Teaching Orientation and Mobility Skills for Students with Autism and Visual Impairments in Public SchoolsNora Griffin-Shirley, PhD, COMS

Devender Banda, PhD, BCBA-D

Phoebe Okungu, MA

Texas Tech University

International AER Conference 2014, San Antonio

Background

Children with autism and visual impairment represent a population of students with unique and varied educational needs.

The rising numbers of children with autism spectrum disorders (ASD) have received national attention and the Center for Disease Control and Prevention (CDC, 2014) estimates 1 in 68 children in the United States are identified with ASD.

Characteristics Associated with Autism

Deficits in communication, language, & social interactions. Behavioral excesses.

More recently associations with motor coordination have been made (Nayate, Bradshaw, & Rinehart, 2005).

Evidence suggests that cerebral dysfunction associated with ADS may cause difficulty with visual feedback during motor learning tasks (Johnson, Rinehart, White, Millist, & Fielding, 2013).

Literature Review According to Carvill (2001) as early as 1958, Keeler looked

at childhood schizophernia and found that 5 children who were blind had similar characteristics of those with infantile autism.

The severity of sensory impairments and the time of onset make it difficult to determine the exact number of individuals with ASD and sensory impairments (Mukaddes, Kilincaslan, Kuckyazici, Sevketoglu, and Tuncer, 2007) .

Lund and Troha (2008) mention that the prevalence of autism is higher in individuals with impairments (11.6%) and the risk of autism increases with the severity of visual impairment.

Literature Review… More recently, Absoud, Parr, Salt, and Dale (2011) confirmed

that young children with congenital severe visual impairment were at risk of early social communication difficulties by school age, and reported that 11 to 40% met criteria for autism.

Iketa, Davitt, Ultmann, Maxim, and Cruz (2013) examined 407 children diagnosed with autism and found that 40% participants with autism had ophthalmologic disorders.

Literature Review…

Professionals working with individuals, either with autism or sensory impairments, are often ill equipped to serve students with dual diagnosis because these children have unique needs due to their comorbid conditions (Gense & Gense, 2005).

With the existence of disabilities, more attention needs to be focused concerning research with this population (Goodman & Minnie, 1995; Parker, Davidson, & Banda, 2007)

Need for the Study

A systematic data collection method is highly recommended to measure student progress, and outcomes, to monitor and evaluate educational plans, to determine the efficacy of O&M instruction, and to justify the need for O&M services to school administrators (Fazzi & Naimy, 2010; Jacobson, 2013; Pogrund, et al., 2012)

Need for the Study Careful methodological design considerations are necessary

in studies involving low-incidence disabilities.

According to the Council for Exceptional Children (CEC), single subject design has the benefit of sufficient methodological rigor to offer adequate evidence for guiding educational practice (Honer, et al., 2005; Kratchwill, et al., 2010).

Need for the Study This design provides protection from many of the threats to

internal validity and is especially effective (Odom et al., 2003)

This study involved a single subject, multiple-baseline design across participants to train students with autism and visual impairments to travel using their canes.

(Bianco, 2013)

Purpose of the Study

To train two students with autism and visual impairment in orientation and mobility (O&M) to travel in school settings using their folding canes.

Method

The study included two participants who attended public schools in the Southwest of US.

The university Institutional Review (IRB) approved the study.

Parental consent was obtained prior to conducting the study.

Method-Participant 1 Lana (pseudonym)

12-year-old

Attends elementary school in a self-contained classroom and was included 50% of the time in a general education classroom

Exam in 2001 indicated congenitally blind, nysatgmus, probable Leber’s Congenital Amaurosis , and CVI

Limited use of vision; legally blind

Lana continued… Meets criteria for autism Severe receptive language impairment Profound impairment in pragmatic/social language Her assessment for intellectual functioning fell into the delayed

range on all areas of the Developmental Profile-3 (DP-3) (Alpern, 2007).

Low range on the Vineland II Parent-Caregiver Rating Scale and The Teacher Rating Scale (Sparrow, Cicchetti, & Balla, 2005)

Standard score of less than 50 which falls into the delayed range of the Adaptive Behavior Scale (Lambert, Nihira, & Leland, 1993)

Lana continued… Problem behaviors

Eye poking Self stimulatory behavior (stamping feet, flapping hands) Hugging Running away

Lana-Target Behavior The teacher and the O&M specialist indicated that Lana

required training in independent travel with accompanying school personnel to and from her classroom to an outside gymnasium using her folding cane.

Method-Participant 2 Andrew (pseudonym)

19-year-old male Non-verbal Diagnosed with autism Functionally blind due to self-inflicted injury to eyes Attended self-contained classroom 100% of day Lives at residential facility Eye report includes retinal detachment, glaucoma, & hyphemia of

the right eye; retinal detachment, & traumatic cataract in the left eye

Diagnosed with autism and intellectual disability by educational agency in 1996

Andrew continued… Problem behaviors

Self-injurious behaviors (hitting temples with fist) Screaming Striking the floor with his cane Masturbating Spitting

Andrew-Target Behavior

Overall IEP Goals

Increase functional communication

Improve social skills

Reduce self-injurious behavior

Learn to use folding cane

Settings-Lana

Lana’s self-contained classroom Special education teacher A paraprofessional 6 students with disabilities (varying functioning levels) Gymnasium located 200 feet from school building Lana must walk 80 feet to double doors leading outside then

another 120 feet along a sidewalk to reach the gymnasium

Settings-Andrew Andrew’s self-contained classroom

Special education teacher 3 paraprofessionals 3 students with severe ad multiple disabilities The physical arrangement includes multiple rooms: a main

classroom with a kitchenette and laundry facilities, a bathroom, a supply room, and an activity room (e.g., bed swing, table for crafts, sofa and chairs)

A 67 foot corridor outside Andrew’s classroom was the training environment

Dependent Variable

Time taken to complete route

All sessions were videotaped. For each trial time was recorded from the videotapes when the students took their first step and ended with their last step.

Each sessions included at least five trials, but on some occasions, less than five were conducted.

Time was calculated for each trial using an average time per session.

Method-Design

A multiple-baseline across participants was used to determine the functional relationship.

Baseline data collected for both participants began concurrently. Intervention began with Lana following 3 baseline sessions. While Lana received intervention, Andrew continued baseline, 3

additional baseline sessions followed by intervention. Visual analysis was used to determine relationship between

independent and dependent variables.

Procedure-Lana

Lana The COMS, classroom teacher, and the paraprofessional

selected the training route based on functional needs prior to O&M instruction.

For preference assessment, 5 toys (clapper, noise putty, play dough, pair of magnets, and a rubber bracelet) were used

She first received all the toys then they were withdrawn to begin the test.

Procedure - Lana

Test were conducted for 3 days, each day had 3 trails/sessions.

During tests toys were arranged on a table in front of student

She was asked to pick 1 and allowed to play with it for 2 minutes this procedure was repeated until all the toys had been picked

Lana chose the noisy putty as the most preferred followed by the magnets

Procedure-Andrew Andrew

The classroom teacher decided the training route based on the student’s needs as he never received formal O&M training prior to this study.

4 items were used (rattle, music, body lotion, and teddy bear) for preference assessment

The same procedure was used for Andrews as was used with Lana.

His preferred object was the rattle, followed by the lotion because it was the second preferred item.

Baseline Established by allowing the student to navigate an O&M

route as typically completed during daily routines with some verbal and physical assistance.

Lana

Able to traverse outdoor section of the route if she can hear people near the gym, but quickly became disoriented if she did not hear other people.

Received verbal and physical reinforcement (i.e., hugs, tickles, playing with noise putty) after completion

Baseline

Andrew

Instructed to travel with human guide and was never introduced to the cane

Reinforcement included high-five and lotion

Intervention-Lana Greeted by COMS inside her classroom

COMS indicated the purpose of the training

Lana retrieved her cane and appropriate clothing for outdoors

Lana & COMS exited classroom into the corridor at the starting point

Intervention - Lana

COMS instructed Lana to walk to gym 5 times by herself using her cane

COMS provided verbal prompts when needed

Reinforcement was given following the completion of the 5 repetitions of the route, then session terminated

Intervention -Andrew COMS greeted Andrew inside classroom

Was instructed to get cane and lotion (when he did not comply COMS gave these items to him)

COMS guided Andrew to the starting point of the training route (at the end of his classroom hallway)

COMS instructed using verbal communication

Intervention - Andrew

COMS provided verbal prompts when needed (when he did not comply COMS offered physical assistance such as hand under hand)

Upon completion of route positive reinforcement was used

After completion of 5 trials, the session was terminated (on some occasions less than 5 trials were conducted if problem behaviors were exhibited)

Interobserver Agreement

A trained graduate student viewed the videotapes independently and scored 30% of the sessions for each participant for baseline and intervention sessions.

The interobserver agreement was calculated by finding the percentage of agreement between the two observers and the percent of agreement was 94% (range 88% to 99%) for both participants.

Procedural Integrity

A checklist of the intervention procedure was developed. A graduate student independently rated the item “yes” when that particular item was implemented correctly and “no” when not followed.

Procedural integrity was calculated using the number of steps completed by the total number of steps multiplied by 100.

The procedural integrity for Lana was 91% (range 86% to 100%) and for Andrew was 95% (range 86% to 100%).

Autism and VI O&M Study 1

Baseline Intervention

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Results

Description of Results

The previous figure displays the baseline and intervention graph for both students. On average, Lana travelled 152 sec during baseline while during intervention she took 120 sec.

Furthermore, the graph shows that the trend was highly varied at baseline and more stable (almost flat) towards the end of the intervention.

On average, Andrew travelled 64 sec during baseline while during intervention he took 42 sec. Furthermore, the graph shows that the trend was highly varied at baseline and more stable (almost flat) towards the end of the intervention.

Overall, the participants reduced their travel time from baseline to intervention.

Discussion

Results show that both participants took less time post intervention.

Anecdotal reports from the special education teachers indicated that the intervention was beneficial for the participants.

(Strechay, 2013)

Discussion

The COMS reported that Lana was able to make choices about her reinforcers at the end of the intervention during several sessions.

Andrew’s teacher mentioned that he was walking with his folding cane under supervision and was more willing to express himself using his communication board and was happy while walking.

Discussion

Plausible reasons for participants’ improvement may have been the use of: Reinforcers through preference assessment Systematic instruction including task analysis, modeling,

prompting, reinforcement, fading O&M instruction focusing on cane travel Continuous monitoring through data collection

However, robust results were not evident in this study because of the participants’ problem behaviors during O&M training

Recommedations

Replication of the current study as well as more intervention studies with children with autism and visual impairments using single-subject designs are recommended. The use of single-subject design is prevalent in special education (Horner et al., 2005) but not evident in the O&M field.

We need to move beyond anecdotal reports and case studies to document the efficacy of O&M instruction. This endeavor will provide a much needed foundation for evidence-based practices in O&M instruction due to the lack of experimental research in the field.

(Daigle, 2008)

Recommendations Prior to O&M interventions, preference assessments are

necessary to determine reinforcers to enhance the impact of training.

The O&M specialists working with children with autism and visual impairments should collect data and make data-based decisions while providing O&M instruction.

Limitations

Data collection during baseline was not stable before we introduced the intervention to Lana. However, the intervention was necessary because of time constraints and teachers’ requests.

No strong functional relation between dependent and independent variables was established, but overall, participants took less time to travel during intervention session.

Finally, no data was collected on maintenance and generalization because of the end of the school year.

Conclusion The results of the study should be considered preliminary

More research is needed to confirm or replicate the results.

In the field of O&M, interventions using the experimental designs are in its infancy, and the current study is an attempt to provide a basis for future researchers.

(Gomez, 2013)

Contact Information Texas Tech University

Nora Griffin-Shirley – n.griffin-shirley@ttu.edu 806-834-0225

Devender Banda – devender.banda@ttu.edu 806-834 4827

Phoebe Okungu – phoebe.okungu@ttu.edu 806-834 0225

ReferencesAbsoud, M., Parr, J.R., Salt, A., & Dale, N. (2011). Developing

a schedule to identify social communication difficulties and autism spectrum disorder in young children with visual impairment. Developmental Medicine & Child Neurology, 53, 285-288. doi:10.1111/j.1469-8749.2010.03846.x

Alpern, G.D. (2007). Developmental Profile 3 (DP-3). Los Angeles, CA: Western Psychological Services.

Carvill, S. (2001). Sensory impairments, intellectual disability and psychiatry. Journal of Intellectual Disability

Research, 45, 467-483. doi:10.1046/j.1365-2788.2001.00366.x

Centers for Disease Control and Prevention. (2012). Autism Spectrum Disorders — Data and Statistics. Retrived, from http://www.cdc.gov/ncbddd/autism/data.html

References Fazzi, D.L., & Naimy, B.J. (2010). Teaching orientation and mobility to school-age children. In W. R. Weiner, R. L. Welsh & B. B. Blasch (Eds.), Foundations of Orientation and Mobility (Vol. 2, pp. 208-262). New York: AFB Press.

Gense, M.H., & Gense, D.J. (2005). Autism spectrum disoders and visual impairment: Meeting students' learning needs. NY: AFB Press.

Goodman, R., & Minnie, C. (1995). Questionnaire screening for comorbid pervasive developmental disorders in congenitally blind children: A pilot study. Journal of Autism and Developmental Disorders, 25

Horner, R.H., Carr, E.G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71, 165-179.

Ikeda, J., Davitt, B.V., Ultmann, M., Maxim, R., & Cruz, O.A. (2013). Brief report: Incidence of ophthalmologic disorders in children with autism. Journal of Autism and Developmental Disorders, 43(6), 1447-1451.

ReferenceJacobson, W.H. (2013). The art and science of teaching orientation and

mobility to persons with visual impairments. New York: AFB Press.

Johnson, B.P., Rinehart, N.J., White, O., Millist, L., & Fielding, J.(2013). Saccade adaptation in autism and Asperger’s disorder. Neuroscience, 243, 76- 87.doi:10.1016/j.neuroscience.2013.03.051

Kratochwill, T.R., Hitchcock, J., Horner, R.H., Levin, J.R., Odom, S.L., Rindskopf, D.M., & Shadish, W.R. (2010). Single- case designs technical documentation. What Works Clearinghouse Retrieved from

http://ies.ed.gov/ncee/wwc/pdf/wwc_scd.pdf

Lambert, N., Nihira, K., & Leland, H. (1993). AAMR Adaptive Behavior Scale - School (2nd ed.). Austin, TX: PRO-ED.

Lund, S.K., & Troha, J.M. (2008). Teaching young people who are blind and have autism to make requests using a variation on the picture exchange communication system with tactile

symbols: A preliminary investigation. Journal of Autism and Developmental Disorders, 38, 719-730. doi: 10.1007/s10803-007-0439-4

References

Mukaddes, N.M., Kilincaslan, A., Kucukyazici, G., Sevketoglu, T., & Tuncer, S. (2007). Autism in Visually impaired individual. Psychiatry and Clinical Neurosciences, 61, 39-44. doi: 10.1111/j.1440-1819.2007.01608

Nayate, A., Bradshaw, J.L., & Rinehart, N.J. (2005). Autism and Asperger's disorder: Are they movement disorders involving the cerebellum and/or basal ganglia? Brain Research Bulletin, 67(4), 327-334. doi: 10.1016/j.brainresbull.2005.07.011

Odom, S.L., Brown, W.H., Frey, T., Karasu, N., Smith-Canter, L.L., & Strain, P.S. (2003). Evidence-based practices for young children with autism: Contributions for single- subject design research. Focus on Autism & Other Developmental Disabilities, 18(3), 166-175.

Parker, A.T., Davidson, R., & Banda, D.R. (2007). Emerging evidence from single-subject research in the field of deaf-blindness. Journal of Visual Impairment & Blindness, 101(11), 690-700.

ReferencesPogrund, R., Sewell, D., Anderson, H., Calaci, L., Cowart,

M.F., Gonzalez, C.M., . . . Roberson-Smith, B. (2012). TAPS-Teaching age-appropriate purposeful skills: An orientation and mobility curriculum for

students with visual impairments (3rd ed.). Austin: Texas School for the Blind and Visually Impaired.

Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland-II: Vineland adaptive behavior scales: Survey forms manual (2nd ed.). Circle Pines, MN: American

Guidance Services.

Reference-Images Collected from Google Image

Bianco, B., (2013). White Walking Stick Project in Senegal and Togo. retrieved from www.amoaonlus.org

Daigle, C., (2008). logic defying sighting. retrieved from

www.cathrine.daigle.com/

Gomez, K., (2013). Multi-sensor navigation gadget for people who are blind. retrieved from

www.electronicsnews.com.au/news/

Strechay, J., (2013). This White Cane Day, Slim and I are Ready to Strut our Stuff. retrieved from www.afb.org