Exam 5

Question 0

Do you find the lack of services and employment opportunities for adults with ASD surprising? Do you think this will change as a generation of children who have received ABA services becomes adults?

Answer 0

I don’t find this surprising given how relatively recent the diagnosis is. It has only had its own diagnostic category since 1980 in the DSM-III. Since then, the diagnosis rate has grown exponetially, so there have only really been high numbers of adults with autism diagnoses in the past 10-15 years. This will definitely change somewhat as today’s children with ASDs become adults. Where in the past children with autism may have gone through school in special education with no additional services, children today may start receiving services well before entering pre-school.

Question 1

What are examples of how characteristics of autism make adulthood especially difficult for individuals with ASD?

Answer 1

Social deficits can lead to both social and legal deficits. Self-stimulatory and other behaviors may be worrisome, offensive, or frightening to other community members. Communication that has only been used with a specific few people (perhaps family and a 1:1 aide at school) may not be functional with other community members, and there may not be anyone available to assist in commuication. Deficits in intiation (of activities, communication, etc.) skills. Difficulties understanding social nuances and following social rules. Less tolerance for social offenses by adults as compared to children. Generally a lack of social skills training programs for adults. Bigger bodies make SIB, aggression, and repetive behaviors more dangerous/intrusive. Poor access to good services for adults. Deficits in adaptive behavior. Little is known about the long-terms outcomes of adults with ASDs.
(Core characteristics: communication difficulties, social deficits, repetitive behaviors)

Question 2

Why are ABA interventions less common with adults with ASD than children?

Answer 2

Some people believe that ABA-based interventions are only for children and not adolescent or adult learners. There is also less research involving these older populations. Large effort for EIBI (and similar) has obscured the usefulness ABA for older learners. Mosconception that ABA is for simple and one-step skills but not complex, multielement skills. Typically requires much more response effor ton the part of the instructor (e.g., teaching to purchase a meal vs. receptive labeling for a young learner).

Question 3

What skills have been targeted in recent research studies that increase safety and independence of adults with ASD?

Answer 3

Safety: 1) responding to vibrating pagers by handing information cards with calling information to adults in the community; 2) answer a phone and follow directions to give card to adult in community, then phone to talk to caregiver
Independence: Fading instruction and reinforcement (and increasing physical distance of the instructor) using a Bluetooth earpiece for an adult learning to grocery shop

Question 4

Describe the study by Gerhardt et al. (2003) on decreasing the aggression of Richard. Also, review the actual study in D2L (Unit 5 link). Critique the intervention and its long-term effects.

Answer 4

Richard had autism and ID, was large, nonverbal, and had adaptive behavior deficits, and his aggression had led to injury and hospitalization. Bx maintained by escape from demands and sometimes access to preferred foods. NCR food delivery on VI-30 second schedule. FCT: raised hand to ask others to leave room. Immediate and dramatic decrease in aggression with these combined treatments.
The intervention seemed to be fairly straight-forward but there was the issue of treatment integrity when NCR was not being carried out correctly, which had an adverse effect on Richard’s behavior. Considering that this occurred within the first three weeks, it seems likely that it could occur again and may need regularl-scheduled integrity checks. A component analysis would have been useful, but the risk of injury may have been too great to even purposefully withdraw either component. The loss of integrity that acted as a sort of withdrawal did help to show the effectiveness of that component after it was reinstated in the appropriate manner following staff training.

Question 5

If you work with children with autism, are adult needs and services addressed with the family? If so, how? If you work with adults with ASD, what are the strengths and limitations of the services provided?

Answer 5

Adult needs have been addresssed with the adolescents I work with, but I haven’t been a part of discussions regarding future services. In terms of needs, I help run a social group for adolescent girls, and we target skills that will be useful for them as they progress through their teens and into adulthood. For example, we practice getting ready to go out, independently making choices and stores and restaurants and paying for the items. My organization does serve adults, but I have not been directly involved with any of these clients (they only make up maybe 1-3% of our client base).

Question 6

View this video. Discuss the issues facing adults with autism. Note that Peter Gerhardt is the author of chapter 12.

Answer 6

Very few services available after age 21. Thought of as civil rights issue for children but not adults. Individuals end up being put on waiting lists and sitting at home. Lack of staff trained to work with adults. Much of staff is younf females, but males may need more male role models (e.g., how to use urinal appropriately). We are pretty good with physical but not mental (sensory, etc.) accomodations. Necessity for job coaches when working (funding for them ends at 21).

Question 7

What does this amazing article tell us about the importance of communities, families, and inclusion for adults with autism? Discuss your reactions.

Answer 7

Adults with autism may outlive their parents, who have likely been primary caregivers. It’s important for the community to be inclusive and not just pity or fear those with autism. Adults with autism can hav long, fulfilling lives with supportive families and communities. Donald learned to golf, drive, and solo travel (including out of the country) after a rough start to life and a poor outcome presumed.

Question 8

What conclusions can be drawn from the evidence-based research as far as whether or not psychotropic drugs should be used with children with autism?

Answer 8

Drugs should be used sparingly and only when other strategies to reduce malaptive behaviors have failed. Many studies have had low methodological quality. There may be serious side-effects for young children.

Question 9

Even though single subject design studies may be dismissed by the medical profession, what questions have been answered in this research that cannot be answered in group design studies?

Answer 9

How do drugs affect behaviors in home vs. clinical settings? How do drugs affect the outcomes of functional analyses? Can drugs reduce destructive behavior?

Question 10

If using psychotropic medication with an individual with ASD, how do you show accountability? If behavior is not carefully monitored, what mistakes might be made?

Answer 10

(Accountable interventions are those or which the goals, procedures, and results are clearly specified and the benefits of the intervention are obvious in the treated individual.) Goals must be clear and in the participant’s best interest. Procedures must be unambiguous and implemented with fidelity. Decisions must be made on the basis of actual changes in target behavior and other relevant characteristics of the participant. Careful documentation must be done.Treatments must be adequately measured. Medications must be administered according to the experimental regimen. Experimental conditions and their sequencing must allow observed changes in target behavior to be attributed with confidence to the drug. Data analysis must be adequate for detecting clinically important changes in client behavior. Without careful monitoring, confirmation bias may lead to the belief that improvements have occured when none actually exist. Faith can easly overpower objectivity. High-quality outcome data is necessary. Assessments of those with autism should be conducted through a multidisciplinary approach, and interdisciplinary service coordination is a critical piece of assessment and accountability.

Question 11

Although there is currently no best practice for monitoring psychotropic drugs outside of a research context, what are some recommendations? Why is it important to carefully monitor effects and not just rely on a global impression of change by a caregiver?

Answer 11

Procedures must be unambiguous and implemented with fidelity. Decisions must be made on the basis of actual changes in target behavior and other relevant characteristics of the participant. Careful documentation must be done.Treatments must be adequately measured. Medications must be administered according to the experimental regimen. Experimental conditions and their sequencing must allow observed changes in target behavior to be attributed with confidence to the drug. Data analysis must be adequate for detecting clinically important changes in client behavior. Without careful monitoring, confirmation bias may lead to the belief that improvements have occured when none actually exist. Faith can easly overpower objectivity. High-quality outcome data is necessary. Assessments of those with autism should be conducted through a multidisciplinary approach, and interdisciplinary service coordination is a critical piece of assessment and accountability.

Question 12

Provide examples of how psychotropic drugs may act as EO’s or AO’s for individuals with autism.

Answer 12

Drugs may increase/decrease the reinforcing/punishing effects of certain other stimuli. They may alter sensitivity to particular dimensions of reinforcment, influence sensory acuity, and elicit responses incompatible with required operants. The effects of drugs depend on the consequences maintaining behaviors. e.g., respiridone as AO that selectively reduced the reinforcing effectiveness of escape from demand as well as the probability of occurrence of responses that had historically produced that outcome. Methylphenidate acted as an EO for social activities and an AO for food.

Question 13

What evidence exists that shows individuals with autism respond to psychotropic drugs differently than other people?

Answer 13

Comorbity is common in people with autism, which will affect the outcomes of drug treatments. Some individuals with autism already have overfocused attention, and stimulant medications may make this focus even more narrow. Differing results of drugs used to treat hyperactivity. There is little research on these potential differences.

Question 14

Discuss issues and concerns pertaining to psychotropic drug use that you have observed or experienced in your work.

Answer 14

Certain drugs can improve some behaviors while causing issues in other areas. A child given medication to reduce hyperactivity may become sedated and less responsive to interactions. There are also many issues with using a variety of medications. One of my previous clients was diagnosed with autism, OCD, and diabetes. It was sometimes unclear as to which drugs led to which effects.

Question 15

After reading the section on precision teaching and the Standard Celeration Chart, are you a convert? Why or why not?

Answer 15

Precision Teaching involves daily recording of the frequencies of different classroom performances on a standard celeration chart. This permits teachers and students to project the outcome of the procedures they are using. Standard charts facilitate sharing data. High performance aims and custom-tailored prescriptions maximize learning. PT has become a system for defining instructional targets, monitoring daily performance, and organizing and presenting performance datain a uniform manner to facilitate timely and effective instructional decisions. SCC originated as an extension of the cumulative recorder. SCCs have a standard scale on each axis. SCCs use straight rather than curved lines, and all straight lines have the same value. Variability in data becomes normalized and equalized. Outliers can easily be detected. Baseline stability becomes readily apparent. SCC offers a powerful visual medium for graphically analyzing data. No scaling, which can cause distortion or hidden effects in behavior change.

Question 16

How would the Learning Channel Matrix be useful in your work with children with autism?

Answer 16

Learning channels help form the clearest description of the antecedent-response contingency. LC matrix offers an opportunity for an organized taxonomy of stimulus control. Inputs on left column (6 common sensory modalities) and outputs on the bottom row (8 possible behavioral responses). Target Bxs can be entered into each cell. Multiple learning channel inputs may be necessary for desired output/s. For a goal of see-say, seehear-say might be a necessary first step. Learning in one channel is generally independent from others. LCs is meant to aid describing stimulus control and planning for generalization. It would be helpful in my work to determine whichc learning channels are proficient when developing new goals and tasks.

Question 17

How can behavioral fluency help children with autism? Describe an example of a study you might design to see if fluency increases learning with children with autism. Have you carried out any fluency programs with children with autism? Discuss the effectiveness of the program.

Answer 17

Fluency with clerical skills reduced aggression and SIB. Three learning outcomes associated with behavioral fluency: retention, endurance, and application. Fluency with basic skills will help with learning later more advanced/complex skills. Plan, develop, and implement skills practice routine, then analyze the visual display of student performance and decision making. Advantages of PT and behavioral fluency: long-term retention, endurance, and application of specific behaviors. Study: make fluency goals and see how fluency translates to later skills acquirement. I’ve been involved with fluency programs for reading sight words and giving answer to basic math problems (i.e., addition and subtraction with numbers 0-9).

Question 18

What is Direct Instruction versus direct instruction?

Answer 18

Direct instruction (lowercase) is a general term for the explicit teaching of a skill-set using lectures or demonstrations of the material, rather than exploratory models such as inquiry-based learning. DI is a systematic instructional approach that integrates carefully sequenced curriculum with effective instructional strategies and teaching principles. It is effective with kids with ASD. It has an emphasis on both quality instructional methods and quality curriculum design. it includes a sophisticated analysis of the content to be taught. Curriculum is organized to promote generalization. It’s based on two important beliefs: the rate and quality of children’s learning is a function of environmental events; and educators can increase the amount of learning in the classroom by carefully controlling all relevant details of instructional interactions. DI programs are both research-based and research-validated for students with diverse learning needs.

Question 19

What is meant by research-based versus research-validated? In what academic areas and with what populations is Direct Instruction research-validated?

Answer 19

Research-based means the components of a program such as instructional strategies or curricular targets have been shown to be effective through scientific research. This term doesn’t mean that that program as a whole has been directly evaluated. Research-validated means a program has been directly tested in scientific research and been found to be effective. DI is research validated for basic and conceptual academic skills (math, oral and written language, social skills) and for learners with a wide range of general functioning levels, ASD, disadvantaged students. Children with moderate MR have successfully been taught reading, math, and language skills.

Question 20

How are several features of Direct Instruction especially relevant for children with autism?

Answer 20

The unique design of DI may address the needs of children with ASD in terms of the difficulties these individuals often have in focusing on relevant stimuli and generalizing information. DI programs include systematic and langue teaching, a structured learning environment, predictable routines, consistency, and a cumulative review. It permits training and supervision to staff to ensure standardized instructional delivery. Instruction is individualized through placement tests to appropriately match instruction to child’s needs and ongoing data-based decision making. Promotes generalization, which is helpful for individuals with ASD. Capitalize on the preference of children with ASD for predictable routines. Scaffolded instruction. Comprehensible/structured learning environment. Carefully planned sequence of instruction. Rather than units/modules, programs are organized into tracks (sequences of instruction on a particular skill/topic across multiple lessons in a program. Task variation is helpful for skill acquisition, on-task responding, motivation, improvement in affect, and decreased problem behavior.

Question 21

What research is needed in the area of Direct Instruction for children with autism? Have you used any Direct Instruction programs? Discuss the effectiveness of the program.

Answer 21

Studies that address academic skills. Do results vary based on the age or functional level of the individual with ASD? Does success depend on the content addressed? Will effectiveness vary based on which outcome measures are selected? Systematic research on the efficacy of DI with students with ASD. Success of a variety of DI programs with children presenting an array of learner characteristics. Most of what’s known about using DI with kids with ASD comes from clinical experience.

Question 22

Lovaas (parents) What key technique does the chapter’s author use to encourage parental involvement in teaching ABA programs?

Answer 22

“We add a requirement that, before a skill is considered mastered by a child, each parent must be able to obttain the same success level as was obtained by the staff. Initially, parents may find this requirement threatening. However, the following procedure is designed to make this as painless and supportive as possible. In fact, once involved this way, we have found that parents are very satisfied with their participation, feel confident in their knowledge of the treatment, are more likely to volunteer for treatment hours, and generalize their use of skills more readily throughout the day.”

Question 23

Lovaas - What procedures and key features ensure that parents can successfully teach a program to their child (one already mastered by the behavior therapist, p. 311)?

Answer 23

At least one weekly meeting with parent to describe skill and methods being used and answer any questions. Aid models program, then parent does it and receives feedback with remodeling and turn-taking as necessary. The parent teaches only after the skill is mastered with the aide. The aide always models before asking the parent to engage. (The child carries behavioral momentum from the aide’s turn to the parent’s turn. Continuation of the program depends on the parent’s involvement.)

Question 24

Lovaas - What procedures and key features ensure that parents can successfully teach a program of the week to their child (incidental teaching)?

Answer 24

One mastered program selected per week. Models and prompts to implement in new settings, then with child present. Assignment given for trials to conduct/take data on for the week and plans to review progress. Focus on one program for week. After mastering about 50 programs per year, generalization will likely occur. Encouraged to put data sheet in obvious place and target specific times/ocassions throughout the day.

Question 25

Lovaas - What does the author mean when he says that parent training is not “parent blaming” nor is it “normal parenting?”

Answer 25

A word of caution. Some parents and professionals become very uncomfortable when we talk of parent training because it conjures up the psychoanalytic theories, very much alive today as parent blaming. Our emphasis has nothing to do with blaming parents for their children’s condition. These children do not become disabled due to the environment their parents provide. For example, most familis have typical siblings growing up alongside the child with developmental delays. What we are providing is a professional treatment that has been carefully worked out over many years and at great expense. It is not “normal” parenting - normal parenting does not result in the gains that professional treatment achieves. Normal parenting does not ameliorate the challenging conditions that these children present. However, parents can learn all or most of these professional skills, and they have the motivation and intensity to help their children, even more so than professional persons. Parents have been proving this simple fact over the past 25 years.

Question 26

Lovaas - How is the parenting role in a behavioral treatment program different from traditional programs?

Answer 26

The natural tendency of staff and parents alike is to rely on staff to engage the child and complete programs. In human services and education, parents have rarely been genuinely empowered to take a leadership role in meeting their children’s needs. Both staff and parents typically expect the staff to fill the “expert” role and place responsibility on the staff to maintain quality control over programming; however, these expectations subvert the therapeutic need to fully involve the parents in intervention. Therefore, supervisors must be vigilant to prevent these tendencies from taking hold. Supervisors should look beyond the staff hours to the family’s 24-hour day to analyze where the treatment needs augmentation. In clinic meetings, parents must be given a central role in training and decision making. Parents must meet the competencies necessary to train new staff members in the necessary treatment skills.

Question 27

Lovaas - How can Behavior Analysts structure parent training so that it is less stressful and very reinforcing for the parent?

Answer 27

Recognize that parents and their children with developmental delays have a history of substantial failure communicating with each other. It is very supportive of professionals to acknowledge this to parents before requesting parent participation, and also to predict the heightened difficulty parents are likely to face. This will help parents face the adversity with less stress. (Fathers may be even more sensitive to failure in front of a group than may mothers.) When providing feedback to parents, staff should be sensitive to the impact of negative feedback and be careful to outweigh it with genuine positive reinforcement. First assign fun programs that have a high likelihood of child cooperation and fit into the parents’ interests. Skills such as hugging and saying ‘‘I love you,” reinforcing activities that cause the child to laugh, and play activities that are special interests of the parents and siblings will help support the parents’ maintenance of skills. In both clinic- and workshop-based parent training, parents need to learn to address tantrums directly by purposely using reinforcement contingencies for which the child has been known to tantrum, rather than avoiding using these contingencies out of fear of tantrums. Staff may need to create a community of reinforcement within the family for behavioral treatment- in the face of the parents’ natural emotional avoidance of tantrums, for example. Directly address spouse conflict during tantrums in clinic meetings by requesting that both parents reinforce the other for following through with the prescribed treatment for tantrums and acknowledge that this is a sign that the parents are effectively working with the child.

Question 28

What are challenges for Behavior Analysts who work with parents and families from diverse cultures? What can Behavior Analysts do to increase our respect and sensitivity to diversity among families?

Answer 28

Some cultures may understand autism as something that can be cured. They may rely on punishment in child rearing. Men may not feel comfortable taking directions from female BAs. Certain child behaviors may be more or less desireable than within the BA’s own culture. BAs can learn more about each family’s culture in general and ask the family about any specific points of clarification. If the BA finds a child’s behavior to be unusualy, she can first wait for the reation of another family member, if present.

Question 29

View this powerful video. Discuss the effects of autism on siblings, parents, and the grandparent, Robert MacNeil.

Answer 29

It takes away time and resources from other family member’s desires and activities. It can feel like everything revolves around the child with autism at the expense of everyone else. It can be more difficult to form typical relationships with the child with autism.

Question 30

Sturmey - Explain the desirable features of staff training according to Reid and Parsons (l995).

Answer 30

Efficient, effective, and acceptable. Efficient means that training is delivered quickly with the minimum resources necessary to produce the change in staff behavior desired. Training should be feasible based on the size, turnover rate, and other specifics of a given organization. Effectiveness of training should be judged based on student outcomes. Training procedures should be acceptable to participants, supervisors, and the organization (can’t be too effortful, embarrassing, or interfere with important work goals.

Question 31

Sturmey - Describe the components of behavioral skills training (BST). Provide an example of a skill you’ve taught others (or have been taught) using BST.

Answer 31

Instructions, modeling, rehearsal, and feedback to mastery. Instructions - minimal verbal training, description of skill and its importance, answering/asking questions, all in easily-understandable language. Modeling - in vivo or on video, with child or with trained student/confederate, pros and cons of each. Rehearsal - trainees pratice skills with students, role play, or a combination of these, usually multiple brief sessions with some feedback and modeling of incorrect steps. Feedback - verbal, written, graphical, should be presented in good-needs work-good order, immediate is best.

Question 32

Sturmey - What seem to be the active, effective components of behavioral skills training? How do the active components compare to traditional staff training?

Answer 32

Modeling, rehearsal, and feedback. Traditional staff training tends to be based largely on written and verbal instructions without any programmed models, rehearsal, or feedback.

Question 33

Sturmey - What training methods appear to be successful in the literature on training staff to carry out discrete trial teaching? Are you surprised that there are so many unanswered questions about DTT? What other research questions do you have?

Answer 33

BST; lectures with written and oral exams on which 100% accuracy is required; graphic feedback of past performance. Yes; do skills from BST for DTT generalize to novel programs and students? How can inadvertant cuing be avoided? How can student generalization to different teaching situations, people, and materials te targeted?

Question 34

Sturmey - Describe what is meant by a pyramidal method of skill training. Have you used pyramidal training? What are the pros and cons?

Answer 34

Supervisors are taught the target skill, how to teach that skill, and how to take data on other staff members using BST. Train-the-trainer procedure. I haven’t used it but can imagine pros and cons. Pros - quicker and likely less expensive dissemination of skills training, no need for outside services to continually come in to train new staff. Cons - potential loss of fidelity over time and transfers from trainee to trainer, those without sufficient training may believe they are qualified to teach when they are not.

Question 35

Sturmey - What areas need to be addressed in future research on staff training? What research questions do you have in addition to those in the chapter?

Answer 35

Utility of training procedures for staff performance that is variable and flexible - investigate the use of procedures to increase variability in staff performance. Consumer satusfaction and social validity data collection from trainers, polling for training suggestions. What training mechanisms promote generalization of staff performance? Which components of BST are effective? Organization of disparate studies into staff curriculum that addresses important staff skills and se of BST.
How does training compare between more and less experienced staff? Does training some skills rely more heavily on certain parts of BST than training other skills?