Implementing Evidence-Based

Practices in SchoolsDr. Cathy Pratt, BCBA-D

DirectorIndiana Resource Center for AutismIndiana Institute on Disability and

CommunityIndiana University

Phone: (812) 855-6508Fax: (812) 855-9630

www.iidc.indiana.edu/irca

Instructional Approaches• A single instructional strategy

should not drive a student’s program. What we want students to learn and how each learns best should guide our choice of instructional approaches and serve as the framework for how we teach a student. Process versus outcomes.

Strategies

• One size does not fit all….need to find best fit for child and for family.

• Business of Autism• Helping families make informed decisions.

http://www.iidc.indiana.edu/styles/iidc/defiles/irca/abaproviders2014.pdf

• Utilizing strategies that are evidence-based.

Process In Indiana

• History of Project• Initial Focus on Secondary• Close to 100 Schools• Focus on Student Outcomes• School Assessment: APERS• School-wide Impact

Evidence-Based Practices

• According to the National Professional Center on Autism funded by OSEP (http://autismpdc.fpg.unc.edu/), evidence-based practices include the following:

What are these evidence-based practices?

• Antecedent-Based Interventions• Cognitive Behavior Intervention• Differential Reinforcement• Discrete Trial Teaching• Exercise• Extinction• Functional Behavioral Assessment• Functional Communication Training

What are these evidence-based practices?

• Modeling• Naturalistic Intervention• Parent-Implemented Intervention• Peer-Mediated Instruction• Picture Exchange Communication

System• Pivotal Response Training• Prompting• Reinforcement

What are these evidence-based practices?

• Response Interruption/Redirection• Scripting• Self-Management• Social Skills Training• Social Narratives• Structured Play Groups• Task Analysis• Technology-Aided Instruction and

Intervention

What are these evidence-based practices?

• Time Delay• Video Modeling• Visual Support

More Websites

• http://www.nationalautismcenter.org/nsp/

• http://autisminternetmodules.org/

Fidelity of Implementation

Learning Characteristics Associated With Autism

Spectrum Disorders• Concrete/Hands On• Literal/Difficulty with Comprehension• Highly Distractible/Intensely Focused• Variability in Performance• Rule Bound/Insistence on Sameness• Immediate Perfection/Closure• Transitions/Unstructured Time Difficult• Organizational Difficulties• Need for Predictability and Routine• Need for Activities that Motivate• Need for Repetition

Engagement/Intensity of Instruction

• Engage Often• Importance of Routines• Incidental Teaching: Every moment is a

teachable moment.• At the same time, some children may

need planned breaks.• Engage/read/talk to the child. Will talk

about this within social narratives.

Classroom Schedule

• Calendar

• Reading

• Daily 5

• Lunch

• Recess

Functional Behavioral Assessment:

• A process for determining the relationship between a person’s internal/external environment and the occurrence of problematic behavior.

Hypothesis Statement(Problem Behavior Pathway)

SettingEvents

TriggeringAntecedents

ProblemBehavior

MaintainingConsequenceEnds an Activity

Gains Access to Desired Event/Activity

Attention

Sensory

Autism/AnxietySeizuresMedicationsAllergiesCommunication LimitationsSensory ChallengesLack Self-Regulation and Self-ManagementPoor Social Skills

Certain DemandsToo Much TalkingTransitions: Leaving School BusChanges in RoutinesCertain academic work…too much paperwork and being read to or lectured to.

Pinching Yelling ScreamingElopementRefusalKickingHitting

Hypothesis Statement(Problem Behavior

Pathway)

Setting Triggering Problem MaintainingEvents Antecedents Behavior Consequence

Strengths/Skills:

Self-Management System

• Increases Desired Behavior• Decreases Interfering Behavior• Teaches Students How To:

• Monitor their own behavior• Record their own performance• Obtain reinforcement purposefully

http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/SelfManagement_Steps.pdf

Ultimate Goals

• Decrease Use of Paraprofessional• Enhance Skills Needed for

Employment• Enhance Skills Needed for Post-

Secondary Options• Enhance Quality of Life

Sample Self-Monitoring: Assignment Completion/

Check-in/Check-out

Direct Instruction

• Direct, Systematic and Purposeful Instruction.

Exercise

• Now considered an evidence-based practice.

• Build in structured play and exercise….swimming and other types of physical activity.

Communication

• Challenge For All• Opportunities Must be Embedded

Across the Day and Across the Grades

• Not Simply About Services of SLP• Everyone has to encourage

communication.

Communication• May be nonverbal or minimally

verbal• Difficulty with practical conversation• Echolalic: immediate or delayed• Pronoun difficulties• Repetitive language• Difficulty with sarcasm…very literal • Interrupts others

• Difficulty starting, joining or ending conversation

• Difficulty asking for help• Difficulty staying on topic• Unusual voice or speech• When instructions given to whole group,

may not understand they apply to him/her as well

• Slow in processing information

Communication

Overview – Functional Communication

• FCT is used to decrease the incidence of interfering behaviors and to replace subtle, less clear communicative forms with clearer communicative forms.

• Teaching functional communication will increase an individual’s independence and decrease some challenging behaviors.

How FCT Works

• An FBA is conducted to identify the purpose of the challenging behavior.

• A more desirable or acceptable form of communication for the child to use as a replacement for the challenging behavior is identified.

• Challenging behaviors are ignored and only replacement behaviors are acknowledged and prompted. Again, can not ignore challenging behaviors that are potentially dangerous.

FCT• Can use any or all modalities to

teach functional communication –speech, pictures, sign language, gestures, writing.

• Create opportunities for communication by controlling access to materials or sabotaging a routine.

FCT• Offer opportunities for requesting

(choices, small portions, etc.).

• Teach communication within functional routines.

Naturalistic Language Strategies

• Activities are child-centered and take place during naturally occurring routines and activities.

Naturalistic Language Strategies

• This teaching strategy is a hybrid approach that promotes communication/language development through environmental arrangement; responsive communication partners; and prompting, modeling, and reinforcement.

Naturalistic Language Strategies

• Naturalistic language strategies promote more complex skill acquisition and generalization and maintenance of skills.

Examples of Naturalistic Interventions

• Learner-directed activity – learners select what they want to do within the environment.

Examples of Naturalistic Interventions

• Goal is to label animals. Different animal toys are offered, but the child decides to work on an animal insert puzzle. Staff then encourages the child to label each puzzle piece representing an animal.

Examples of Naturalistic Interventions

• Routine activity – routine activities take place on a regular basis.

Examples of Naturalistic Interventions

• Goal – Jeff is to use words to request: “open.” During snack time, staff present several tasty options in a clear, partitioned container in small portions. This presentation gives Jeff several opportunities throughout snack time to request “open.” Staff will open the container, and he can select his snack option.

Picture Exchange Communication System

(PECS)• PECS is a behaviorally-based,

alternative (aided) communication system.

• Children and adolescents with ASD use visual-graphic systems to communicate with others.

Picture Exchange Communication System

(PECS)

• PECS has been shown to promote speech development and production in previously nonverbal learners.

Total Communication

• May use a combination of sign, words, and pictures.

• Sabotage during routines...instead of just giving a child a cookie. Prompt them to ask. Instead of just tickling, prompt them to ask.

Repetition

• Teaching and practicing across settings and people.

• Hundreds may be required.• Assists with generalization.• Do not confuse rote memorization

with true comprehension.

Receptive Communication• If child does not follow directions, try

to say it in a different way.• Sometimes we use too many words.• Sometimes we are too abstract.• Saying the same thing over and over

again that has not worked will not be successful.

• Fewer words. Visuals. Gestures. Prompting.

•The majority of students with ASD are VISUAL learners.

Learn more quicklyReduce aggressive or self-injurious behaviorDecrease frustration and anxietyLearn to adjust to changesComplete tasks by themselvesGain independence

Visual strategies can benefit all children by

enhancing the individual’s understanding.

Individual 5 point scales

SHOW them what TO DO!

Visual Supports• 5 point scale

How to Line Up

Rules for Reinforcement• Reinforcers must be individually

determined. • Based on observation of behavior change. • When teaching or strengthening a new

behavior, reinforce frequently.• When maintaining behavior, use

intermittently. • Must directly follow behavior. • Specifically state why a behavior is being

reinforced.

Reinforcers• Can identify through various means what

is reinforcing.• Primary includes edible and sensory• Secondary includes a tangible, privilege or

activity. • Generalized conditioned reinforces are

items that can be used in exchange for a wide range of back-up reinforcers such a money, tokens, stickers.

Reinforcement Systems

Reinforcement Systems

Reinforcement Schedules

• Variable• Fixed

Created 2006 IRCA

Shaping

• Reinforcing successive approximation toward the desired goal. Expectations for success and reinforcement are gradually increased.

• Example: picking a toy up. Putting a shoe on.

• Don’t expect immediate perfection.

Differential Reinforcement Schedules

• Differential Reinforcement of Higher Rates of Behavior (DRH).. to increase low social initiations

• Differential Reinforcement of Lower Rates of Behavior (DRL)…to decrease self-stimulatory behaviors

• Differential Reinforcement of Other Behavior (DRO)… to increase non-occurrence of out of seat behavior

Differential Reinforcement Strategies

• Differential Reinforcement of Incompatible Behavior (DRI)…reinforcing behavior that is physically incompatible. Eating at table versus walking around house.

• Differential Reinforcement of Alternative Behaviors (DRA)…to increase hand-raising versus talking out in class.

Rapport/Praise and Feedback

• Specify Behavior Praised• Rapport Building• Positives Outweigh Negatives• Coach parents and others in telling child

what to do; not what not to do.

Errorless Learning

• Teaching tasks correctly upfront. Does not allow child to get into incorrect patterns of behaving.

• Corrective feedback is less effective.

Extinction

• Ignoring a Behavior• Extinction burst.• Should not use with dangerous

behavior. • Use with other strategies.• Choose your battles.

Prompts

• No Universal Prompt Hierarchies• Fading• Prompt Dependency • Types: Verbal, Visual, Modeling,

Physical, Gestural• May use different prompts for

different situations.

Discrete Trial Teaching• Great to use for teaching specific

tasks. • Mass trials.• Can be used individually or in group. • Prompt to Response to Consequence• Have to make sure generalization

and maintenance are planned.

Premack Principle

• A less preferred behavior, followed by a highly preferred behavior, becomes stronger.

• If-then…..

Task Analysis

• Task broken down into discrete steps• Observe a number of competence

individuals• Consult with experts• Perform the task yourself• Develop task analysis of common

home activity.

1 2 3 4

Sequence of dressingSequence of Dressing

Chaining

• Backward: Last part of chain is taught first.

• Forward: First step is taught first until mastery.

• Total Task: Training assistance provided for steps not mastered.

Behavioral Momentum

• Deliver 3 to 4 highly preferred activities or requests and then introduce a less preferred tasks with support.

Choice Making

• Identify preferred and non-preferred objects or activities

• Determine if choices are acceptable.• Present Choices• What opportunities do you see for

building choice into the day? How would you guide parents on this?

Social Challenges

• A primary challenge of those on the autism spectrum.

• According to Gresham and Elliot, socially acceptable learned behaviors enable a person to interact with others in ways that elicit positive responses and assist in avoiding negative responses.

Social Skills

• Difficulty recognizing non-verbal behavior, body language, and facial expressions

• Difficulty waiting• May prefer solitary play• Social rules may be confusing• May appear to be in own world• May prefer to play with toys then with

people

Social Skills

• Difficulty making and maintaining friends

• Socially awkward• May appear rude• May intrude on personal space• May not understand turn taking

Strategies Overview

• Social Narratives• Social Skills Training/Groups• Video Self-Modeling• Peer-Mediated Instruction

Power Card Strategy

• The Power Card Strategy uses the child’s special interests to motivate and improve specific behaviors.

• Summarizes steps the special hero wants the student to remember in specific situations

• Acts as a cognitive rehearsal

Power Card

Clifford wants all of the children to be safe, so remember:

1.Never run away from the playground.

2.Stay with the children and teachers.

3.Have fun and play with other boys and girls.

Power Card Strategy Using the Bathroom

Superman and the Bathroom

During his many flights to help people in need, Superman has found it necessary to stop and use the bathroom once in a while. He knows it is important to go when he needs to, and he doesn’t wait for someone to ask him if he has to go. He knows that it is important for superheroes to take care of their bathroom needs on their own.

Superman would like for you to consider these three

facts:1. When you are at home, don’t wait

for someone to ask if you need to go to the bathroom. Just go when you need to go. (Don’t ask, just go.)

2. When you are at school, tell your teacher that you need to go to the bathroom. Try to go every time there is a scheduled break, even if you don’t feel you need to. (Tell teacher, then go.)

:

Superman would like for you to consider these three

facts:

3. If you are away from home, tell an adult you are with that you need to use the bathroom and have them show you where it is located. (Tell adult, have them show where.)

Superman is proud of young men who can take care of their own bathroom needs!

:

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Social Story Comic Strips

I want to work on the computer,

NOW!

No, I have to finish my math and ask the teacher before I can work on the computer.

Mrs. Smith, my math is done. Can I work on the computer now?

Comic Strip Social Story by Glenda Pate

• Mode of teaching that uses video recording and display equipment to provide a visual model of the targeted behavior.

• Videos on teeth brushing, washing hands, etc.

Video Self-Modeling

Social Skills Groups

• Used to teach individuals with ASD ways to appropriately interact using small groups of 2 to 8. Pros and cons of this approach.

Peer-Mediated Instruction

Used to teach typically developing peers ways to interact with and help learners with ASD in increasing social opportunities within natural environment. May need to support siblings in playing with their brother/sister on the autism spectrum.

Play

• Structure play to teach the child how to follow directions, interact with others, imitate, attend for increasing periods of time, and so forth.

• Again, engagement is critical and should be fun.

Importance of Imitation

• Imitation is a critical developmental milestone.

• Imitation is central to the understanding of self and others.

Importance of Imitation

• Imitation helps children and adolescents acquire and practice important social and communication skills.

• Imitation is often an important component of play.

Generalization

• Teach Sufficient Examples• Training in Multiple Settings with

Multiple People• Training Loosely• Use Intermittent Reinforcer

Parent Implemented Intervention

• ASD impacts the entire family.• Be reasonable and realistic.• Realize they may be balancing

multiple family member needs. • Coach and demonstrate. • Encourage them to take care of

themselves and of other family members. Give them permission to do so.

Parent Implemented Interventions

• Minimize guilt. • Understand the big picture of family

life. • Providing resources so parents can

educate siblings and other family members.

Change Process

• Takes Time• Takes Strong Leadership• Entire School Effort• Embed within Other Initiatives• Measured Outcomes

Finally:

• Individuals with autism spectrum disorders present complex challenges. There is no easy answer. Because of the differences in these individuals there is no standard approach that will work with all. At the same time, good instruction works with all students. Think in terms of universal design.