Addressing the Challenging Behaviors Associated with Autism

UTISM PECTRUM EWS TM A YOUR TRUSTEDS SOURCE OF SCIENCE-BASED AUTISM EDUCATION,N SPRING 2015 INFORMATION, ADVOCACY, AND COMMUNITY RESOURCES VOL. 7 NO. 4 Addressing the Challenging Behaviors Associated with Autism

A Proven Method to Reduce Challenging Behaviors in Any Environment

By George Suess has created a positive, restraints-free envi- Chief Executive Officer ronment for people with autism and many The Arc of Delaware County, NY other developmental disabilities—and helped other organizations reduce their use of restraints too, with the same step- he behavior challenges related by-step approach used internally. to autism can feel daunting for This approach is based on a series of family, caregivers, and commu- proven steps that move toward a culturally nity service organization profes- reinforced positive approach to reduce and Tsionals alike. But dwelling on challenging even eliminate challenging behaviors in a behaviors leads to a focus on questions way that is actionable for organizations, such as, “What will we do when this indi- schools, and home care environments. vidual displays this challenging behavior By applying these steps, other profession- again?” The answers often lead to a cul- als and family caregivers can do the same: ture focused on intervention and physical restraints. 1. Let Go of Preconceptions - There is a Caregivers often feel that this approach common belief that in order to prevent is not effective, and they’re right—phys- people from hurting themselves or others, ical intervention to address behavior one must physically intervene. This idea is challenges can result in escalation, hu- outdated, ineffective, and can hold teams miliation, and injury. But the field of com- back from making the all-in personal in- munity support services has relied on these But instead of focusing on handling neg- It’s possible to break the cycle of nega- vestment that is necessary to gain real re- traditional, reactive approaches for so long ative behaviors, what if the question care- tive reinforcement and physical restraint, sults from a positive approach. there is little belief and less conviction that givers asked was, “What will we do to pre- and shift to a dynamic that focuses in- The most effective way to dramatically positive, proactive philosophies and ap- vent this individual from behaving in this stead on encouraging positive behaviors. proaches can work. negative way again?” At The Arc of Delaware County, the team see Proven on page 28

Assessment and Treatment of Problem Behavior for Adults with ASD

By Ethan Eisdorfer, MA Functional Assessment & Axelrod, 1999). While the literature 2007). It has been estimated that it costs Mikala Hanson, BA, and of Problem Behavior validating the effectiveness of these pro- approximately $3.2 million dollars to finan- Robert H. LaRue, PhD, BCBA-D cedures is clear, assessing the maladaptive cially support an autistic person over their Douglass Developmental Disabilities Functional assessment is an important behavior of adults with autism presents lifetime (Ganz, 2006). With limited funds Center at Rutgers University first step in the effective treatment of mal- unique challenges as compared to assess- available, assessment and treatment practic- adaptive behavior. Functional assessment ment with younger populations. Some of es are more likely to use less thorough mod- represents a collection of procedures used these challenges are highlighted below. els of assessment and treatment which re- s individuals with autism age to determine the environmental factors quire less time, money and other resources. out of the educational system, that cause and maintain maladaptive be- Legislation - Perhaps one of the most sig- families are faced with a num- havior. Functional assessments may in- nificant barriers for older individuals with Lack of qualified staff - Another significant ber of challenges. Maladaptive clude indirect assessment procedures (e.g., autism is the fact that legislation mandat- challenge is the lack of available trained Abehavior, in particular, can be a significant questionnaires and structured interviews), ing the use of functional assessments only staff with experience working with adults stressor for families of adults with Autism descriptive assessment (e.g., collecting ob- extends to individuals up to age 21. As a with ASD. Many staff members tasked Spectrum Disorder (ASD). While estimates servational data related to the antecedents result, adults diagnosed with autism are not with assessment and treatment plan devel- of the prevalence of problem behavior vary and consequences of maladaptive behav- entitled to the same behavioral supports as opment lack the necessary training to do so considerably, it tends to be more common ior), and functional analysis (e.g., hypothe- their younger counterparts. Consequently, effectively (Sigafoos, Roberts, Couzens, & in individuals with ASD relative to other sis testing and the manipulation of environ- adults diagnosed with autism have few- Caycho, 1992; Wood, Luiselli, & Harchik, disorders. Common topographies of prob- mental variables). er opportunities to have sound functional 2007). This gap in the availability of well- lem behavior include aggression, self-inju- Over the last several decades, a robust assessments conducted, which can lead to trained professionals can lead to poorly de- rious behavior, property destruction, ritual- literature validating the effectiveness of poorer outcomes over time. signed assessment and treatment. istic behavior, disruption, and inappropriate functional assessment has emerged. The vocalization, as a few examples. While literature has shown that these assessment Cost of services - Providing services for Severity of the maladaptive behavior - An- procedures for assessment and treatment procedures are effective for identifying adults with autism spectrum disorders rep- other barrier to effective assessment and for these kinds of problem behavior are the function of maladaptive behavior and resents a substantial economic expense for treatment is the severity of the behavior well-established in the behavioral litera- that treatments based on these procedures families and government agencies (Cimera being treated in adults. Adults with autism ture, the adult population presents unique are more effective than treatments that are and Cohan, 2009; Ganz, 2006; Järbrink,

challenges for families and care providers. selected arbitrarily (Pelios, Morren, Tesch McCrone, Fombonne, Zanden, & Knapp, see Adults on page 26

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Cindy Alterson, PhD, BCBA, Principal and Program Director Chairman Devereux Millwood Learning Center Jorge R. Petit, MD, President Quality Healthcare Solutions Group Joel Bregman, MD, Medical Director and Director of Psychiatry The Center for Autism Vice-Chairman Barry B. Perlman, MD, Legislative Chair Joseph D. Buxbaum, PhD New York State Psychiatric Association Director, Seaver Autism Center Icahn School of Medicine at Mount Sinai Secretary Susan M. Cortilet-Jones, MS, LMHC Peg Moran, LMSW, Vice President, Operations, Center for Regional Healthcare Innovation Licensed Therapist/Adult Coaching Specialist for Autism and Neurodiversity Westchester Medical Center Discovering Your World Treasurer Stephen E. Freeman, LCSW Debra Pantin, LCSW, Associate Executive Director The Freeman Group VIP Community Services Members of the Board Lynda Geller, PhD, Founder Spectrum Services, A Cooperative of Independent Peter D. Beitchman, DSW, LMSW, Principal Practices and Organizations, New York, NY Behavioral Health Consultation Constance Y. Brown-Bellamy, MPA, Vice President, Community and Government Relations Ami Klin, PhD, Director ICL Marcus Autism Center Carmen Collado, LCSW, Chief Networking and Relations Officer Harold S. Koplewicz, MD, President ICL Child Mind Institute Jonathan P. Edwards, LMSW, Training Specialist, Parachute NYC NYC Department of Health and Mental Hygiene Cecelia M. McCarton, MD, Founder and Executive Director The McCarton Foundation Alan Eskenazi, MA, CPHQ, CASAC, Senior Associate Executive Director The McCarton School (for Autism) Department of Psychiatry, Woodhull Hospital Mary Hanrahan, LCSW, Behavioral Health, Clinical Services Management Judith R. Omidvaran New York Presbyterian Autism Parent Advocate, New York Joseph Krasnansky, LCSW, Vice President and Chief Program Officer Theresa Pirraglia, Co-Founder and Board Member Lower Eastside Service Center FECA, The Foundation for Empowering Citizens with Autism Judith R. Omidvaran Autism Parent Advocate, New York John C. Pomeroy, MD, Founding Director Theresa Pirraglia, Co-Founder and Board Member Cody Center for Autism and Developmental Disabilities FECA, The Foundation for Empowering Citizens with Autism Stony Brook University Medical Center Janet Z. Segal, LCSW, Executive Vice President Emerita Patricia Rowan, LMSW, Consultant and Advocate Four Winds Hospital and President, Four Winds Foundation Kid’s Connection Alan Trager, LCSW, Chief Executive Officer Westchester Jewish Community Services Pat Schissel, LMSW, Executive Director Asperger Syndrome and High Functioning Autism Association Naomi Weinstein, MPH, Director, Center for Rehabilitation and Recovery Coalition of Behavioral Health Agencies

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Addressing the Challenging Behaviors Associated with Autism

1 A Proven Method to Reduce Challenging Behaviors 21 An Effective Approach for Schools to Prevent & Manage Behaviors 1 Assessment and Treatment of Problem Behavior for Adults 21 YAI International Conference: May 4-7, in New York City 4 Steps to Increasing the Success of a Behavior Plan 22 Growth Hormone Treatment Improves Social Impairments 6 The Effects of Cortisol on Individuals with ASD 22 The Changing World of OPWDD Services and Supports 8 Using ABA to Improve Communication Skills in Developmental Center 23 Rumination: Past, Present, and Future 10 Autism and Safety: It’s Unpredictable 24 Using an FBA and BIP to Manage Challenging Behavior at School 12 Awake Challenged and Punctually Challenged 24 Understanding the Father Factor While Raising Children with ASD 13 What to Expect When Expecting a Functional Behavior Assessment 25 Why I Wasn’t Afraid to Label My Son 14 Contributing Factors of Aggression and Self-injury in Autism 26 Behavior as Desire for Control in Autism Spectrum Disorders 15 Challenging Behavior During Emergencies: Advice for First Responders 27 Understanding Aggressive and Self-injurious Behavior 16 Should Parents Tell Their Children They Have Asperger’s? 29 Bitten by the Truth 17 Addressing Setting Events to Make Behavior Plans More Effective 29 Building ABA-Informed Services in Adult Residential Setting 18 Why Emotional Literacy Is So Important 30 The Effect of Physiological and Environmental Factors on Behavior 19 Common Mealtime Concerns in Individuals with ASD 31 Proactively Addressing Skill Deficits in Students to Prevent Behavior 20 Is the Label or the Person the Focus? 33 Opinion: Standardized Testing Poorly Accommodates Special Education

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Steps to Increasing the Success of a Behavior Plan

By Lana Small, MSW we also need to do some pre-planning. The to the plan without evaluating the possible The YAI Network writer of a behavior plan would have as- outcomes. sessed the target behaviors, the learner’s skill set and the needs of the environment. 3. Know yourself, especially your kryp- large percentage of caregivers of The person who will implement the plan tonite. Remember that green crystal that children with autism will want often does not properly assess his/her pre- could turn the man of steel into a weak, (or need) to implement a behav- paredness to put the plan in action. One of bumbling mess? Each of us has our weak- ior plan. When I ask a parent the things that we overlook is that a behav- nesses in areas that would prevent the im- Awhat he or she wants out of a behavior plan ior plan for the child is also a behavior plan plementation of a behavior plan. Plans re- designed for his or her child the answer can for the parent, caregiver or professional quire consistency, attention to detail, and usually be found among the following: “I who will implement it. clear and logical thinking. When would want my child to be more compliant with Here are some important strategies to either of these be a problem in your inter- requests. I want her to be less resistant to prepare for implementing a behavior plan: actions with your child? Is it when your participating in tasks. I want her to develop child does a particular behavior that you more appropriate skills. I wish he could let 1. Acknowledge that you, as the imple- find just unbearable? When you are tired? me know what he wants so I don’t always menter, are also on a behavior plan. A After a stressful day at work? When others have to be guessing. I want him to make behavior plan has instructions for the im- are present in the environment? Knowing better choices. I want her to give up her plementer, as well as what is expected of these weaknesses and deciding how to deal own desires and interests sometimes and the child. If a schedule is to be employed with them is important to your success. engage in other activities.” to produce specific actions, the instructor These are all worthy outcomes for behav- must abide by the timeframe for prompting 4. Practice managing your feelings. Some ior plans. For a child with autism who gets Lana Small, MSW appropriate behaviors. A behavior plan de- of us are better at this than others. If you stuck in routines, responding to the requests pends on the implementer’s ability to pro- wear every emotion on your sleeve or in that do not include reinforcing activities As the implementers of the plans, we are duce the right behavior at the right time. your posture, others, including your child, from his/her point of view, successfully motivated for change with all of the bene- The person employing the plan must be will read them and respond. Many parents communicating needs and learning skills fits. But why are behavior plans so difficult able to change his or her behavior as need- tell me they do not pay attention to their that will help him/her be more effective in to execute? Even the clearest written and ed. The child is not the only one who needs child’s inappropriate behavior because the environment are all important skills. detailed plan can be challenging to start, to do something different. they understand that the behavior is moti- A successful behavior plan benefits the keep going and see through. The problem I vated by a need for attention. While it is parent as well. A parent develops a more have discovered – no discussion about the 2. Take the time to learn the basic theory true that they may not respond verbally, the positive view of the child, gains confidence pre-plan preparation and overall planning. on which the strategy or plan is based. The contortions of their face and the stress that in parenting skills, feels more in control of Before a builder starts his construction, knowledge of why you perform a particular is obvious from their body language says, the environment and achieves a healthy re- he surveys the land, develops the blue behavior at a specific time gives credibility “I see you, you got my attention.” Or, by spect for the child and his/her abilities. A prints, looks at his budget and gets all his to what you do and makes it easier. It will well implemented plan benefits all parties. certifications. Before we implement a plan also help you avoid making “adjustments” see Success on page 35 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 5 PAGE 6 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

The Effects of Cortisol on Individuals with ASD

By Jeanne D’Haem, PhD little while but his sister was upset for the and Irene Van Riper, EdD entire weekend. William Paterson University According to the research of Corbett, et al, 2014, there may exist a spectrum of responsivity to stress. Some individuals have ne Saturday, Catherine Mau- abnormally high levels of cortisol when rice took her son and daughter, faced with a stressful situation, while oth- Daniel and Anne-Marie, for a ers have abnormally low levels (Ruttle, et walk. Anne-Marie has autism. al, 2011). The length of time the behavior OA little black dog ran out of a driveway, persists is also relative to the level of cor- yapping excitedly. Ann-Marie was afraid tisol. In some individuals, stress arousal and began to cry. This excited the puppy heightens the level of cortisol, but this re- then began to jump up on her. The dog action begins to decrease as time elapses. was not dangerous, he just wanted to play. This same research study explains that an Anne-Marie started to run around scream- individual may adapt to long-term stress ing and would not respond to her mother’s with a decrease in cortisol, demonstrating efforts to reassure her. Her mother finally under-arousal in stressful situations. picked Anne-Marie up and took both of the Individuals with ASD, like Anne-Ma- children home. Daniel cried for about five rie, often have hyper-responsivity to stress minutes and was soon calm. Anne-Marie (Corbett, Schupp & Lanni, 2012). Stress cried for the rest of the weekend. levels are related to factors such as age, This scene is described in the book, Let gender, SES and context in relationship to Me Hear Your Voice: A Family’s triumph the individual. If an individual with ASD, over Autism. Similar situations take place Jeanne D’Haem, PhD Irene Van Riper, EdD as in Anne-Marie’s case, is faced with an every day in classrooms and homes with unexpected situation, the event may be ex- individuals with autism. A neurobiological or fight response to stress. Small increas- would not listen to her mother. Her brain perienced as quite stressful. perspective can help us to understand inci- es have positive effects. However, higher was so chemically stressed she could not Once we understand what is happening, dents like this and assist those with autism. levels have been shown to impact cogni- respond as she would normally. Spratt et physically, to individuals with autism when When an individual becomes stressed tive function. al (2014) found significantly higher serum they are stressed it becomes clear that hav- by a strange dog, for example, the body When we are highly agitated and there- cortisol response in children with autism. ing appropriate interventions in place is produces cortisol; a neurobiological stress fore cortisol levels are high, thinking and Analysis showed significantly higher peak crucial. Walker (1995) conceptualized the hormone reflecting hypothalamic-pitu- memory are affected (Jacob and Nadel, cortisol levels and prolonged duration of “acting out cycle.” The phases of calm, itary-adrenal (HPA) axis activity. It has 1985). Anne-Marie’s body was flooded the cortisol elevation in children with au- agitation, out-of-control, de-escalation and been termed the stress hormone because it with cortisol and she could not process tism. Daniel, who was also frightened of is secreted at higher levels during a flight her mother’s reassurance. It is not that she the puppy, was able to calm down after a see Cortisol on page 38 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 7 PAGE 8 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

From Crisis to Competence - ABA Used to Improve Communication Skills in Developmental Center

By Vivian Attanasio, BCBA, problematic request (the mand) of the indi- James O’Brien, BCBA, vidual to restart the television show. and Amy Bukzspan, BCBA Research from thirty years ago suggest- Services for the UnderServed Inc. ed replacing problematic ways of requesting with more appropriate forms. This is known as Functional Communication pplied Behavior Analysis Training (Carr & Durand, 1985) or mand (ABA) is a science wherein training. This involves teaching individuals procedures, based on basic prin- an appropriate alternative way to request ciples, are applied to important for the things they want instead of the prob- Amatters of everyday life in order to help in- lematic ones. The form of the request can dividuals increase functional skills, while be utilized through vocal, signs, picture ex- decreasing problematic ones (Cooper, Her- change system (such as PECS), or any aug- on, & Heward, 2007.) Most notably, ABA mentative device (vocal output systems). has been utilized to improve the quality of In August 2014, the Services for the life for children with developmental dis- UnderServed in New York was awarded abilities, specifically children who have a federal Balanced Incentive Program In- been diagnosed with Autism Spectrum Dis- novation Fund grant (BIP) to transfer the order. ABA teaching strategies have been technology of ABA generally used with highly successful in improving functional children to adults with developmental communication skills, self-help skills and After the behavior technician engaged Stephen with the balloon for a few disabilities. Services for the UnderServed social skills. Moreover, they have been ex- (SUS) is a nonprofit human services agen- tremely successful at helping to decrease minutes, the behavior technician held the balloon. Stephen then said, cy who serves individuals and families maladaptive-problematic behaviors such “Balloon” on his own without prompting to gain access to the balloon with a wide range of challenges; mental as physical aggression, repetitive self-stim- and continue the social interaction with the behavior technician. illness, intellectual/developmental disabil- ulation, and self-injurious behaviors. ities, HIV/AIDS and veterans compound- B.F. Skinner’s analysis of verbal behav- specific response. That is, we get what we al may collapse on the floor, kicking and ed by histories of homelessness, substance ior (1957) suggests that language is behav- want! Many individuals with developmen- screaming when his/her favorite television abuse, poverty and unemployment. ior and can be thought using behavioral tal disabilities have learned problematic show is turned off. A concerned caregiver The BIP grant is looking to transition in- procedures (e.g. reinforcement). Arguably, ways to request (mand) for the things they will typically turn the television back on, dividuals over the age of 21 in the borough one of the most important skills we all want. These include physical aggression, console the individual or find another way of Brooklyn from institutional care first naturally learn is asking for things self-stimulatory behavior, and self-inju- to make the individual happy and calm. In we want. This produces an immediate and rious behavior. For instance, an individu- this way, the caregiver has reinforced the see Competence on page 34

Private Practice Model Workshop 7 Continuing Education Credits for BCBAs

Friday, April 10, 2015 from 9am – 5pm

Hotel Pennsylvania, 401 Seventh Avenue, New York, NY 10001

Cost: $299

“An entrepreneurial mindset is key to building capacity in these challenging economic times.” Terence Blackwell, BCBA, Chief Operating Officer, Services for the UnderServed, Inc.

Since 2008 this “Developing the Private Practice Model” workshop has been presented at the annual ABA International Convention to Behavior Analysts who are in private practice, or who would like to enter into private practice who are considering accessing the insurance benefits afforded under the various State mandates for Autism Insurance to families of children with ASD. NYS, along with many states, is offering licensure for the professional practice of Behavior Analysis. The opportunity provided by licensure allows BCBAs to develop their own business and to bill insurance companies for their services. The Private Practice Model teaches the key skills required to initiate and sustain a professional Private Practice including: financial, legal, marketing and practice considerations. The seminar is designed to inform attendees of the requirements of many areas of business requirements.

UPCOMING EVENTS Preventing Problem Behavior: A Workshop with Dr. Brian Iwata June 2, 2015 Please contact [email protected] for additional information. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 9 PAGE 10 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Autism and Safety: It’s Unpredictable

By Jill F. Harris, PhD and vehicles; pupil transportation; mass Adrienne P. Robertiello transportation; traffic control devices Children’s Specialized Hospital • Law enforcement and criminal justice system: Minimizing confrontational hile safety is important to ev- encounters; Person with ASD as victim; eryone, it is a major concern Perpetrators with ASD; Competence among many people with and consent; Strategies to reduce inci- autism spectrum disorder dents; Judicial system W(ASD) as the complex communication, social, sensory and behavioral challenges as- • Neglect, abuse, bullying, exploitation: sociated with ASD may place people with Increased risk; Misconstrued environ- this disorder at increased risk of injury or ments and behaviors; Victims/perpetra- death. Indeed, research indicates that near- tors; Red flags; Assessment and response ly half of children with ASD have eloped from a safe place with 26% having gone • Search and Rescue: Common challeng- missing long enough to cause concern and es; Modified responses; Prevention; be in danger of drowning or being injured identification and response options by a vehicle. Yet, only half of parents of (personal tracking devices, medical children with ASD report receiving guid- alerts, etc.) ance on preventing or addressing elopement behaviors (Anderson, Law, Daniels, • Crisis intervention: Understanding ASD et al., 2012). While the disorder is felt to and family dynamics; Misinterpreta- not affect life expectancy, Danish research- Jill F. Harris, PhD Adrienne P. Robertiello tions of household environments; Pre- ers found that the ASD mortality rate may vention and mitigation; Response mod- be twice as high as the general population place a person with ASD at increased risk. child protection workers, and emergency ifications/de-escalation; Restraint issues (Mouridsen, Bronnum-Hansen, Rich, et For example, a person with ASD may be shelter staff receive training to improve al., 2008). Shavelle and colleagues (2001) drawn to water or fire. The person may also safety awareness in order to prepare, pre- • Emergency response and management: found that accidents from suffocation or consider a place or object comforting and vent, and more effectively intervene. Preparedness; Assessment; Response; drowning may contribute to elevated death not recognize that their “safe place” has With funding from Kohl’s Cares, Adri- Recovery; Mitigation; Communication rates among people with ASD. People with become hazardous. Insistence on same- enne Robertiello, Autism Outreach Educa- channels and methods; Evacuation; ASD may also experience other safety con- ness may lead to meltdowns and increase tor at Children’s Specialized Hospital, has Shelter challenges/supports; ASD-spe- cerns such as increased risk of victimiza- in physical aggression or self-injurious created training curricula and materials to cific emergency preparedness materials tion due to bullying or harassment (Carter, behaviors during transitions between tasks address this need. 2009), sexual abuse (Sullivan & Knutson, or when routines are changed. Sensory is- Sample curriculum for the person with • Community education and supports: 2000), or injury resulting from restraint or sues may lead a person with ASD to be hy- ASD may include but not be limited to: Safety education and resources; iden- seclusion (Kutz, 2009). per-sensitive to temperature, pain, sound, tification and communication options Some common reasons for ASD-related light, texture, or crowds. This may result • Circles of intimacy and body boundaries (augmentative communication, medi- emergency calls include events where the in challenging behavior as an attempt to cal alerts, personal tracking, etc.); 911 person has escaped from a caregiver, home avoid the stimuli. Hypo-sensitivity may re- • Recognizing community partners – Identifiers; Register Ready; State au- or school; wandered to an unsafe place in- sult in seeking out stimuli as demonstrated Who can help and how to interact tism registries; Service animals; Adap- cluding attempting to enter nearby build- by reduced sensation of pain, recognition tive safety equipment ings; caregiver actions being misinterpret- of injury or ability to gauge rough from • Recognizing, preventing, and respond- ed; a person with unusual behavior being gentle touch. Co-morbid conditions that ing to bullying While some emergency responders have interpreted as suspicious, threatening or on affect some people with ASD may further adopted online training on ASD and safety, drugs; rearranging store materials being in- impact on safety. For example, cognitive • How not to bully others interactive workshops may be more com- terpreted as shoplifting; or when a person impairment may affect ability to recognize prehensive and effective as they provide displays escalating behaviors and the caller safety risks and to follow directions. Motor • What to do if I am harassed – How not opportunities for direct interaction and fo- is unaware of the autism (Debbault & Leg- difficulties may reduce balance and coor- to harass others cus on specific concerns. acy, 2004). It should be noted that accura- dination, placing the person at increased Recommended specific strategies for cy of statistics regarding safety issues and risk of injury. Feeding issues may affect • Sexuality, sexual expression, and pro- first responders include: people with ASD may be in question since regulation of pace or amount of food, re- tection from abuse data recorded in emergencies may not in- sulting in choking or vomiting. Pica may • Ask basic closed-ended information clude whether a perpetrator or victim has also be a concern. Seizure disorders may • Safety workers and their roles questions. a disability such as ASD. Clinical use of increase risk of injury or death. Sleep dif- the medical diagnostic code for wandering ficulties common among those with ASD Sample curriculum for first responders • Avoid unnecessary touching or restraint. (V40.31) is one way to promote appro- may result in the person with ASD being and other service providers may include priate treatment planning and accuracy of awake and unsupervised when others in but not be limited to: • For crisis de-escalation, approach in tracking data. the residence are asleep. Increased activity quiet non-threatening manner, calm level may contribute to elopement, darting • Overview of autism spectrum disorder tone, reduce gestures and reduce touch; Characteristics of ASD and into traffic, or having difficulty remaining reduce sensory challenges; provide fa- Relationship to Safety seated during travel. • Personal, social, and societal aspects; miliar objects; watch personal space; Features often associated with emer- Effects on daily life through the lifespan simplify language and be concrete; ASD may impact safety in a myriad of gency situations such as alarms, flashing don’t insist on eye contact or verbal re- ways. Social communication deficits as- lights, crowds, and commotion may trig- • Dangerous situations; Reduced fear sponse; and recognize that self-stimula- sociated with the disorder may affect the ger increased agitation among people with of danger; Unpredictable responses/ tory behaviors may be calming. ability of the person to effectively com- ASD. First responders may misconstrue behaviors municate concerns or understand verbal features in the home environment such as • During Search & Rescue, be aware directions. Nonverbal communication in- scars from self-injurious behavior, extra • Personal safety; Vulnerability; Chal- of need to use forced entry due to ex- cluding body language and tone may be security on windows and doors, and less lenges/adaptive methods of reporting tra locks; may be hiding in personal misunderstood. For example, commands home decorations, which may or may not danger/incident “safe place;” search areas with water such as “stop” or “look out” may be misin- indicate abuse or neglect. first, and expand search parameters and terpreted, resulting in reduced response to In order to address this major concern, • Community and citizen safety: Water don’t ignore dangerous places. community officials and emergency warn- it is important that people with ASD, their dangers; appropriateness of communi- ings. Social challenges may impact recog- families, and service providers including cation/behaviors; Potential inability to • Teach 911 dispatchers to recognize char- nition of harassment or bullying and effec- first responders (police, fire, emergency seek help acteristics of ASD; use simple concrete tive handling of such situations. Restricted medical technicians, paramedics), daycare, interests and repetitive behaviors may also school, therapy and healthcare workers, • Vehicular and travel safety: Personal see Safety on page 41 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 11 PAGE 12 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Awake Challenged, Punctually Challenged, and Underground Thursday Challenged

By Jennifer Kolarik, BS “Punctually Challenged” Lead Career Coordinator CIP Brevard Most of my students have “Executive Function” challenges that impact them on the job. Ken, one of my favorite students, ne of the biggest hurdles that was severely “punctually challenged” due adolescents and young adults to “EF” issues. on the ASD or LD Spectrum Ken had his Associate’s degree and face is having a reversed sleep several certifications. He was very bright Oschedule where they stay awake at night and had a great sense of humor. Ken often (often playing video games or surfing the showed up at my office 15 minutes before internet) and sleeping during the day. This he was supposed to be at work and let me is especially so if students are living in- know he didn’t have enough gas to get to dependently for the first time. No one is his internship. It turns out he liked to drive around to tell them to “go to bed.” around over the weekend and then realized This impacts their work lives whether his car was on empty just as he was about it’s volunteering, interning, or doing a paid to leave for work on Monday morning. job. Even if they make it to work on time, To make matters worse, Ken did not car- they may lack energy and even nod off be- ry his debit card with him and would have cause they are tired and/or sleep deprived. to go to into the nearest bank to withdraw Meet Melanie. Melanie was very bright money from his checking account to put and enthusiastic about her internship gas in his car. He knew by that point that working with animals. Soon after she he would be late for work. Ken would started her internship, her supervisor no- then need to contact his internship super- ticed that when Melanie sat down during visor again and explain that he was going slow times, she would close her eyes for to be late. what she thought was a moment and then I helped Ken by working on his orga- fall fast asleep. It was my job to figure out nizational and planning skills. We made how to best help her stay awake at work. evening and morning checklists to address I came up with some strategies so Melanie everything that needed to be done (includ- and others like her, who were continually ing checking the gas tank the night before) “awake challenged,” could do their jobs so that he allowed time to buy gas in the without falling asleep on the job or nod- morning, if he needed it. We put this in the ding off. form of a reproducible checklist that he would fill out each night. Suggested Strategies for We decided that each night he needed to: “Awake Challenged” Students Check the car for gas, lay out work clothes, shower and shave, make a lunch, charge Help your “awake challenged” students his cell phone, and make sure that his keys realistically decide how many hours of and backpack were by the front door. sleep each one will need each night and It was a long slow process until Ken fi- what time he/she needs to wake up by in nally saw this routine’s value. By prepar- order to get ready and “make it to work ing the night before, he could identify if he on time.” Based on that information, de- needed to plan extra time in the morning to cide (together) on a good bedtime and get address any glitches or things that would a promise (in writing if you can) that he or make him late for work. she will try to stick to it. Ken is an example of a student who had Students might ask a roommate or their the education and experience to succeed roommates to support the fact that he or but didn’t have the “EF” skills in place she will be going to bed at this time each to make sure he had gas or plan ahead for night. Students like Melanie can also use a getting gas. simple spreadsheet and record how many Repetition and routine turned out to be hours per night they sleep, as well as the the key in helping Ken. Over time with time they went to bed and got up in the repetition, repetition, repetition, and occa- morning. As patterns develop you can fur- sional nagging from me, this young man ther aid students with positive reinforce- made wonderful strides in his punctuality. ment or extra help and encouragement. Ken now has worked nearly full-time for Encourage students to develop a wind- the same company for a number of years. down routine. A hot drink, reading for half an hour and then turning off the light, “Underground Thursday” Challenged having a hot shower or relaxing bath, or doing some gentle yoga or stretching right What is “Underground Thursday” do before bed will set the scene for a solid you ask? It could really fall on any day of night’s sleep. the week - but for Zach, his “underground” Ask the student to set an alarm or multi- day would always be a Thursday. He ple alarms to help her/him remember when used up so much effort and energy to get it is time to go to bed and time wake up. through his Monday to Wednesday work Have the “awake challenged” young days that he would call in “sick” almost person bring healthy snacks and drinks to every Thursday or every other Thursday. It work each day and take occasional breaks was as predictable as the tides. so he/she can eat, hydrate, and boost ener- Zach and I had many one-on-one chats gy levels. The student should not develop about this. I finally determined that Zach an overdependence on caffeine or energy lacked the key skill of “perseverance” for drinks to keep awake. Instead encourage the times when he was feeling overwhelmed, him/her to keep a food or energy journal to learn more about his or her daily patterns. see Challenged on page 35 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 13

What to Expect When Expecting a Functional Behavior Assessment

By Melissa L. Olive, PhD, BCBA-D, Patrick N. O’Leary, MA, BCBA, and Abigail V. Holt, MA, BCBA Applied Behavioral Strategies, LLC

n 1994, the Individuals with Disabil- ities Education Act (IDEA) mandated the use of Functional Behavior Assessment (FBA) under certain Iconditions for special education students. Today, FBA is used to set the foundation for treatment of challenging behaviors in schools, homes, group homes for adults with disabilities, and even in-patient hos- pitals for the treatment of severe challenging behavior. Over thirty years ago, scientists first made connections between challenging behavior and consequences associated with behaviors. For example, Horner and Budd taught communication to a participant and Melissa L. Olive, PhD, BCBA-D Patrick N. O’Leary, MA, BCBA Abigail V. Holt, MA, BCBA noted that challenging behavior decreased when communication increased (Horner & Budd, 1985). Iwata and colleagues (Iwata, Table 1 on page 37 for a list of possible Indirect Assessments her history, and potential settings and cir- et al., 1982/1994) demonstrated they could consequences and examples. cumstances that are most problematic. cause challenging behavior to increase In order to determine the function of Indirect assessment, the first step in the At the onset of the indirect assessment, or decrease simply by changing conse- behavior or why behavior is occurring, as- FBA process, is designed to drive future evaluators will identify and define targeted quences to targeted behaviors. As a result sessors must complete a number of steps. assessment steps (O’Neill et al., 1997). In- behaviors using objective, observable, and of these initial investigations, researchers These include indirect assessments, direct formation gathered during these initial as- measurable descriptions (Alberto & Trout- later began designing treatments for chal- assessments, and functional analysis. We sessments help the evaluator identify spe- man, 2012). Evaluators will also review re- lenging behavior based on its function. will describe each step with more detail. cific areas that should be of further focus. lated records and documents to determine Specifically, the function or the payoff of This paper will not focus on how to do an These assessments do not typically involve how information about the client’s history the behavior is maintained by the individ- FBA but rather what ingredients to look for clients themselves, but rather include inter- ual gaining or avoiding consequences. See when an FBA is being completed. views and record reviews about the client, see Expect on page 37 PAGE 14 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Contributing Factors of Aggression and Self-injury in Autism

By Jenny E. La Barbera, PsyD, BCBA-D Once the stimuli can be identified the func- When these situations occur, there are Co-Director tion of the problem behavior can be deter- multiple options for conducting an ongo- NY Behavior Analysis and mined and a behavior intervention plan can ing assessment of the individual’s needs Psychological Services be developed. and behaviors and examining extraneous These methods are highly effective in variables that may be at play. Furthermore, identifying the function of an individuals’ additional evidenced-based treatments lthough self-injury and aggres- self-injurious and aggressive behaviors, geared towards reducing other interfering sion are not included in the diag- however, when the results are indicative of symptoms could prove to be beneficial and nostic criteria for a diagnosis of a behavior that serves multiple functions should be sought out. autism, they are often associated or a sensory function, treatment options When an individual is engaged in what Awith the diagnosis (American Psychiatric may become more complicated. In these has been determined to be a sensory main- Association, 2013). These symptoms are situations, an individual’s self-injurious tained behavior or a behavior that appears often the most problematic and concerning behaviors may initially serve the function to serve multiple functions and has not symptoms that caregivers face when seek- of obtaining access to a desired object or been successfully addressed, it is critical to ing treatment for their loved ones. Best activity, however, if the object or activi- rule out other variables that are likely com- practices indicate that the first course of ac- ty at that moment is not of the quality or pounding the problem. Sleep and mood tion is for the person to receive a thorough quantity that the individual desires, he may disturbances, side effects of medication, assessment that not only assesses specific resort to engaging in self-injury to obtain diet, and medical problems can result in times and activities in which the behaviors a reaction from another individual. Hence, physical or mental challenges. may be more severe, but the function or self-injury serves multiple functions and For example, Johnson, Giannotti, and purpose of the behavior itself. Informa- although initially it was the result of a de- Cortesi (2009) found that 40% to 80% of tion from multiple respondents is typically sire to obtain access to an item or activity, children with autism spectrum disorders necessary to obtain adequate information Jenny E. La Barbera, PsyD, BCBA-D it may have transformed into fulfilling a (ASD) experienced insomnia. Further- regarding the nature of the individual’s dif- desire to obtain attention. more, anxiety, autism symptom severity, ficulties. This assessment process is called functional analysis (FA), which is a type Occurrences such as these become even gastrointestinal problems, and sensory sen- a functional behavior assessment (FBA). of functional behavior assessment. This more complicated when an internal drive sitivities were found to be associated with Once a functional behavior assessment is type of assessment is considered to be the (sensory function) is responsible for the sleep disturbance in individuals with au- conducted, the results of the assessment standard in assessing problem behaviors behavior. It is often difficult to identify the tism spectrum disorders (Hollway, Aman, are then used to develop a treatment plan (Hanley, Iwata, & McCord, 2003). A func- motivating drive of sensory maintained & Butter, 2013). that is individualized and specifically ad- tional analysis is a standardized procedure, behavior and offer a competing response. With regard to medication, side effects dresses the method in which interventions conducted in a controlled setting, in which Confusion and doubt of initial hypotheses of commonly prescribed medications for and modifications will be implemented the presentation and removal of stimuli is are common responses to behaviors such aggression and self-injury, such as Aripip- to assist the individual in obtaining his or systematically conducted for the purpose as these when behavior intervention plans razole (Otsuka Pharmaceutical Co., Ltd., her needs with a more acceptable form of of identifying which stimuli results in the do not produce the desired effect on the tar- behavior. A second assessment option is a highest proportion of problem behaviors. get behavior. see Self-injury on page 43 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 15

Managing Challenging Behavior Due to Autism During Emergencies: Advice for First Responders

By Vanessa Tucker, PhD, BCBA-D tion impairments and the presence of re- Prevention Tactics Assistant Professor of Special Education stricted and repetitive patterns of behavior Pacific Lutheran University (American Psychiatric Association, 2013) The first priority is to provide high qual- paired with atypical responses to sensory ity training in the basic aspects of ASD to stimuli. A person with this diagnosis may all first responders during initial ongoing irst responders are by definition react very differently to the stimulation and training. This content needs to highlight available and on call twenty-four demands of an emergency situation. These the unique learning and behavioral needs hours a day to provide emergency issues set the stage for challenging behav- of those with ASDs including specific tac- services ranging from medical to iors. A person with ASD may have limited tics that can be used to quickly interpret Fsafety and protection needs. In most cas- communication skills impacting their abil- and respond to behaviors. Training should es these encounters are brief, intense and ity to respond to commands, provide infor- emphasize the incredible variability of this are paired with stressful episodes includ- mation about their internal states or result- population as well as the need for partner- ing medical emergency, fire or other life ing in behaviors that increase risk such as ship with families and caregivers. Training threats. These encounters must be managed running or aggression to self and others. should focus on the core impairment areas well and require expert intervention on the Sensory stimuli in the form of lights and of ASDs as they pertain to the demands of part of first responders to quickly provide sirens may be misinterpreted by the person an emergency situation. First responders assistance. These encounters intensify as threatening or aversive. The presence need to understand that children and adults when a child or adult with Autism (ASD) of strangers dressed in unfamiliar cloth- with ASD may not respond to commands, is involved. First responders, including po- ing with equipment that invades personal may struggle with the sensory aspects of lice, fire and Emergency Medical Services space can be a trigger for behavior. Tactile the situation, will not be good reporters of (EMS) can benefit from guidance regard- defensiveness (dislike of being touched or symptoms, may not comply with medical ing the needs of this population. Vanessa Tucker, PhD, BCBA-D touching things) can create tremendous examinations and might run away from The literature regarding this topic is barriers to a physical exam or to the use of supports. They also need to be prepared for sparse at best. A review indicates that first emergency care needs. The literature high- equipment designed to obtain vital signs. aggression and to interpret this as a proba- responders need more training in this topic lights higher risk in terms of such emer- Behaviors can create tremendous risk to ble communication breakdown rather than as well as other disabilities (Good, 2011; gency situations as elopement, wandering all involved and should be addressed by an intentional act. White, 2012). A child or adult diagnosed (Law & Anderson, 2011) and drowning both through prevention and response tac- Familiarity with EMS agencies is a vi- with ASD is seven times more likely to (Myers, 2012). Greater research into tech- tics. Prevention is the first line of defense able prevention tool. For example, a child need emergency medical services as com- niques that positively support those with followed by using strategies that meet the with ASD may be prone to running/eloping pared with a typically developing compar- ASD during emergencies is needed for unique needs associated with ASD. Re- from her home. This child may not react in ison group (McDermont, Zhou & Mann training purposes and effective interven- sources will be provided for more specific a typical manner to interactions with 2008). Mims (2008) classifies this population (Kupietz, ND). supports, training and information avail- tion as “high risk” in terms of medical and ASD is defined by social communica- able for first responders and families. see Emergencies on page 32 PAGE 16 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Should Parents Tell Their Children They Have Asperger’s?

By Shuli Sandler, PsyD avoid saying it at all costs, because of the Spectrum Services sense of impairment it represents. In this re- and Michael Rosenthal, PhD gard, it can feel like an albatross. They may Child Mind Institute see Asperger’s as a challenge that holds them back from their potential. Disclosing the diagnosis can present other issues. For diagnosis of Asperger’s can be example, because children with Asperger’s an overwhelming experience often have difficulties with the subtle nu- for parents and children. Some ances of communication, it may be hard for parents may feel an initial sense them to learn when it is appropriate or inap- Aof relief at finally finding an answer to propriate to share the information with oth- their child’s difficulties; at the same time, ers. Furthermore, there is misunderstanding it also can foreshadow a long and trying about the diagnosis at a societal level and road ahead full of therapies, academic all too often it is framed in terms of its defi- difficulties, and social skill building. As ciencies rather than its differences. clinicians who often evaluate and treat We think this is an extremely important children with Asperger’s, one of the ma- yet complicated issue, and one that needs jor questions parents frequently ask us is to be dealt with carefully and sensitively whether they should share the information to maximize the child’s adjustment to what about the diagnosis with their child. This lies ahead. is a complicated decision that deserves This article presents some ideas for con- careful consideration. sideration, as well as guidelines for parents Children who have been given an ex- struggling with this very issue to help them planation and understanding of the label make the right decision for their child. of Asperger’s may feel a sense of belonging after realizing that there are lots of Psychiatric Versus Medical children out there just like them. Rather Shuli Sandler, PsyD Michael Rosenthal, PhD than feeling stigmatized or defective, they For better or for worse, our society feels may experience a sense of empowerment Asperger’s label as a potential cornerstone diagnosis can also feel oppressive. Chil- differently about psychiatric diagnoses and in having a community of like-minded for building self‐advocacy skills, and it can dren may feel a sense of shame or embar- medical diagnoses. Interestingly, many par- children they may find at school, camp, help facilitate a sense of control in their rassment. To some, the word Asperger’s ents feel less conflicted about the prospect or in various social skills groups or other lives. For some, Asperger’s may be seen can feel like a disease or a term describing of telling their child that they have a per- treatment settings. It can offer inroads for less as a disorder and more as a positive what is “wrong with them.” We have seen vasive medical condition such as diabetes forging connections with others who share and fundamental part of their self-concept. children who were exposed to the word similar challenges. Children may use their On the other hand, learning about their Asperger’s when they were diagnosed but see Asperger’s on page 28 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 17

Addressing Setting Events to Make Behavior Plans More Effective for Individuals with Autism Spectrum Disorders

By Philip Smith, PhD, and and supporting the development of more Daniel J. Baker, PhD, NADD-CC positive alternative behaviors that meet the The Boggs Center on Developmental same needs. In this way, behavior special- Disabilities at Rutgers Robert Wood ists have the opportunity to individualize Johnson Medical School the development of behavior intervention and support plans, much in the way that clinicians individualize the treatment of hallenging, disruptive, and po- mental health disorders based on the feel- tentially dangerous behaviors ings and past experience of the patient. frequently are a concern for care- Since most individuals who engage in givers and family members of in- problem behavior either don’t know or Cdividuals with Autism Spectrum Disorders can’t communicate why they engage in the (ASD). In recent years, the methodology behavior, it is necessary for support provid- of Functional Behavior Assessment (FBA) ers to assess the behavior in order to deter- has come to be recognized as one of the mine the function of the behavior. This is most effective means of addressing these true both for individuals with strong cogni- behaviors (Carr, 1994). The technology of tive skills, as well as those who have some this approach has been developed through degree of intellectual disability, because the efforts of practitioners working un- most of us are not very good observers of der the Positive Behavior Supports (PBS) ourselves. In order to do this objectively model, building on research that has grown and effectively, researchers have demon- out of the scientific endeavors of Applied strated that in most cases, the function of a Behavior Analysis (ABA). Philip Smith, PhD Daniel J. Baker, PhD, NADD-CC behavior can be discovered by identifying What this approach has come to show the typical antecedents that immediately is that even behaviors that look the same another person might be motivated by searchers have come to recognize that ef- precede the behavior, and the consequenc- to a casual observer (physical aggression, an effort to alleviate pain or discomfort. fective intervention strategies need to be es that typically follow these the behavior self-injury, destruction of objects) may ac- Through systematic analysis, behavioral individualized and based on the function. (Carr, 1994). The circumstances that pre- tually be quite different depending on who scientists have been able to identify cir- This involves adapting behavior plans cede the behavior are considered to serve performs the behavior, what setting it oc- cumstantial factors that help in understand- based on recognition of the identified as triggers for the behavior, while the con- curs in, and a variety of other conditions ing what influences the motivation and/or needs and using that insight, first to focus ditions that follow the behavior have come or circumstances. For example, self-injury meaning of the behavior for the person the on meeting those needs in order to prevent to be understood as rewarding, or in exhibited by one person might be motivat- individual (Wacker et al., 1990). problem behavior. Once this has been ac- ed by escape from a task demand, while The value of this approach is that re- complished, efforts are directed to teaching see Setting Events on page 39 PAGE 18 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Why Emotional Literacy Is So Important

By Jaime Fleckner Black, PsyD concerns about bullying, violence, and sui- The best programs help children become Spectrum Services cide, but these programs are certainly not better observers of themselves and others. the norm at this time. They guide them in appropriate ways of expressing themselves. Parents of children ocial and emotional literacy devel- Social Skills Groups in school groups should request specific op over time and need to be nur- Teach More than Manners plans and ask about generalization strate- tured just like any other skill such gies. Parents can reinforce practiced skills as math or riding a bike. Unlike Certain children, particularly those with at home and with play-dates. Smath or bike-riding, however, the teaching autism, Aspergers, and social phobia re- of emotional literacy is often overlooked. It quire more guidance and support in devel- Social Skills Groups Specific to Adults has been referred to as the “missing piece” oping social and emotional competencies. of education despite its profound impact on Social skills deficits are a hallmark of these There are also groups available for children’s well-being. Emotionally compe- conditions and they tend to persist into adults who struggle socially and emotion- tent individuals are able to communicate adulthood due to a dearth of interpersonal ally. The goal is to increase social aware- effectively, empathize, problem solve, and experiences. How can a child learn conver- ness and for members to develop a better resolve conflict. Studies have shown that sation skills, conflict negotiation, and per- understanding of the world around them. kids who develop these skills are more spective taking, for example, if she has no Social skills groups can help adults navi- likely to do well at work as adults, have one to practice with? The right kind of so- gate the interpersonal complexities of the longer-lasting marriages, and have lower cial skills group could help a child develop workplace, establish platonic and romantic rates of anxiety and depression. Studies these kinds of skills, but not all social skills relationships, and understand social norms also suggest that emotionally-literate char- groups are created equally. in different situations. acteristics like self-restraint, persistence, Effective groups: and self-awareness are better predictors What Parents Can Do with Children of life outcomes than common academic Jaime Fleckner Black, PsyD • Promote skill generalization to the measures. In addition, these children tend outside world and often take place on There are many opportunities in daily to do better in school due to their ability and former bullying victim, developed one the playground or in other real-world life to learn and reinforce social awareness. to work well with others, control impulses, such program called Ruler. Ruler’s goal is locations where real-life problems At the park, for instance, while observing and appropriately channel emotions. to develop children’s capacity for self-re- tend to unfold a group of people interact, try asking your flection and critical thinking. Students child to describe the relationships among What Is Being Done In Schools? and teachers use concepts such as “mood • Stimulate social motivation them. It does not matter whether they get meters” to help gauge emotions. Teach- it right - what’s important is that the child Many schools are embracing the reers encourage children to develop coping • Reinforce appropriate social responding is thinking about how social cues are infor- search and implementing social-emotional mechanisms, such as using self-talk or tak- mative. If your child is hesitant to engage, learning (S.E.L) programs. Mark Brackett, ing a walk when upset. S.E.L. has received • Increase the understanding of nonver- senior research scientist at Yale University more attention in the past few years due to bal communication see Emotional on page 46

Spectrum Services

A Cooperative Private Practice Offering an Array of Specialized Services Spectrum Services provides child and adult diagnosis, family and couples therapy, social seminar and social skills groups, specialized individual skill- building therapy, cognitive behavior therapy (CBT), trauma focused therapy and EMDR, dialectical behavior therapy approaches, mindfulness work, college coaching and transition support, psychoeducational, neuropsychological, and speech & language testing, vocational support, family support, and educational consulting for individuals and families affected by Autism Spectrum Disorders and related conditions. Lynda Geller, PhD, Founder www.spectrumservicesnyc.com • [email protected] 303 Fifth Avenue, Suite 1003, New York, NY 10016 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 19

Common Mealtime Concerns in Individuals with ASD

By Brandon Nichols, MSEd, BCBA, LBA non-preferred food items when a child re- and Michelle Myers, BA, BCaBA fuses to eat or consume the correct amount The Tom Golisano Center of food, the child may be more likely to for Autism at Springbrook display inappropriate behaviors during meals to avoid eating less preferred food (Bachmeyer, 2009). Similarly, if a caregiv- eeding problems in children with er provides access to preferred food items ASD may include selective eat- when a child refuses to eat less desirable ing or “picky eaters,” rapid eating food items, the child may be more likely to (child takes numerous bites within refuse in the future in order to gain access Fa short period of time), inappropriate meal- to the preferred foods. time behaviors (e.g., tantrums), and inad- Knowing the signs and symptoms of equate intake/food consumption. These feeding issues for children with ASD can behaviors can lead to numerous health be challenging. Many caregivers are unfa- (e.g., aspiration, choking), developmental, miliar with common symptoms and strug- and social concerns for children. Feeding gle with knowing when to get help. Some problems occur more frequently in chil- of the most common signs and symptoms dren with ASD than in typically develop- of feeding problems include: ing children (Burklow, Phelps, Schultz, McConnell, & Rudolph, 1998). Studies • If there are weight changes (loss or gain) have shown that 72% of children with ASD eat a “narrow” variety of foods, 31% Michelle Myers, BA, BCaBA and Brandon Nichols, MSEd, BCBA, LBA • If a child only eats a limited number display sensitivity to various food textures, of food items or only certain textured and 53% of children with ASD have some risk of long-term eating problems (Piazza foods a challenge (Baxter, Bellando, Pull- food (e.g., only soft foods) type of nutrient deficiency related to feed- & Carroll-Hernandez, 2004). iam, Watson, Powell, Srivorakiat, & Bing, ing patterns (Schreck, Williams, & Smith, Feeding behaviors in children with ASD 2014). This can include but is not limited • If mealtime behaviors are causing stress 2004; Field, Garland, & Williams, 2003; may occur for numerous reasons and are to certain textures and colors (e.g. child Cornish, 1998). Additionally feeding is- specific to each individual. These include only eats beige food or refuses to eat any • If a child complains or shows signs sues can be extremely stressful for both the medical, sensory, and behavioral caus- green foods; a child may not eat crunchy of pain (e.g., constipation, tooth pain, child and the family. Therefore, the suc- es. If a child is having medical problems or soft foods). Numerous researchers have food allergy/rash) cessful treatment of feeding problems can such as constipation, stomach aches, or reported that the inadvertent reinforcement have significant impacts such as improved toothaches then this may result in a child of inappropriate mealtime behaviors fre- Even when a caregiver observes these health, improved quality of life for both refusing to eat. Similarly, many children quently contributes to the onset and main- signs or symptoms, identifying what to children and families, decreased mental with ASD have difficulties with sensory tenance of feeding problems (Piazza et al., health problems in families, and reduced processing and this can make eating certain 2003). For example, if a caregiver removes see Mealtime on page 45 PAGE 20 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Is the Label or the Person the Focus?

By Patricia Fratangelo Executive Director Opportunities and Choices in Life

eople who are diagnosed with Autism are often seen first for the diagnosis that they have. Many times programs are developed by Porganizations that have expertise with the labeled disability. People with autism are often accepted into programs based on this diagnosis. This is not unlike many other disabling conditions, hence the many programs that are available for elders, people with developmental disabilities, people with mental health diagnosis, people with The Center for Children autism, the list goes on. As the saying goes, “birds of a feather flock together.” Although these programs are not wrong with Special Needs or do not mean to harm, it is just the nature of the program that may not meet the needs of each person involved. When you & truly begin to know a person and see them Patricia Fratangelo for the unique individual that they are, you The Center for Independence may find that the predetermined program with standing up for what he felt was right, may not be the best fit. and at the time it was right for him. After a To bring this to point, while sitting at a lot of planning, Steve moved into his own meeting with many Commissioners of our apartment with a combination of paid and state, a conversation began about the need unpaid support to equate a 24 hour service. for proper assessments. Of course every At first mom was extremely involved, Dr. Michael D. Powers, Director department in each state feels that they are helping to decorate or stopping in unex- properly assessing its clientele and has the pectedly. But as Steve became more secure proper programs to meet their needs. But the in his lifestyle, he began to hold a line. He real question is, are the assessments for a pro- would move things that mom brought in • Diagnosis and evaluation of children and adults gram, or are the assessments really weigh- and put them where he wanted, saying it ing the needs of the person being assessed? was his home. When she walked in unex- When this question was brought up, it struck pectedly, he learned to tell her to knock • Outpatient treatment for children and adults a nerve. The reaction was, if we really evalu- first and remove her shoes, as this was his with ASD and their families ated what each person needed, they may not home. If anyone tried to put his clothes fit into the “silos” we have developed. away he would tell them No! This was im- This is exactly the reason why predeter- portant for him to do. • Consultation and program development to mined programs do not work for all people. As Steve began to know more people at Could this not be the cause of why many his housing complex, he began to get in- educational programs and human service behavioral problems then begin to rise? volved in community BBQ’s and would organizations Listening to each person with autism has take his turn to host one. He would get help taught us a lot about how a system can best from his housemate and his staff to invite support each individual. As with each of people to come over. If mom showed up he • Consultation and training for professionals us, every person with autism has different would make it clear that this was his party aspirations, skill sets, histories, communi- not hers. cation needs, and goals that they wish to Steve went through a tough and embar- work on and move towards. It is with tak- rassing experience at the State Fair over 20 ing the time to try to understand this, that years ago that left an obvious scar on him Providing evidence-based services to individuals with one can pick up on what is sometimes re- that drew negative attention and forced ferred to as authentically important in that his family to leave. As he would drive by Autism and other neurodevelopmental disabilities person’s life. with staff he would say, “I want to go to and their families for over 20 years. I will introduce you to two men who are the fair…I want to go…I can’t go…I can’t each diagnosed with autism. Each of their go…” Year after year he would say this names has been changed. Each person and and every year he would say, “Maybe next their story is very different from the other. year.” After about five years, Steve asked Their success is in the planning that oc- if he and the staff could go together. The curred to get them what was needed, not staff told him yes and that they could leave 2300 Main Street, Glastonbury, CT 06033 just what was available. One of the men whenever he wanted. The day arrived and was previously in a situation that did not without anxiety Steve went to the fair and & work and caused great angst. The other had a great time. After being there for was asking to continue life with a normal about two hours Steve said, “I need to go.” 2213 Main Street, Glastonbury, CT 06033 lifestyle. The success is with each individ- They quietly left the fair and went back to ual’s journey. The downfall would be if this apartment. On the way home, Steve these men had been grouped together. shared the following: “Sometimes it takes me more time… 860.430.1762 office ● 860.430.1767 fax Steve Learns to Stand Up for Himself sometimes I can’t just do something the whole day. I can get filled up like a pool of [email protected] ● www.ccsnct.org Steve always lived a sheltered life with water - but when the pool is full, the water family who adored him and always took care just runs to the ground. When I get filled of him. As Steve got a bit older and moved www.facebook.com/ccsnct into being an adult, he began to struggle see Focus on page 40 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 21

Positive Behavioral Interventions and Supports: An Effective Approach for Schools to Prevent and Manage Challenging Behaviors

By Christine Alter, LCSW based upon the school’s clear expectations. development of appropriate behaviors. Social Counselor For example, “Responsibility” is a common PBIS schools support students with a New York Institute of Technology value for PBIS schools. It might be defined three-tier behavioral approach. The Pos- Vocational Independence Program by arriving to school and/or class on time. itive Behavioral Interventions Supports Staff is trained to use the code of conduct framework incorporates more intensive to acknowledge or address both appropri- supports for those individuals and groups ositive Behavioral Interventions ate and inappropriate behaviors. Schools of individuals who need it. The multi-tiered and Supports (PBIS) was devel- develop clear protocol for recognizing and approach gives schools the flexibility to oped in the 1980s as a data based rewarding those students who meet school handle all types of behaviors, including the behavioral intervention for stu- expectations. They also intervene when more challenging ones. Pdents with behavioral disorders (BD). students are not meeting expectations. Pro- Universal expectations or tier one sup- Positive Behavioral Interventions and Sup- tocol usually includes reviewing the school ports set school wide guidelines for the be- ports (PBIS) is an evidence based approach value and explaining how to demonstrate havior of all students. Students (and staff) which incorporates behavioral and aca- the value with behavior. If required, more are explicitly taught the expected behav- demics supports within a comprehensive specific skill development can be offered. iors. Interventions focus on teaching stu- framework. The PBIS philosophy gained More serious or repetitive violations be- dents to understand the school’s social, be- support in the 1990s, with the reauthori- come disciplinary matters which are han- havioral and academic rules. Students are zation of the Individuals with Disabilities dled by administration’s predetermined held accountable to this “code of conduct”. Act (IDEA) of 1997. A subsequent grant data-based procedure. By incorporating a PBIS approach schools and its funded research indicated that PBIS According to the DSM-V, Autism Spec- are able to explicitly explain their culture. should focus on prevention, data driven trum Disorder (ASD) has two key charac- Students are better able to understand and decisions, school-wide programming, and teristics; deficits in social communication navigate school expectations. Students direct social skill teaching, all within a col- and restricted or repetitive behaviors and who meet or exceed school expectations laborative team-based approach (Sugai and Christine Alter, LCSW interests. Students with ASD often expe- receive reinforcement or rewards. Simonsen, 2012). rience difficulties with; social reciproci- Tier-two and tier-three interventions offer Positive Behavioral Interventions and learn best with routine and repetition. Un- ty, interpreting nonverbal social cues and additional assistance to individual(s) who Supports is a great tool to help schools pre- der the PBIS framework, schools create developing social relationships. (www. are exhibiting more challenging behaviors vent and manage challenging behaviors, their own unique set of expectations which autismspeaks.org/what-autism/diagnosis/ and might need extra attention or skill de- as well as teach and reinforce school wide they define with explicit and concrete be- dsm-5-diagnostic-criteria). PBIS focuses velopment to meet school requirements. Ti- expected behaviors. The PBIS process em- haviors. Staff and students alike are taught on both academic and social skill builder-two and tier-three supports help schools phasizes consistency and continuity and the school specific “code of conduct” which ing. This school-wide behavioral frame- meet the needs of students who require therefore would work well in addressing is usually developed around a school mas- work clarifies expected behaviors and uses the needs of students on the spectrum who cot or theme. Student behavior is evaluated re-teaching and reinforcement to encourage see Effective Approach on page 40

YAI International Conference May 4-7, in New York City

By The YAI Network Among some conference highlights are:

Living utism will be a major focus at YAI’s 2015 International Con- Dr. Stephen Shore, Clinical Assistant ference, Living, Loving, Work- Professor of Special Education, Adelphi ing & Learning in Intellectual University, New York (www.autismasperg- Aand Developmental Disabilities, May 4-7, er.net/bio.htm), on the benefits of teaching in New York City. individuals with ASD a music curriculum Over 200 presenters, from as far as Aus- and how it can enhance social skills, com- tralia and Alaska, will provide attendees munication, and other aspects of life. with techniques and strategies that can be effective with children, adolescents and Loving adults with autism and other developmental disabilities. YAI’s annual global gath- Dr. Isabelle Hénault, an expert on rela- ering at The Hilton New York Midtown tionships and sexuality in individuals with serves as a major forum for the exchange autism and Asperger’s syndrome (www.cl- of ideas and information in the field. inique-autisme-asperger-mtl.ca/brunowick- “As we mark the 25th anniversary of the er/Isabelle_Henault_en.html). She is the Americans with Disabilities Act in July, author of Asperger’s Syndrome and Sexual- we should remember that many children ity: From Adolescence through Adulthood. with disabilities grew up under ADA and Her book has been translated in eight lan- are living and working in the community guages. Her newest book written with Tony today as adults,” said Matthew Sturiale, Attwood and Nick Dubin is titled, The Au- CEO of YAI. “But as our field continues to tism Spectrum, Sexuality and the Law. change, so has the definition of inclusion and quality of life. Children and adults on Working the autism spectrum, and their families deserve the same dignity, freedom of choice, Anita Lesko, BSN, RN, MS, CRNA, and sense of belonging to a community as of Flying High with Autism Foundation, anyone else in society. We need to listen to Florida (www.bornwithaspergers.com). the individuals we support to see what is important to them.” see Conference on page 36 PAGE 22 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Growth Hormone Treatment Improves Social Impairments in Patients with Genetic Disorder Known to Cause Autism

By The Mount Sinai Hospital at ty, the ability of synapses to strengthen or The Mount Sinai School of Medicine weaken over time, in response to increases or decreases in their activity. It is currently approved by the Food and Drug Adminis- growth hormone can signifi- tration for the treatment of short stature. cantly improve the social im- The Mount Sinai study is the first to pairment associated with autism suggest that IGF-1 is safe, tolerable and spectrum disorder (ASD) in associated with significant improvement Apatients with a related genetic syndrome, in both social impairment and restrictive according to a pilot study conducted at the behaviors (fascination with one subject or Icahn School of Medicine at Mount Sinai activity; strong attachment to one specif- and published today on Pub Med, a public ic object; preoccupation with part[s] of an database of biomedical topics maintained object rather than the whole object; pre- by the National Institutes of Health (study occupation with movement or things that originally published in the December 12 is- move) in people with Phelan-McDermid sue of the journal Molecular Autism). syndrome, said the study authors. The study results focus specifically on Researchers enrolled nine children aged the use of insulin-like growth factor-1 5-15 years who were diagnosed with Phel- (IGF-1) to treat Phelan-McDermid syn- an-McDermid syndrome in a placebo-con- drome (PMS), a disorder caused by a dele- trolled, double-blind, cross-over design tion or mutation of the SHANK3 gene on study. All participants were exposed to chromosome 22. Along with facing devel- three months of treatment with IGF-1 and opmental and language delays and motor three months of placebo, in random order. skill deficits, most people with PMS also Compared to placebo, the IGF-1 phase was have autism spectrum disorder. Alexander Kolevzon, MD Joseph Buxbaum, PhD associated with significant improvement SHANK3 is a focus of research in the in social withdrawal and restrictive behav- field because of its essential role in the it to be a relatively common cause of ASD. causes of ASD converge on common un- iors as measured by the Aberrant Behavior function of synapses, the gaps between “Ours is the first controlled trial of any derlying chemical signaling pathways, the Checklist and the Repetitive Behavior Scale nerve cells that “decide” whether messag- treatment for Phelan-McDermid syn- findings of this study may have implica- respectively, both standard behavior scales es continue along nerve pathways as they drome,” says Alexander Kolevzon, MD, tions for many forms of ASD.” used to assess treatment effects in ASD. regulate bodily processes. While Phel- Clinical Director of the Seaver Autism IGF-1 is a commercially available com- Preclinical studies of SHANK3 deficient an-McDermid syndrome is a rare disorder, Center at the Icahn School of Medicine at pound that promotes nerve cell survival, advanced genetic technology has revealed Mount Sinai. “Because different genetic synaptic maturation and synaptic plastici- see Hormone on page 27

The Changing World of OPWDD Services and Supports

By Peter Pierri Employment Opportunities a manner that assumes a job coach will Executive Director eventually fade from the job site and the InterAgency Council of Developmental Nationally, the rate of employment individual will remain employed without Disabilities Agencies, Inc. among individuals with developmental on-site supports. We know that for many disabilities is extremely low and New York individuals on the autism spectrum, acquir- lags behind many other states. OPWDD ing job skills is only part of the reason why or every parent who watches their submitted a plan to the Federal government support on the job is necessary. Often their child morph into a young adult focused on how they would improve this communication deficits and/or behavioral right in front of their eyes, this situation. The plan calls for the number of challenges require long-term supports in transformation is filled with an- people in competitive employment to in- order for them to retain their employment, Fticipation, uncertainty and limitless chal- crease by at least 700 individuals annual- and therefore, a job coach may be need- lenges. For the parent with a child on the ly. Competitive employment is defined as ed long-term to ensure long-term success autism spectrum these issues are magni- employment in an integrated setting, in the for the individual. Fortunately, OPWDD’s fied as they begin to explore the world of general workforce, where a person earns at proposal for revising the funding for sup- supports funded and regulated by New least minimum wage. To achieve this goal, ported employment is being designed to al- York State’s Office for People with De- OPWDD is creating a new service called low a job coach to remain in place as long velopmental Disabilities (OPWDD). Of Pathway to Employment, which focuses as the individual needs that support. course, many families receive some OP- on comprehensive career planning. It will OPWDD’s plan also calls for the closure WDD services when their children are provide assistance for participants to obtain of all sheltered workshops in 6 years, due younger, often in the form of respite or af- or maintain competitive employment. This to the fact they are segregated environ- ter school programs. In fact, almost 25% service is now becoming available and it ments that do not afford the opportunity for of all people served by OPWDD are under engages a participant in identifying a career typical interactive exposure with people the age of 22. However, by the time stu- direction; provides instruction and training without disabilities. New York’s sheltered dents reach 16 years of age, families need Peter Pierri in pre-employment skills; and develops a workshops collectively serve almost 8,000 to begin planning for the days after gradu- plan for achieving competitive, integrat- individuals. OPWDD anticipates 50% of ation from school. Effective and thorough approach. Some of these changes are driv- ed employment. Within 12 months, the these individuals will transition to some transition planning is absolutely crucial to en by reforms of long-standing funding outcome of this service is intended to be form of competitive employment within help determine what supports the young reimbursement formulas. However, much a determination of the participant’s stated the next 6 years and OPWDD will be giv- adult will need to lead a productive and of OPWDD’s transformation is derived career objective; a detailed career plan to ing individuals, and their families, informa- fulfilling life. Complicating this process from initiatives on the part of the Federal guide individualized employment sup- tion regarding employment alternatives. is the current transformation of virtually government, whose effort is focused on ports; and preparation for supported em- Those that will not choose this path may every service offered by OPWDD, includ- ensuring that individuals with develop- ployment services and obtainment of a job. have either medical or behavior-related ising various day and residential supports, mental disabilities are actively engaged in Current reimbursement rates for OP- sues that would create significant barriers employment services, as well as those ser- the full complement of available commu- WDD’s supported employment service are vices offered through a self-determination nity experiences. problematic as they are designed in such see OPWDD on page 30 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 23

Rumination: Past, Present, and Future

By Jennie England, MA, BCBA, aggression, self-injury, property destruc- and James T. Chok, PhD, BCBA-D tion, and more recently food refusal and Melmark rumination. Although not within the scope of this article, the majority of functional analyses of rumination conducted have umination is characterized by revealed that, in most cases, rumination is regurgitation of previously in- maintained by an automatic reinforcer (Ly- gested food into the mouth, and ons, Rue, Luiselli, and DiGennaro, 2007; re-chewing, re-swallowing or Wilder et al., 2009; Woods, Luiselli, and Rexpelling that food (Chial, Camilleri, Wil- Tomasson, 2013), meaning that often the liams, Litzinger, and Perrault, 2003). Al- reinforcer for ruminative behavior is pro- though rumination is typically observed in duced by the behavior itself and is not so- infants and individuals with developmental cially mediated. However, the use of func- disabilities, it does occur in adolescents, tional analysis to determine the functional children, and adults with normal intelli- reinforcer of ruminative behavior is limit- gence (Chail, Camilleri, Williams, Litzing- ed and more research is needed in this area. er, and Perrault, 2003). It is estimated that Several treatment options have been an average of 6-10% of individuals with used to treat ruminative behavior, includ- severe intellectual disability who are living ing punishment, differential reinforcement in a residential treatment facility engage in of alternative behavior, differential rein- rumination (Lang et al., 2011). There are forcement of other behavior, the delivery several medical conditions/diagnoses that of a competing item, and manipulation could result in ruminative behavior. These of meal variables. Positive punishment, include gastro-esophageal reflux disease, Jennie England, MA, BCBA James T. Chok, PhD, BCBA-D which involves the presentation of an aver- upper gastrointestinal motility disorders sive stimulus following a response, and a (e.g., gastroparesis), and bulimia nervosa tified. These include, but are not limited article on the importance of determining subsequent reduction in behavior, has been (Chial, Camilleri, Williams, Litzinger, and to, unkempt personal appearance and foul the function of behavior prior to treatment, effective at decreasing rumination. Sajwaj, Perrault, 2003). The medical consequenc- odor, which can result in social isolation the use of functional analysis has become Libet and Agra (1974) were able to elimi- es of engaging in rumination over a pro- and/or decrease in educational or vocation- a cornerstone assessment in the field of nate rumination in an infant, by squirting longed period of time range from halitosis al opportunities (Lang et al., 2011). Thus, it applied behavior analysis. Functional anal- unsweetened lemon juice into the infant’s to malnutrition, dental erosion, and weight is important that behavioral treatments for ysis results allow clinicians to determine mouth at the first sign of rumination. The loss (Chial, Camilleri, Williams, Litzinger ruminative behavior, in conjunction with what types of environmental conditions elimination of rumination also resulted in and Perrault, 2003). In addition to medical medical interventions (when applicable), evoke challenging behavior and what con- increased weight gain, babbling, smiling, complications, several social consequenc- are evaluated. sequences maintain it. Functional analyses es of ruminative behavior have been iden- Since Iwata et al.’s (1982/1994) seminal have been conducted for behaviors such as see Rumination on page 44 PAGE 24 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Best Practices for Understanding and Managing Challenging Behavior at School: Using an FBA and BIP

By Meir Flancbaum, PsyD, Elena Zaklis MA, BCBA, and Michael Selbst, PhD, BCBA-D Behavior Therapy Associates

hen addressing behavior problems, a careful assessment provides the foundation for effective and efficient Wintervention. Consider the following scenario: After struggling with headaches for nearly a week, you visit a doctor. Follow- ing a brief discussion, the doctor suggests brain surgery. While surgery may be effective, it is also possible that your headaches are related to the fact that the prescription in your glasses is out of date. Or, they may be caused by not drinking enough fluids on a daily basis. You would not want to undergo an eye exam if the headaches could be alleviated by drinking more water. And you would not want to undergo surgery, if the headaches Meir Flancbaum, PsyD Elena Zaklis MA, BCBA Michael Selbst, PhD, BCBA-D could be treated by purchasing updated lenses. While there are multiple treatment Conducting an FBA and Code (Chapter 6A:14) requires school per- ses about the reasons the problem behavior options for headaches, the quickest and Developing a BIP sonnel to complete an FBA and BIP when a maybe occurring. A BIP refers to strategies most effective way to alleviate them is to student displays behaviors that significant- designed to reduce the problem behaviors precisely identify the cause. The most effective way to understand ly interfere with daily functioning. and increase desired behaviors. Similarly, effective management of and manage these behaviors is to conduct An FBA refers to the full range of proce- It helps to think of an FBA/BIP as a five challenging behaviors in children, such as a Functional Behavior Assessment (FBA) dures to identify a specific problem behav- step model: tantrums and non-compliance, must begin and develop a Behavior Intervention Plan ior, to understand the factors leading up to with a careful, detail-oriented assessment. (BIP). The New Jersey Special Education and following it, and to generate hypothe- see Best Practices on page 46

Understanding the Father Factor While Raising Children with ASD

Robert Naseef, PhD consistently reported that fathers tend to times weekly. Even more played with their Psychologist “specialize” in play, whereas mothers spe- children and ate meals with them frequent- Alternative Choices cialize in caretaking and nurturance. This ly. Two-thirds read to them several times narrow view failed to capture similarities weekly. Ninety percent of fathers living of fathers and mothers on child develop- with children ages 5 to 18 reported eating athers of children with autism tend ment. The emerging role of fathers over meals together several times per week and to be either very involved or with- the past three decades has spurred re- talking with them about their day. Two out drawn and virtually absent from in- search. Increased father involvement has of three fathers helped with homework fre- teractions with professionals—with been demonstrated to result in improved quently, and about half took their children Fthe majority seemingly uninvolved. From cognitive competence, increased empathy, to or from activities. this observation, many professionals as- fewer sex-stereotyped beliefs, and better sume that fathers do not wish to be involved. self-control. Father Involvement in Is this really the case, or do men relate and Lamb further speculates that increased Clinical Interventions need to be engaged somewhat differently? paternal involvement promotes both par- Fathers are often poorly represented at ents’ fulfillment. Fathers can be close to Men are less likely than women to seek IEP meetings, conferences, and support their children while mothers can also be mental health services and medical treat- groups for parents of children with au- close to their children and pursue career ment across race, ethnicity, age, and pa- tism. Usually they are at home watching goals. Lamb concludes that fathers and rental status (Addis & Mahalik, 2003). Not the children so that their partners can at- mothers seem to influence their children in surprisingly, fathers are significantly less tend, or they are at work providing for their similar rather than dissimilar ways. Paren- involved in clinical interventions for their families. Men generally prefer to do things tal warmth, nurturance, and closeness are children than mothers, and fathers tend not to help out as opposed to connecting by associated with positive child outcomes re- to be included in the overwhelming major- talking about the stresses and strains. gardless of whether the parent involved is ity of research on child- and family-relat- Until relatively recently, the role of fa- a mother or a father. ed therapy. Nonetheless there is evidence thers in child development was largely ig- Jones and Mosher (2013) in a nation- suggesting that fathers have a positive in- nored in the professional literature. While Robert Naseef, PhD ally representative survey of over 10,000 fluence on child behavior when they are traditionally regarded as providers and men found that most American fathers say included in the mental health treatment. protectors, fathers were not expected to be sequently the literature specifically about they are heavily involved in hands-on par- Research has consistently shown that involved in day-to-day parenting, with the fathers of children with ASD is limited; enting. This results in significantly better men are less likely than women to admit to notable exception of discipline. In empha- however, the broader literature can inform outcomes for their children in academic uncomfortable or negative feelings (Addis sizing the importance of mothers, research- contemporary practice and research. success, fewer behavior problems, and & Mahalik, 2003). Seeking help typically ers lost sight of the father in the family con- healthier eating habits. Fathers living with involves recognition of problems and is in text. The word parent became synonymous Father Involvement children younger than 5 reported that 90% direct conflict with the masculine gender with mother. This same trend applied to bathed, diapered, helped toilet or helped fathers of children with disabilities. Con- Lamb (2010) found that past studies their children to get dressed at least several see Father on page 36 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 25

Why I Wasn’t Afraid I might rush you whenever you try to call to you impatiently when you stop to explain something to me in your halted, count all the tubs of frosting in the aisle of to Label My Son robotic speech. the grocery store. Every day I would feel exasperated and “Jack, come on. Let’s go!” Dear Jack, frustrated and angry and scared. I might But instead, I will myself to slow down, even feel embarrassed or ashamed. to stop the cart next to you and help you When you were about year old, we saw a Maybe we would hide in the house like choose the best, most perfect pink frost- bunch of doctors and specialists to try and we did when you were a toddler, avoiding for the heart-shaped Valentine’s Day figure out why you didn’t talk or point or ing play dates and trips to the library so I cake you’ve been talking about baking for look at us. And at that time, many people didn’t have to see all the other kids who weeks and weeks. told us not to rush to give you a label. could wave bye-bye and blow kisses and Maybe I would wish your baking phase “Be careful with a label, because it will play peek-a-boo. was over, because sometimes it wears on be on all of his forms and medical records,” But now, we don’t hide. We go to the me. But as I become more and more ac- one man advised. movies and to church and to restaurants quainted with autism, I know there will just “It will follow him for the rest of his and roller skating. We go on vacation. be another phase lurking right behind it—it life,” another woman warned. Jack, you are labeled. And every day could be something innocuous like when See Jack-a-boo, people don’t like labels. I feel exasperated and enlightened and you used to rub soap all over the walls, but No one wants to be limited or boxed in or aware and frustrated and thrilled and angry maybe it will be something dangerous and classified. They especially don’t want to and scared. I feel protective and vulnerable scary, like when you used to try and run be pigeon-holed, which actually has lit- and inspired. behind cars to see the license plates. tle to do with a bird and more to do with However, I never, ever feel embarrassed With your label, I have learned to enjoy compartmentalizing people into teeny-tiny, or ashamed. the hoof beats of horses, because I know mutually exclusive categories. (Well, I might have been a little bit em- there are zebras ahead. But at the tender age of 18 months, the Jack proudly writing out his barrassed the time we went to see Malefi- If we didn’t know you had autism, Dad- doctor diagnosed you with autism spec- cent and you announced, “We don’t need dy and I would probably be divorced. The trum disorder, and from that point forward, Valentine’s Day cards to BUY your candy. We have some HID- pressure of fitting a square boy into a round you were labeled. DEN IN MY MOTHER’S PURSE,” to the world would be way too much for us, and Honestly? I’m glad. See, if you didn’t have this label, I would guy who took our tickets.) we would crack apart. Now, I’m not saying I’m glad you have au- probably snap at you to stop jumping and Renouncing your label would be a fun- Oh, we still argue. You know that. We tism. I’m not really sure how I feel about that. rocking and flapping. damental rejection of who you are, like de- disagree on whether or not you should wait I’m just saying I’m glad we know you I would think you were naughty and rude nying that you have blue eyes or long legs. have autism. I’m glad for the label. and disrespectful. If I didn’t know you had autism, I might see Label on page 38 PAGE 26 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Behavior as Desire for Control in Autism Spectrum Disorders

By Daniel Crofts, MA you find yourself often unable to comply man life, a combination of nature and nur- Day Habilitation Assistant with what is expected of you. ture, heredity and environment, inner and Genesee County Chapter NYSARC Doesn’t sound so easy, does it? In sim- outer. I would say, therefore, that we need ilar circumstances, who wouldn’t look to look at behavioral issues in autism in for and seize whatever little control they reference not only to autism as a diagnosis, ccasionally we all need a gentle could? Here is where behavioral concerns but also to autism as a human phenomenon reminder that autism is not an can come into play. – which is to say, we have to look outside abstraction floating around in If you think about it, disruptive behav- as well as in. The whole “dance” of nature the ether. Autism is real precise- ior is almost like a kind of magic. In your and nurture, which profoundly influences Oly because people experience it, and sep- mind, play the part of the misbehaving behavioral habits, starts in the formative arate cases of autism spectrum disorders child a moment: With a single word, ges- years of infancy. For that reason, I make a differ so markedly because their subjects ture, action or refusal, you can exercise a momentary digression. are unique individuals with different per- powerful influence on your environment. Why do babies cry? In a word, desire. sonalities, experiences, genetic and envi- Facial expressions change, adults turn their They want to be fed. They want to be put ronmental influences, etc. attention away from whatever they were to bed. They want to have their diapers For that reason, in my opinion, any ex- doing before in order to handle the situa- changed. They want to be cuddled and ploration of behavioral issues in autism tion you are creating, the whole mood and loved. And lest we think that crying is the should be prefaced by a consideration of atmosphere of your surroundings change, only infantile behavior associated with human behavior in general. and your peers might even have behaviors such needs, let us keep in mind the “suck- Certain behavioral issues are particular of their own. Quite possibly, you may even ing” gestures a baby will make with his/ to autism. This is especially true of senso- be able to get out of unwanted situations or her mouth in anticipation of receiving milk ry-related behaviors, and I would say that obtain something that you desire. from the breast (or from the bottle, depend- the sensory component, after considering on the mother’s method). ation of possible medical concerns, should How’s That for Control? Many psychologists will tell us that this come first. Daniel Crofts, MA is part of the infant’s desire for integration At the same time, there are as many rea- Again, there are many kinds of behav- of experience, for correspondence of in- sons for human behavior as there are ways control might be in any instance. So imag- ior. For people on the autism spectrum as ner needs and outer reality. A major need of behaving, and people on the autism ine being a child on the autism spectrum: well as for everyone else, these tend to be of the infant is, of course, learning to un- spectrum are no different in that regard. Your sensory sensitivities are such that the rooted in deeply ingrained habits and pat- derstand his world and himself. But s/he is That said, I want to focus on a motivation world seems always to be either attacking terns of thought. To be sure, an individual so radically dependent on adult caregivers for human behavior that is perhaps not at- you or preparing to do so; your under- person’s free will is the only factor in direct that his/her self-confidence and self-con- tended to as much as it might be: Control. standing of social, personal and practical causal relationship with his/her behavior trol will only attain healthy development No one likes to lose control. Most of us norms are so different from those of the (except in cases of severe intellectual in- to the degree that adult controls and aids – even if unconsciously – will latch onto it world around you as to make you feel like capacitation). But there are a variety of key wherever we can, however superficial our you are on another planet some days; and influences that are, like so much else in hu- see Control on page 35

Adults from page 1 AB models of functional analysis - AB Functional analysis of precursor behavior models of functional analysis involve - Precursor models of assessment general- often engage in challenging behavior that manipulating the settings or antecedents ly involve conducting a functional analy- is considerably more intense in compari- for problem behavior and observing the sis for a less severe problem behavior that son to that of the behavior of their younger effect on the occurrence of the behavior. reliably precedes the more severe chal- counterparts. The risk of injury may deter For example, a practitioner may expose lenging behavior. For example, if inap- staff members from running sound func- a student to low levels of attention (e.g., propriate vocalizations were to occur im- tional assessments despite the empirical acting distracted) or presenting difficult mediately prior to aggression, conducting support for their use. demands (e.g., a math worksheet) and then a functional analysis of the vocalization observe the effects on problem behavior. may yield information about the function Concern with running traditional function- These manipulations may provide valuable of the aggression without actually evoking al analyses - While traditional functional information about what triggers and main- it. Precursor models of assessment have analysis represents the most accurate way tains problem behavior. For instance, if an garnered empirical support for their use to determine the function of the behavior, individual engages in problem behavior (e.g., Smith & Churchill, 2002) and may it is also the most intrusive and time-in- when presented with demands, but does be particularly useful for limiting the oc- tensive assessment method. Furthermore, not engage in the absence of demands, it currence of problem behavior during the there is a concern that this kind of assess- suggests that escape may be the function of assessment process. ment involves the evocation of maladap- the behavior. The outcome data recorded tive behavior, which increases risk to the from this type of assessment is comparable Intervention Strategies for Adults learner and the staff who are conducting to traditional functional analyses and has with Autism Spectrum Disorders the assessments. been shown to be empirically sound (Free- man, Anderson, & Scotti, 2000; Anderson Broadly speaking, best-practice inter- Complexity of challenging behavior in & Long, 2002). ventions can occur at one (or more) of adults - Intervening with challenging be- Robert H. LaRue, PhD, BCBA-D three points along the ABC sequence of havior in adult populations with autism Trial-based models of functional anal- problem behavior described above: doing tends to be more labor-intensive and dif- ysis - Trial-based models of functional something to the environment before the ficult, in that it tends to be more complex. promises the subsequent effectiveness of analysis involve running extremely brief behavior happens, training an alternative Maladaptive behavior that has occurred interventions and worsens outcomes for sessions (e.g., 1-2 minutes) and only rein- behavior to replace the maladaptive be- over the course of many years may be con- the adult ASD population. forcing the first instance of the maladap- havior, or changing what happens after trolled by many different factors and have tive behavior. This method of assessment the behavior has just occurred. It bears multiple forms, which can increase the dif- Assessment Solutions has garnered empirical supported and has repeating that the implementation of all of ficulty and the duration of the assessment been shown to correspond well with tradi- these strategies either require or are great- and intervention process. In light of these challenges, there have tional functional analysis (Bloom, Iwata, ly enhanced by an accurate understanding been a number of less intrusive assessment Fritz, Roscoe, & Carreau, 2013; LaRue, of the function of the maladaptive behav- These concerns often lead to the use of variations that may be of particular use Lenard, Weiss, Bamond, Palmieri, Kel- ior in question, which may be determined less intrusive, yet less empirically sound for older learners exhibiting challenging ley, 2010). In addtiion, this assessment through functional assessment techniques. modes of assessment. The use of less sup- behavior. These procedural variations in- method reduces the overall occurrence The bottom line is that better assessments ported methods of assessment increases clude: AB models of functional analysis, of maladaptive behavior, thus mitigating permit better treatments. the likelihood of errors occurring in the trial-based functional analysis, and the concerns about evoking and reinforcing assessment process, which in turn, com- functional analysis of precursor behavior. maladaptive behavior. see Adults on page 41 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 27

Understanding Aggressive and Self-injurious Behavior

By Rachel LaPiana, MSEd, BCBA in turn, encourages the behavior to occur ABA Training Coordinator more frequently in the future. Reinforce- QSAC ment is individualized and personal and must possess desirable properties. Be- havior is maintained through reinforcing hen addressing challeng- consequences present in the environment; ing behaviors, specifically however, not all items and activities will when it comes to aggressive maintain the same reinforcing value over behaviors and self-injury, time, across environments and across peo- Wit’s important to understand the reason ple as the significance of things change day as to why these behaviors are occurring to day and often moment to moment. before determining a solution. The behav- In relation to severe problem behavior ior of all living organisms serves specific that can put an individual at risk or risk the purposes; and the reason behavior occurs safety of others, experts strive to identify varies depending on an individual’s need the function and the maintaining reinforcer in a given moment. Dependent on the cir- as soon as possible in order to implement cumstances, one behavior can serve mul- an intervention quickly. Initially, a clear tiple functions or multiple behaviors can description of the behavior is required in serve one purpose. order to assess the function. Antecedents, Understanding the basic function of be- setting events and environmental factors havior is pertinent when dealing with the are all subject for review when determin- behaviors related to individuals on the ing the function of any behavior. Experts autism spectrum. Research indicates that often look to do a functional assessment individuals with greater skill deficits often jurious and aggressive behaviors can be a perature. Once basic needs are met, individ- and sometimes a functional analysis to de- engage in higher rates of aggressive behav- result of biological or biochemical compo- uals then look to satisfy what are known as termine a cause or pattern in behavior. iors. This is likely due to inefficient com- nents leading to compulsive type behaviors secondary needs. Secondary needs include Maintained across all functions, aggres- munication abilities, reduced socials skills that are difficult to treat (Autism Speaks, items and activities that are learned and are sive behaviors toward one’s self or others and social supports, as well as a greater 2012). However, in general, most behav- comprised of things that living beings deserve to meet the needs of the individual. degree of intellectual disabilities (Stur- iors are learned and reinforced over time. sire but do not require for survival. Often times, individuals with autism are mey, n.d.). Aggressive behaviors tend to be At the very core of most human behav- In relation to human action and primary unable to make requests for the things they more prevalent during the younger years of ior is the inherent need to satisfy primary vs. secondary needs, the term reinforce- need and want. Once identified, the func- a person’s life and appear to be directed to- needs. The primary needs of all living be- ment is widely used in the behavior ana- tion of aggressive behaviors that are emit- ward familiar people and caregivers as op- ings are classified as unlearned and natural; lytic community. Reinforcement refers to ted can be replaced with a more appropriate posed to strangers (Autism Speaks, 2012). these include hunger, thirst, sexual drive, the presentation or removal of a stimulus Further, some studies suggest that self-in- and the ability to maintain appropriate tem- immediately following a behavior which see Aggressive on page 32

Hormone from page 22 Mount Sinai. “Results from this pilot trial imental therapeutics who are dedicated to single medical school, the Health System will facilitate larger studies that more de- discovering the biological causes of ASD. has an extensive ambulatory network and mouse models developed at Mount Sinai finitively inform efficacy and better target- The Center strives to develop innovative a range of inpatient and outpatient ser- and human neuronal models derived from ed therapeutic treatments.” diagnostics and treatments for integration vices—from community-based facilities to pluripotent stem cells (stem cells that This study was funded by that Beatrice into the provision of personalized, com- tertiary and quaternary care. have the capacity to produce several dis- and Samuel A. Seaver Foundation and by prehensive assessment and care for people The System includes approximately tinct biological responses) of humans with the National Institute of Mental Health, with ASD. The Seaver Autism Center was 6,600 primary and specialty care physicians, SHANK3 deficiency previously suggested part of the National Institutes of Health. founded through the generous support of 12-minority-owned free-standing ambulato- that IGF-1 can reverse synaptic plasticity the Beatrice and Samuel A. Seaver Foun- ry surgery centers, over 45 ambulatory prac- and motor learning deficits. These studies About the Seaver Autism Center for dation. For more information, visit www. tices throughout the five boroughs of New formed the basis of this clinical trial and Research and Treatment at Mount Sinai seaverautismcenter.org. York City, Westchester, and Long Island, as the results provide support for the ongoing well as 31 affiliated community health cen- effort to develop related drug treatments. The Seaver Autism Center for Research About the Mount Sinai Health System ters. Physicians are affiliated with the Icahn “This clinical trial is part of a paradigm and Treatment at Mount Sinai conducts School of Medicine at Mount Sinai, which shift to develop targeted, disease modify- progressive research studies aimed at un- The Mount Sinai Health System is an is ranked among the top 20 medical schools ing medicines specifically to treat the core derstanding the multiple causes of autism integrated health system committed to both in National Institutes of Health funding symptoms of ASD,” says Joseph Buxbaum, spectrum disorders (ASD). The multidis- providing distinguished care, conducting and by U.S. News & World Report. PhD, Director of the Seaver Autism Center ciplinary team is comprised of experts in transformative research, and advancing For more information, visit www.moun- and Professor of Psychiatry, Genetics and the fields of genetics, molecular biology, biomedical education. Structured around tsinai.org, or find Mount Sinai on Face- Genomic Sciences and Neuroscience at model systems, neuroimaging, and exper- seven member hospital campuses and a book, Twitter and YouTube. PAGE 28 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Proven from page 1 the number of physical interventions by 80 manage problems. percent within 18 months.” For a family or When consistent in this practice, the ben- reduce challenging behaviors and see individual caregiver, it may be “I will work efits will quickly become evident—people positive improvement is to fully commit with [name] to reduce tantrums by 10 per- respond well to praise and reinforcement to bringing about a new kind of environ- cent this month.” when it is properly and lavishly used. ment—the caregivers have to change be- Organizations should make sure that This applies to how staff training is ap- fore the individual with challenging behav- measurable goals are announced loud and proached in addition to direct interaction iors will. clear throughout the organization. with individuals with autism.

2) Gather Data - It’s important to start by 5) Share the Plan with the Full Team - 7) Redefine Key Support Roles - This is collecting baseline data for several rea- Dramatically increasing the effective use especially important in organizations, sons. Having a quantitative measure of the of praise and reinforcement is an essen- where the roles of specialists like psy- starting point allows accurate and objective tial element of a positive approach. Most chologists and behavioral specialists progress tracking, encourages new think- people who work in this field have never need to evolve from doing to teaching. ing, and demonstrates ultimate success. worked in or experienced an environment Job descriptions may need to be rewrit- The first step is to determine what the where praise and reinforcement are used ten to reflect this change. They should caregiver or organization wishes to mea- lavishly. adopt a view of themselves as behavioral sure, and how that data will be collected. This presents a dilemma whereby many mentors to direct service, supervisory and Examples include: number and types of staff members feel they use praise and re- clinical staff. physical interventions utilized by the orga- inforcement effectively when, in fact, sig- The goal of this process is to put the tools nization and its various departments, num- nificant improvement is needed. of positive practice in the hands of the peo- bers of injuries, number of tantrums, the An immediate step can be taken to col- ple who do the work. Rather than the tra- amount and extent of damage to property, lect base line data. The types and rates ditional paradigm of having a very small and others as relevant. Each organization of reinforcement should be counted for a percentage of “behavioral specialists” on may determine what it will measure, but, George Suess particular time interval. Then goals can be staff, the emerging new paradigm will use measurement is critically important. established and an organized effort can be existing specialists to train and develop the team expertise as well as their willingness initiated to dramatically increase both the entire workforce so that 100 percent of the 3) Assess Internal Team - This is primarily to change or improve. types and rates of praise and reinforce- team will become specialists in positive geared toward organizations, but would be ment. Consider challenging staff to praise behavioral approaches. relevant for any group working together to 4) Define a Plan and Goal - Depending or reinforce each person they are working Outside of organizational settings, care- create a more positive environment for an on their size and current expertise any with once per minute for one week. givers should consider, who else plays a individual with autism to reduce challeng- given organization should be able to dra- role in the individual’s life? Be sure ev- ing behaviors, including families, caregiv- matically reduce their reliance on phys- 6) Increase Praise and Reinforcement - eryone is on the same page with this new ing teams, and others. ical interventions within one to three Positivity means focusing on the good in positive approach. Instituting this type of change will go years. A proper internal assessment will people and on the good times. It nourishes more or less easily depending on the ex- generate the information and analysis strong, caring and productive relationships. 8) Limit the Availability of Physical Inter- pertise of the team involved, and their necessary to set a proper goal within a The most powerful tool for positivity is vention - Another way to help reduce the willingness to embrace whatever changes reasonable time frame. consistent use of praise and reinforcement. implementation of physical intervention is affect them individually. An early step in For an organization, that goal might look This practice frees caregivers to use their the process should be to objectively assess like “The XYZ Organization will reduce creative power to find solutions rather than see Proven on page 42

Asperger’s from page 16 the meaning of the diagnosis and cautious powerful defenses for parents which, if left Thinking about the Child’s about attributing a label that can be lifelong. unattended or unresolved, can have a mean- Age and Level of Functioning or asthma then a psychiatric one. So, why ingful impact on how their child makes the difference? One of the big answers is Parents Processing sense of their diagnosis. Therefore, if you Children are diagnosed at various dif- stigma. Despite how far we’ve come in the Their Own Experiences are considering having this discussion with ferent ages, across different times in their field, psychiatric disorders of the mind are your child, we recommend first investing lives. They can be diagnosed as young as viewed and treated differently than those Another important consideration is the time into exploring your beliefs and bias- two or three or well into adolescence, so of the body. And even parents of special parents’ reactions to the diagnosis. One es about their diagnosis. Even if you hold the discussion about when and how to talk needs children, while likely more sensitive thing to keep in mind is that our children these views close to your chest, your chil- to a child about the diagnosis will likely be to the effects of the stigma, are not neces- are reflections of ourselves. More often dren may pick up on them implicitly. We impacted by the age of the child. In addi- sarily immune to them. than not, one or both parents identifies with are big advocates of parents scheduling tion, the Asperger’s diagnosis can be given This issue is especially complicated what their child is going through because meetings with a psychologist as a means to a wide range of children with various when it comes to autism spectrum disor- they experienced similar struggles them- of processing through their own feelings challenges and levels of emotional maturi- ders. There are some in the field who don’t selves. There are times where a child’s di- about their child’s diagnosis before sharing ty. Some children may be able to grasp the view Asperger’s or autism spectrum disor- agnosis may also bring to light a parent’s it with their child. These meetings can help nature of the diagnosis at seven and eight, ders as disorders at all but rather as unique undiagnosed condition that has been un- parents clarify some of their own feelings while for other children, it may seem too ways of perceiving the world that should treated or misunderstood for many years. and help them formulate a language and de- abstract, even at 16 years old. Both a child’s be embraced rather than cured. All of this Acknowledging their child’s disability may scription that they are comfortable with in makes it even harder for parents to gauge therefore trigger painful memories and speaking with their child. see Asperger’s on page 33 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 29

Bitten by the Truth

By Alexandra Bricklin, MA, MT-BC had vehemently sought absolution. What proved, I did not. It wasn’t until she began Parent and NSEAI Certified more could I do to help this wild (adult) smiling again saying, “I love you mom- Special Education Advocate child acquire impulse control? my!” that I began to confront the source of my own pain and suffering. Five Days Later At first I thought I was merely sick from hree years ago, at 4 am in the the deadly antibiotic I had taken in order morning, my life began to unravel The jury approved an additional two to prevent infection from the human bite when my daughter sank her teeth week commitment, but I convinced them I had sustained. The antibiotic did carry into the fleshy part of my inner to discharge her into pending 24/7 in- a warning label: Can cause serious diar- Tthigh. “Mommy, please help me!” she home supports. Within two weeks, I had rhea. I had a stool sample taken. The lab begged as she fell to her knees and grabbed two awake staff all night long, 7 nights a test came back negative. Then I rational- my legs. Then she clamped down hard and week. They blocked her from beating on ized that it must be exhaustion and disori- held on tight like a pit-bull. I screamed, my bedroom door. In response, she threw entation from my loss of control over my her teeth still embedded in my inner thigh. household objects at them and threatened own home that was causing me to feel so When the policeman approached her, she to kill them. ill. I was having flu-like symptoms - night kicked him. He faced her down and hand- Each night, I lay wide awake locked up sweats, chills, chronic diarrhea, stomach cuffed her. Two emergency responders in my bedroom listening to her tirades, pain and no appetite. I was restless, irrita- strapped her into a gurney and shuttled off shuddering like a victim of an air-raid. In ble and couldn’t concentrate. to the hospital. That morning we had seen the morning, I got up, made her breakfast When I could no longer eat anything, I a Cognitive Behavioral Specialist for my and went to work, leaving her in the care of took myself to the emergency room with daughter’s nocturnal panic disorder and the next shift. my suitcase packed. I wanted to be admit- its resulting insomnia. This specialist had It was agonizingly stressful trying to ted. At least I could receive IV fluids and confronted her: “If you continue keep- adjust to the 12 different people coming some rest. The ER doctor grinned. “You ing your mommy up at night, she will get and going in and out of my house day and think you need to be admitted, huh?” he sick!” This, of course, was the trigger that night. My feelings of discomfort with the joked. He had been on duty that dreadful set her off that night. Ever since her dog strange people awake all night in my living night. When he inquired if she was still liv- had died, she had been terrified of falling room resulted in forfeiting all urges to go ing at home, he ordered a CT scan, pumped asleep. Her solution was to stay awake. downstairs for anything, not a cup of tea or me intravenously with Pepcid AC and sent When I arrived at the ER, I learned she Alexandra with her daughter a snack, not for anything. I reassured my- me home with a tranquilizer. had bitten hospital personnel. This ex- Rebecca (above) self that all of those people were necessary “Ok, so now what?” I argued with my- plained the 4-point restraints and a bleed- to keep my daughter out of institutional- self. And then, in the midst of my angst, ing catheter hanging between her bare legs. How had my cute, beloved autistic child ization. I honestly did appreciate them tre- a subtle but miraculous thought revealed She remained in 4-point restraints until grown up into such an ugly dangerous mendously. So, why was I so miserable? itself. “I don’t want to live with her evening when involuntarily admitted into adult? For 26 years I had allowed myself Even when her screaming out for me acute psychiatric care. be held captive by her angry outbursts, and began to diminish and her insomnia im- see Truth on page 34

Building Comprehensive, ABA-Informed Services in an Adult Residential Setting

By Rishi Chelminski, BCBA, Terence G. Blackwell, BCBA, needs of adults diagnosed with ASD are take a functional analytic approach to Much in the same way, at SUS we have and Louis Cavaliere likely to increase over the lifespan. If their treatment. This means that interventions found that therapists of many disciplines, Services for the UnderServed Inc. needs persist, the applicability of ABA-in- are chosen based on direct, empirical ob- direct-service professionals, and care formed services persists as well. In order servations of each individual’s own pref- coordinators can collaborate well when to provide the highest-quality of services erences and values, skills, and relation- their work is unified by the language and hroughout the United States, ser- across the lifespan, new models of ABA- ship with their environment (Hagopian & principles of ABA. vices for school-aged children based practices need to be developed that Boelter, 2005). This last idea is one which may require with Autism have been bolstered work beyond the school setting. This task Along with the movement towards per- perhaps the most difficult cultural shift by IDEA (the Individuals with is daunting on many levels; the world of son-centered planning, there has been within adult service agencies. Although TDisabilities Education Act). Of the ser- adult services exists on framework of fund- a concerted movement towards evi- ABA is a science which informs practice, vices IDEA has made available, those in- ing and oversight that presents challenges dence-based, data-driven interventions. and therefore a potential tool for uniting formed by the science of applied behavior not seen in the school setting. However, This is another area in which ABA-based many disciplines and providing compre- analysis (ABA) are gaining broad recog- in 2011 Services for the Underserved Inc. services are fundamentally well-suited to hensive care, it is often used in isolation nition as the most successful (Lilienfeld, (SUS) committed to taking on this chal- provide solutions. Under an ABA-based from other services that an individual may 2005; Rogers & Vismara, 2008). A re- lenge, and many of the individuals we model, treatments are not only developed receive. As an agency wishing to integrate view of recent publications, whether it be serve have already begun to benefit from based on empirical observations, but are ABA into our palate of services, at SUS the National Institutes of Health, the US this decision. continuously evaluated using data analysis we have chosen to move away from the Surgeon General, opinions of a variety of We were fortunate in our timing. Al- of an individual’s behavior. mindset of “having an ABA therapist that State and national departments of health, though ABA is often thought of as a field Finally, the coming climate in our is available to our individuals,” and in- or over 50 years of scientific research, suited to working with children, many of field is one that recognizes interdisci- stead move toward the more comprehen- points to the fact that ABA-informed ser- its guiding principles dovetail well with plinary collaboration as an essential part sive goal of “having a range of therapists vices are the foundation for effective treat- recent trends in adult services. In recent of high-quality, person-centered care available, all of whom use ABA to inform ment of individuals with Autism Spectrum years, “one size fits all” models of care (World Health Organization, 2010), an their practice.” Disorders (ASD). have given way to an emphasis on per- idea bolstered by the implementation of Creating such a comprehensive clinical At the age of 21, many people with ASD son-centered interventions (for a review initiatives such as the Affordable Care environment requires long-term strategic transition into systems where ABA-in- on Person-Centered Planning, see the Act. Such collaboration requires a natural planning. It is probably not surprising that formed services are few and far-between, NYS OPWDD website www.opwdd. science-based language and set of prin- we have chosen our Behavior Intervention and the barriers to receiving such services ny.gov). ABA-based services have, by ciples that crosses disciplines. Within a Specialists to take on the role of bringing are high. The needs of these individuals their fundamental nature, always been en- medical environment, practitioners of ABA-informed services to our programs. do not cease once they reach 21. To the tirely person-centered. Indeed, this is one myriad medical disciplines collaborate However, we also recognized early on contrary, a review by Happe and Charlton reason why they are so readily funded in well with one another because they are that this project required commitment (2012) published in the journal Geron- the school setting through IDEA. Practi- united by the common language and prin- tology identifies many ways in which the tioners who use ABA to inform their work ciples of biology, chemistry, and physics. see Residential on page 31 PAGE 30 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

The Effect of Preceding or Antecedent Physiological and Environmental Factors on Challenging Behavior

By Mindy Scheithauer, PhD, BCBA, may engage in the same behavior to get out pens his mother may give him breaks to served during academic work. Joanna Lomas Mevers, PhD, BCBA-D, of doing work. By determining the reason allow him to calm down. When the child The physiological effects of medications and Nathan A. Call, PhD, BCBA-D challenging behavior occurs, therapists can is tired, homework is likely to be even less may also result in certain activities being Marcus Autism Center tailor treatment to address the individual’s enjoyable than normal (or more aversive). more or less preferred. For example, Nor- Emory University School of Medicine specific needs. The majority of these tech- Thus, if homework is more aversive and thup, Fusilier, Swanson, Roane, & Borrero niques address the consequence aspect of aggression results in avoiding homework, (1997) found that access to food and activ- behavior by ensuring that, following the aggression might be more common during ities was less reinforcing when a child was hallenging behaviors (e.g., ag- challenging behavior, the individual does homework time when the child is tired. In on methylphenidate (e.g., Ritalin, Concer- gression, self-injury, and disrup- not receive the preferred outcome that mo- another example, a child who engages in ta). In another study, methylphenidate was tion) are prevalent among indi- tivated that behavior and instead receives aggressive behavior to gain access to food found to specifically decrease disruptive viduals diagnosed with an autism the preferred outcome for more adaptive/ (e.g., when the child aggresses caregiv- behavior when an individual was given Cspectrum disorder (ASD; Hartley, Sikora, appropriate responding. ers assume he/she is hungry and offer a attention following this behavior (Dice- & McCoy, 2008). These behaviors are a These consequence-based strategies are snack) may be more likely to aggress if sare, McAdam, Toner, & Varrell, 2005). common referral concern for treatment be- extremely important and effective, but it he/she is particularly hungry. In this case, Research has also suggested that menses cause they can cause injury, interfere with is also important to consider how anteced- being hungry makes food even more pre- (Taylor, Rush, Hetrick, & Sandman, 1993), adaptive development, and increase famil- ents can guide treatment, especially for ferred and is therefore likely to increase ear infections (Carr & Smith, 1995), and ial stress (Herring et al., 2006). individuals who engage in challenging be- aggression that often results in food. Vari- sleep deprivation or fatigue (Kennedy & Behavioral treatment techniques are an havior infrequently (e.g., only engages in ables that make an event more or less Meyer, 1996) are all physiological states effective way of addressing challenging challenging behavior once a month) or at preferred or reinforcing are referred to as that may increase the likelihood of prob- behavior for individuals with ASD exhib- variable rates (e.g., a lot of problem behav- motivating operations. lem behavior in certain contexts. iting a range of challenging behavior (e.g., ior for two days followed by a week with Physiological states may frequently In addition, environmental variables may Horner, Carr, Strain, Todd, & Reed, 2002). none). In these situations, it may be espe- serve as motivating operations by chang- serve as motivating operations. Kennedy The basis of behavioral treatments focuses cially important to consider antecedents to ing preferences for certain items or activi- and Itkonen (1993) found that one individ- on three factors: 1) the antecedent or what identify when problem behavior is most ties. Past research suggests that individuals ual with a developmental delay engaged in occurs before challenging behavior; 2) the likely and develop a treatment that will experiencing pain and discomfort may ex- more self-injury and aggression when she behavior itself; and 3) the consequence or work specifically during these times. hibit more problematic behavior, especial- woke-up late and had a hurried morning what happens after the behavior. Through Several variables may serve as anteced- ly when problem behavior results in escape routine, whereas another individual with careful consideration of these three ele- ents for problem behavior in that, when (or a break) from aversive activities such as similar problem behavior was more likely ments, a clinician can determine the behav- these variables are present, they increase homework or chores. For example, Kenne- to exhibit this behavior when encountering ior’s function, or reason “why” the individ- the likelihood of problem behavior in a dy & Meyer (1996) found an individual’s traffic on the way to school. For both of ual engages in challenging behavior. For certain context. For example, a child may self-injurious behavior was more likely these individuals, behavioral treatments example, some individuals engage in prob- become aggressive every so often when when he was exhibiting allergy symptoms, lem behavior to get attention while others asked to do homework. When this hap- and this increase was most commonly ob- see Effect on page 43

OPWDD from page 22 the world of employment anytime soon, ing parents, remaining in their family’s dividuals on the autism spectrum (or any OPWDD’s day habilitation programs home may not be a realistic option. In ad- other developmental disability) with the to employment, or they may be of the offer an alternative service. These pro- dition, with the lack of affordable housing statewide scope of New York’s services age to retire. Alternate options for these grams are designed to assist an individ- in many communities, most individuals’ is untested nationally. Under this plan, individuals include: support services at ual to acquire needed skills in self-help, SSI payments are insufficient to afford instead of paying providers directly for one’s home, self-directed supports, or a communication, social and recreational rent in regular community-based hous- each service they provide for an indi- day habilitation program. Many who are areas, among others. Due to the Feder- ing. Even if affordable housing is found, vidual, OPWDD will pay managed care new to the workforce will begin with al government’s advocacy to ensure full sometimes the budget created for an indi- entities a capitated rate (a per person per part-time positions as they test out their community integration, over the next vidual may not cover the cost of 24-hour month amount) and they in turn will pay job skills and attempt to match their in- couple of years many of the existing day staffing. This specifically becomes a ma- providers for each service. These man- terests and skills with available jobs. In habilitation locations will need to modify jor challenge for individuals on the autism aged care entities would be responsible addition, there are other individuals with their programs to ensure that participating spectrum. Reliable residential waiting list for coordination of all Medicaid funded more severe and complex disabilities that individuals receive their services in as in- data is admittedly limited. However, ac- services including OPWDD, healthcare, may not have the interest or skills to ac- tegrated environments as possible. This cording to June 2014 information from mental health, substance abuse, and per- quire employment. In either situation, will result in participants spending more OPWDD, there were 6,436 individuals sonal care. Enrollment in the managed there must be a system in place to ensure time in volunteer experiences, or receiv- in need of residential services within 2 care program will be voluntary for indi- there are meaningful activities available ing their supports in natural community years and another 5,309 individuals who viduals during at least the first 2 years. during times when their family or care- locations surrounded by people without needed residential service by 2020. These While this program was originally slated giver is working. Traditionally, New disabilities—as opposed to segregated numbers are daunting by anyone’s mea- to begin in 2013, it has once again been York State has always made this commit- large program locations. sure, and it is highly unlikely OPWDD delayed. OPWDD has recently begun a ment, while many other states have not. will have the resources in the near future review of its managed care plan and a With the myriad of changes in OPWDD Residential Services to address this level of need. new start date will not be announced until services, advocates need to ensure this this review is completed. level of commitment is maintained. The Over the past 5 years, OPWDD’s fund- Managed Care In summary, the scope and pace of Commonwealth of Massachusetts pub- ing for new residential services has de- changes in OPWDD services is staggering lished a document in November 2013 creased significantly when compared to Since 2011, OPWDD has been plan- to many. As a result, families need to en- regarding their supported employment previous levels. In addition, the Feder- ning to convert its statewide system of sure that they afford themselves sufficient program entitled “Blueprint for Suc- al government has been advocating the services to a managed care model. This time to properly plan the best match of ser- cess,” which states that Massachusetts greater use of integrated environments for is, however, a New York State initiative vices to meet their needs. In spite of the “…remains committed to providing indi- residential supports. As a result, the focus and not a Federal one. Instead it is part uncertainty that surrounds us, we still need viduals’ needed day services in a manner on residential services has changed from of the Cuomo Administration’s plan to to remember that New York maintains the that maintains stability for families and one that relies primarily upon OPWDD bring all Medicaid under a managed care most comprehensive array of services to residential providers during non-work certified group residences to a greater umbrella. While there are many divergent people with intellectual and developmental hours.” If New York reaffirms a similar emphasis of providing supports in fami- opinions regarding the benefits of man- disabilities in the nation. That still counts commitment, it would alleviate many un- lies’ own homes or in typical communi- aged care, it can be an effective method for a lot, and should provide a degree of certainties families may have. ty-based housing. This approach may cer- of delivering services and data does in- comfort for the future. tainly benefit many individuals, however, dicate improved healthcare outcomes for Day Services those who need a greater level of support some people enrolled through Medicaid. For more information about the Inter- or supervision may find this approach However, its effectiveness as a tool to Agency Council of Developmental Disabil- For individuals who will not be entering lacking. For individuals residing with ag- provide long-term support services to in- ities Agencies, Inc., visit www.iacny.org. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 31

Addressing Skill Deficits in Students with High Functioning Autism as a Proactive Approach to Prevent Behavioral Challenges

By Edel McCarville, PsyD vention package is often necessary. Mere- and Colleen Menard, MSEd ly addressing challenging behavior that is Levittown Public Schools occurring without addressing skill deficits that exist will not teach students replacement adaptive skills that they need in order tudents with high functioning au- to be successful. Adaptive functioning is tism (HFA) typically display cogni- important because adaptive skill is close- tive abilities in the average to above ly related to functional independence and average range, and some superior quality of life (Scahill & Lord, 2004). Srange; therefore often participate in gener- Students with ASDs experience delays al education classes. While these students related to social communication, therefore have many strengths, specific educational specific teaching to target these deficits approaches are often needed to address the can help to improve school performance. core deficits of an autism spectrum disor- Lack in skill-set may appear as lack of mo- der. Failing to address the specific needs tivation in a student with HFA. Additional- of students with HFA may in turn lead to ly, difficulties with cognitive flexibility are these students displaying challenging be- common; meaning students with HFA of- haviors (Myles, 2005). ten have difficulty in “going with the flow.” A proactive and multi-dimensional ap- Accepting changes or creating an alterna- proach using antecedent interventions can tive plan when a student’s idea does not be effective in addressing the core deficits work out the way they anticipated can lead associated with ASDs and the individual to behavioral challenges. A modified cog- needs of students with HFA. Specifically, nitive behavioral therapy (CBT) approach interventions addressing deficits in social is effective in helping students to restruc- communication, behaviors associated with Colleen Menard, MSEd and Edel McCarville, PsyD ture thoughts that lead them to becoming having a restricted range of interests, or “stuck.” CBT approaches have been shown stereotyped patterns of behavior should be with an ASD may have one additional di- students with ASDs, it may be necessary to significantly reduce mood disorders in part of a student’s educational program. agnosis, and 40% may have two additional to consider these additional skill deficits. children with ASDs (Bauminger, 2002). Further, individuals with HFA often strug- diagnoses. Common comorbid conditions If core deficits are not addressed, then stu- Educational staff can modify traditional gle with adaptive functioning; meaning are ADHD, developmental coordination dents are likely to experience more signifi- CBT in order to accommodate the needs of they may need support to complete cer- disorder, anxiety disorders and depressive cant challenging behaviors. Due to the va- students with HFA. Providing visual tain daily activities in school. Also, it is disorders (American Psychiatric Associ- riety of components involved in educating important to note that 70% of individuals ation, 2013). Therefore, when educating children with HFA, a multi-leveled inter- see Deficits on page 42

Residential from page 29 These policies and procedures primed als living there, while still making progress References the environment within our agency for the in reducing their challenging behavior and from a broader array of stakeholders, substantial part of our ABA project: bol- strengthening their adaptive skills. Hagopian, L. P, & Boelter, E. W. (2005). from the direct service professionals stering the ranks of our clinical staff with In much of the nation, 1:1 staffing is re- Applied behavior analysis and neurodevel- up through the agency to the CEO and Board-Certified Behavior Analysts, and garded as one of the most restrictive and opmental disorders: Overview and summa- Board. Integrating ABA as a science that (more recently) Registered Behavioral intrusive services that can be prescribed to ry of scientific support. Kennedy Krieger informs practice (rather than a practice that Technicians. These clinicians have brought an individual. These individuals’ ABA-in- Institute. exists in isolation) means that in some way, ABA’s functional-analytic perspective to formed services have not only furthered an ABA-based solution must be offered to our agency, and with it a person-centered, their clinical progress, but have also given Happe, F., & Charlton, R. A. (2012). Aging meet the needs and expectations of all of data-driven, highly-collaborative model them new measures of independence and in Autism Spectrum Disorders, a mini-re- these stakeholders. of services that has already begun to pro- dignity. It is with this vision that we contin- view. Gerontology. 58:70-78. Towards this end, we undertook this duce results for the individuals we serve. ue our roll-out of ABA-informed services, project with the consultation of experts We would like to close this article with an and look forward to seeing similar devel- Lilienfild, S. O. (2005). Scientifically un- within the fields of ABA and residential exciting example of these results. opments from our colleagues in New York supported and supported interventions for care, who have helped bring ABA-in- In recent years, SUS has begun serving a State. As we face the challenge of adapting childhood psychopathology: a summary. formed services to other settings. In partic- large number of individuals with very com- ABA from the school setting to the adult Pediatrics. Mar; 115(3):761-4. ular, the leadership of Dr. Brian Iwata has plex needs. These young adults came to us services setting, we hope to create an en- proven essential to our progress; Dr. Iwata from agencies specializing in the treatment vironment in which individuals with ASD New York State Office for People With is among the world’s foremost researchers of very severe self-injury and aggression, can continue to access cutting-edge treat- Developmental Disabilities (2014). “Per- in the clinical application of behavior anal- as they were deemed as having behavior ments after 21, and across the lifespan. son-Centered Planning.” ysis. With his assistance we were able to “too severe” to be treated in a traditional mount a series of lectures and discussions setting. Following their transition to adult Rishi Chelminski, BCBA, is Director Rogers, S. J., Vismara, L.A. (2008). Ev- that generated interest in ABA among our services, SUS was able to use ABA-in- of Behavior Services, Terence G. Black- idence-based comprehensive treatments agency’s management and clinical staff. In formed services to not only manage these well, BCBA, is Chief Operating Officer, for early autism. Journal of Clinical this way, we learned what these stakehold- individuals’ behavior service plans, but and Louis Cavaliere is Executive Vice Child and Adolescent Psychology. Jan; ers needed from us, and addressed their also conduct a controlled reduction of the President of Developmental Disabilities 37(1):8-38. needs by developing policies and proce- restrictive and intrusive interventions that Services at Services for the UnderServed dures that satisfied both their requirements, many of them had grown accustomed to. Inc. For more information, contact Rishi World Health Organization (2010). and the best-practices models common to In one house alone, we were recently able Chelminski at [email protected] or visit “Framework for action on interprofession- the field of ABA. to fade away 1:1 staffing for half individu- www.sus.org. al education and collaborative practice.” PAGE 32 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Emergencies from page 15 going to do (e.g. checking heart rate) be- calmly, literally and provides visuals when- Diagnostic and Statistical Manual of Men- fore attempting to use this on the person. ever possible. Recognition of these events tal Disorders. (5th ed.). Arlington, VA: strangers nor respond to commands to stop, Caregivers and parents can help respond- as frightening and unpredictable can con- American Psychiatric Publishing. come here or to get into an unfamiliar vehi- ers to understand what kinds of touch are tribute to the prevention of frustration and cle. Preventative supports in the home in- likely to be met with tactile defensiveness impatience on the part of the first responder. Good, D. (2011). Autism Spectrum Disor- clude making sure there are door locks and and can demonstrate effective strategies. der: A fire/EMS challenge. Fire Engineer- alarms as well as instructional methods to Carefully explain, in very simple language, Resources ing, 164 (3), 42-51. teach replacement behaviors. Parents can what you are doing if it involves touch or also address this behavior by making their the use of equipment on the person’s body. Behaviors that are emitted by individuals Kupietz, K. (ND). Best practices for Au- local EMS agencies (e.g. police and fire) Overall fear of the unfamiliar can be ad- with ASDs during emergencies can be un- tism during emergencies. Retrieved from: aware of the situation and making a face to dressed by allowing the child or adult to predictable, frightening and difficult for all http://www.usfa.fema.gov/pdf/efop/ face visit. Personnel should be made aware have a favorite comfort object, to retreat (if involved. There are a number of resources efo46708.pdf. of the child’s unique communication, be- safe and feasible) to a familiar area or to available that are openly accessible for any havioral and sensory needs and any other sit with a familiar person. Emergency sit- interested party. For example, the Nation- McDermont, S., Zhou, L. & Mann, J. limitations. Introductions in advance of uations such as fires or car accidents may al Fire Protection Association (www.nfpa. (2008). Injury treatment among children emergency situations can go a long way to require different response methods and are org/disabilities) has a web page dedicated with Autism or Pervasive Developmental increasing the effectiveness of a possible beyond the scope of this particular article. to providing information about emergency Disorder. Journal of Autism and Develop- intervention. Communication difficulties can be dealt response issues. In 2010 this organization mental Disorders, 38(4), 626-633. Emergency situations can cause the most with during situations by relying on parents released an interactive social story spe- rational of adults to struggle with remain- or caregivers if available and following cifically designed to address the unique Mims, T. (2008). Seeing an invisible dis- ing calm and organized. The parent or care- their lead. Responders must remember that needs of children with ASD in response ability: Autism spectrum disorder awareness giver may be distracted with the responsi- a person with ASD may very not respond to smoke alarms entitled “I Know My Fire training for firefighters in Tuscaloosa, Ala- bilities of comforting the person with ASD to commands the first time and will need Safety Plan” (NFPA, 2010). This book bama. National Fire Academy EFO Paper. and less able to provide history to the EMS processing time as well as possible aug- can be personalized to the individual child provider. Parents and caregivers might con- mentative systems. The team should dele- and interacts with electronic platforms. Law, P. & Anderson, C. (2011). IAN re- sider making a “quick guide” to keep by the gate one person to be the main communi- Autism Speaks (www.autismspeaks.org) search report: Elopement and wandering. door that includes pertinent medical infor- cator in any situation. This person should has a basic information page dedicated Retrieved from: http://iancommunity.org/ mation, insurance numbers and basic visual speak calmly and avoid the tendency to to best practices in an emergency situa- cs/ian_research_reports/ian_research_re- systems that can support communication. repeat or raise their voice to gain compli- tion. Their list of “Quick Facts for EMS” port_elopement. All household members should be aware of ance or a response. Providing a few extra provides concise and helpful strategies the location of this guide for quick access it seconds of wait time to process language (www.autismspeaks.org/family-services/ Myers, S. (2012). Review of mortality in in the event of an emergency. is critical. Use a “talk, wait, repeat” model autism-safety-project/first-responders/ autism drowning. Association for Science when asking questions or providing basic emergency-services). Training, prevention in Autism Treatment. Retrieved from: Intervention Tactics commands. Repeating of questions or com- and intervention strategies can all assist to http://asatonline.org/resources/articles/ mands should be paired with a visual, ac- create a more positive experience for those mortality.htm. First responders can make multiple tion or model on a caregiver or other safe with ASDs and the first responders who changes to their approach and responses to person. The language should be kept as lit- provide emergency assistance. National Fire Prevention Association address communication, sensory and resul- eral as possible, while avoiding the use of (2010). I Know My Fire Safety Plan. http:// tant behavioral needs. Sensory responses humor or sarcasm, as these are often misin- Summary www.nfpa.org/press-room/news-releas- are an issue in ASD and warrant certain terpreted by persons with ASD. Eye contact es/2010/nfpa-releases-interactive-fire-safe- adjustments to the typical response pattern. may be fleeting, avoidant or otherwise im- Training is a vital component of the first ty-storybook-for-children-with-au- First responders may consider decreasing paired. Demanding eye contact may result responder’s ongoing professional devel- tism-spectrum-disorder Retrieved from the amount of lights and sirens on approach in less compliance and more refusals. En- opment and should include a focus on the www.nfpa.org. to the scene. They should limit the number courage the person to look at the responder variability of ASDs as well as the general of personnel who enter a home and consid- by using a favorite object or other item and needs that encompass the definition of this Rzucidlo (2003). Autism 101 for EMS er a “two at a time” approach if possible. A bringing it to their eye level. Do not insist disorder. Ongoing research into best prac- practitioners. Retrieved from: http:// person with ASD may retreat in fear based on “look at me” during an examination. tices during emergencies is needed along www.paemsc.org/assets/files/Au- upon presence of strangers. Limiting the The person with ASD may require with a continued focus on training for all tism%20101%20for%20EMS%20Practi- number of strangers as well as devices and transport in a vehicle to obtain further in- providers. Emergency situations for chil- tioners.pdf noise can help in these situations. tervention. The unfamiliarity of the vehi- dren and adults with ASDs require a spe- Sensory reactions (hypo or hyper, de- cle paired with strangers, lights and other cial focus on prevention through building Quick Guide for Emergencies (ND). pending on the person) may influence the sensory influx may trigger stress reactions familiarity as well as intervention that con- https://www.autismspeaks.org/family-ser- responder’s ability to effectively use equip- leading to refusal behavior. Encourage the siders the core impairment areas. vices/autism-safety-project/first-respond- ment and/or to touch the person during caregiver or parent to be the model for any ers/emergency-services. Retrieved from a physical examination. The responder action including, for example, the use of a Vanessa Tucker, PhD, BCBA-D, is As- www.autismspeaks.org. should ask the parent or caregiver to assist backboard, neck brace or other immobiliz- sistant Professor of Special Education whenever possible during an intervention. ing device. The action of a familiar adult at Pacific Lutheran University. For more Stelter, L. (2013). First responders, take Effective techniques include starting the “doing it first” may change the level of information, please contact Dr. Tucker at note: CDC reports 1:50 children has Au- examination in a distal to proximal fash- compliance with the actual person. Physi- [email protected]. tism. Firehouse, 38 (8), 101-107. ion (Rzucidlo, 2003) and modeling what is cal interventions may lead to increased re- going to be done with the caregiver or par- fusal and aggression. In these situations the References White, B. (2012). Autism awareness for ent first. Other techniques might include first responder should limit conversation the fire service. Minnesota Fire Chief. Jan- using a doll to demonstrate what you are and verbal input to one person who speaks American Psychiatric Association. (2013). uary/February, 30-32.

Aggressive from page 27 ticular behavior to escape a place, person, result of attention seeking motivating sys- part of the individual’s history of behavior, or task. If historically, the task is removed tems. These studies have found that chil- best practice is to first rule out any medical and socially acceptable behavior. For exam- or the individual is taken away from the dren learn to emit problem behavior in re- issues or concerns by seeking medical atten- ple, if an individual is hungry and is not able original environment upon demonstration sponse to low level adult attention (Carr &, tion to the problem immediately. If there are to request food items effectively, upon see- of aggressive or self-injurious behavior, it Durand, 1985). Treatment packages must no medical reasons as to why the behaviors ing food he or she might hit a caregiver to is probable that he or she may have learned focus on teaching individuals to request are occurring, professionals can then look to alert attention in order to be given a meal or that in order to escape or avoid something attention aptly. identify the maintaining variables and exe- a snack. Similarly, if a teacher asks a child that they “don’t like,” aggression or self-in- An individual may present with aggres- cute appropriate behavior strategies. to put away a favorite toy and, in turn, the jury is what is necessary in order to have the sive or self-injurious behaviors as a result of Self-injurious behaviors can be the re- child begins to pull at his/her eyelashes it is aversive stimulus removed under a specific a medical issue. If the person has a limited sult of a motivational system that does not likely that the child is not ready to put away circumstance. By identifying causal factors ability to communicate, he or she may not require any other person to mediate (i.e. the toy and would like more time to play. (e.g. patterns in behavior and antecedents be able to explain to a caregiver that they are provide), which is known as automatic rein- At times, an individual might act aggres- and/ or consequences to behavior), a clini- not feeling well or that something is wrong. forcement. When the behavior itself is mo- sively or demonstrate self-injurious behav- cian or teacher can create a plan to teach the It can very difficult to identify as the rea- tivating and enjoyable to the individual per- iors as a result of being presented with a individual to make requests more suitably. son for particular behaviors if there are no son and he or she is not looking to acquire change in the environment that is thought to Some studies suggest that aggressive or observable symptoms of illness. If aggres- be aversive. He or she may engage in par- self-injurious behavior can be an extreme sive behaviors are new and have not been a see Aggressive on page 40 AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 33

Opinion Piece: Standardized Testing in Schools Inadequately Accommodates Special Education

By Vicki Ofmani, MEd, LDT-C Praxis exams, they are not considered instructional methodologies is one of the Supervisor/SLE Coordinator “highly qualified” to teach those subjects core foundations that have kept New Jer- The Forum School at the high school level without taking a sey’s reputation as the premiere state for mandated number of college credits in that educational practices in force. However, specific subject area. This is discriminato- theories in economics are easily accessible o Child Left Behind (NCLB) ry as at the high school level the general from the internet. covers many federal education education subject area teacher may teach Standards are necessary in educa- programs. The act, in 2001, was the special education students with NO tion. The Common Core State Standards put forth to strengthen Ameri- special education experience or course- (CCSS) are what is expected. They are cri- ca’sN educational system by requiring States work. Again, the emphasis is placed on teria, ideals, goals. They are the top rung. to implement accountability systems cov- achieving subject matter knowledge, not Academic content standards are statements ering all schools and all students. Although necessarily meeting the unique needs of about what students should know and be NCLB covers various education programs, the classified student. able to do upon finishing point of each the requirements for testing accountability As many of us in the special education grade level. There are simply too many. It and school progress undoubtedly receive arena would lament, there is a gap in rea- has been the intent of the states’ consor- the most attention. No Child Left Behind soning here. At a time where more and tiums to make the standards rigorous to requires each state to test each student more of our students are identified with “make” us Americans more competitive in in reading and mathematics each year in disabilities such as Autism Spectrum Dis- the global market. They simply have not grades 3 – 8 and once during high school. order, Behavioral Disabilities, and Specific taken into consideration developmental In science, states must test one time in Learning Disabilities, regular education markers. Our students meet these markers grades 3-5, 6-8, and high school. teachers are not required to be highly qual- at a far different pace than their typically It seems improbable that any educator ified in areas such as “applied behavioral developing peers. That is explicitly why would argue the point that all our students analysis” or “best practices in differential they have been classified in New Jersey should be proficient in grade-level math instruction.” However, special education for educational consideration under the and reading. It is also plausible to trust that Vicki Ofmani, MEd, LDT-C teachers must be highly qualified in aca- law (N.J.A.C. 16A:14). the school system should have expectations demic areas which mean they are tested on The intent is clear and admirable. The that adequate yearly progress will be made refers to the fact that each teacher with- items such as the Asia/Pacific economic content standards are proclamations that and that it should be measurable. In order in the school should be fully certified by indicators. Far be it from offering ideas of should ensure teachers that their students for a school to have made adequate yearly the state and that they must demonstrate isolationism, special educators are, how- have the skills and knowledge they need progress, it must meet its target for student their knowledge of the subject they teach ever, focused on the child’s social, psy- to be successful at each stage of learning. reading and math aptitude each year. through specific credentials or scores on chological and physiological development However, the vastness of them; the complex No Child Left Behind also requires that tests. Though a teacher with Special Edu- as a whole being. Their understanding of all teachers be highly qualified. This term cation certification may pass subject area typical and atypical child development and see Testing on page 44

Asperger’s from page 28 is unique about the child with Asperger’s 3) Role models: Many role models exist child’s forging of his or her unique identity. is the level of discrepancy that can exist that speak openly and share their challeng- While it may take time, we believe treating age and developmental level should be between different areas. A 10-year-old es. Having your child learn about different your child with respect and support when factors when thinking about disclosing the with Asperger’s may have a reading lev- role models in pop-culture or sports with sharing this information will help your child’s diagnosis and considering ways to el equivalent to a teenager in high school specific areas of difficulty who model per- child to integrate this information and em- share this important information. but math abilities of a five year old. What severance, hard work, and embracing their power him or her for success and self-ac- can be difficult for the child is the feel- challenges can be helpful. Thankfully, we tualization through hard work, insight, and How to Talk with Your Child ing of having such a large split inside of have many role models in our culture that understanding. them. It can also be valuable to highlight are open about their challenges, so it might The decision to share the diagnosis is the feeling of this dramatic chasm be- be helpful to find a role model that con- Over the years in diagnosing and work- a deeply personal and heavily nuanced tween the areas. nects with the child’s area of interest. For ing with children with Asperger’s and one; a one‐size-fits-all approach does not example, finding a baseball player with their families we have been humbled and apply. Obviously, there are lots of things 2) Using metaphors: Even though each an area of difficulty for a child interested challenged by this complex issue. As men- to consider. Our view is that in most cas- child’s challenges are unique, there are cer- in baseball, or learning about an engineer tioned earlier, there is no singular approach es, there is tremendous value in having an tain characteristics that are fairly common with difficulties for a child who loves because each child is unique and what will open discussion with your child about the in children diagnosed with Asperger’s. It transportation, or an actor on a child’s work for one child may not work for anoth- nature of his or her difficulties and sharing might be helpful, again depending on the beloved television show who has shared er. We hope that this article has stimulated with them their diagnostic label may be an age and maturity of the child, to use met- some challenges. some “food for thought” or ideas about important part of this conversation as well. aphors to talk about some of these symp- how to empower our children by helping Whether this conversation is being toms. For example, to explain executive 4) Respect their processing style: Chil- them get to know themselves better. prompted by a recent evaluation and diag- functioning difficulties, we may talk about dren’s reactions to these talks reflect a full nosis, or parents have chosen to disclose a huge pile of papers, with no folders to range of responses. Some children will Shuli Sandler, PsyD, is a Psycholo- this information after keeping it quiet, odds organize them. To explain cognitive inflex- have many questions and want to under- gist with Spectrum Services in NYC. For are your child knows something is differ- ibility, we may talk about a child’s brain stand more. They may want to look up more information, please email shulisan- ent about them. In general we have found getting “stuck” and unable to move past what different words mean and feel like [email protected]. that children construct all sorts of fantasies something. For emotional dysregulation, they can’t stop talking or thinking about it. Michael Rosenthal, PhD, is a pediatric and ideas about what is wrong with them we may talk about a child whose feelings Other children will be resistant to talking neuropsychologist with expertise in the and having a candid discussion may actu- feel way too big for his little body, and more about it, and will want some space to evaluation and treatment of children and ally dispel some of their worst fears. Below for social deficits, we may talk about go- process this information in their own quiet adolescents from pre-school through early are a few suggestions to foster an open dis- ing to visit a foreign country and feeling way. The biggest gift you can give to your adulthood. He is specialized in diagnostic, cussion with your child: like we have a hard time understanding child is to respect his or her own unique developmental, and neuropsychological the language or culture. We have found self and provide space and an opportunity evaluations of children with ADHD, ex- 1) Highlighting strengths and weakness- the use of metaphors particularly valuable to think and reflect about this information. ecutive dysfunction, learning disabilities, es: We all have things we are good at and in highlighting what it can feel like for a You may want to enlist the help of men- social cognitive weaknesses, and emotion- things we are not as good at. It’s pretty child with Asperger’s dealing with these tal health professionals to facilitate the al/behavioral challenges. Dr. Rosenthal easy to come up with a list for each of us. difficulties. These metaphors can also be healthy processing of some very compli- is also an expert in the identification and It might be helpful for each of the fami- used to explain to siblings, family mem- cated information. We very much believe management of children when complex ly members, including parents, to speak bers, friends or teachers when they don’t that the understanding and synthesizing of questions exist about autism spectrum dis- about three things they are good at and understand why these children are having a this information is an important part of the orders. For more information, please email three things that they struggle with. What difficult time in some of these areas. developmental process and integral to your [email protected]. PAGE 34 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Competence from page 8 with the delivery of preferred items and ac- nician would vocally or physically prompt over, they can improve the lives of those tivities for each of the clients participating the correct form of the mand either vocally with limited communication skills. ABA/ placements to individual residential alter- in the BIP grant. During the screening pro- or using ASL. Data were collected on each VB should be considered best practices for natives (IRA) or other less restrictive place- cess, individual’s communication systems presentation of the item being requested. teaching adults with disabilities so that they ments and avoid reliance on long-term care were assessed and forms of communication Prompts were faded as needed based on the can continue to grow and change over time services. The BIP grant specifically targets were identified for each client. motivation of the individual for the item be- in the least restrictive environments. individuals living at home in the communi- The individuals demonstrated a wide ing presented. Additional data were collect- ty with significant high risk for placement range of communication skills. Approx- ed daily on targeted challenging behaviors. Vivian Attanasio, BCBA, is Director of in an institutional setting, individuals being imately 9 of the individuals were able to The behavior intervention specialist would BIP, James O’Brien, BCBA, is an ABA discharged from residential school setting communicate using vocal speech. They then review these data to determine if chal- Consultant, and Amy Bukzspan, BCBA, is out of state and individuals being discharged were able to request basic wants and lenging behaviors were decreased due to the a Behavior Intervention Specialist at Ser- from NYS Developmental Centers. needs, label common items and objects in manding intervention. vices for the UnderServed Inc. For more The main objectives of the project are their environment and engage in beginning The findings across the four individuals information, contact Vivian Attanasio at to decrease poly pharmacology, decrease communication skills. Two of the clients who were non-verbal show a range of 3%- [email protected] or visit www.sus.org. visits to the emergency room and hospital- used minimal vocal communication skills 67% decrease in challenging behaviors once ization due to maladaptive behavior by in- with high rates of maladaptive behaviors. the manding intervention was implement- References creasing functional communication skills, The last four clients were nonverbal and ed. These findings suggest that when indi- teaching age appropriate leisure skills us- were learning to mand (request) using ASL viduals with limited communication skills Carr, E.G., & Durand, V.M. (1985). Reduc- ing ABA technology. (American Sign Language) in addition, were provided the opportunity to request ing behavior problem through functional The behavior staff at SUS began screen- they also engaged in moderate frequency their specific preferred items, the frequency communication training. Journal of Ap- ing individuals from a state intermediate of maladaptive behaviors on a daily basis. of maladaptive behaviors were decreased, plied Behavior Analysis, 33, 53-71. care facility in August. The individuals tran- The behavior technicians began the treat- therefore demonstrating that ABA technolo- sitioned to SUS in October 2014. During ment session with one manding session gy is an effective intervention for decreasing Cooper, J.O., Heron, T.E., & Heward, W.L. this time, preference assessments and func- (Sundberg & Partington, 1998) daily during challenging behaviors such as aggression, (2007). Applied behavior analysis: 2nd tional analysis were conducted to develop snack time at the residence with the clients self-injury and self-stimulatory behaviors. edition. Upper Saddle River: New Jersey: effective treatment plans that included high that were non-verbal. The behavior techni- In summary, ABA is a hard science that Pearson Prentice Hall. preference items and activities for the BIP cian was seated at a table with preferred food teaches replacement skills to individuals participants. Direct care staff were trained items for the assigned individual he/she was with disabilities who have developed a mal- Skinner, B. F. (1957). Verbal behavior. with specific behavior techniques for 15 paired with during the session. In addition, adaptive manding repertoire over their life- New York: Appleton-Century Croft individuals. Preferred items and activities the assigned program specialist was also time. The preliminary results from the BIP were also purchased and made available to present during the teaching session. The be- grant suggest that adults with developmen- Sundberg, M. L, & Partington, J. (1998). the individuals upon returning from their havior technician would present 2 preferred tal disabilities can benefit from the technol- Teaching language to children with autism day habilitation program. Behavior techni- items to the individual. Once the individual ogy of ABA, along with the use of Skinner’s or other developmental disabilities. Pleas- cians trained caregivers to pair themselves declared his/her choice, the behavior tech- analysis of verbal behavior (VB). More- ant Hill, CA: Behavior Analyst Inc.

Truth from page 29 idential housing. Again, my daughter went and back into my bedroom and resumed this door between us. Then she picked up out of control! I barely escaped out the enjoying tea and TV in my living room un- a chair and began beating the door down. anymore!” I heard myself blurt out loud. front door. She pursued for a full city block til the fatal night we rushed Hagley to the Unfortunately it was hollow. I grabbed my This was not a new revelation but I now screaming at the top of her lungs that she emergency animal hospital where he was cell phone and her service dog and headed had a new level of conviction. The pow- was going to kill me. A neighbor called the diagnosed and died of kidney failure. We for the car. I called the police. Four police- er of that thought in that particular mo- police. By the time they arrived we were were devastated! And, our daughter’s sleep men arrived. The next day we bought a solid ment opened me up to a visceral state of both back inside and she was calm. disorder returned with a vengeance. We wooden door. I reiterated: “Either you accept self-preservation. When your baby bites That’s when it dawned on me! My daugh- were all miserable, and grief-stricken but the door, or back to the psychiatric hospital your breast, it is time to wean! And so, I ter thought being a tyrant was normal. That at least the violence did not return. Soon, you will go.” She conceded. And that was went home that night a changed mother. night, I had the most important conver- the service dog agency replaced her yellow the last physical attack she ever launched on sation with her I will ever have. I calmly lab with a black one. We participated in the me. Twice she initiated a head butt maneu- Initiating the Disengagement Process and clearly explained that if she ever tried graduation ceremony all over again with a ver. Both times her head came within two to hurt me again, she would go back to the new dog named Duff. It was love at first inches of mine and stopped. She was acquir- I began keeping an overnight bag packed. psychiatric hospital and NEVER RETURN sight! We all breathed a sigh of relief. ing rudimentary impulse control. On nights that I suspected she might tan- HOME. I meant it. This was not a threat. I trum, I called on friends for a place to sleep. finally was able to communicate in a way Temporary Inconvenience, Hope is Restored When she started screaming at me, I walked that she understood. If she wanted all of the Permanent Improvement out and sat in public places like the library, good things her mommy and daddy provid- Today marks our first year anniversary of or my car. Instead of attending to her every ed her, she needed to stop hurting me. We decided it was time to initiate the living with a wall between us. We now live need, I began focusing on my own health. next level of separation by selling our in an old house with a huge yard, in need Eating caused an icy feeling that started Service Dogs to the Rescue town house and buying a duplex: one side of extensive repair. Management is a full- in the pit of my stomach to shoot up my for her and the other for us. We figured we time job, of which I do not get paid. Con- neck and down my arms and legs ultimate- After a year and a half of waiting, our could at least afford a wall between us. sequently, we have downsized to one salary ly produced a sickly weakness similar to daughter was finally matched with a spe- We found a house with a mother-in-law and one car. But, we are making progress. shock. My temperature hovered between cially trained companion dog. His name apartment and frantically stepped up the Our daughter continues to improve. Yes- 96.1 and 97. I was cold all of the time. I lost was Hagley, a strapping 83 lb. yellow Lab- process of selling our home. Cleaning, paint- terday, while driving, she began running 15 pounds. I took a cot and sleeping bag up rador Retriever. His “work” was to sleep ing, floor replacements and trying to keep it one of her standard petty tyrant routines. to our third floor finished attic space, put with our daughter. With the comfort of his looking like Better Homes and Gardens was I reminded her she was dependent on us a “PLEASE DO NOT DISTURB” sign on warm body snuggled up against her, she a feat, but we moved into our new life on a for the ride. She threatened me in her fa- the door and installed a chain lock. began sleeping through the night. cold afternoon in March. The plan was sim- miliar sing-song voice, “I’ll punch you in Was I insane? For 27 years, I had been Through commitment to her new dog, ple: Daughter gets the 3-bedroom house and the face!” I ordered my husband, “Turn the a mommy that tolerated being hit, kicked, she began caring for others in a way that 25 rents 2 rooms to compatible peers. We live in car around!” She shouted, “No! No! No! I screamed at and even bitten. I had been a years of strategic interventions had not ac- the efficiency apartment. This was the best didn’t mean that literally, I’m sorry!” We mommy who would religiously wake up complished. One day she instructed him to we could do, and all that we could afford. all laughed and kept right on going. each morning and serve breakfast with a “load up” into the car. She had forgotten to smile as if nothing bad had happened! For stand out of the way. As he jumped through The Final Battle Alexandra Bricklin is a music therapist the past 27 years, I had been possessed by the opening between her head and the back currently living with her husband in an motherly preoccupations with a child who seat, he hit her chin so hard it caused her We had moved twice before, each time apartment above the garage of the house would never grow up and may never stop teeth to sink into her lip and split. She had had resulting in psychiatric hospitalization. owned by Rebecca Bricklin’s Personal As- being abusive! It was time to take charge bitten herself. When I then explained, “You This time was different. I could retreat into surance Team Inc., the corporation founded over this intolerable situation! I requested have to get control over yourself, so you my apartment and lock the door. It worked to create and protect quality of life across an out-of-home placement. can get control over your dog,” she didn’t for a few months. Then one day she launched lifespan for their daughter Rebecca and two start screaming at me. Instead she just re- a physical attack. I reached the door of my roommates. To learn more, visit our Face- Crushing News Leads to plied: “You’re right mom.” apartment, entered quickly and locked it. I book page, Rebecca Bricklin’s Personal As- Greater Understanding In three short months, Hagley sin- warned her: “If you don’t calm down, I will surance Team Inc. at www.facebook.com/ gle-handedly replaced the need for all call the police!” She replied in her evil car- CormmunityforRebecca or contact Alexan- My heart sank when we were denied res- overnight staff. I moved out of the attic toon voice: “HA HA HA, I will NOT allow dra at [email protected]. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 35

Challenged from page 12 was one of those people who just need a little extra time in the mornings. Being able anxious, depressed, or tired. Instead of to start his a job at 10 am instead of 8 am or hanging in there and getting himself to 9 am allowed Zach to be on time and the ac- work on Thursdays, he’d give up and call commodation was motivation to stop call- in “sick.” ing in sick half way through the work week. Zach was working toward his A.S. in In- At one point we considered having Zach formation Technology and was very bright. work a part-time job. Although I would When he was at his internship, he did a love for every young adult to maintain a good job. But as Woody Allen said “Eighty full-time job (whether volunteer, intern- percent of success is showing up.” Here is ship, or paid), I would rather see a student how I helped Zach. work part-time 20-30 hours per week and be successful than try to unsuccessfully Strategies to Help “Underground maintain a full-time job. Thursday Challenged” Zach This article was excerpted from Chapter I had him turn in a copy of his internship 5, Autism and Learning Differences (An timesheet to me every week or every two Active Learning Teaching Toolkit), by Dr. weeks so we could review work attendance Michael McManmon, EdD, and Francine and identify any reoccurring patterns. This Britton, published by Jessica Kingsley allowed me to show him in black and Publishers, London 2015. white, that he was missing work on most Thursdays. Jennifer Kolarik and CIP Brevard student Thea Judin Jennifer Kolarik serves as the Lead In addition to having Zach set multiple Head Career Coordinator at The College alarms to get up on Thursdays as an audio membering to take his medications for anx- We set up a sleep routine (that he would Internship Program (www.cipworldwide. clue, we looked at his underlying problem iety and depression when he was feeling track and chart) and made getting a good org). CIP is a comprehensive program of anxiety and depression and realized anxious or depressed. We looked at this pat- night’s sleep another self-help priority. serving teens and young adults with As- that Zach’s stress was being dealt with by tern as well. Having Zach verify with me We asked his supervisor at work if Zach perger’s, Autism and other Learning Dif- avoidance. that he had taken his medication daily (via a could start an hour later in the morning or ferences. CIP offers year round and sum- He also told me that he had trouble re- quick check-in, text, or email) also helped. stay an hour later in the afternoon. Zach mer programs at six locations nationwide.

Success from page 4 your parenting skills or the quality of your become more involved when you just can’t. are here to stay and there are new expec- relationship. You are more likely to falter Who can prompt you with the “cut it out” tations for his/her behavior. the second time you give an instruction, on your strategy if you feel guilty even sign from outside the view of the child? Who your voice is raised, your nostrils are flared when there is really nothing to be guilty can give you the “thumbs-up” for keeping it Often behavior plans are created to be and the vein in your neck is throbbing. A about. Do not get distracted from your task. together during a tough encounter? Is there implemented at a time when parents and neutral face and a calm tone are required someone you can defer to during your kryp- caregivers are at their wits end, are frus- and sometimes need to be practiced. 6. Prepare the environment for what is about tonite moment? It is also helpful in general trated by the child’s behavior and environ- to come. This includes both the physical en- to get feedback on how you are doing. It can ments are chaotic and out of control. Give 5. Don’t take your child’s behavior per- vironment and the people in it. Ask yourself: be difficult to objectively assess your own your plan a greater probability of success sonally. Know that when your child is en- “What will need to happen to make my plan behavior during or after an interaction. by preparing yourself and your environ- gaging in a challenging behavior, he/she is work? Do I need to make arrangements for ment for its implementation. not doing so to offend you. People engage others in the home while I tackle implemen- 8. Be prepared for the behavior to get One last suggestion - be kind to yourself. in behaviors because it meets a need. The tation? Does someone need to take on some worse before it gets better. Often par- There will be times when you may analyze principles of applied behavior analysis in- of the other caregiver responsibilities?” In ents are gung-ho at the start of the plan your actions and think that the plan dictat- dicate that there are four reasons why be- some cases, you may want to make chang- but soon start to wane when the rate or ed a different behavior. Do not beat your- havior occurs: attention (I want something es to the arrangement of furniture and other intensity of behavior increases. This is self up. Identify what precipitated the error of or from you), escape (I need you to help items to address safety. Consider if there are in fact a good sign and means the plan is and make your adjustments. You can do it! me avoid or delay something), self-stimula- places you should designate for certain tasks working. Do not stop now. The child rec- tion (I can make myself feel good) or pain. because the space is quieter, better lit, etc. ognizes that there is a change in his/her Lana Small, MSW, is Coordinator of Even verbal statements like “I hate you,” environment and is struggling against it. YAI’s Community Habilitation program. “You never … ,” or “You don’t love me” 7. Share your plans with others. Identify peo- He/she liked it the way it was. It is up to She has worked in the field for 21 years should be treated as behaviors to get his or ple who can support you by simply holding the implementer to be consistent so that and holds an MSW from Hunter College her needs met, rather than an analysis of you accountable for your own behaviors or the child “learns” that the changes made School of Social Work.

Control from page 26 This reinforces my earlier point about be- reparably, but enough to cause problems). (and respond to) signs of autism spectrum havior being rooted in a quest for control, This is why I would heartily support re- disorders earlier. assist, rather than hinder, this development. and about how relative lack of control can search into signs of autism in the early In the meantime, let us remember that be- Erikson (1963) touched on something provoke unwelcome behavioral responses. stages of infancy; this could perhaps give havior is a language. Bad behavior should like this when referring to the phenomenon As far as autism goes, I ask that the read- us some clues as to how the receptivity of not be tolerated, but neither should we just of “mutual regulation” (p. 68), and elabo- er not misunderstand me. I am not trying children on the spectrum to modes of entry to “squash” it, and in so doing stifle the rated on it in the following passage: to resurrect the outdated and very offensive vironmental conditioning, in combination symptom at the expense of the underlying The unavoidable imposition on the child notion that a child’s autism is the fault of with the latter, might influence later autis- issue. There is a whole personal history, a of outer controls which are not in suffi- his/her parents (this may be true in rare and tic behaviors. Something makes me think whole story to be told in anyone’s behavior cient accord with his inner control at the extreme cases, but not for the most part). that this would be much more fruitful than – a story of needs, fears, wants, anxieties, time, is apt to produce in him a cycle of Rather, it is precisely the genetic and interi- focusing only on the neurological compo- and perhaps even a desire to communicate. anger and anxiety. This leaves a residue of or component of autism that prompts me to nent of autism, as if these children came an intolerance of being manipulated and cite the above passage from Erikson’s book. “pre-wired” for later behavioral patterns. Daniel Crofts is a 30-year-old man with coerced beyond the point at which outer Presumably, the brain of someone on the Again, I am not suggesting that parents Asperger Syndrome. He has an MA in En- control can be experienced as self-control. autism spectrum differs (that is, in some are to be blamed for their children’s autis- glish/Literature from the State Universi- Connected with this is an intolerance of respects) from the neurotypical brain right tic behaviors – any more than fluorescent ty of New York College at Brockport and being interrupted in a vital act, or of not from the very beginning. So already, in- lights should be “blamed” for an autistic experience in the fields of freelance jour- being permitted to conclude an act in an id- fants with autism spectrum disorders are at child’s sensory meltdowns. But autistic nalism, substance abuse prevention, online iosyncratically important way. All of these a disadvantage when it comes to “mutual children, like all other human beings, are higher education, and service to people anxieties lead to impulsive self-will—or, regulation.” Their modes of “inner con- social beings, and the interaction of in- with developmental disabilities. He may be by contrast, to exaggerated self-coercion trol” will differ from those of neurotypi- herited traits and exterior influences (both contacted at [email protected]. by stereotypy and lonely repetition. Here cal children, and will likely be in conflict interpersonal and environmental) is as im- we find the origins of compulsion and ob- with standard modes of “outer control.” If portant for them as for anyone else. That References session and the concomitant need for the we follow Erikson, we must conclude that said, I think it would be helpful to both par- vengeful manipulation and coercion of self-confidence and personal adjustment ents and children if we knew a little more Erikson, E.H. (1963). Childhood and Soci- others (p. 409, italics included). will inevitably suffer as a result (not ir- about this, and if we were able to detect ety (2nd ed.). NY: Norton. PAGE 36 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Father from page 24 ship between the parents and facilitating more likely to engage in play that stretches autismbrainstorm.org. He can be contact- communication on the day to day issues. beyond the physical properties of the toys ed at [email protected], role which includes lack of emotional ex- Some fathers have expressed a wish to be (Labrell, 1996). As their child’s primary and he blogs on his practice website, www. pression, control, and self-reliance. Typi- supported by other fathers of a child with an play partner, fathers have a distinctive role alternativechoices.com. cally men have a more active coping style ASD. Clinicians can facilitate these connec- in supporting their child’s development than women and prefer active problem tions where men can discuss their concerns through play. Research has demonstrated References solving rather than talking about the prob- and possibly show emotion with peers. that interventions can improve both play lems. The general misconception that ther- Until recently, there was a trend toward re- and language outcomes for children with Addis, M. E., & Mahalik, J. R. (2003). apy involves merely talking about prob- search questions which looked only at stress ASD, but the intervention did not record Men, masculinity, and the contexts of help lems rather than actively solving problems and burden in families of children with de- data specifically on fathers (Kasari, Papa- seeking. American Psychologist, 58, 5-14. tends to deter men from participating in velopmental disabilities. Recent studies rella, Freeman, & Jahromi, 2008). treatment. Engaging fathers requires effort show that these negative impacts are neither From a parental perspective, it tends to Blacher, J. & Baker, B.L. (2007) Positive im- by mothers and therapists whose attitudes as common nor as severe as previously be- be more difficult to engage in play with a pact of intellectual disability on families. Amer- about the importance of involving fathers lieved. Blacher and Baker (2007) empha- child who has less repetitive and more var- ican Journal on Mental Retardation 5, 330-48. in child and family are important. size the shift to investigate the positive and ied play. However, with intervention fathers negative impact in order to arrive at a more may be uniquely suited to support the play Bristol, M. M., Gallagher, J. J. & Schop- Fathers of Children with balanced view. Clearly, there is a role for development of their children with ASD. ler, E. (1988) Mothers and fathers of young Developmental Disabilities incorporating positive perceptions in parent developmentally disabled and nondisabled education and intervention programs. Conclusion boys: Adaptation and spousal support. De- Prior to 2000, there was a consensus velopmental Psychology, 24, 441-441. in the professional literature that mothers Increasing Father Involvement By focusing primarily on mothers, re- and fathers initially respond differently to searchers, and interventionists may be in- Clarke-Stewart, K.A. (1980). The father’s a child with a disability. Fathers seem less Given the increased evidence of greater advertently placing burdens on mothers. contribution to children’s cognitive and so- emotional and focus traditionally more male parent involvement with their children, Since fathers more commonly work more cial development in early childhood. In F.A. on long-term problems such as the finan- one would expect greater participation of fa- hours outside the home, employment pro- Pedersen (ed.) The father-infant relation- cial burden. Mothers respond more open- thers in early intervention for their children vides a respite and may in part explain ship: Observational studies in the family set- ly with their emotions and are more con- with ASD. Nonetheless, mothers continue to their lower levels of stress as compared to ting (pp. 111-146). New York, NY: Praeger. cerned with the challenges of the daily care be the primary participants in both autism re- mothers. Increasing father involvement in of the child. Consequently, fathers who are search and early intervention. This de-facto early intervention and special education Davis, P.B. & May, J.E. (1991). Involving less involved in daily interaction with their one-parent participation model ignores the may have positive outcomes for both chil- fathers in early intervention and family children tend to have a prolonged period of growing evidence that mothers and fathers dren and parents. support programs: Issues and strategies. denial about the disability and its implica- each play an early and integral role in the Flippin and Crais (2011) conclude that Children’s Health Care 20, 87-92. tions (Seligman and Darling, 2007). development of their children, perhaps par- fathers have unique ways of playing and Parental roles were thus polarized, and ticularly in their social and communicative interacting with their children. Incorporat- Flippin, M. & Crais, E. R. (2011). The fathers were observed to be uncomfortable skills (Flippin & Crais, 2011). Continuing to ing more play activities that reflect fathers’ need for more effective father involvement with female-dominated service systems. ignore fathers may result in missing oppor- tendency toward physical or “rough-and- in early autism intervention: A systematic The daytime hours of schools and agen- tunities to maximize social-communicative tumble” play and increasing active sessions review and recommendations. Journal of cies did not accommodate fathers’ working gains for young children with ASD. with fathers, as opposed to more didactic Early Intervention, 33, 24-50. lives. In their discussion of fathers in early Evidence from studies of father–child in- sessions, is a first step in making interven- intervention and family support programs, teractions with typically developing children tions more father-friendly. On the other Hastings, R. P., Kovshoff, H., Brown, T., Davis and May (1991) pointed out that fa- indicates that fathers offer different language hand, in general women tend to gather ex- Ward, N. J., Espinosa, F. D. & Remington, thers of children with intellectual disabili- models than mothers which make important planations and directions. Early interven- B. (2005) Coping strategies in mothers and ties were frequently considered as an after- contributions to children’s language devel- tion is a predominately female field which fathers of preschool and school-age chil- thought by professionals. opment (Clarke-Stewart, 1980). Fathers tend is relationship oriented, providing support- dren with autism. Autism the International to use a more complex language model with ive feedback to parents, primarily mothers. Journal of Research and Practice 9, 377-91. Fathers of Children with Autism their children than do mothers such as with Men prefer receiving feedback from peers. vocabulary that is more varied. Although it As opposed to waiting until all the informa- Jones, J. & Mosher, W. D. (2013). Fathers’ Recent research literature on fathers of is likely that this may apply to communication is gathered, men are more comfortable involvement with their children: United children with autism lacks topics that relate tive development for children with ASD, jumping in to take action and problem solve. States, 2006-2010. National Health Statis- to the involvement of fathers in intervention there is sparse data to confirm this. In their Increasing fathers’ involvement will like- tic Reports; no. 71. Hyattsville, MD: Na- for their child and intervention on fathers extensive review, Flippin and Crais (2011) ly require implementing more father-friend- tional Center for Health Statistics. themselves. In research on mothers and fa- found only three single-subject experiments ly learning and teaching styles such as peer thers of preschool and school-age children that specifically reported that fathers par- feedback, task-oriented learning, and video Kasari, C., Paparella, T., Freeman, S., & with autism, Hastings et al. (2005) found ticipated in parent communication training modeling. Focusing on communication and Jahromi. L. B. (2008). Language outcomes in that fathers reported using more avoidant with their children with autism. An assump- play interventions in ASD research has po- autism: Randomized comparison of joint at- coping strategies and less problem-focused tion seems to be that outcomes for mothers tential to help fathers to feel more effective tention and play interventions. Journal of Con- coping than did mothers. The emotions of also apply to fathers. However, as discussed, in their relationship with their child with sulting and Clinical Psychology, 76, 125-137. fathers are often unacknowledged or seen fathers have different language models and ASD. Reduced maternal stress and greater as secondary to the needs of the child and may have a unique influence on communi- family cohesion could be important collat- Pleck, J. H. (2010). Fatherhood and mascu- mother, and these findings have clear im- cation development of their children. eral effects for the family. linity. In M. E. Lamb (Ed.) The role of the plications for clinical practice. Also through play, both mothers and father in child development (pp. 27-57). While mothers typically seek help from fathers help their children achieve higher Robert Naseef, PhD, is a psychologist Hoboken, NJ: John Wiley & Sons, Inc. external sources, fathers are more likely to level language and symbolic abilities, and and father of an adult son with autism. rely on the support of their partner (Bristol there are qualitative and quantitative dif- His latest book is Autism in the Family: Seligman, M. & Darling, R.B. (2007) Or- et al., 1988). The implication is that clini- ferences between parents. A father’s play Caring and Coping Together (2013) by dinary families special children: A systems cians will best meet the needs of fathers by with his child is typically more active and Brookes Publishing. He also moderates a approach to childhood disability. New working toward strengthening the relation- rough-and-tumble. In addition, fathers are monthly father’s discussion group at www. York: The Guilford Press.

Conference from page 21 of-Sync Child, Inc, Maryland (http:// Management, Person-Centered, Planning, als, behavioral health professionals and out-of-sync-child.com/about-carol). This Post-Secondary Education, Quality of Life anyone working or committed to creating a Not knowing she had Asperger’s until age presentation for parents, educators, ther- Residential, Self-Advocacy, Self-Direc- society that embraces difference. 50, Anita managed to successfully main- apists and other professionals will review tion, Sensory Integration, Social Skills, tain a full time career as a Certified Regis- how Sensory Processing Disorder plays Special Education, Staff Development, To register or for more information, visit tered Nurse Anesthetist. She will share her out at home and school and how to recog- Technology, and Transition. yai.org/conference2015. Questions? Contact strategies and mechanisms of coping in a nize underlying sensory issues. The conference is designed for family Abbe Wittenberg, Conference Planner, at world of neurotypicals. members, people with ID/D, physicians, 212-273-6472 or [email protected]. Other topics throughout the conference Direct Support Professionals, social work- Shop now for YAI’s award winning Learning include: Advocacy, Aging, Arts, Com- ers, physical and occupational therapists, DVDs, Digital Downloads, YAI Resource munication, Community Building, Com- speech-language pathologists, administra- Center memberships and New Videos on Carol Kranowitz, MA, Author of “Out- munity Inclusion, Early Childhood, Em- tors, higher education faculty, early inter- Demand at YAI’s Online Training Store at of-Sync Child,” and President of Out- ployment, Family Empowerment, Health, vention and special education profession- yai.org/trainingstore. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 37

Expect from page 13 evaluators may also examine setting functions shown in Table 1 below or any and rating scales, followed by direct as- events. Setting events refer to the setting, combination of those functions. sessments consisting of direct observa- may impact behaviors. For example, eval- climate, or context within which the be- Scientific studies have yet to prove that tions with data collection, and a detailed uators may review prior medical records havior and consequence occur. Setting anxiety is a function of behavior. How- analysis of the data complete with graphs. (with appropriate consent, of course) to events are antecedents and may occur im- ever, when a student feels anxious about A function or combination of functions identify potential medical causes or in- mediately before a problem behavior or a situation, he may engage in a behavior should be identified for each target be- fluences on the behavior. In this example, hours or days in advance. Setting events in order to escape the situation. Similar- havior. And finally, the results of the FBA evaluators may discover that the client can include environmental factors (noise, ly, a student may have anxiety because should be used to develop an appropriate has a history of chronic ear aches and in- temperature level, unplanned schedule she cannot have something she wants. BIP for the student. fections. Evaluators may look to identify changes, overstimulation), social fac- She may engage in behaviors in order to how these aches and infections may im- tors (a death or illness in the family, an have her way or obtain what she wants. Melissa L. Olive, PhD, BCBA-D, is Ex- pact the target behavior. Prior testing re- encounter with a peer, receiving a bad Similarly, “control” is not a function of ecutive Director, Patrick N. O’Leary, MA, sults, previously attempted interventions, grade), or physiological factors (lack of behavior. While it may feel that a student BCBA, is Clinical Case Supervisor, and and recommendations of past service pro- sleep, side effects of medication, medical is trying to control the adult’s behaviors, Abigail V. Holt, MA, BCBA, is Clinical viders may also yield helpful information. condition, illness, pain). Once specific ultimately, the student is either obtaining Supervisor and Feeding Clinic Manag- Evaluators should also complete an setting events are identified by the evalu- desired consequences or avoiding unde- er at Applied Behavioral Strategies, LLC interview with relevant parties including ator, this information may be used to desirable situations. in New Haven, CT. Correspondence con- parents, caregivers, teachers, siblings, or termine how to prevent a behavior from Occasionally, and often for research cerning this article should be addressed to anyone else with consistent client contact occurring or how to decrease the likeli- purposes, evaluators need to complete an Melissa L. Olive, P.O. Box 3957 New Ha- (in some cases, even the client herself) hood of a behavior. additional step in order to demonstrate or ven, CT. E-mail: missy@appliedbehavior- (Alberto & Troutman, 2012). The infor- A final direct assessment evaluators prove the function of the behavior. Outside alstrategies.com. mation provided is necessarily impacted may use is called a preference assess- of research, evaluators may not be certain by the interviewee’s relationship with the ment. Evaluators may conduct preference why behaviors occur even after analyzing References client. Evaluators are interested in the assessments to assist them in identifying all the data. Then, evaluators or research- form or topography of the behavior, the stimuli likely to serve as reinforcers spe- ers would complete a functional analysis. Alberto & Troutman (2012). Applied be- contexts where the behavior occurs, situa- cific to an individual student. Preference During a functional analysis, antecedents havior analysis for teachers (9th ed.). Up- tions when the behavior never occurs, and assessment may also be completed indi- and/or consequences are experimentally per Saddle River, NJ: Pearson Education. the time of day behaviors are most likely rectly by interviewing others or by com- manipulated systematically and behaviors to occur. Sleep patterns, medication, med- pleting rating scales about reinforcers. are measured precisely under each condi- Bijou, S. W., Peterson, R. F., & Ault, M. H. ication changes, and dietary factors may However, research has shown that direct tion. Evaluators create detailed graphs to A Method To Integrate Descriptive And Ex- also be important types of information. preference assessments yield most accu- reveal how behaviors are affected by var- perimental Field Studies at the Level of Data Finally, rating scales are another type rate results. ious antecedents and consequences. It is And Empirical Concepts. Journal of Applied of indirect assessments used to help eval- only through experimental analysis that Behavior Analysis, 1, (1968): 175-191. uators ascertain why individuals believe Data Analysis evaluators know with certainty the func- behaviors are occurring. Specific rating tion of target behaviors. Durand, V. M. & Crimmins, D. B. The scales, like the Motivation Assessment Following the completion of indirect Motivational Assessment Scale. In V.M. Scale (MAS; Durand & Crimmins, 1990) and direct assessments, evaluators ana- Linking the FBA to the Durand (Ed.). Severe Behavior Problems: or the Questions About Behavior Func- lyze all the data. The purpose of the data Behavior Intervention Plan A Functional Communication Training Ap- tion (QABF; Mattson & Vollmer, 1995), review is to illuminate any patterns among proach. New York: Guilford Press, (1990). provide a series of questions interviewees antecedents, behaviors, and consequences Once the evaluator has determined the answer on a Likert-scale rating (e.g., 1 (O’Neill et al., 1997). While reviewing as- function of the target behaviors through Horner, H. R., & Budd, M. C. (1985). Ac- is less likely to 6 is most likely). These sessment data, evaluators seek to answer careful assessment and data analysis, quisition of manual sign use: Collateral re- assessments do not rely on direct ob- the following questions: the behavioral team, including parents, duction of maladaptive behavior, and factors servation of the target behavior, rather, teachers, and other relevant members will limiting generalization. Education and Train- evaluators rely on others’ statements who • Are the same antecedents occasioning develop an individualized behavior inter- ing of the Mentally Retarded, 20, 39-47. have had direct experiences with target behaviors? vention plan (BIP) to specifically address behaviors. Direct assessments, where the target behaviors. The FBA results should Iwata, B., Dorsey, M., Slifer, K., Bauman, practitioner has direct contact with the • Are behaviors followed by similar be used to develop the BIP. The team will K., & Richman, G. (1982/1994). Towards target behavior, often follow indirect as- consequences? create a plan for adults to modify trigger a functional analysis of self-injury. Journal sessments. antecedents to prevent target behaviors of Applied Behavior Analysis, 27, 197-209. • Is the behavior occurring within the from occurring. Replacement behaviors (Reprinted from Analysis and Intervention in Direct Assessments context of the same activity, materials, will be taught for the student to use in lieu Developmental Disabilities, 2, 3-20, 1982.) and/or people? of challenging behaviors. A plan will be Evaluators utilize direct assessments developed to teach team members how to Matson, J. L., &Vollmer, T. (1995). Ques- once target behaviors have been identified • Does the individual terminate the behav- reinforce the new replacement behaviors. tions About Behavioral Function (QABF). and indirect assessments have been com- ior following a particular consequence? And finally, strategies will be identified for Baton Rouge, LA: Scientific Publications. pleted. Direct assessments consist of an team members to utilize following instanc- examiner or other trained observer view- A high quality FBA will include data es of challenging behavior. O’Neill, R. E., Horner, R. H., Albin, R. W., ing students and their behaviors in natural and graphs to depict the findings of the In summary, when expecting an FBA, Storey, L., & Sprague, J. R. (1997). Function- environments where behaviors occur while analysis. The results of an FBA lead to a consumers of behavioral services should al Assessment and Program Development for simultaneously taking notes and/or scoring hypothesis about why behaviors occur. anticipate an indirect assessment phase Problem Behavior: A Practical Handbook. data. Several types of direct observation Hypotheses may include any one of the 8 consisting of interviews, record reviews, (2nd ed.). Pacific Grove: Wadsworth. data may be collected. In particular, examiners note antecedents and consequences Table 1. surrounding behaviors. Examiners also make note of the time behaviors occurred Possible Functions of Challenging Behavior. as well as other important variables such as who was present with the student and Possible Function Variations Examples what types of activities occurred. This type of data collection is most often referred to as ABC Analysis (Bijou, Peterson, & Ault Get Something Obtain Attention Child hits sibling. Child receives long lecture about not hitting. 1968) where A stands for antecedent, B Obtain Objects Child throws tantrum at store in checkout line. Child gets candy to stop tantrum. stands for target behaviors, and C stands for consequences. Obtain Activities Child has a meltdown so staff let him play on computer to self-calm. Evaluators may also collect data using a scatterplot form. This data collection pro- Obtain Sensory Child rocks back and forth and wiggles fingers. Child receives visual input. cedure allows evaluators to note if behav- Avoid Something Escape Attention Child never raises hands during class to avoid being called upon. iors occurred often, some, or none of the identified time periods throughout the day. Escape Objects During mealtime, child throws food and plate. Non-preferred food is removed. These data provide evaluators with more Escape Activities During group instruction, child hits peers, child is sent to time out. specific information about the contexts where behaviors occur. Escape Sensory Child has a stomach ache. Child hits self in the head and endorphins relieve the belly pain. During the direct assessment process, PAGE 38 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Cortisol from page 6 Ann-Marie was the bravest of all! She can help to dilute the cortisol. Disorders and Significant Disabilities at stood there and said, ‘Go away, dog!’” David became highly agitated if his bus William Paterson. She is currently co-ed- recovery are widely accepted. Occasional- Anne-Marie began to repeat, “Go away was late or the daily schedule changed. iting a book describing this program. Dr. ly we do not know what has triggered the dog!” and smiled calmly. The cortisol had Sending him to a “time-out” room, as Van Riper may be reached at vanriperi@ agitation, since there are both fast and slow finally drained and she could access her punishment for screaming and biting, in- wpunj.edu. triggers. A person may become upset by a neo-cortex and was able to learn a new skill creased his behavior. A calm-down area loud noise, or a series of small events such (Maurice, 1993, pp. 179). Social stories, de- was created in a private corner. David was References as their favorite shirt not being available veloped by Carol Grey (1993), are anteced- introduced to the area and reminded that and the bus running late. During this pe- ent prompts to prepare individuals with he could choose to listen to music, look at Baranek, G. (2002). Efficacy of sensory riod stressed individuals are unable to stay ASD for events that are stressful. They de- train schedules, or sit in the beanbag chair and motor interventions for children with on task and may be non-compliant. Con- scribe situations from the person’s point of when he felt agitated. He found the bean- autism. Journal of Autism and Develop- frontation or punishment at this stage may view and suggest different behaviors. Once bag chair soothing and would often pull a mental Disorders. 32(5). 397-422. serve as an additional trigger and result in a trigger has been identified, a story can be second one on top during highly stressful an even greater adrenal cortisol secretion. written to prepare the individual with a way times, similar to Temple Grandin’s squeeze Corbett, B.A., Schupp, C.W. & Lanni, K.E. During the acceleration phase, many to manage the stressful stimulus. machine. He was usually able to return to (2012). Comparing biobehavioral profiles individuals will attempt to draw others Nathan hated loud noises, especially fire his task after about 20 minutes. Eventually across two social stress paradigms in chil- in by hitting or screaming. In peak, out- drills. He would scream for hours after the he learned to ask for the calm- down area. dren with and without autism spectrum dis- of-control periods, cortisol has impaired loud warning rang. So we wrote The Fire Individuals with ASD are physiologi- orders. Molecular Autism 3(13).1-10. cognitive function. Restraint is sometimes Drill Story with him. The book acknowl- cally prone to higher levels of cortical ex- needed in order to keep the person from edged his stress, and related a sequence citation than others. Caregivers, teachers Corbett, B.A., Swain, D.M., Newsom, harming themselves or others. During the of events he should follow. He read the and parents must be aware of this chemical C.,Wang., L., Song.,Y. & Edgerton, D. de-escalation period, students become book over and over on fire drill days and response to stress and its longer duration. (2014). Journal of Child Psychology and calmer. Finally the cortisol level diminish- was able to keep himself calmer, refraining Most people know when they are getting Psychiatry 55(8). 924-934. es and a period of subdued behavior and from screaming. upset and have developed strategies to help interactions follows. The response to a student, who is agi- them calm down. This is even more im- Grey, C. (1994). The new social stories Typical descriptions of the acting out tated or even in the out-of-control phase, portant for children and adults with autism. book. Los Angeles, CA: Future Directions. cycle include “went crazy;” “lost it;” and is critical. Punishment will only increase “gone nuts.” These descriptions are harm- the stress reaction. There should be conse- Jeanne D’Haem, PhD, began her ca- Jacobs, W. and Nadel, L. (1985). Stress-in- ful because they blame the person and do quences for inappropriate behaviors. How- reer as an ESL teacher in Somalia with the duced recovery of fears and phobias. Psy- not acknowledge the cortisol excitation ever during the throes of an episode is not Peace Corps. She was a special education chological Review 92(4). 512-531. that has made them biologically unable to the time to enforce them. A person in the teacher and supervisor for many years. access normal thinking. We would not pun- midst of adrenal cortical excitation is not She worked with children from pre-school Maurice, C. (1993). Let me hear your ish a person with cerebral palsy for walk- capable of learning, so response strategies to high school with special needs, medi- voice: A family’s triumph over autism. ing slowly. It is well established that peo- need to be taught and reviewed frequently. cal problems, and or limited English. She Fawcett Books, NY, NY. ple with ASD become easily over aroused Breathing is an important tool in calm- is now an Associate Professor of Special and, once over-stimulated, they remain so ing the mind. When an individual inhales Education at William Paterson Universi- Ruttle, P.L., Shirtcliff, E.A., Serbin, L.A., for extended periods (Baranek, 2002). We slowly, with a longer exhale, it help the ty, Wayne, NJ. Her areas of expertise are Fisher, D.B., Stack, D.M. & Schwartzman, need to stop punishing individuals with body to become calm. Individuals with behavior management, education law and A.E. (2011). Disentangling psychobiolog- ASD, in a state of adrenal cortisol arousal, ASD can be taught slow, careful breathing the inclusion of children with disabilities in ical mechanisms underlying internalizing for not being able to respond appropriately. techniques. Directing a person to “breathe general education programs. Dr. D’Haem and externalizing behaviors in youth: Longi- It is impossible for them to do so! with me” is much more effective then may be reached at [email protected]. tudinal and concurrent associations with cor- Understanding that adrenal cortical ex- shouting “calm down!” Irene Van Riper, EdD, is an Assistant tisol. Hormones and Behavior 59 123-132 citation can last for hours, or even days in Individuals have different ways to recov- Professor of Special Education in the De- some individuals, is crucial when design- er from stressful situations. When parents, partment of Special Education and Coun- Spratt, J. Nicholas, J., Brady, K., Carpenter, ing interventions. Every time Anne-Marie teachers or caregivers are aware of indi- seling at William Paterson University L., Hatcher, C., Meekins, K., Furlanetto, R., began to quiet down, she would remem- vidual preferences, they can offer choices. in Wayne, NJ. Dr. Van Riper has had 90 Charles, J. (2011). Enhanced cortisol re- ber the dog and “go off again,” crying and Music can be very calming. Some teachers hours of Orton-Gillingham training and sponse to stress in children in autism. Jour- terrified. Her mother tried reassuring her use motor-related songs, beginning with is completing the 100 hours of practicum nal of Autism and Developmental Disorders. and then ignoring her behavior, but noth- large movements and ending with whispers to be awarded the Associate Level from DOI 10.1007/s108033-011—1214-0 75-81. ing worked. and slow controlled movements. Back- the Academy of Orton - Gillingham Prac- On Monday, Catherine tried to de-dra- rubs, weighted vests or slow rocking can titioners and Educators. Dr. Van Riper is Walker, M., Calvin, G. & Ramsey, D. matize the incident by telling a social story be soothing and allow the brain to quiet an authority in Autism Spectrum Disor- (1995). Antisocial behavior in schools: about the dog. “The dog….made so much down. The old phrase, “take a walk and get ders and is instrumental in building the Strategies and best practices. Brooks/Cole noise…and we all told that dog to stop. a drink,” is often effective since the water graduate program for Autism Spectrum Publishing, Pacific Grove, CA.

Label from page 25 two. For sixty-four cards.” known only as the difficult brother; the boy mentalized or reduced. You are loved and Standing under the fluorescent lights, in who would not play basketball or dance to embraced, and maybe even the tiniest bit in line at Disney or order chicken fingers an aisle full of plastic flowers and teddy Michael Jackson or watch The Muppets at understood. at dinner or apologize for the tantrum you bears, I thought about how you haven’t night with rest of us. As for me, I have learned many lessons threw at a barbecue. Ultimately, we are try- been invited to a birthday party or play You would have felt left out, isolated, from the autism label. I have learned how ing to figure out how to best soften your date in well over five years. In over five angry. You would have hated us. to slow the cart in the grocery store and edges, so the world may look and feel and years, not a single person has called the Then maybe the difficult brother would find the pinkest frosting. I have learned taste a little kinder. house for you, or rang our doorbell, or have grown into the troublesome teenag- how to compromise with chicken fingers, But mostly, Daddy and I celebrate. sent an E-vite. er and eventually, the weird uncle no one and that we should always buy our candy Without your diagnosis—your la- I could have asked you, “Who, Jack? wants to sit next to at Thanksgiving. at the movie theater. bel—I’m not sure I would go to such Who will you send them to?” Instead, we see you. Because of a label, And one cold afternoon in February, I lengths to decorate for every single holiday. Or told you, “No, Jack. I think one pack- we actually see you for who you really are; learned that friendship’s truest measure is But you remind me to go into the basement age is plenty.” a funny, quirky, original boy. And every not how many times the phone rings or the and bring up the green shamrocks and red, I didn’t. I simply said, “Definitely. Defi- day our family works to bridge the gap be- amount of invitations in your mailbox. glittery hearts. Your delight is so tangible, nitely get two.” tween usual and unusual, the neurotypical It’s the courage to stand at the kitchen your joy so real, that I can’t help but be Watching you walk up to the counter and otherwise. counter, student directory in hand, and swept up in the magic. clutching two boxes of red cards, I couldn’t “This is my brother, Jack. He has autism. write out sixty-four cards for Valentine’s “Mom. The hearts. They go on the shelf help it. My throat tightened and my eyes He hears you differently.” Day. again. And on the table.” welled. Because of autism’s label, we eat our “For my friends, Mom. I have so many.” Then there was our trip to Walgreen’s to Because there is some pain not even a dinner surrounded by hearts. buy valentines. label can abate. You have autism. This is not your fault “What Color Is Monday?” is available “Two. I need to buy two boxes.” But without it, our family would only ap- or my fault or Daddy’s fault. This is not on Amazon.com and BarnesandNoble.com. “Why? Why two?” preciate normal. If we didn’t have a name anyone’s fault. It just is. You can also follow Carrie on her weekly “There are thirty-two. Thirty-two in for your unusual characteristics, you may But you are not limited by your label. blog: www.WhatColorIsMonday.com and each. I have a lot. Of friends now. I need have faded into the background, eventually You are not pigeon-holed or compart- Facebook.com/WhatColorIsMonday. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 39

Setting Events from page 17 can increase the likelihood that an anteced- atic behaviors that accompany an ASD. resources for obtaining such information can ent will trigger problem behavior, either by Appropriate identification of anxiety, and be found through the National Association behavioral terms, reinforcing the behav- putting the person in a state that makes the determination of the role this plays as a pre- for Dual Diagnosis, with a listing of resourc- ior. The reinforcement occurs because the behavior more likely, or cuing the individu- disposing factor for problematic behavior, es on NADD’s website (www.thenadd.org). outcome of the behavior either meets a felt al that an outcome they desire is available. is an important factor in developing appro- Care providers also need to know how the need, or provides some type of physical, so- Research has shown that setting events can priate and effective supports. Specifying mental illness will likely affect the behav- cial, or emotional pleasure or satisfaction. include environmental conditions, social feelings of anxiety as a setting event would ior of the person. In conclusion, we wish to A cornerstone of behavior intervention in- influences, or physiological factors. Ex- justify the inclusion of calming activities highlight the need for consideration of the volves developing an understanding of the amples of common environmental setting or relaxation exercises as a precursor in- very nature of ASDs as a potential setting various factors that help to explain why the events for individuals with ASD include tervention designed to prevent the problem event for problem behavior. We encourage problem behavior occurs. This includes the disrupting a person’s routine, and/or being behavior. Recognition of an anxiety disor- the creation of comprehensive functional as- identification of: (a) the settings events, de- in a situation that he or she is unable to pre- der as a setting event would indicate that sessments that consider both ASDs and po- scribed below, (b) the antecedents, which dict upcoming events. Social setting events clinical intervention and treatment of that tential anxiety disorders among persons with specifically cause the behavior to occur, (c) may include being left alone for a period of disorder should be identified as a preven- ASDs. Effective treatment of challenging an operationally defined problem behavior, time or fighting with a family member or tion strategy for those problem behaviors. behaviors requires thinking across various and (d) an outcome or consequence that re- roommate. Illness, pain, sleep deprivation, This kind of assessment of behavior and de- ways in which we as a field have looked at sults from the behavior, which the person hunger and medication changes are just velopment of a Functional Behavioral As- understanding problem behaviors. finds rewarding and motivates them to en- a few examples of internal factors that in- sessment hypothesis afford the opportunity gage in the behavior again. These four ele- crease the likelihood of problem behaviors. both to recognize and address important Philip Smith, PhD, is Assistant Professor ments are sometimes are referred to as the In some cases, the occurrence of a dis- factors that often are neglected in develop- of Pediatrics and Project Manager of Com- “four-term contingency.” order, specific disability, or psychiatric ill- ing behavior plans, along with establishing munity Positive Behavior Supports and For example, an individual may be ness may be considered a setting event for a framework that facilitates the integration Daniel J. Baker, PhD, NADD-CC, is Asso- prompted to perform a task s/he does not the occurrence of problem behavior. This is of behavior intervention and support plan- ciate Professor of Pediatrics, both at The wish to complete, and they may respond significant because psychotropic medica- ning with clinical intervention. Boggs Center on Developmental Disabili- by engaging in problem behavior. When tions have the potential to alter an individu- In addition to identifying environmental ties at Rutgers Robert Wood Johnson Med- the caregivers shift their attention to man- al’s response to environmental stimuli. For variables that precede and follow problem ical School. For more information, please aging the behavior, it may be difficult to instance, researchers have recommended behavior, the functional assessment gathers visit www.rwjms.rutgers.edu/boggscenter. follow through on efforts to get the person that selection of psychotropic medications information about an individual’s commu- to complete the task. If the individual does include consideration of specific pharma- nication, social skills, and other aspects of References not complete the task, the behavior is rein- cological treatment effects on an individ- adaptive functioning and circumstances. forced by the individual’s escape from the ual’s response to environmental stimuli This information can be used to design Carr, E. G.. (1994). Emerging Themes in demands. Researchers have identified a va- maintaining both adaptive and problemat- interventions to teach the individual new the Functional Analysis of Problem Behav- riety of other functional patterns in addition ic behavior (Thompson & Symons, 1999; skills effectively competing with a problem ior. Journal of Applied Behavior Analysis to escape, which include: gaining or avoid- Schall & Hackenberg, 1994). This high- behavior. For instance, an individual may 27, 393–399. ing social attention, gaining access to items lights an important concern regarding the engage in disruptive behavior at school or or activities the individual desires, and cre- relationship between functional assessment work in order to avoid persisting on a dif- Schall, D. W., & Hackenberg, T. (1994). ating patterns of sensory stimulation that of behavior, function based behavioral in- ficult task. The functional assessment pro- Toward a functional analysis of drug treat- are satisfying or comforting (Carr, 1994). tervention, and drug treatment. cess may indicate that the individual does ment for behavior problems of people with Accurate identification of these functions These factors highlight a variety of con- not know how to ask for assistance or how developmental disabilities. American Jour- often leads to individualized strategies, and cerns related to the impact of what would to complete the task. In other cases, an in- nal on Mental Retardation, 99, 123-134. when these are applied systematically, pro- be considered setting events, on the devel- dividual may have strong social and com- actively, and in conjunction with a wide opment and implementation of effective munication skills that are not being used in Thompson, T., & Symons, F. J. (1999). array of educational and other support pro- behavior support plans for individuals settings where problem behaviors are oc- Neurobehavioral mechanisms of drug ac- grams, can make a tremendous impact on ef- with ASD. Several examples highlight curring. Information related to an individ- tion. In N. A. Wieseler, R. H. Hanson, & G. fectively reducing the frequency and severi- this concern. First, many individuals with ual’s social and communication skills will Siperstein (Eds.), Challenging behavior of ty of problematic behaviors, and supporting ASD have an unusual need or craving for provide the foundation for selection and persons with mental health disorders and more positive behavioral alternatives. One specific types of sensory stimulation. Un- teaching of new, adaptive skills that may severe developmental disabilities (pp. 125- challenge in applying these strategies with derstanding the unique pattern of sensory function to replace problem behaviors or 150). Washington, DC: American Associa- individuals who have ASDs though, is that needs and their relationship to problematic reduce the motivation to perform them. tion of Mental Retardation. characteristics of the ASD may serve to in- behaviors is an important factor in devel- The clinician or behavior specialist who crease the likelihood that the individual will oping effective intervention and support desires to work with individuals with ASD Wacker, D. P., Steege, M. W., Northup, engage in a particular behavior. strategies. The focus on setting events pro- and who may be dually diagnosed should be- J., Sasso, G., Berg, W., Reimers, T., Coo- This type of influence on behavior would vides a means of making adaptations to come familiar with the clinical literature re- per, L., Cigrand, K., & Donn, L. (1990). A be classified as a setting event. These are proactively meet sensory stimulation needs garding mental illnesses and their treatment. component analysis of functional commu- conditions which alter what a trigger or part of a support plan designed to prevent An understanding of psychiatric diagnoses nication training across three topographies stimulus means to the person (e.g., a rein- the problematic behaviors. and pharmacological treatments is extremely of severe behavior problems. Journal of forcer is more available), or influence the at- A related consideration is the frequent important in providing the most comprehen- Applied Behavior Analysis, 23, 417-429. titude, capacity, or need that a person brings co-occurrence ASD and anxiety disorders sive and effective intervention and support. In to the circumstances in which a behavior (White et al., 2009). The experience of the mental health literature, it has been noted White, S.W., Oswald, D., Ollendick, T., & may occur. While the antecedents and set- anxiety, its impact on adaptive functioning, that one of the most critical areas of support Scahill, L. (2009). Anxiety in children and ting events both precede problem behavior, and the potential justification for diagnosis for families is information about mental ill- adolescents with autism spectrum disor- setting events do not trigger problem be- of a co-occurring disorder often are over- ness, the impact it may have on behavior, and ders, Clinical Psychology Review, 29, Is- havior by themselves. Rather, setting events shadowed by the symptoms and problem- how these conditions can be treated. Valuable sue 3, 216–229. Behavioral Health News Leadership Awards Reception Honoring:

Alan B. Siskind, PhD, LCSW Andrew Solomon, PhD Phillip Saperia Former CEO, JBFCS Author, Far From the Tree and The Noonday Demon, CEO, The Coalition of Independent Clinical Practice Winner of the National Book Award, and Professor Behavioral Health Agencies “Founders Award” of Clinical Psychology, Columbia University “Advocacy Award” “Humanitarian Award” Keynote Speaker

Wednesday, May 20, 2015 - 5:30 PM - 8:30 PM NYU Kimmel Center - Rosenthal Pavilion, 10th floor - 60 Washington Square South, NYC For more information and to register, please visit www.mhnews.org/AwardsReception.htm PAGE 40 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Focus from page 20 alized and had been for most of his life. He aspirations for a better life. He was a man building for the future and I need consisten- was seen as severely autistic, non-com- who had not had a bit of education who cy on all of your parts, if I am to be success- up with too much stuff going on I get upset municative, with limited intelligence, and then enrolled in a supported service to au- ful in school or whatever else I pursue.” and cry. No one understands that just be- had many behavioral problems. He was dit classes at the local university while he Both of these men, classified with au- cause I get upset and cry it doesn’t mean destined to leave the institution because also worked to obtain his GED diploma. tism, have much to say with the experiences that I do not like what I am doing. Some- of the institution being closed, not because “I want to say this is the happiest I have that they have had in their life. They each times, it is just too much - too long. I still people there saw a brighter future for him. felt in a long time. Also, I can’t believe that speak to how misunderstood each of them like to do things like everyone else. Some- Once out, he moved in with his family and I’m actually excited about the future. The and others have become. It is this misunder- times everything is too much for me, the then began to receive support in his new actual thought of attending a university is standing that leads people with autism down noise, the people - I become very anxious home. One of his supporters felt that Mike now a living reality. A benchmark of some a path of overload and behavioral problems. and get very upset.” was trapped into a web of autism and began sort I am here today. I am very pleased at all These men do not profess to speak for all That day the staff realized: We need to to help him to have a voice. His support- of the progress we have made. Eats a per- with autism, they only speak for themselves take the time to listen. Sometimes some- er helped him to identify communication son up inside when options are few and far from their perspective on what is meaning- one with autism cannot tell us what is not boards and devices. This support staff was between. I am looking forward to the day ful to them. The success of their support will working or why. But with listening, gentle amazed at the interest and intelligence that when abroad I can live. I mean not abroad only come when the direct care professional support, a deep respect, trust and meaning- Mike exhibited as they began to research but more independently. I think someday, is able to earn the deep respect of the person ful relationship, different approaches may what might work for him. Mike essentially all the world will see we disabled have who is labeled and help them down a path bring out wonderful experiences. made all the decisions, and worked to order much more in common than differences. of being a distinguished member of their the device. Once the device was obtained, I want to complete my GED, see the community and not just a client of a system. Institutionalized with No Potential Seen a flood of information came from Mike. world, and come to have a place of my own He was so misunderstood before. He was and my bachelor’s degree. I want a more For more information, please email pat- When we met Mike, he was institution- a man of great strength, intelligence and active say in what I want and need. I am [email protected] or visit www.oclinc.org.

Effective Approach from page 21 the inappropriate behavior. Environmental students can better understand the behav- plements their school expectations known factors such as when, where and how are ioral expectations across all settings (i.e. as “The Bears Code.” For more informa- extra support to meet universal expectations. examined. A plan for interrupting the pat- classroom, hallways & cafeteria). Tier-two tion, please visit www.nyit.edu/vip. Tier-two interventions usually target a tern of inappropriate behavior and replac- and tier-three interventions provide the re- small group of students who demonstrate ing it with a more appropriate behavior petitive teaching and progress monitoring References similar behaviors. Tier-two supports usu- is developed. Any tier-three intervention to encourage appropriate behaviors across ally involve reviewing the rule or behav- would be communicated, monitored and all school settings. As you would imagine, LaVoie, R, It’s So Much Work to Be Your ior not being demonstrated in a systematic implemented with school wide consistency parental involvement and support is often Friend Helping the Child with Learning way. Interventions which are embedded and continuity in accordance with the data crucial to the success of these supports. Disabilities Find Social Success, Simon & into the schools arsenal of support tools driven practices of PBIS (Lohrmann, For- PBIS focuses on student outcomes and Schuster, 2005. such as offering a social skills or academic man, Martin, Palmieri, 2008). behaviors in both the academic and social skills group to students would be examples At school, students are expected to learn arenas. Students with ASD benefit from Lohrmann, Forman, Martin, Palmieri, Un- of tier-two supports. Such groups would how to manage themselves and their sched- routine and structure. PBIS sets clearly derstanding School Personnel’s Resistance focus on breaking down the steps to obtain ules. The expectation of self-management stated rules and school–wide expectations. to Adopting School wide Positive Behav- a specific skill and then provide opportu- and accountability is supported by the sys- Consequently, the PBIS approach is help- ior Support at a Universal level of Inter- nities to practice this new skill. These sup- tems of PBIS. Evidence-based practices ful to promote appropriate behavior and vention, Journal of Positive Behavior In- ports provide increased attention, structure which are documented to work for individ- address challenging behavior. Consistent tervention Vol 10 Number 4 October 2008 and skill development for the student(s). uals with ASD such as modeling, prompt- teaching and re-teaching of expectations is p. 256-269). Such interventions can also be helpful in ing, reinforcement, social skilled training, an integral component of each tier of sup- providing data driven feedback to both the task analysis, video modeling and visual port under PBIS. The collaborative team Sugai and Simonsen, Positive Behavioral student and the families about progress support can all be incorporated into the var- approach and predictability of disciplinary Interventions and Supports: History, Defin- made in meeting expectations. ious tiers of the PBIS approach (Wong, C., procedures is a good fit when working on ing Features and Misconceptions, Center Tier-three supports are the most specific Odom, S.L., Hume, K., Cox, A. W., Fettig, promoting appropriate behaviors for stu- for PBIS & Center for Positive Behavioral and intensive because they focus on indi- A., Kucharczyk, S., … Schultz, T.R., 2013). dents with ASD. Interventions and Supports, University of vidual student needs. At tier-three the em- It is widely accepted that students with Connecticut June 19, 2012. phasis is on understanding the function of Autism Spectrum Disorder learn best Christine Alter, LCSW is a Teacher and the undesirable or challenging behavior for when given concrete rules and consistent Social Counselor at the New York Institute Wong, C., Odom, S.L., Hume, K., Cox, A. the particular student (obtain something, reinforcement. Their stress level is also of Technology’s Vocational Independence W., Fettig, A., Kucharczyk, S., … Schultz, escape something, or just getting atten- diminished when they can predict their Program (NYIT-VIP). The Vocational In- T.R. (2013) Evidence-based practices for tion). Interventions are developed based environment (LaVoie, 2005). The school- dependence Program is a U.S. Department children, youth and young adults with Autism upon individual evaluations such as func- wide nature of PBIS is therefore ideal for of Education approved Comprehensive spectrum Disorder, Chapel Hill: The Univer- tional behavioral assessments. Behavioral students with Autism Spectrum Disorder. Transition and Post-secondary (CTP) pro- sity of North Carolina, Frank Porter Graham intervention plans are often developed in The explicit nature of the PBIS frame- gram. Ms. Alter is chairperson for VIP’s Child Development Institute, Autism Evi- an effort to have a consistent response to work operationalizes pro-social values so Dare to Care PBIS Committee, which im- dence-Based Practice Review Group.

Aggressive from page 32 By identifying the reinforcing variables QSAC (Quality Services for the Autism Sturmey, P. (n.d.). Treatment interven- and the function of these behaviors, profes- Community) is committed to providing tions for people with aggressive be- anything additional professionals are faced sionals can look to create treatment plans the most appropriate interventions to our haviour and intellectual disability. Re- with a treatment and intervention challenge. that will replace the harmful behavior and participants as possible. As a behavior trieved from http://www.wpanet.org/ Often, covert observations are conducted in often functional communication training analytic program, we continue to rely on uploads/Education/Educational_Resourc- order to ascertain that automatic reinforce- is pertinent to the treatment design. It is evidence-based practices to improve the es/autism-part4.pdf ment is the true function of self-injurious important to note, however, that behavior lives of our participants in a socially sig- behavior (Toussant & Tiger, 2012). Profes- treatment plans must maintain a function- nificant and safe way. For more informa- Toussaint, K., & Tiger, J. (2012). Reducing sionals must discretely observe the individ- al equivalence between the two behaviors. tion related to challenging behavior and/or Covert Self-Injurious Behavior Maintained ual engaging in this behavior in the absence In other words, if for example, the function treatment plans, please view our website at by Automatic Reinforcement Through of other people, without a response from of the aggressive or self-injurious behavior www.QSAC.com or contact Rachel directly A Variable Momentary DRO Procedure. anyone and across environments and vari- is hypothesized to be attention seeking, the at [email protected] or 718-728-8476. Journal of Applied Behavior Analysis, ous times of day. Once it is identified that treatment plan must include a component 45.1(Spring), 179-184. the function of the behavior is automatic, to teach a more suitable way of requesting References therapeutic interventions can be designed attention as opposed to providing an escape Vollmer, T., & Iwata, B. (1991). Establish- and implemented. Although functional from a demand, additional access to pre- Borrero, C., & Borrero, J. (2008). Descriptive ing Operations and Reinforcement Effects. analyses are extremely useful for the basis ferred items, or using a time out procedure. and Experimental Analyses of Potential Pre- Journal of Applied Behavior Analysis, 24 of treatment development, assessments are Due to the severity of aggressive and cursors to Problem Behavior. Journal of Ap- (2(Summer)), 279-291. often not possible due to the risks of harm self-injurious behaviors, professionals plied Behavior Analysis, 41.1(Spring), 83-96. to the individual or therapists (Borrero & strive to identify the cause of behaviors Why is Autism Associated with Aggres- Borrero, 2008). as soon as possible. By understanding the Carr, E., & Durand, V. (1985). Reducing Be- sive and Challenging Behaviors? (2012, Of all behavior that can occur, aggressive function of behavior as opposed to focus- havior Problems Through Functional Com- January 1). Retrieved February 5, 2015, and self-injurious behaviors are by far the ing on the form alone, lasting treatment in- munication Training. Journal of Applied Be- from https://www.autismspeaks.org/sites/ most dangerous and troublesome to treat. terventions are possible. havior Analysis, 18 (2(Summer)), 111-126. default/files/section_1.pdf AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 41

Safety from page 10 • In preventing abduction and sexual ex- Emergency” pamphlet for individuals C., Mandell, D.S., Hagopian, L. & Law, ploitation, use role playing, video mod- and first responders, emergency informa- P.A. (2012). Occurrence and family impact language; ask simple questions to iden- eling, and practice scripts with com- tion forms, identification cards, and more of elopement in children with autism spec- tify real danger(s); clarify understand- mon lures. Use social stories relating to available at www.childrens-specialized. trum disorders. Pediatrics, 130: 870-877. ing of instructions; pause to allow time whom to approach for help, methods of org/KohlsAutismAwareness/safety. to process information; and redirect recognizing and avoiding uncomfort- Carter, S. (2009). Bullying of students with conversation to stay on topic. able and unsafe situations. Additional Resources Asperger Syndrome. Issues in Comprehen- sive Pediatric Nursing, 32:145-154. Practical interventions for families: • To increase travel safety, use adaptive Autism Society Safe and Sound www.au- car seats or transport safety restraint; es- tism-society.org/living-with-autism/how- Debbault, D. & Legacy, D. (2004). Autism • To reduce drowning risk teach wa- tablish travel rules; and use social stories. the-autism-society-can-help/safe-and-sound and law enforcement role call briefing vid- ter safety; use locked fences/gates eo. Debbaut Legacy Productions, Prt St. around any source of water; train life- • Consider the use of service animals to Autism Speaks Autism Safety Project Luice, Florida. guards to recognize ASD; utilize safety help protect, calm, regulate behaviors, www.autismspeaks.org/family-services/ mechanisms including alarms; notify and prevent escape. autism-safety-project Mouridsen, S.E., Bronnum-Hannsen, H., neighbors, pool owners, and local first Rich, B. & Isager, T. (2008). Mortality and responders; and ensure adequate super- • Evaluate if proper use of 911 should be National Autism Association Autism Safe- causes of death in autism spectrum disor- vision during outings near water. taught if the person does not recognize ty www.autismsafety.org ders: An update. Autism, 12(4): 403-414. real dangers or emergencies. • For elopement challenges, use video Jill F. Harris, PhD, is Director of Program Shavelle, R.M., Strauss, D.J., & Pickett, J. (2001). modeling, reinforcers, and social sto- Resources Development and Adrienne Robertiello is Au- Causes of death in autism. Journal of Autism ries to teach person to walk safely. Use tism Educator at Children’s Specialized Hospi- and Developmental Disorders, 31(6): 569-576. special locks, personal tracking devices Children’s Specialized Hospital has as- tal. Please visit www.childrens-specialized.org. and security alarms. Use identification sembled free, downloadable resources for Sullivan. P.M. & Knutson, J. (2000). such as ASD alert card, medical alert people with ASD, caregivers, and service References: Maltreatment and disabilities: A popula- jewelry, or iron-on garment labels; providers. Resources include the Autism tion-based epidemiological study. Child child identification kits. Family Safety Handbook, “911 Means Anderson, C., Kaw, J.K., Daniels, A., Rice, Abuse and Neglect. 24(100): 1257-1273.

Adults from page 26 Consequence-based strategies - The last with ASD. Preventative strategies, replace- costs of services and employment out- category of interventions are those which ment skills (FCT) and extinction all remain comes achieved by adults with autism in Antecedent-based strategies - Techniques alter the outcomes produced by the be- key components in designing effective in- the US. Autism, 13 (3), 285-302. that modify the environment prior to the havior in a way that make the behavior terventions for this population. In cases occurrence of a behavior in order to prevent less likely to happen again in the future. in which extinction is not a viable option, Freeman, K. A., Anderson, C. M., & Scotti, that behavior from occurring are known as Consequence-based strategies may in- practitioners must increase emphasis on J. R. (2000). A structured descriptive meth- antecedent-based strategies. These tech- clude breaking the relationship between other preventative treatment components to odology: increasing agreement between de- niques may include providing access to a behavior and the outcome that has pre- keep people safe. scriptive and experimental analyses. Educa- preferred items/activities or breaks from viously been associated with it, known as There exists a troubling gap in state of tion and Training in Mental Retardation and task demands on a schedule, independent extinction, and may also include adding or assessment and intervention for older in- Developmental Disabilities, 35 (1), 55-66. of the occurrence of the maladaptive be- removing something from the individual’s dividuals with ASD. Failure to identify vi- havior in order to reduce an individual’s environment which makes the problem able solutions for this population can lead Ganz, M. L. (2006). The costs of autism. motivation to engage in problem behav- behavior less likely to occur in the future, to poor outcomes, including more intru- In, S.O. Moldin & J.L.R. Rubenstein ior. This procedure, referred to as noncon- referred to as punishment. sive interventions, more restrictive place- (Eds.), Understanding Autism (pp. 475- tingent reinforcement (NCR), has been ments, and an increased likelihood of psy- 502). Boca Raton, FL: CRC Press. shown to be effective in reducing problem It is important to note that, in many cas- chotropic medication use. The assessment behavior in individuals with autism (Voll- es, these interventions may be combined and treatment approaches outlined above Järbrink, K. McCrone, P. Fombonne, E. mer, Iwata, Zarcone, Smith, & Mazaleski, in a way that improves their effectiveness provide an important starting point in the Zanden, H. Knapp, M. (2007). Cost-im- 1993), and may be effectively combined for addressing problem behavior. For ex- development of a comprehensive model of pact of young adults with high-functioning with other behavioral interventions. ample, when attempting to treat problem care for this rapidly growing population. autistic spectrum disorder. Research in De- Antecedent-based strategies are a particu- behavior through the training of a new velopmental Disabilities, 28, 94-104. larly important tool in the treatment of prob- adaptive communicative request with FCT, Ethan Eisdorfer, MA, and Mikala Han- lem behavior in adults with ASD. As noted it can be advantageous to have problem be- son, BA, are doctoral candidates at the LaRue, R. H., Lenard, K., Weiss, M. J., previously, older individuals with ASD may havior contact extinction. This effectively Graduate School of Applied and Profes- Bamond, M., Palmieri, M., Kelley, M. E. be capable of extremely dangerous and creates a scenario where the new response sional Psychology (GSAPP) at Rutgers (2010). Comparison of traditional and tri- harmful actions as compared to the capabili- “works” and the old one does not, which University and Robert H. LaRue, PhD, al-based methodologies for conducting ties of children. As the saying goes, an ounce can increase the speed at which the desired BCBA-D, is Director of Behavioral and functional analyses. Research in Develop- of prevention is worth a pound of cure. behavioral change occurs. Research Services at the Douglass Devel- mental Disabilities, 31, 480-487. However, the use of strategies like NCR re- When intervening with adults with ASD opmental Disabilities Center at Rutgers, quire the presence of an adequate number of in particular, the risks of implementing ex- The State University of New Jersey. For Pelios, L., Morren, J., Tesch, D. & Axelrod, well-trained staff to ensure that the schedule tinction may be prohibitive. Under these more information, please contact Robert S. (1999). The impact of functional analysis is followed correctly and consistently. circumstances, practitioners need to em- LaRue, PhD, BCBA-D, at (848) 932-4500 methodology on treatment choice for self-in- phasize the use of preventative procedures or [email protected]. jurious and aggressive behavior. Journal of Functional Communication Training and FCT to address challenging behavior. Applied Behavior Analysis, 32, 185-195. (FCT) - FCT is an intervention strategy that Identifying strategies for decreasing mal- References involves teaching an individual to use an adaptive behavior without the use of ex- Sigafoos, J., Roberts, D., Couzens, D., & adaptive response to take the place of prob- tinction represents an important area in Anderson, C. M., Long, E. S. (2002). Use Caycho, L. (1992). Improving instruction lem behavior (Carr & Durand, 1985). FCT need of research. of a structured descriptive assessment for adults with developmental disabilities: consists of providing the individual with a In conclusion, as rates of autism diagno- methodology to identify variables affect- evaluation of a staff training package. Be- means of accessing preferred items and ac- sis continue to rise, more and more adults ing problem behavior. Journal of Applied havioral Residential Treatment, 7, 283-297. tivities in an easy and effective way (e.g., on the spectrum will be in need of effec- Behavior Analysis, 35, 137-154. using a touch card, sign language, or an tive assessment and treatment procedures. Vollmer, T. R, Iwata, B., Zarcone, J. R., augmentative communication device). The Despite the fact that the majority of the Bloom, S. E., Iwata, B. A., Fritz, J. N., Smith, R. G., & Mazeleski, J. L. (1993). unique appeal of FCT is that it leads to the related literature reflects the needs of chil- Roscoe, E. M., & Carreau, A. B. (2013), The role of attention in the treatment of at- acquisition of a new functional skill. This dren with autism, some helpful insights Classroom application of a trial-based tention-maintained self-injurious behavior: means that the benefits that are observed regarding working with the adult popula- functional analysis. Journal of Applied Be- Noncontingent reinforcement and differen- following FCT are more likely to result tion have emerged. Assessment strategies, havior Analysis, 44 (1), 19-31. tial reinforcement of other behavior. Jour- in enduring change, and may prevent the such as AB analyses, trial-based functional nal of Applied Behavior Analysis, 26, 9-21. emergence of future maladaptive behavior. analyses (FA), and precursor FAs, represent Carr, E. G. & Durand, V. M. (1985). Re- One special consideration in the use of FCT empirically-sound assessment procedures ducing behavior problems through func- Wood, A. L., Luiselli J. K., & Harchik, is that the behavior under treatment may that may limit the risks associated with tional communication training, Journal A. E. (2007). Training instructional skills have a long history of reinforcement, and challenging behavior in older populations. of Applied Behavior Analysis, 18, 111-126. with paraprofessional service providers at therefore may persist even after the new al- Relatively little research has investigated a community-based habilitation setting. ternative response has been trained. treatment issues as specific to individuals Cimera, R. E. Cowan, R. J. (2009). The Behavior Modification, 31(6), 847-855. PAGE 42 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Deficits from page 31 ing systematic desensitization interventions. Many students with HFA lack appropri- Bellini, S., Akullian, J., & Andrea, H. Systematic desensitization can be done by ate coping skills. These skills are necessary (2007). Increasing social engagement in supports, scripts to outline the presenting gradually teaching students to tolerate stim- to self-regulate, and often require specific young children with autism spectrum dis- problem, and coming up with reasonable uli that present as aversive to them. instruction. Effective coping techniques orders using video-self modeling. School solutions to the problem can be effective Many students with HFA experience dif- such as: deep breathing using a visual Psychology Review, 36(1), 80-90. tools to use when students face scenarios ficulties with emotional recognition and counting chart, progressive muscle relax- that seem dire and hopeless to them. For regulation. Teaching correct recognition of ation (systematically tensing and releasing Gray, C. (2000). The new social story book. instance, presenting a visual diagram of the emotions can be done using visual supports major muscle groups), or “going” to a calm Arlington: Future Horizons. problem helps students think about how or through video modeling. Video model- place (using guided imagery or visual sup- they may adjust and modify their behavior. ing for individuals with ASDs has shown ports) can help students calm themselves. Henry, S. & Myles, B.S. (2007). The com- When students expend their energy on to be effective in addressing social-com- Additionally, these supports assist students prehensive autism planning system (CAPS) small problems, they often get drained munication skills, functional skills, and with self-regulation, and can interrupt the for individuals with Asperger syndrome, and become unavailable for learning. behavioral functioning. Additionally, those behavioral challenge while redirecting the autism, and related disabilities: Integrat- Oftentimes, these small problems can skills learned through video modeling can student to a calm place. When presenting best practices throughout the student’s lead students to feeling overwhelmed. be maintained over time and generalized to ed with an intense behavioral situation day. Shawnee Missions, KS: Autism As- Frequently, students with HFA will need other settings (Bellini & Akullian, 2007). (i.e., the student is completely unable to perger Publishing Company. guidance in developing solutions to these Behavior mapping is another tool that emotionally regulate), the removal of the problems to prevent an extreme emotion- teaches students to conceptualize what be- stressor may be required. Very often stu- Horner, R. H., Carr, E. G., Halle, J., Mc- al reaction. For example, not receiving a haviors are expected in different situational dents will tell you exactly what has caused Gee, G., Odom, S., & Wolery, M. (2005). perfect score on a test could be experi- contexts, and can increase a student’s over- them to become angry or frustrated, so it is The use of single subject research to iden- enced as a traumatic event for a student all social competence (Winner, 2007). important to listen to what they have to say. tify evidence-based practice in special edu- with a rigid thought process. Frequent Individuals with HFA frequently show The use of Atwood’s emotional thermome- cation. Exceptional Children, 71, 165-179. practice is often required to prepare stu- deficits in executive functions (EF), hence ter (2004), to allow the student to self-rate dents for the fact that they will be pre- often display problems with inhibition, the level of intensity of their emotions in Koegel, R.L., Openden, D., & Koegel, L. sented with problems on an ongoing basis planning and organizing, shifting topics, and the moment can be helpful. What is con- K. (2004). A systematic desensitization and that these problems will vary in mag- self-monitoring behavior (Semrud-Clike- sidered to be challenging behavior can take paradigm to treat hypersensitivity to au- nitude depending on the issue. Forgetting man, Walkowiak, Wilkinson, & Butcher, many forms and may require different re- ditory stimuli in children with autism in to bring in your homework or losing a 2010). Arranging the instructional setting active approaches. Whichever approach is family contexts. Research and Practice game is a less severe problem than getting to address these EF deficits can further as- used, it is important to remain calm while for Persons with Severe Disabilities, 29(2), into a fight on the playground. Learning sist in preventing behavioral challenges. helping the student to de-escalate. When 122-134. to recognize the size of the problem and Environmental modifications can provide the student is calm, this serves as an op- the reaction that matches that problem students with ASD the structure, visual sup- portunity to debrief and discuss possible Matson, J. L., Matson, M. L., & Rivet, T. T. is an important skill that students must ports, and predictability they may need in alternative solutions to the challenging be- (2007). Social-skills treatment for children learn. Cognitive restructuring to address order to learn new skills (Henry & Myles, havior that was exhibited, and to develop with autism spectrum disorders: An overview. distorted thoughts and literal interpreta- 2007). A distraction free environment con- a plan should the student encounter this Behavior Modification, 31(5), 682-707. tions of events can be done using cartoon sists of materials being well organized and problem again. thought bubbles of specific scenarios. Us- shelves labeled. Color-coding students’ ma- Myles, B. S. (2005). Children and youth ing this type of visual modality can be an terials (i.e. books, folders) specific to each Edel McCarville, PsyD, is a School Psy- with Asperger syndrome: strategies for effective tool in teaching students how to subject is helpful. This provides critical in- chologist and Colleen Menard, MSEd, is a success in inclusive settings. Thousand modify how they think, feel and behave formation that assists in finding and putting Special Education Teacher for Levittown Oaks, CA: Corwin Press. in a social context (Wellman, Baron-Co- away materials without additional support Public Schools. For more information, hen, Caswell, Gomez, Swettenham, Toye, from the teaching staff. Visual cueing sys- please contact Edel at emccarville@levit- Scahill, L., & Lord, C. (2004). Subject selec- & Lagattuta, 2002). Additional school tems, such as models for writing assign- townschools.com. tion and characterization in clinical trials in based interventions such as modeling, ments, and behavioral expectations should children with autism. CNS Spectrums 9, 22-32. reinforcement, and social stories can fur- be displayed throughout the classroom and References ther improve skill development in natural on the students’ individual desks. Semrud-Clikeman, M., Walkowiak, J., settings (Gray, 2000; Matson, 2007). For Behavioral interventions are most effec- American Psychiatric Association. (2013). Wilkinson, A., & Butcher, B. (2010). Ex- example, the goal of a social story is to tive for students with autism (Horner, Carr, Diagnostic and statistical manual of mental ecutive functioning in children with as- provide correct social information leading Halle, McGee, Odom, & Wolery, 2005). disorders (5th ed.). Washington, DC: Author. perger syndrome, ADHD-combined type, the student to more appropriate responses. The behavioral principle of positive rein- ADHD-predominately inattentive type, In school, many students with HFA often forcement can be used to increase the per- Attwood, T. (2004b). Exploring feelings: and controls. Journal of Autism and Devel- experience anxiety; which affects their abil- formance of desired skills. Positive rein- Cognitive behavior therapy to manage an- opmental Disorders, 40(8), 1017-1027. ity to focus, participate in social activities forcement can occur as part of a class-wide ger. Arlington, Texas: Future Horizons. with peers, and in instruction. Difficulties or individual positive behavioral support Wellman, H. M., Baron-Cohen, S., Caswell, with communication and problem solving system. Regardless of the reinforcement Bauminger, N. (2002). The facilitation of R., Gomez, J. C., Swettenham, J., Toye, E., skills may lead to increased anxiety and approach used, it is important to develop social-emotional understanding and social & Lagattuta, K. (2002). Thought-bubbles behavioral challenges in school. Many stu- goals or targets for reinforcement collab- interaction in high functioning children help children with autism acquire an alter- dents may appear to be noncompliant or op- oratively with the student. This will max- with autism: Intervention outcomes. Jour- native theory of mind. Autism-The Interna- positional, when in fact the behaviors they imize the student’s willingness to partici- nal of Autism and Developmental Disor- tional Journal of Research and Practice, are demonstrating are more related to skill pate. When collaborating with the student, ders, 32, 283-298. 6(4), 343-363. deficits. Many students with HFA experi- it is essential to clearly define and provide ence anxiety related to specific fears which direct explanation of behavioral targets. A Bauminger, N. (2007). Brief report: Indi- Winner, M.G. (2007). Social behavior appear to be a result of conditioned learning token economy is one method to deliver vidual social-multi-modal-intervention for mapping: connecting behavior, and emo- (Koegel, Openden, & Koegel, 2004). These positive reinforcement for meeting behav- HFASD. Journal of Autism and Develop- tions across the day. San Jose, CA: Think phobias may be successfully addressed us- ioral objectives. mental Disorders, 37(8), 1593-1604. Social Publishing.

Proven from page 28 participants in the process understand that avoided altogether? How could caregivers should be successful in most environ- physical restraint is a last resort. proactively reinforce positive behaviors to ments—The Arc of Delaware County team to make it less available. In some organi- replace the challenging behavior? has seen it time and again within the orga- zations all employees are trained in the use 9) Increase Scrutiny of Physical Inter- In an organizational setting, scrutiny of nization, as well as in other organizations of physical interventions. Simply adopting ventions - It’s important to not only use these instances also sends a powerful mes- that adopt this method. a policy whereby only the absolute fewest positive reinforcement, but also to reduce sage throughout the organization that these number of staff necessary in a given loca- the use of physical interventions. Taking are serious goals being set. Scrutiny will George Suess is the CEO of The Arc of tion are so trained sends a powerful mes- a careful look at instances when physical be even more effective if it emphasizes a Delaware County, NY, and founder of fwd- sage. As does adopting a policy that only intervention is used can help in this effort. search for root causes rather than blame. shift, a suite of services designed to help our “best” or most “experienced” employ- This means pausing after the situation is It’s important that the entire environ- human service organizations transform ees will be so trained. over and considering some key questions: ment’s culture commit to making this their cultures, and reduce behavior chal- In other settings, this can be applied by What triggered the situation? What could change—one individual can’t effect this lenges. Contact him at (607) 865-7126 or keeping tools used for physical restraint prevent or minimize the challenging be- change alone. But when these steps are [email protected] and learn more at out of easy reach, and ensuring that all havior in the future? Can the situation be applied consistently over time, this shift www.delarc.org. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 43

Effect from page 30 ponents are used strategically before the References and Developmental Disorders,32(5), 423- occurrence of problem behavior. For ex- 446. doi: 10.1111/j.1365-2788.2006.00904.x based on why the behavior occurred were ample, if a child is found to be more likely Carr, E. G., & Smith, C. E. (1995). Bio- attempted, but it was not until strategies to engage in problem behavior to get out logical setting events for self-injury. Men- Horner, R. H., Day, H. M., & Day, J. R. to address these specific environmental of homework when he/she is tired, it may tal Retardation and Developmental Dis- (1997). Using neutralizing routines to re- antecedents were implemented that prob- be beneficial to allow for a nap or decrease abilities Research Reviews, 1, 94-98. doi: duce problem behaviors. Journal of Ap- lem behavior was consistently decreased. the amount of work on days that he/she is 10.1002/mrdd.1410010204 plied Behavior Analysis, 30, 601–614. doi: Horner, Day, and Day (1997), identified tired before problem behavior occurs. Re- 10.1901/jaba.1997.30-601 that delaying or cancelling a planned ac- active strategies, such as allowing a child Dicesare, A., McAdam, D. B., Toner, A., & tivity (e.g., school events and outings) in- to stop working following problem behav- Varrell, J. (2005). The effects of methylphe- Kennedy, C. H., & Itkonen, T. (1993). Ef- creased the likelihood of problem behavior and take a nap because the child is tired nidate on a functional analysis of disrup- fects of setting events on the problem be- ior, specifically during academic work, should be avoided, as this is likely to ex- tive behavior: A replication and extension. havior of students with severe disabilities. for two individuals with developmental acerbate the problem by teaching the child Journal of Applied Behavior Analysis, 38, Journal of Applied Behavior Analysis, 26, delays. For both individuals, the treatment that problem behavior results in a break 125-128. doi: 10.1901/jaba.2005.155-03. 321–327. doi: 10.1901/jaba.1993.26-321 included specific components (e.g., 10 from work. Instead, caregivers/teachers minutes access to a preferred activity or should take data on sleep and problem- Hartley, S.L., Sikora, D.M., & McCoy, R. Kennedy, C. H., & Meyer, K. A. (1996). rescheduling the event on a calendar) to atic behaviors to determine if a relation- (2008). Prevalence and risk factors of mal- Sleep deprivation, allergy symptoms, and prevent problem behavior during days that ship exists between them, and if it does adaptive behaviour in young children with negatively reinforced problem behavior. these antecedents occurred. then strategically plan for changes in the Autistic Disorder. Journal of Intellectual Journal of Applied Behavior Analysis, 29, In summary when treating problem be- environment prior to starting homework Disability Research 52(10), 819–829. doi: 133–135. doi: 10.1901/jaba.1996.29-133 havior, it is crucial to focus on how one on these days. Environment-behavior re- 10.1111/j.1365-2788.2008.01065.x can alter the consequences of problem lationships are crucial in understanding Northup, J., Fusilier, I., Swanson, V., behavior when developing interventions, challenging behaviors exhibited by in- Herring, S., Gray, L., Taffe, J., Tonge, Roane, H., & Borrero, J. (1997). An eval- but it is as important to consider anteced- dividuals diagnosed with ASD, and best G., Sweeney, D., & Einfield, S. (2006). uation of methylphenidate as a potential ent events. In all of the studies discussed practice is to consider both antecedents Behaviour and emotional problems in establishing operation for some common above, antecedents were strategically as- and consequences in behavioral assess- toddlers with pervasive developmental classroom reinforcers. Journal of Applied sessed, meaning that data were collected ments and treatments. disorders and developmental delay: As- Behavior Analysis, 30, 615–625. doi: on a daily basis regarding problematic sociation with parental mental health and 10.1901/jaba.1997.30-615 behaviors and specific antecedents. This Mindy Scheithauer, PhD, BCBA, is a family functioning. Journal of Intellectu- type of assessment is crucial to determine Postdoctoral Fellow, Joanna Lomas Mev- al Disability Research, 50, 874–882. doi: Taylor, D. V., Rush, D., Hetrick, W. P., if and how antecedent events are playing a ers, PhD, BCBA-D, is Assistant Professor, 10.1111/j.1365-2788.2006.00904.x & Sandman, C. A. (1993). Self-injuri- role in an individual’s challenging behav- and Nathan A. Call, PhD, BCBA-D, is ous behavior within the menstrual cy- ior. Following this assessment, strategies Assistant Professor at the Marcus Autism Horner, R.H., Carr, E.G., Strain, P.S., Todd, cle of women with mental retardation. can be put into place to reduce the effects Center at Emory University School of A.W., & Reed, H.K. (2002). Problem Behav- American Journal on Mental Retarda- these variables have on problem behavior. Medicine. For more information, please ior Interventions for Young Children with Au- tion, 97, 659–664. doi:0.1352/0895-8017 It is important that these treatment com- visit www.marcus.org. tism: A Research Synthesis. Journal of Autism (2003)108<0117:MDAABS>2.0.CO;2

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Self-injury from page 14 are prevalent in individuals with autism challenging behaviors such as self-injury Johnson, K. P., Giannotti, F., & Cortesi, G. spectrum disorders, particularly when and aggression are of concern, an effective (2009). Sleep patterns in autism spectrum 2014, December) and Risperidone (Sca- there is a comorbid diagnosis of intellectu- course of action includes conducting an disorders. Child and Adolescent Psychiat- hill, Koenig, Carroll, Pachler, 2007), can al disability (Matson & Shoemaker, 2009), FBA and FA early on to rule out any main- ric Clinics of North America, 18, 917-928. produce unwanted challenges. Two con- and studies have shown that children with taining sources of reinforcement that could cerning side effects of Risperidone include seizure disorders display greater impair- be addressed and possibly avoid unneces- Matson, J. L., Neal, D., Hess, J. A., Ma- weight gain and an increase in appetite ments in the areas of adaptive behaviors, sary intrusive interventions with potential han, S., & Fodstad. (2010). The effect of (Scahill, et al., 2007), and these unintended personal/social abilities, communication, side effects, prior to considering other fac- seizure disorder on symptom presentation results carry additional significance with a motor abilities, and cognitive abilities than tors that could be impacting the individu- in atypically developing children and chil- child who is already displaying aggressive children without seizure disorders (Mat- al’s mood and behavior. dren with autism spectrum disorders based behaviors. Additionally, if the function of son, Neal, Hess, Mahan, & Fodstad, 2010). on the BDI-2. Developmental Neuroreha- the self-injury or aggression was to gain It is also suspected that seizure disorders Jenny La Barbera, Psy.D., BCBA-D, is bilitation, 13(5), 310-314. access to food or if food was the most impact children with ASD to a greater de- the co-director of NY Behavior Analysis reinforcing item to a child prior to the in- gree than children with other developmen- and Psychological Services, an agency that Matson, J. L., Shoemaker, M. (2009). In- troduction of the Risperidone, the child’s tal delays (e.g., spina bifida, cerebral palsy, provides assessment and treatment services tellectual disability and its relationship to difficulties could be exacerbated. microcephaly, Down’s syndrome). Unde- to individuals with autism and other mental autism spectrum disorders. Research in A diagnosis separate to an autism diag- tected medical diagnoses, such as seizure health concerns. She can be reached at La- Developmental Disabilties, 30, 1107-1115. nosis is another possible explanation for disorders, can offer a possible explanation [email protected] or at 646-780-9227. self-injury and aggression, so, it is critical for delays in progress and conflicting hy- Otsuka Pharmaceutical Co., Ltd. (2014, that individuals undergo a thorough eval- potheses of the function of an individual’s References December). Medication guide Abilify. uation and receive accurate diagnoses. self-injury or aggression. Retrieved from http://www.otsuka-us. Tsiouris, Mann, Patti, and Sturmey (2003) Given these aforementioned circum- American Psychiatric Association. (2013). com/Products/Documents/medguide_ found that aggression and self-injury was stances, it is critical that caregivers of Diagnostic and statistical manual of mental abilify.pdf not an equivalent symptom of depression in individuals with autism consider all pos- disorders (5th ed.). Washington, DC: Author. individuals with intellectual disabilities. As a sible explanations for self-injury and ag- Scahill, L., Koenig, K., Carroll, D. H., & result, it would not be logical to assume that gression displayed by their loved ones and Hanley, G. P., Iwata, B. A., & McCord, B. Pachler, M. (2007). Risperidone approved an individual with an intellectual disability that psychological and medical profes- E. (2003). Functional analysis of problem for the treatment of serious behavioral possesses a dual diagnosis of depression due sionals investigate alternate explanations behavior: A review. Journal of Applied Be- problems in children with autism. Journal to displays of self-injury or aggression, how- for an individual’s concerning behaviors havior Analysis, 36, 147-185. doi: 10.1901/ of Child and Adolescent Psychiatric Nurs- ever, it is worth considering if another un- and inform caregivers of any other possi- jaba.2003.36-147 ing, 20(3), 188-190. derlying disorder is influencing the individu- ble explanation. al’s behaviors. It is also beneficial to receive All treatment options explored should Hollway, J. A., Aman, M. G., & Butter, Tsiouris, J. A., Mann, R., Patti, P. J., & a second opinion when there are questions or be evidenced-based in order to be confi- E. (2013). Correlates and risk markers for Sturmey, P. (2003). Challenging behaviors inconsistencies within a diagnosis. dent that the treatment will produce the sleep disturbance in participants of the au- should not be considered as depressive Medical diagnoses in combination with expected outcome and to avoid losing tism treatment network. Journal of Autism equivalents in individuals with intellectual autism can also exacerbate a child’s im- time in which effective treatments could & Developmental Disorders, 43, 2830- disability. Journal of Intellectual Disabili- pairments. For example, seizure disorders be improving the individual’s life. When 2843. doi: 10.1007/s10803-013-1830-y ty Research, 47(1), 14-21. PAGE 44 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Rumination from page 23 found to be effective, one major limita- reinforcing qualities (e.g., taste, texture). tellectual disabilities: A systematic review. tion exists to extending these treatments Although there are medical diagnoses Research in Developmental Disabilities, reaching for objects, and interest in social to a residential or home setting. The juice where rumination is seen as a symptom 32, 2193-2205 attention. Another punishment procedure and flavor spray were delivered on a dense (e.g., gastro-esophageal reflux), there are that has resulted in decreased rumination schedule, which would be difficult to im- times when no medical basis for rumi- Lyons, E. A., Rue, H. C., Luiselli, J. K., was reported by Singh, Manning, and An- plement across a school day or residen- nation is apparent. In these cases behav- DiGennaro, F. D. (2007). Brief function- gell (1982). Singh, Manning, and Angell tial hours. However, these may be viable ioral interventions, in conjunction with al analysis and supplemental feeding for (1982) prompted twins, who engaged in treatment options if individuals are taught medical recommendations or as a prima- postmeal rumination in children with de- ruminative behavior, to brush their teeth, to administer the item themselves or rumi- ry treatment, may assist in decreasing or velopmental disabilities. Journal of Ap- for 2 minutes, with a toothbrush soaked in nation does not occur throughout the day eliminating rumination. Early behavioral plied Behavior Analysis, 40, 743-747. doi: Listerine and wipe their lips with a face (Wilder et al., 2009). strategies emphasized the use of punish- 10.1901/jaba.2007.743-747 cloth dipped in Listerine. Results of the Due to the limited success and cumber- ment, whereas more recent interventions procedure showed a decrease in rumina- some nature of the treatments described have utilized reinforcement and anteced- Rast, J., Johnston, J. M., Drum, C., Con- tive behavior and an increase in stereotyp- above, researchers have begun manipu- ent modification. Behavior analysts have rin, J. (1981). The relation of food quanti- ic and appropriate behaviors. Due to the lating antecedent variables which may re- much to offer in the treatment of rumina- ty to rumination behavior. Journal of Ap- rapid decrease in rumination and the seri- sult in decreased rumination. Researchers tion given their adherence to ongoing data plied Behavior, 14, 121-130. doi: 10.1901/ ous medical and social concerns related to evaluated the effects of caloric intake and collection and the systematic exploration jaba.1981.14.121 chronic rumination, positive punishment supplemental feedings for individuals who and analysis of variables that might influ- was historically used as an appropriate engage in ruminative behavior. These an- ence rumination. Rhine, D., Tarbox, J. (2009). Chewing gum treatment for rumination. However, today tecedent manipulations have shown prom- as a treatment for rumination in a child clinicians evaluate the effectiveness of ising results in decreasing rumination. In Jennie England, MA, BCBA, is Clinical with autism. Journal of Applied Behav- less restrictive procedures such as differ- 1981, Rast, Johnston, Drum, and Conrin Case Manager and James T. Chok, PhD, ior Analysis, 42, 381-385. doi: 10.1901/ ential reinforcement of other behavior, the systematically evaluated the effect that BCBA-D, is Director of Clinical Services jaba.2009.42-381 use of competing items, diet changes, and food quantity. The researchers manipulat- at Melmark. For more information, please non-contingent access to stimuli prior to ed food quantity from regular portions to visit www.melmark.org. Wilder, D. A., Register, M. Register, S., beginning a punishment based procedure satiation portions. When the participants Bajagic, V., Neidert, P. L., Thompson, R. to decrease rumination. were eating satiation portions they were References (2009). Functional analysis and treatment Non-contingent delivery of food or permitted to eat as many “potatoes, cream of rumination using fixed-time delivery drink has been shown to reduce rumina- of wheat, unflavored grits, and/or bread” as Chial, H. J., Camilleri, M., Williams, D. E., of flavor spray. Journal of Applied Behav- tive behavior (Lyons, Rue, Luiselli, and they wanted. The authors found that when Litzinger, K., Perrault, J. (2003). Rumina- ior Analysis, 42, 877-882. doi: 10.1901/ DiGennaro, 2007). However, in order for participants were given satiation portions tion syndrome in children and adolescents: jaba.2009.42-877 these treatments to maintain low levels of the duration and frequency of rumination Diagnosis, treatment, and prognosis. Pedi- rumination they often need to be delivered decreased. Other researchers have reported atrics, 111,158-162 Woods, K. E., Luiselli, J. K., Tomassone, frequently, which can be impractical for similar results (Johnston, Greene, Rawai, S. (2013). Functional analysis and inter- caregivers and result in undesirable side Vazin, and Winston, 1991). Thibadeau, Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bau- vention for chronic rumination. Journal of effects for the client, such as weight gain. Blew, Reedy, and Luiselli (1999) provid- man, K. E., Richman, G. S. (1994). Toward a Applied Behavior Analysis, 46, 328-332. Therefore, researchers have also evaluated ed unlimited access to white bread for 1 functional analysis of self-injury. Journal of doi:10.1901/jaba2007.743-747 treatments which can be easily delivered hour post meal. The authors made the de- Applied Behavior Analysis, 27, 197-209 frequently in a natural environment. Rhine cision to use white bread because this was Sajwaj, T., Libet, J., Stewart, A. (1974). and Tarbox (2009) decreased ruminative a preferred food for the participant and the Johnston, J. M., Greene, K. S., Rawal, A., Lemon-juice therapy: The control of behavior, in a 6-year-old, by providing starch content was similar to foods used Vazin, T., Winston, M. (1991). Effects of life-threatening Rumination in a six- non-contingent access to chewing gum. in other satiation diet programs. This pro- caloric level on ruminating. Journal of Ap- month-old infant. Journal of Applied Be- Kliebert and Tiger (2011) decreased ru- cedure resulted in significantly decreased plied Behavior, 24, 597-603. doi: 10-1901/ havior Analysis, 7, 557-563. doi: 10.1901/ mination, maintained by automatic rein- levels of rumination. In follow-up obser- jaba.1991.24.597 jaba.1974.7.557 forcement, by providing access to apple vations the researchers found that these juice every 15 seconds, after lunch. These results were maintained up to 15 months Kliebert, M. L., Tiger, J. H. (2011). Di- Singh, N. N., Manning, P. J., Angell, M. J. results, however, did not maintain in post after the conclusion of the study. rect and distal effects of noncontingent (1982). Effects of an oral hygiene punish- non-contingent juice sessions, which were Future researchers and clinicians should juice on rumination exhibited by a child ment procedure on chronic rumination and conducted right after the 15 second access evaluate different variables that may have with autism. Journal of Applied Behav- collateral behaviors in monozygous twins. to apple juice sessions. Similarly, Wilder similar effects on rumination. These vari- ior Analysis, 44,955-959. doi: 10.1901/ Journal of Applied Behavior Analysis, 15, et al., (2009) decreased rumination in a ables include, food type (e.g., meat, starch, jaba.2011.44-955 309-314. doi: 10.1901/jaba.1982.15-309 37-year-old male by delivering an apple fruit), food texture (e.g., smooth versus pie flavored spray every 10 seconds. The crunchy), and food preference. For exam- Lang, R., Mulloy, A., Giesbers, S., Pfeiffer, Thiabadeau, S., Blew, P., Reedy, P., Luisel- researchers used an audible tone to sig- ple, it is possible that an individual may B., Delaune, E., Didden, R., Sigafoos, J., li, J. K. (1999). Access to white bread as an nal delivery of the spray, which they had be more likely to ruminate after eating a Lancioni, G., O’Reilly, M. (2011). Be- Intervention for chronic ruminative vomit- taught the individual to self-administer. preferred food in comparison to a non-pre- havior interventions for rumination and ing. Journal of Behavior Therapy and Ex- Although both of these treatments were ferred food to gain additional access to its operant vomiting in Individuals with in- perimental Psychiatry, 30, 137-144

Testing from page 33 they introduce the topic or book name they education students achieve more in school. unable to access the curriculum readily are writing about, state an opinion, supply a But since NCLB started, the standardized deserve a quality look. The quick answer nature of them at every developmental reason for the opinion, and provide a sense tests-based ‘accountability’ era more than is alternate assessment. In reality, this oc- learning stage; the disregard for different of closure (CCSS W.1.1).” The adoption of a dozen years ago, there has been no evi- curs with little frequency. That same New learning abilities (heavens - let’s not dis- this standard does not usurp the instruction dence to show that standardized tests have Jersey law that provides for a free and ap- criminate) makes monitoring of the yearly of creatively teaching our students to write improved student achievement…” If we are propriate education for our students man- mastery of these standards horrendous for in complete sentences or discern the differ- saying that the standards provide the goals dates that “…most be tested in a standard- our special students with severe emotional ence between fact and opinion. In fact, pro- and the curriculum provides the day to day ized manner (N.J.A.C. 16A:14-14.1).” In disturbances. Our special education stu- viding a focus for learning and a goal, how- objectives towards reaching those goals, a document that goes on for 165 pages to dents, as part of their IEP, typically have ever lofty, and every level throughout our with our students we are continually mea- explain the needs for adjustments and ad- some but not all of the grade level standards students’ education is profoundly necessary. suring their mastery of objectives towards aptations in the world of special education, in their yearly plans. The question begs to The manner of assessment, by formative goals which they may (or may not) meet. with individualized educational plans and be asked: Why would we presume to test data, however is not promoting the equality Why are we spending so much time testing specialized accommodations and modifi- them on a standardized test which measures that the state is longing for. High standards the goals themselves? The training program cations, standardized testing is something vast numbers of markers to which they have are now the calling card for college and ca- needs to be evaluated and measured and that serves us poorly. not been introduced. The CCSS do not pre- reers; but once again, what sets the individ- monitored. The objectives measured and scribe the curriculum, instructional practic- ual apart - the soft skills - is a summative maintained and yes, the bar held high. Vicki Ofmani, MEd, LDT-C, is Super- es, the materials or the texts teachers use to measure. Our students’ ability to live and Today and tomorrow we only want suc- visor/SLE Coordinator at The Forum assist students through the learning process. learn independently will not be measured cess for our students. Given a dozen edu- School, located in Waldwick, NJ. She is However, our special students don’t neces- by the Partnership for Assessment of Read- cators, parents, students, and politicians also a Member of the Board of Trustees sarily (nor do they usually) make those gains iness for College and Careers. According to you may get quantitatively diverse ideas for The Daniel Jordan Fiddle Foundation within the one year as prescribed. For exam- the Washington Post (June 27, 2014) “… of how to achieve that for the child. Spe- in Ridgewood, NJ. For more information, ple, by the end of first grade students should Apparently, the [Department of Education] cial education children, especially those please visit www.theforumschool.com or be able “to write an opinion essay in which believes that more testing will help special with profound disabilities that leave them email [email protected]. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 45

Mealtime from page 19 Reward behaviors that you want to contin- while implementing these basic strategies springbrookny.org or visit the Springbrook ue seeing: If the child exhibits a behavior (Baxter et al., 2014). By using these “care- website at www.springbrookny.org. do next can be difficult. Many parents and you want to see such as trying new foods giver friendly” strategies, caregivers may caregivers are left with the question of or eating all of his/her dinner, reward them be able to prevent the need for more spe- References “What do I do now?” It is recommended for doing this. Rewards may include so- cialized interventions (Bachmeyer, 2009). that caregivers begin seeking assistance cial attention such as praise or high five’s, While there are some simple strategies Backmeyer, M.H. (2009). Treatment of with primary care providers (Baxter et al., getting access to preferred food items, or that families can implement without con- selective and inadequate food intake in 2014). Primary care providers generally favorite toys/activities. sultation from a specialist, there are also children: a review and practical guide. Be- have the skills to help evaluate and decide interventions that have been effective in havior Analysis in Practice, 2(1), 43 – 50. the first course of treatment. The primary Ignore challenging behavior: When pos- reducing feeding problems but require a care provider is able to manage the prob- sible, do not provide extra attention to a specialist. If your child continues to strug- Baxter, B., Bellando, J., Pulliam, Watson, lems in many situations. However, if ad- child who is doing things that you do not gle with mealtimes using some of the sim- J., Powell, P., Srivorakiat, L., & Bing, N. ditional assistance or expertise is needed want them to display. Common challeng- ple strategies above, you will want to share (2014). Exploring Feeding Behavior in Au- then the primary care provider is able to ing feeding behaviors may include spitting, these struggles with the primary care pro- tism: A Parent’s Guide. Autism Speaks. make referrals to the correct specialists. throwing food, or screaming. Limiting the vider and perhaps contact a Board Certified These specialists may include allergists, amount of attention may reduce the enjoy- Behavior Analyst (BCBA) with experience Burklow, K.A., Phelps, A.N., Schultz, J.R., gastroenterologists, psychologists, speech ment or any “fun” the child may be having treating feeding challenges. It is important McConnell, K., & Rudolph, C. (1998). language pathologists, occupational thera- by displaying these behaviors. At times, it to highlight that these more complicated Classifying complex feeding disorders. pists, registered dieticians, and/or behavior may not be possible to ignore the behavior interventions should not be done without Journal of Pediatric Gastroenterology and analysts. If extra assistance is needed then due to safety concerns and you may need support and guidance from the appropriate Nutrition, 27, 143 – 147. the caregivers, primary care provider, and to consult with an expert for additional ad- specialist(s). additional specialists are able to work to- vice concerning how to best manage your In summary, it is important to empha- Cornish, E. (1998). A balanced approach together to address the problem. child’s challenging meal-time behaviors. size how challenging and stressful feeding wards healthy eating in autism. Journal of Not all feeding issues require expert as- problems can be for parents/caregivers of Human Nutrition and Dietetics, 11, 501 – 509. sistance and there are situations where care- Follow the rule of 3: When presenting children with ASD. Feeding problems are givers are able to intervene using simple food to your child it is important to present often complicated with each child’s prob- Field, D., Garland, M., & Williams, K. strategies to correct the problem such as: a combination of preferred and non-pre- lems being unique. In many cases, even (2003). Correlates of specific childhood ferred food items. The rule of thumb is to with professional guidance, the strategies feeding problems. Journal of Pediatrics Create a schedule and routine: This may in- offer 3 foods at a time and at least 1-2 of listed above may result in slow progress and Child Health, 39, 299 – 304. clude having your child eat at the same time these foods should be items your child al- marked by small, subtle gains (Baxter et and place. By creating a schedule the child ready likes. The other food should be an al., 2014) or may be entirely ineffective. Piazza, C.C., & Carroll-Hernandez, T.A. will learn what is expected during meals. item your child does not like. This will Feelings of frustration, sadness, or hope- Assessment and treatment of pediatric feed- expose your child to non-preferred food lessness may be overwhelming to caregiv- ing disorders. In: Tremblay RE, Barr RG, Avoid eating all day: Having food and drink items and get used to having those food ers. Thus, it is recommended that caregiv- Peters RDeV, eds. Encyclopedia on Early available all day decreases your child’s ap- items near him. Initially, encourage your ers reach out for support and individualized Childhood Development [online]. Montre- petite and may limit how much they want to child to try a small bit and gradually try to coping techniques from family, friends, al Quebec: Centre of Excellence for Early eat during mealtimes. If you’re full, you’re get them to eat a little more. Eventually, the professionals, or support groups. By en- Childhood Development; 2004: 1-7. Avail- not going to want to eat anymore! goal is for the child to eat a good size por- suring their own mental health, they may able at: http://www.enfant-encyclopedie. tion of the new food. be better able to successfully implement com/Pages/PDF/Piazza-Carroll-Hernande- Limit the amount of distractions during feeding interventions like those above, in zANGxp.pdf. Accessed February 27, 2015. mealtimes: Distractions take the focus off Presentation of food items: Altering the collaboration with a physician. Finally, it the food and may lead to the child being way you present new foods may increase is recommended that caregivers keep the Piazza, C.C., Fisher, W.W., Brown, K.A., more focused on the activities rather than eat- your child’s willingness to try them. Pres- treatment team informed of the child’s Shore, B.A., Patel, M.R., Katz, R.M. et al. ing. Common distractions include television, ent new foods in small bites or in fun, fa- progress and remember to celebrate even (2003). Functional Analysis of inappropri- video games, toys, books, phones, comput- miliar ways that make it more likely your the smallest improvements. ate mealtime behaviors. Journal of Applied ers, and an excessive number of people. child will eat them. Behavior Analysis, 36, 309 – 324. Brandon Nichols, MSEd, BCBA, LBA, Model healthy eating behaviors: Children It is important to note that each child is Clinical Coordinator and Michelle My- Schreck, K.A., Williams, K., & Smith, A.F. learn many new things by watching and is different and these strategies may not ers, BA, BCaBA, is Assistant Clinical Co- (2004). A comparison of eating behaviors imitating the behaviors of others. So make be effective for every child. Caregivers ordinator at The Tom Golisano Center for between children with and without autism. sure that you model the feeding behaviors should have ongoing dialogue and support Autism at Springbrook. For more informa- Journal of Autism and Developmental Dis- you want to see. from the child’s primary care provider tion please contact Brandon at nicholsb@ orders, 34, 433 – 438.

Free Support Group For Families of Adults with Asperger’s Syndrome and High Functioning Autism The focus of the support group is to assist families in understanding the complex issues related to their adult child impaired with Asperger’s Syndrome or High Functioning Autism. At many of our meetings, we have speakers address various topics of importance related to these syndromes. For more information, visit our website www.FAAHFA.com or contact the facilitators: Bonnie Kaplan - [email protected] | Judith Omidvaran - [email protected]

Socialization and Life Skills Group For Asperger’s Syndrome and High Functioning Autistic Adults Focused on: Employment and Vocational Issues, College Coaching and Supports, Socialization, Self-Advocacy, Dating, and Relationships For further information contact the facilitators: Patricia Rowan, LMSW - (914) 736-7898 - [email protected] | Susan Cortilet, MS, LMHC - (845) 406-8730 - [email protected] Upcoming Meeting Dates: 2015 - 4/26, 5/17, 6/7, 9/27, 10/25, 11/22, 12/13 Westchester Arc The Gleeson-Israel Gateway Center 265 Saw Mill River Road (Route 9A) Hawthorne, NY 10532 PAGE 46 www.mhnews-autism.org AUTISM SPECTRUM NEWS ~ SPRING 2015

Emotional From page 18 word. Shows can even be watched with- Dr. Jaime Black is a licensed psychologist email [email protected]. out sound to gauge a child’s awareness practicing in New York City at Spectrum © 2013 AHA Association. Further restart by describing your own thought pro- of social nuance. The difficulties these Services (spectrumservicesnyc.com) and in production of this article is prohibited cess. You can even say the exact opposite children (and adults) face tend to be tied Westchester, NY. She works with individu- without express written permission of of what might be obvious in an attempt to difficulties drawing social inferences, als of all ages with Asperger Syndrome and AHA. This article was reprinted with per- to draw your child out of silence. Exer- not to a fundamental inability to connect. related conditions, doing psychotherapy, mission and was originally published in cises like these can also be done while There are many creative ways for parents conducting evaluations, and facilitating the Fall 2014 issue of AHA Association’s watching television. Body language is to help their children improve their social socialization groups including an improv On The Spectrum. For more information, often more revealing than the spoken competencies. social skills group. For more information, visit www.ahany.org.

Best Practices from page 24 Step 4: Developing the plan - Writing a BIP of the problem behaviors. Discussing the you, how do you see yourself implement- involves identifying behaviors you would FBA provides the foundation for a more ing these procedures, and what obstacles Step 1: Precisely define the problem be- like to see more of (i.e. replacement behav- meaningful discussion about interventions. do you foresee? With school personnel and havior - Behaviors should be identified iors) and selecting strategies to facilitate the Before closing the meeting, make a plan caregivers already stressed and pressed for and described in terms that are specific, development of these behaviors. Replace- for monitoring progress. Is the intervention time, it is important to strategize with them observable, and measurable. For example, ment behaviors can include specific skills, being implemented as prescribed? Are data in a real and practical way about how the “calling out” may be defined as “a student such as social skills or functional communi- being collected and graphed? Are there procedures will be implemented. speaking during a class discussion with- cation. In the case of the student calling out any changes that need to be made? Are the out raising his hand and being called on to in class, a replacement behavior might be caregivers being updated? These are all Train school personnel - Teaching educa- speak.” It would be insufficient to say the for the student to raise his hand and wait to important components of a successful plan. tors and caregivers to implement proce- child is “impulsive” since that can occur be called on before speaking. In the example Incorporate antecedent-based interven- dures appropriately and correctly is im- in many different ways. A “tantrum” may of tantrum behavior, replacement behaviors tions - Antecedent-based interventions are portant for the student’s success. Identify be defined as a child “saying ‘no,’ yelling, may be verbally expressing emotions in an critical, yet commonly overlooked. An- which staff requires training, plan when and flailing his/her body onto the floor.” appropriate way, engaging in an alternative tecedent interventions refer to strategies the trainings will take place, and identify This is contrasted with labeling the child coping strategy to manage anger (such as that help to prevent the problem behavior who will provide the training. If no per- as having “anger management problems,” taking deep breaths) and/or complying with from occurring. In other words, they are sonnel at the school are able to provide the which is vague. As a rule of thumb, a be- the instructions (e.g., making the bed, doing proactive, rather than reactive. Be sure that training, consideration should be given to havior is sufficiently defined when two ob- homework, doing classwork). It is critical antecedent strategies are included in the bringing in an outside consultant. Training jective observers could independently spot for parents and school personnel to help BIP. Consider a student who is engaged of educators and caregivers should con- it based on the definition provided. children practice replacement behaviors in the problem behavior of flopping out of sist of a proven, multi-component process and reinforce them with praise, as well as to his chair after completing five math prob- that includes direct instruction, modeling, Step 2: Measurement - The purpose of consider additional forms of reinforcement, lems. Antecedent-based suggestions may rehearsal/role play and corrective feed- measurement is to determine the frequen- such as prizes or privileges. include modifying the instructional task back (Stewart, Carr, and LeBlanc, 2007; cy, intensity, and duration of a target be- for the student and/or allowing the student Miles and Wilder, 2009). In the example of havior. For example, “calling out” may Step 5: Evaluate - The evaluation phase access to a preferred task after completing teaching a student how to request a break, occur 3 times in a day or 10 times in a involves taking an honest look at wheth- three math problems. modeling the procedure for the staff, role 45-minute class period. Tantrums may er the procedures are being implemented playing the procedure (i.e. taking turns be- occur only twice a day, but may last 60 as designed, reviewing data to determine Identify replacement behaviors - Recom- ing the teacher and student), and then pro- minutes each and present with strong in- whether there is a reduction in the problem mendations to address replacement behav- viding feedback would help staff adhere to tensity. The measurement stage provides behavior and an increase in desired replace- iors should always be included in the BIP the procedure. baseline data. After an intervention is ment behaviors, and making modification to and reviewed with the team. Replacement conducted, follow-up data can help deter- the plan as needed. For example, regarding behaviors refer to the set of appropriate Keep it Simple - Whenever possible, try to mine whether the intervention is effective the “calling out” behavior, we want to see behaviors which serve the same function keep the plan simple. Overly complicated and can be used to make adjustments to whether the teacher has actually been ig- of the problem behavior. For example, if procedures and data collection methods the plan. Although data collection may noring the calling out behavior and praising a student runs away or yells “NO” when leads to confusion and may result in lack of seem tedious, the rationale is the same the student for raising his hand, as well as an instructional task is presented or a de- adherence and non-compliance to the plan. used by a physician prescribing medica- analyzing the data to determine whether this mand is made, it may be hypothesized that tion for cholesterol – assessing initial and has resulted in an actual decrease in calling the function of the student’s behavior is to Dr. Meir Flancbaum is a licensed psy- follow-up levels ensures that the interven- out. In the case of the tantrum behavior, we avoid or escape the instructional task or chologist at Behavior Therapy Associates tion is working. may want to confirm that the child has been the demand. If the avoidance behavior is in Somerset, NJ. Ms. Elena Zaklis is a practicing his coping skills training and that the result of the task or demand being too board certified behavior analyst at Behav- Step 3: Functional assessment - The goal the specific procedures outlined to occur difficult, replacement behaviors may be ior Therapy Associates. Dr. Michael Selbst of a functional assessment is to better un- when the tantrum behavior or use of a de- to teach the child to calmly ask for help. is a licensed psychologist and Director at derstand the child’s reason for, or function sired replacement behavior occurs is actual- Alternatively, he may be taught to hold up Behavior Therapy Associates. They provide of, the specified behavior. Behavior typi- ly being carried out as planned. a picture card to request a break, utilize a a variety of services for children and ad- cally occurs for a reason – gaining attention “break pass,” or hand the teacher a card olescents with autism spectrum disorders from adults or peers; escaping or avoiding This 5-step process of conducting an that says “one minute please.” and related disorders, including individu- a demand or request; gaining access to FBA and developing a BIP can be time al and group therapy, school-based con- something preferred (or tangible); and try- consuming. Yet, a thoughtful assessment Obtain “Buy-In” - Obtain “buy-in” from sultation, functional behavior assessment ing to obtain or avoid something that is in- and plan developed by parents and/or all of the team members. First, be sure to and behavior intervention planning, and ternally or automatically reinforcing (e.g., school personnel provides the greatest op- clearly explain suggested strategies for in- training workshops for professionals and increasing time listening to pleasant music, portunity to achieve behavioral success. tervention, as well the empirical research parents. For more information about Dr. decreasing painful headache). Hypothe- to support the suggestions. Simply for- Flancbaum, Ms. Zaklis, and services pro- ses about functions are determined based Keys to Putting a BIP into Practice warding the FBA/BIP with a note, “Here vided at Behavior Therapy Associates, vis- on the data collected about what occurs it is, it is all in the report,” will often lead it www.BehaviorTherapyAssociates.com. directly before and after a child exhibits Conduct a Meeting after the FBA is com- to frustration. Second, be sure that all team Correspondence can be directed to mflanc- the target behavior, and are often the key pleted - Set up a convenient time to meet members understand the rationale for the [email protected]. to successful intervention. For example, if with members of the IEP team, including strategies that are suggested. If there is the function of a child’s “calling out” be- school personnel, parents, and private pro- clarity about the reason for procedures, References havior is to gain the teacher’s attention, fessionals who are working with the iden- school staff and parents are more likely to then the teacher’s verbal reprimand may tified child. If any IEP team members are implement them. For example, for the an- Stewart, K. K., Carr, J. E. & LeBlanc, L. A. be increasing the likelihood of it occurring unable to attend in person, consider having tecedent-based recommendation of modi- Evaluation of Family – Implemented Be- again. If a child’s tantrum behavior serves them join by phone or video conference. At fying a task, it may be helpful to explain havioral Skills Training for Teaching Social the function of avoiding a task, sending him the meeting, discuss the results of the FBA that by reducing the response effort to at- Skills to a Child with Asperger’s Disorder. to time-out may be giving him exactly what in detail. Present definitions of the target tain a reward or teaching a functional re- (2007). Sage Publications, 6, 252-262. he wants. Thus, indentifying the function behaviors, explain the rationale for the placement (e.g., saying “break please”), the of a child’s behavior is critical in order to method of data collection that was used, student is more likely to change his behav- Miles, N. I. & Wilder, D. A. (2009). The develop an effective intervention and min- share the results, and discuss the hypothe- ior. Third, solicit feedback about the plan. Effects of Behavioral Skills Training on imize the possibility of responding to the sized functions of behavior. Reviewing the Questions to consider posing to the team Caregiver Implementation of Guided problem behavior in ways that will actually FBA helps ensure that all the participants at include the following: what do you think Compliance. Journal of Applied Behavior keep it going. the meeting recognize the scope and nature about the plan, does the plan make sense to Analysis, 42, 405-410. AUTISM SPECTRUM NEWS ~ SPRING 2015 www.mhnews-autism.org PAGE 47

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