Extinction Bursts and the Importance of Full Disclosure

This blog post was written by Dr. Aleck Myers, Clinical Director for the Autism Society of North Carolina.

Recently, I wrote a behavior support plan for an individual who frequently tantrums. Great methodology, if I do say so myself! It was well written and explained the rationale of the program to family and staff, stressing the importance of strengthening functional communication (the individual was communicating beautifully, just not the way we wanted him to! There’s nothing like a good sit-down-and scream-bloody-murder to let us know when he wants something or wants to quit something!).

We need to give people acceptable tools to express their wants and needs. So the program offered ways to do that. And the program stressed the importance of not paying any more attention to the tantrum behaviors than absolutely necessary. In other words, tantrums were to be placed on “extinction” (removing all attention to the behavior. Note though: not the person; the behavior). So this psychologist left the training feeling good about the program and the willingness of family members and staff to implement the program correctly and collect all of the necessary data.

Two and a half days later, I received a distressed email from Mom. Tantrums were through the roof in frequency, she was exhausted, and she felt that the program was making the individual’s behavior worse. It was then I realized, with great chagrin, that I had failed an important part of my training…I hadn’t described the “extinction burst.”

When you begin to ignore behaviors that are socially reinforced, the behaviors will increase in frequency and intensity almost immediately. This is the extinction burst. You can think of it as, hey, this used to get me what I wanted, now it doesn’t…that makes me mad, so let’s try harder! As a professional, when I see this burst in behavior, I feel assured that the program is going to work. From this parent’s point of view, though, not having been warned, things were getting much worse. Luckily, I was able to reassure the mother that this was not a bad sign, and if she and the staff hung in there, things would improve soon. Mom is a real trooper, and she, Dad, and the staff persisted.

I called the mother a couple of days later and was greatly relieved that a) she was still talking to me, and b) the afternoon after she had emailed me, the unwanted behaviors decreased, and that things were definitely improving now. This was further enhanced by an email two days later, indicating considerable improvement. And that the emphasis on strengthening communication was continuing.

Now if I can just improve my own functional communication!  I think I learned my lesson…

You can reach Dr. Aleck Myers at amyers@autismsociety-nc.org.

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.

Planning for the Future

by Linda Griffin, Parent Advocate Director

Parents of children with autism are often so busy just getting through the day that they forget to plan for the future.  And that future arrives sooner than you expect.  One day you are struggling with toilet training and IEPs and the next day you look up and your toddler is 6 feet tall and the school bus has stopped coming.  The time to plan for the future is NOW!

If your child is 5 or 10 years old, it may be hard to imagine what life might be like for them as an adult.  No one can predict what is or is not possible.  Begin by thinking and asking questions:

• Where will my child live, work and play as an adult?
• How independent will they be?
• Will they live/work independently or with support?
• Will they attend vocational school or college?
• How will they get from where they are now to where they need to be?
• Who can help us with this transition?

The one thing we parents know about our children with autism is that transitions are difficult.  Planning for transitions is extremely important.  If your child is in public school, a transition plan (also known as an ITP – Individualized Transition Plan) will be developed by the IEP Team (Individualized Education Plan) when your child becomes 14 years old.  The team may include the parents, teachers, guidance counselor, transition counselor, vocational counselor, friends, relatives, and other professionals. The team should also include your child.

This is a perfect time for parents to take advantage of the creative minds and the connections of this team of professionals, friends and relatives.  They can look at your child’s strengths and interests and then help to design a set of activities that can successfully move your child from school to adulthood. The plan should outline the training and support that will be needed.

The destination will be different for each student. Some will:

• Work independently
• Work with support
• Live on their own or in a supported apartment
• Go to vocational or technical school
• Go to college

But EVERY child should be taught, supported and encouraged to be as independent as possible. As I have said, planning is important.  Begin now.  Another way to plan is to attend the 2013 ASNC Annual Conference this February.  The theme this year is “Autism Grows Up” and will focus on preparing for adulthood.  Planners recognize that children with autism become adults with autism.  Take this opportunity to meet other families, learn from professionals, listen to the experiences of other individuals and think about the future.

Linda Griffin can be reached at lgriffin@autismsociety-nc.org or 919-865-5090.

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.

Choice: A Building Block of Self-Determination

Editor’s Note: This week’s blog post was provided by Louise Southern, Training Specialist for the Autism Society of North Carolina.

Self-determination is often described as the combination of skills and knowledge that enables a person to engage in goal-directed, autonomous, and self-regulated behavior. Self-determined individuals have the power to exert control over their own lives in order to achieve the outcomes that they desire. Self-determined individuals make things happen in their lives, and they recognize this power within themselves. Goal-setting, decision-making, problem-solving, self-advocacy, and self-management are some of the behaviors that self-determined individuals display.

As we know, these behaviors may not come easily to some individuals with ASD. To help cultivate these skills, it is crucial that individuals with autism experience multiple opportunities each day to make choices. Choice is one of the building blocks of self-determination, and it should be a primary consideration when we design instruction and interventions in school, at home, and in vocational and community settings.

Consider how many choices we make throughout the day. For example, we choose when we need a break at work, which pen we want to use, the order in which we complete certain activities, the route we want to take from point A to point B, and how to spend free time. Some individuals with ASD have moved through school and life without the opportunity to make choices, since everything is arranged and scheduled for them. As a result, some individuals with ASD become increasingly passive and may develop “learned helplessness.” Other individuals might display their inevitable frustration and sense of powerlessness in maladaptive ways – through tantrums, aggressive behaviors, or shutting down.

For individuals who are not able to verbally express themselves, choices should be presented in a concrete and visual mode that meets the individual’s communication needs – via written words, pictures, or objects. These individuals should have a way to initiate communication of their choices as well. For example, they may indicate choice via picture exchange, by touching an image on a choice board, or by reaching for one object when presented with several options.

And remember that individuals who can verbalize their choices may not actually do so. As an educator, I worked with a number of high school students with high-functioning autism or Asperger’s who did not self-advocate even to get their basic needs met. For students who became overwhelmed by a string of verbalized options or open-ended questions, I found that they responded best to a presentation of written options. For instance, the student could circle his or her choice from an array of options, write down his or her choice on a blank line, or place a number next to each task to indicate the order in which s/he wanted to complete certain academic assignments or activities. In some cases, I paired these written options with photographs and other visual cues to support comprehension.

Consider a typical day for the individual you support. Identify opportunities where “neurotypicals” might exert choices and control. Then, consider how or if the individual experiences frequent opportunities every day to express such choices. Present clear options in a way that is meaningful to the individual, using visual supports and structure as necessary. Ensure that s/he is able to communicate his or her preference. By doing this, you are empowering the individual and laying down the first building blocks of self-determination.

Louise Buchholz Southern, a Board Certified Behavior Analyst and former special education teacher, has been working with children and adolescents with ASD since 1997. Louise has extensive experience implementing and overseeing home-based programs that emphasize the integration of Applied Behavior Analysis, Pivotal Response Training, and Structured Teaching elements for young children with ASD. To contact Louise, email her at lsouthern@autismsociety-nc.org.