Autism Spectrum Disorders: Strategies and Interventions

Adrianne Da Silva, M.A.Erin Milhem

Cognitive Deficits

Executive Functioning

Storage and Retrieval of Information of salient information

Processing Speed

Discrepancies between verbal and nonverbal reasoning skills

Abstract thinking and inferencing

Executive Functioning

What is it?

An umbrella term that includes a collection of related functions that are responsible for goal- directed and problem solving behavior.

Executive Functioning The invisible disability

Inhibit

Inability to stop behaviors or impulses

Blurting out answers before being called on

Difficulty taking turns

Careless mistakes in schoolwork

Distraction from task at hand

Beginning task without listening to full instructions

Answering questions without thinking the question through

Difficulty following rules

Lack of personal safety and space

Shift/Cognitive FlexibilityDifficulty changing from one activity to another

Make transitions

Problem solve flexibly

Switch attention

Change focus from one topic to another

InitiateDifficulties with starting a task, activity, and independently generating ideas, response, or problem solving strategies.

Want to succeed at tasks but trouble getting started

Need lots of prompts to begin

Overwhelmed by large assignments

Working MemoryProblems with holding information in the mind for purpose

of completing tasks.

Trouble remembering things

Losing track of what they are doing

Difficulty following directions

Plan/OrganizeDifficulty with managing current and future tasks.

Anticipate future events

Set goals, and develop steps to carry out.

Sequencing a series of steps

Finishing Tasks

Getting lost in the details

Difficulty sorting and classifying information from the concrete to the conceptual level.

Organization of Materials

Problems organizing personal space.

Messy desks, backpacks, bedrooms, lockers, etc.

Trouble cleaning up after self

Keeping track of possessions

MonitorProblems with personal monitoring.

Rushing through work

Careless mistakes

Failing to check work

Failure to notice if things bother other people

Tracking and modifying behaviors and mood states

Emotion Regulation

Ability to identify, monitor, and inhibit emotional responses and implement appropriate coping strategies

Emotional outbursts

Yelling, screaming, swearing

Tantrums, Meltdowns, and Rages

Physical Aggression and property destruction

Low Frustration Tolerance

Depression and withdrawal

Inability to implement appropriate coping strategies

Common Triggers Losing a game

Changes in routine

When other students don’t follow the rules

When he or she doesn’t get his/her own way

When the student gets excited and can’t wind down

Misunderstanding directions

Thinking that their work is not as good as another student

Deficits that can contribute to Difficulty

with Emotion Regulation

Difficulty communicating

Social difficulties

Motor challenges

Cognitive challenges

Neuropsychological factors (hyperactivity, hypo-activity)

Why is emotion regulation important ?

Extreme positive and negative emotions can effect: Communication Attention Problem Solving

Skills Required for Successful ER

Awareness of emotions

Read and interpret nonverbal expressions of emotions

Ability to understand and monitor emotional triggers

Clearly and appropriately express the emotion

Regulate the intensity and timing of the expressed emotion

Steps for Independent emotion regulation

Recognizing the “rumbling” – early warnings signs that the student is starting to escalate

Making plans for coping with emotional events or triggers

Implementing the plan in an appropriate manner

Recognizing the “Rumbling”

As the teacher begin to recognize the signs that the student is beginning to escalate Increased pacing Increased talking or noise making Silly or goofy behaviors restlessness

At first, we may have to recognize for them and help them choose a calming strategy

Begin teaching the students how to notice their signs

Teaching the Skill

Make it as concrete as possible

Write it down – make it visual

Often children need to be taught that there are degrees of emotions

Can be represented with a thermometer or a scale

Coordinate with home plans!

The Incredible 5 Point Scale

Helps individuals rate the emotional state 1 – I am happy and calm 2 – I am a little upset 3 – I am definitely upset 4 – I’m feel like I getting to

the point when I can not control my behavior

5 – I’m unable to control my behavior

Types of Emotion Regulation Strategies

Behavioral Strategies motor actions sensory motor strategies

Language Strategies Self talk Picture communication devices

Advanced Strategies Problem solving Self reflection Perspective taking

The Emotional Toolbox (Attwood, 2004)

Helps students identify tools to use that can help “fix” certain feelings Physical Tools Relaxation Tools Thinking Tools Social Tools

Physical Tools

Going for a walk or run

Playing wall ball

Ride a bike

Play an instrument

Play a sport

Stretching

Relaxation Tools

Drawing

Reading

Listening to music

Finding a quiet safe place

Organizing

Using fidget items

Thinking Tools

Using self-talk (“things will be ok” “it will go better next time” )

Create a personal antidote that can encourage positive thoughts – write it down – (I can ask for help)

Help put the event in perspective for the student

Have the student engage in academic work that he or she excels in

Teach and Practice Skills

Start out with NEUTRAL situations

Role play

Social stories

Video modeling

Develop situations to practice skills – warn the student ahead of time

Reinforce the Use of Appropriate Strategies

Reinforce in both practice and real life situations

When approaching a high probability situation, rehearse with the student and remind about reinforcer

Reinforce immediately

Use behavior specific praise, emphasizing language you are teaching the student

Interventions

+

Response InhibitionEnvironmental modifications

Increase external controls, restrict access to settings or situations in which the child can get in trouble or distracted.

Provide external structure by teaching rules that can be applied and generalized to a variety of situations.

Increase supervision/physical proximity and offer support to bolster the “stop” function.

Implement ways to cue when to control impulses.

Dawson & Guare, 2010

+ Response InhibitionTeaching the Skill

Walk the child through the process, having them practice the skills using a contrived situation, teaching example, or visual aides.

Teach alternative to negative behaviors.

Reinforce the child immediately for using the skill

Teach them repair strategies

Work with the child on identifying the skill being addressed and your understanding of the intent of the behavior.

Dawson & Guare, 2010

Shifting/Cognitive Flexibility

Create a consistent, predictable environment as much as possible.

Create Visual Cues for routines and schedules.

Highlight changes to the routine and help the child build a bridge from the familiar to the unfamiliar.

Allow additional time to adjust to changes in routine

Provide additional support during transitions.

Provide external reinforcers

Environmental modifications

Shifting/Cognitive Flexibility

Teach the child to walk through new situations. This includes self-talk (e.g. “this is different but doesn’t mean it is bad).

How/when to ask for help.

Teach to use a calendar/schedule

Model multiple ways of approaching a task or situation

Teaching ways to self reinforce

Teaching the Skills

Meltzer, 2007

+

Initiation Provide external structure in the form of general guidelines,

cues, and support

Develop schedules and routines.

Use technology

Begin task with the child

Reward completion of tasks

Small groups or peer work

Self-understanding/Reflection

Meltzer, 2010

Working Memory

Visual schedules and check in with schedule throughout the day

Verbal cues or prompting

Timers

Work boxes

Develop structured systems for organization (i.e. worksheets, checklists, etc.)

Written and verbal reminders

Environmental Modifications

Meltzer, 2010

Working Memory

How to attend to details

Repetition, rehearsal, and review

Attaching meaning

Editing/Chunking information

Teaching the Skills

Dawson & Guare, 2010 Meltzer, 2010

Plan/Organizing

Provide a plan or schedule

Break projects into clearly defined subtasks and attach deadlines to each subtask

Avoid asking opening ended questions or random questions in class or group setting

Create a templates

Offer examples of previously finished projects

Environmental Modifications.

Dawson & Guare, 2010

Planning/Organizing

Developing an accurate understand of time

Strategy notebooks

Ability to assess and breakdown tasks

Prioritizing Tasks Obligation Aspiration Negotiation Monitoring Progress

Teaching the Skill

Meltzer, 2010

Organization of materials

Help develop a system for organizing a backpack

System for organizing schoolwork and homework

Coming up with a system for organizing room

Work to help child understand the negative and positive consequence of material management

Physical Structure Clear physical and visual

boundaries.

Boundaries help to understand where each area begins and ends.

Boundaries help establish context and segments the environment.

Minimize visual and auditory distractions.

Establish behavioral expectations

Routines Use the need for routine

in a positive way by teaching and building productive and functional routines that individual’s with ASD will use now and in the future

Characteristics: generalizes, go throughout the lifespan, promotes independence.

Routines First work, then play.

Concept of finished.

Top to bottom.

Left to right.

Check schedule.

Follow directions / instructions.

Schedules / Transition Systems

Visually communicates what activities will occur and in what sequence.

The concrete reference to the schedule helps promote flexibility.

Individualized at the individuals most independent level of understanding.

Needs to be used by the individual.

Schedule / Transition Systems

Assess visual level of understanding (functional vs. representational objects, pictures, photos, words, etc..).

Assess an amount of visual information to be used in schedule (one at a time, part day, full day, etc..).

Select a process for using the schedule (how to sequence and concept of finished).

Work Systems Gives the individual 4

pieces of information in a visual format:

1. What work/activity?

2. How much work/activity?

3. When finished?

4. What’s next? – reinforcement

Cause / effect

Work Systems Identify:

1. Types of routines - left to right, top to bottom.

2. Symbols to be used - letters, numbers, color, written, etc..

3. Concept of finished – box, shelf, drawer, file folder, etc…

4. Reward or motivator.

Visual Structure Visually communicates

information on how to complete the activity or direction.

Helps to combine and organize a series of elements to obtain a desired outcome.

Visual Structure

Teaches flexibility.

Promotes generalization of skills.

Promotes meaningfulness within activities.

Examples: objects; pictures; written instructions; jigs; product samples, etc..

Visually communicates information on how to complete the activity or direction.

Helps to combine and organize a series of elements to obtain a desired outcome.

Visual Structure

The 5 Point Scale

How Does Your Engine Run

System for monitoring arousal levels in young children

High Just right Low