. Continuing to provide as many social opportunities as your child can handle will help keep the momentum going that they may have been established during school. Make sure though that you have planned activities for these play dates so that expectations are clear and that there are opportunities for your child to slip in and out of the play if necessary.

Most importantly enjoy the break. Find ways that you and your child can play together but also find time for yourself. If you or someone you know would like more training and/or support or if you would like a local program in your area to receive training please contact us at the Autism Society of North Carolina Training Department by calling 919-865-5069. Have a great summer!

Leica Anzaldo can be reached via email at lanzaldo@autismsociety-nc.org. For more information about Training Services click here.