I Know What I Like, Do You?

How to Identify What Reinforcers Behaviors: 

A review of "I Know What I Like, Do You?" by Travis Blevins, MS, BCBA

Is preference important? In one word, YES! The identification of motivating reinforcers  (preferences individuals will work to get) can be the key to effective intervention for individuals with emotional, developmental and behavioral difficulties.


Why? In the words of Susan B. Anthony, "Independence is happiness." The pursuit of a meaningful independent life involves these reinforcers, for you, for me, for our kiddos. Our goal as therapists, parents, teachers, and the like should be to assist those individuals in acquiring those preferences, those motivating reinforcers in a safe and healthy way.


First, let's begin by discussing what NOT to do when identifying a child's preference...

• Don't just ask them for a list
• Don't just ask someone who knows them
• Don't just guess
• Don't just watch them
• Don't assume what one child's preferences are relate to another's

Identifying things that motivate people is a science. In fact there's an assessment that behavioral analysts use called "Preference Assessment" or "Reinforcer Assessment." However, there are ways that one can identify the preferences of another using careful tactics and observations.

• Watch the person on multiple occasions
• Depict how they choose to spend their time
• Be aware of what they have access to and what they don't have access to as this might impact the observation
• Allow the child to choose between a combination of preferred and not preferred activities or objects
• Introduce novel activities, consumables, items and people
• Be aware that some activities, items, and people may change the preference for something
• Be creative, you will be surprised by what you find out when you go beyond the typical preferences of children

Specific questions for interviewing:

• What would you do with a million dollars?
• Would you go a whole week without video games to get that?
• What is it about this that you enjoy?
• What is the best thing you have ever eaten?
• Describe your perfect day?
• How do they spend their time?
• How do they spend their money?
• What do they do in their free time?
• Have they ever (fill in the preference item)?
• Describe the perfect day for them?
• What does a day look like without any behaviors?

What if they don't like anything? 

• Expose them to new fun things, places, food, people that they have not seen before, then ask if they want to do that again
• Remember that limited exposure to these things will decrease the preference pool, it is your job to increase their pool, increase their exposure
• Sometimes an individual has a preference for complaining about what they don't like--In other words, they LIKE being listened to by a sympathetic and empathetic ear
• Be aware of non-tangibles such as attention giving

Now what? Now that you know what is liked, help the child obtain it in a safe and healthy way. Enrich their life by teaching appropriate and positive behaviors to get what they like. It is your job to bridge free access to preferences so they have to work for it, even if that just means appropriately requesting the preferred item. It is also important to provide additional motivation for new behaviors.

What does the research say? Just because you have identified a preference does not mean that preference will motivate. The best way to identify preferences is to put it to the test!

What's our goal:

• To enrich every person's life by providing opportunities to experience fun new things
• To teach more appropriate ways of communicating needs and wants
• To support each person in attaining as much independence as they can handle, that means phasing prompts and yourself out so they can be independent

For more information on assessing preferences, please email us at info@gardencolorado.org. 

Until next time, BLOSSOM!

Lauren Thome, MA

Sensory Strategies at Home and in the Classroom

Autism and Sensory Needs

Calming Strategies

• Deep pressure massage; input through shoulders or on back, arms or legs
• Joint compressions
• Stretches
• Snuggling in a sleeping bag, beanbag chair or large pillows
• Blanket wrap
• Blanket swing-slow swinging back and forth in a blanket
• Slow rocking (sitting in an adult's lap or on the floor with adult's arms wrapped around child with slow rocking back and forth)
• Lycra/spandex clothing; Theratogs
• Weighted vest
• Sucking-lollipops, popsicles, hard candy
• Hideout or quiet corner (can use a large box lined with pillows, cover child with bean bags in a crash pit)
• Modified push-ups can be done by whole class as a way to take a break or prepare for a writing assignment; can be done several times a day and is highly recommended for students with low tone, as the deep pressure temporarily facilitates tone to enable better fine motor control while writing
• Stand facing 2 feet from a wall, push off the wall keeping the back and legs straight 5-10 times
• While seated in chair, push off the chair with hands, lifting body up off the chair, 5-10 times
• Fidget toys
• A balloon filled with flour or rice; double the balloon to make it stronger
• A seal-tight baggie containing a small amount of Play Doh, Theraputty or modeling clay
• Hard objects can be placed in the baggie with the dough for tactile feedback: pennies, pebbles, marbles, etc.
• Koosh balls
• A wide variety of small manipulatives can be found at dollar stores
• Handling a fidget toy in the right hand stimulates the left side of the brain for improved language processing during language arts class
• Listen to quiet music with a steady beat using headphones
• Bear hugs (child faces away from you)
• Reduced noise and light levels; whisper voice
• Use a soft voice and slow down your movements and speech
• Make a calming sandwich (make a "hot dog" or "burrito") by having child lay between 2 bean bag chairs or large pillows
• Crash pit

 

Alerting Strategies

• Bright lighting
• Fresh, cool air
• Crunchy or chewy foods (pretzels, carrot sticks, apple slices, licorice, gummi bears, nuts, popcorn, crackers, gum)
• Brisk body movements
• Loud fast paced music
• Having the child run in place, do jumping jacks, jump on mini trampoline, jump into crash pit
• Fast swinging
• Splash cool water on their face or neck
• Sip cold ice water from a water bottle with a straw
• Bouncing on therapy ball
• Running-hide n' seek, tag games, duck, duck, goose game
• Misting cool water from a spray bottle on face
• Cause and effect toys with sounds and lights

Organizing Techniques

• Sucking on hard candy or using curly straws
• Vibration-use a vibrating pillow, toy massager, vibrating pen for sensory stimulation prior to a writing assignment
• Hanging, pushing, pulling. or lifting heavy objects
• Chewing, blowing
• Swimming

Environmental Modifications at Home and in the Classroom

• Take periodic breaks to have everyone close their eyes for one minute
• Turn off the lights when not needed
• Use daylight
• Arrange seats to take advantage of natural light
• Have a section of the room lighted with a table top lamp using an incandescent bulb
• Wear tented glasses in the room
• Control for noise by keeping doors and windows closed with necessary
• Carpeting and drapes help absorb noise and change the acoustics of the room
• Soft classical music playing in the background can be comforting
• Ear plugs
• Headphones to listen to music or books on tape
• Respect the child's complaints of noise pollution, remember they are hearing things that other people do not notice and ordinary sounds can be unbearable for them
• Keep the room temperature down
• Change the air in the room periodically by opening the windows on mild days
• Control for temperature on hot days
• Give the child preferential seating near a cool spot in the room
• Remind the child to remove outer clothing or heavy shirts
• Use a humidifier
• Provide a water bottle at all times
• Properly fitted chair, the child should be able to sit with his feet flat on the floor and his back straight; ankles, knees and hips should be at 90-90-90 angles; depth of chair seat should allow student to sit back in the chair and not hit the back of his knees; chair back should be high enough to support the student
• Table should be at a height that allows the elbow to bend down at about a 30 degree angle
• An air filled seat cushion can provide safe movement while seated in the chair
• Some classes have had success having students sit on large therapy balls
• A bean bag chair for alternative seating when not required to do table top work
• Provide opportunities for vestibular stimulation
• Swing in a hammock, sit in a rocking chair, ride a scooter board, or climb the ropes in gym class; horseback riding is very therapeutic for this
• Aroma therapy
• To improve concentration use orange, lemon, eucalyptus and rosemary
• To increase confidence and self esteem use rose, jasmine, neroli and sage
• To relax and relieve stress use lavender, chamomile, marjoram and basil
• To promote harmony in a group use patchouli, sandalwood, orange and vanilla

Resources

1. Garden Angelis Guide to Aromatherapy: An Introduction to Aromatherapy and the Use of Essential Oils by Susanne Blake (1997)
2. Sensory Stragegies by Sandy Curnow, OTR (2010)
3. Sensory Strategies in the Classroom by Daiane Walker, M.S., OTR/L (2010)

Until next time, BLOSSOM!

Lauren Thome, M.A.

Social Network Shutdown

Autism Awareness or Another Social Fad?

On November first we are asked to shut down our social networks, to refrain from updating our Facebook statuses or tweet for 24 hours to show support for autism. As professionals, parents, teachers, and individuals with ASD, we really need to ask ourselves…

“Is this really going to bring the autism community together, make us stronger, bring on more support, awareness and acceptance OR is this just another social fad?”

As founder of Garden | Autism Services of Colorado and an early childhood mental health specialist for children with autism, I feel compelled to speak out against this worldwide social network shut down campaign. Garden’s mission is to support, empower, and advocate on behalf of all families affected by autism as well as the professionals that support those families.

Many social medians such as Twitter and Facebook bring individuals with autism and Asperger’s together in ways that they would not otherwise be able to connect and share their combined experiences. To take that away, even for a day, is a disgrace. I propose a campaign, every hour for 24 hours we tweet and status update about autism. For 24 hours on November first, autism awareness will be raised, not ignored. Together let’s fight the good fight. Speak up for those who are unable to speak for themselves. Do not fall for yet another social fad. Stand up for what’s right, not what’s hot.

For more information on the Worldwide Social Network Shutdown visit www.CommunicationShutdown.org

As always, your feedback and opinions are welcome. Together we can make a difference in the lives of those we love most.

Until next time, BLOSSOM!

Lauren Thome, M.A.

Prevent-Teach-Reinforce: A Model for School-Aged Interventions

"The PTR Assessment and Intervention process is based on a scientific understanding of how problem behavior is related to and influenced by events and circumstances in the environment."

-PTR Team Manual, USF & UCD (2006)

Overview
Developed by the University of South Florida and the University of Colorado in 2006, this model is designed to guide school-based teams through the Prevent-Teach-Reinforce (PTR) process for supporting students, K through 8th grade, with problem behaviors. With a focus on creating positive behavior supports, this model is heavily aligned on the principals and procedures of applied behavior analysis (ABA). By using functional behavior assessment procedures, reinforcement of desired behaviors, shaping of new behaviors, fading of prompts and reinforcement, and contingency management approaches, this model is applicable to students at all levels of functioning whose behavior problems have presented a significant barrier to instruction for the student and his or her classmates. The PTR consists of five steps including team building, goal setting, assessments, intervention, and evaluation. We will being with the first step--Team Building.

Step One: Team Building
A school-based team should be comprised of individuals who will meet regularly, that will be responsible for developing, implementing, and evaluating the intervention. These teams should include anyone who knows the student or works with them on a consistent basis, including members of his or her family. It is critical for team members to share responsibilities and are held accountable for the plan's implementation allowing for consistency and generalization.

Step Two: Goal Setting
Goal setting is the second step in the PTR intervention model for school-aged classroom behavior management. Once a team is established, the next step is to agree upon the team's vision regarding the broad, future outcomes they want to see for the student. Once a vision is created, short-term goals can be developed. These goals can be similar to the annual goals established in the student's Individual Education Plan. It is important to keep in mind that goals should be able to transfer to multiple environments, with multiple people, and lead to a higher quality of life. Four areas that should be examined include the educational or community setting in which the student will be included, the social relationships of that student, curriculum or academic success, and his or her behavioral outcomes. Once short term goals are determined, baseline data should be taken, using a behavior rating scale, to make sure each goal is observable, measurable and significant impact on the student's life.

Step Three: PTR Assessment
PTR Assessment--The third step in this process takes a closer look at the specific information regarding the student's problem behavior(s). Two major principals underlying this step is first understanding that problem behavior often has a functional and communicative purpose and second, understanding that behavior can be influenced by the events and context in which it occurs that, in turn, trigger the behavior. In order to assess a student's behavior your team must take an individualized look at the prevent component, teach component, and reinforce component as outlined below:

• Prevent Component:
• Determine the times of the school day or specific circumstances when problem behavior is most likely and or least likely to occur.
• Determine if there are specific activities when problem behavior is very likely to occur.
• Determine the specific activities that cooperative and prosocial behavior is most likely to occur.
• Determine if there are specific classmates, adults whose proximity or physical environments are associated with a high likelihood of problem behavior.
• Determine if there are circumstances unrelated to the school setting that occur on some days and not on others that make problem behavior more likely.
• Teach Component:
• Determine if the problem behavior gains attention from others.
• Determine if the problem behavior is often exhibited to gain access to preferred items or to delay a non-preferred task, person or transition.
• Determine what social, problem solving, and communication skills could the student learn in order to reduce the likelihood of the problem behavior occurring in the future. 
• Reinforce Component:
• Determine what consequences usually follow the student's problem behavior.
• Determine if the student enjoys praise and what school-related activities are most enjoyable to the student.

Step Four: Intervention Plan

The next step is to develop an intervention plan. Your team's plan should include at least one Prevent Component, Teach Component, and Reinforce Component in the student's plan. 

• Prevent Teach Interventions
• Provide choices
• Transition supports
• Environmental supports
• Curricular modifications
• Frequent adult verbal positive attention
• Classroom management
• Setting event modifications
• Opportunity for pro-social behavior and peer support
• Peer modeling and reinforcement 

Example Prevent Intervention: The student is most likely to engage in problem behavior during a writing assignment which requires capital and lowercase letters to touch the appropriate lines on the paper. The team might choose to use a curricular modification that includes coordinating the letters of the words with different colored lines to assist the student in determining what letter should touch which line. This prevent component has eliminated the trigger for the problem behavior. 

• Teach Intervention
• Replacement behaviors functional or equivalent
• Replacement behaviors desired or prosocial
• Specific academic skills
• Problem solving strategies
• General coping skills
• Specific social skills
• Teacher pleasing behaviors
• Learning strategies
• Self-management
• Delayed gratification
• Independent responding
• Increased engagement time

Example Teach Intervention: Prior to intervention, the student calls out repeatedly to get the teacher's attention. The functional replacement behavior would be to teach the student to raise his or her hand to get assistance from the teacher.

• Reinforce Intervention
• Reinforce replacement behavior
• Reinforce replacement behavior non-functional or desired, pro-social
• Increase non-contingent reinforcement
• Discontinue reinforcement of problem behavior
• Group contingencies
• Increase ratio of positive to negative responses
• Home-school reinforcement system
• Crisis intervention plan

Example Reinforce Intervention: Prior to intervention, the student kicks the desk each time he or she is asked to complete an independent reading assignment. As a result, the student is sent the the principal's office thus escaping the task and getting attention. After intervention, the student is no longer sent out of the classroom when presenting problem behaviors. However, they will be allowed out of the classroom when he or she completes at least ten minutes of independent reading.

Coaching and implementation of the PTR Intervention Plan should take place after your team has selected the specific PTR interventions. There should be a training session that takes place in the classroom without the student present, when the student is present, and a final coaching session in the classroom with all students present two weeks after the final observation.

Final Step: Evaluation
Once your team has selected interventions to decrease problem behavior and increase prosocial behavior, it is important to continue to collect outcome data that will let your team know if the intervention is effective. Your team should observe the classroom interventions, continue to train staff and follow-up with all members to discuss the outcomes and make adjustments to the intervention plan as needed.

The contents of this manual were developed by the University of South Florida and the University of Colorado at Denver under the Department of Education in 2006. 

Until next time, BLOSSOM!

Lauren Thome, M.A.

Autism & Sleep Disorders

It is not uncommon for families affected by autism to be on the "sleep less, work more schedule," for many it has just become a way of life. However, there are ways to improve your sleep schedule resulting in improved alertness, performance, memory, concentration, better health and mood for both you and your child with autism. This article is a review of the techniques discussed, researched, and utilized by Dr. Terry Katz (2010), an autism sleep disorder specialist.

It is found that up to 83% of children with autism have sleep disturbances-- That is an epidemic! Katz explains that "sleep is needed to remember what we learned, organize our thoughts, engage in tasks of executive functioning, react quickly, work accurately and efficiently, think abstractly, and to be creative," (2010). These apply to all individuals with and without disabilities. Newborns need up to 20 hours of sleep per day, toddlers need 13 total hours, school-aged children  need 10 hours, and adolescents should get at least 9 hours of sleep per night to feel rested and perform at their best the following day.

There are ways in which our environment cues us when it is and is not appropriate for sleep or when to be tired, these cues are called zeitgebers and literally mean "time givers." Zeitgebers include light, time cues, and social demands. Zeitgebers almost get tossed out the window for children with autism because of sensory integration disturbances, inability to tell time, and inability to pick up on social cues; thus resulting in the high percentages of sleep troubles for these families. Beyond zeitgebers, children with autism also experience sleep rhythm and neurotransmitter abnormalities as well as anxiety.

A study by Malow in 2006 found that changes in sleep can result in decreased social withdrawal, decreased anxiety, and decreased emotional reactivity. So, the question is, "how do we improve our sleep?" The first place to start is in behavioral and environmental strategies including, but not limited to the following:

• Rewards for sleeping through the night
• Consistent wake time (yes, even on the weekends)
• Elimination of naps
• Increased physical activity during the day
• Increase in natural light during the day
• Consistent bedtime (even on the weekends)
• Consistent bedtime routine
• Participation in calming activities within 2 hours of bedtime
• Reduction of light within 2 hours of bedtime
• Use of a visual schedule

Make sure you are aware of your child's bedroom environment. Pay attention to the temperature, amount of light and noise in the room. A bedroom should be used for sleep only. If a child's bedroom is also their play room, then they will associate that space with what is most motivating and rewarding-- Play. 

Also, consistency is key in both falling asleep and staying asleep. What a child falls asleep to needs to be consistent throughout the night in order for them to stay asleep. Everybody falls asleep and wakes up every 90 minutes throughout the night, naturally. If your environment is not consistent throughout the night, then it could be difficult to fall back asleep. For example, if a child only falls asleep in your arms, their body will wake them up throughout the night and that child will crawl back into your arms in the middle of the night to feel that same comfort they felt at the beginning of the night. 

A great behavioral intervention I have found to be very helpful is "The Bedtime Pass," (Katz, 2010). Children can use a bedtime pass to leave their bedroom during their bedtime, whether it is to use the bathroom or crawl into bed with mommy and daddy. Parents are in control of how many passes they allow their child and are able to reduce the number of bedtime passes as their sleep gets progressively better and more consistent. If the child did not use all their bedtime passes and stayed in their bed throughout the night, they can turn in their pass in the morning for a prize. This program if very rewarding and effective for children young and old, with and without disabilities, who are having trouble falling asleep and staying asleep throughout the night. 

Another intervention that should be discussed with your doctor is the addition of melatonin or serotonin supplements. Melatonin and serotonin are naturally produced in the body, but it has been said that children with autism have disturbances in the production of these chemicals. Melatonin tells the body when it is tired and serotonin is necessary for the body to produce melatonin. So, if you try a melatonin supplement and you don't see any results, speak with your doctor about serotonin supplements. 

Use these strategies intending on trial and error. Make sure you keep a sleep diary so that you are able to track what works and what doesn't work. Gradually you will see an increase in improved sleep and thus an increase in your overall quality of life. 

References:

Katz, T. (2010). Behavioral Treatments for Sleep Problems in Individuals with DS-ASD. Denver, Colorado: Annual DS-Autism Connection Conference.

Until next time, BLOSSOM!

Lauren Thome, M.A.