Some additional resources for working with children with autism

These were recommended in a class I recently attended and I am passing on the recommendations to you.


Verbal Behavior Therapy

Social Thinking

Social Stories

Social Stories and Comic Book Conversations

The Grey Center

Relationship Development Intervention with Young Children: Social and Emotional Development Activities for Asperger Syndrome, Autism, PDD and NLD

Relationship Development Intervention with Children, Adolescents and Adults

A Work in Progress: Behavior Management Strategies & A Curriculum for Intensive Behavioral Treatment of Autism

Behavioral Intervention for Young Children With Autism

Meaningful Functional Outcomes and Parental Involvement

As many know, one of the problems with the SIB-R is how much it lends itself to malingering. Sometimes this malingering comes from coaching by the provider and other times it is just a parent's rationalization due to a feeling of desperation. This desperation comes from a number of sources, sometimes it is out of a hope that something will be better for their child and sometimes it comes from the need to have someone watch their child and their fear that there is no one except someone from an agency who will watch their child. Often times they have given up on the possibility that their young child with a disability might be accepted by a typical day care or that their older child with a disability might be able to be included in typical programs. While there are always going to be some children who will need specialized supports in order to participate in some type of child care or other activities including family based, for the majority of children we work with there is real hope for significant improvement. Unfortunately there are two primary obstacles, with numerous ancillary obstacles.
#1 Meaningful Functional Outcomes.
If we do not start with the end in mind, we will not know where we want to go. If the end is not meaningful to the parent, the parent will not feel vested and involved and will be less willing to participate. If the path or route taken towards the end does not involve the parent, let alone make sense to the parent, then the parent will disengage further. On the other hand, if the outcome is meaningful to the parent and it's practical functionality is obvious to the parent (because it originated from the parent), the parent will be more likely to be invested in the intervention especially when the parent has been taught both the essentiality of their involvement and been assured that they will be given the requisite skills and supports.
#2 Parent involvement. It is no wonder that SIB-R Maladaptive scores often get worse while the child is making progress in the center or even community with the therapist or tech when there is little or no parental involvement in the actual intervention for the child. There are three primary reason for parental involvement in the actual intervention with the child. 1. It provides more and more consistent intervention for the child. 2. It provides better outcomes for the child. and 3. The parents perception of their ability to help the child, handle the child during difficult times, interact and communicate with the child are heightened. This last issue has become so important in the research that for early intervention there has even been developed The Early Intervention Parenting Self-Efficacy Scale (EIPSES) which you can find on my page at: http://www.collaboration.me.uk/q.php
When used correctly, the SIB-R Maladaptive score is actually reflective of two things, one is the actual behavior of the child and the other is the parent's perception of that behavior, which includes their perception of their personal self-efficacy in relation to those behaviors.

Of course and as is well known, any research about the efficacy of intervention or even any kind of extended additional hours clearly demonstrates that parental involvement is essential.

Reinforcement

There are many types of reinforcement. For our purposes here we will talk about natural reinforcers and contrived (or artificial) reinforcers.A natural reinforcer is any reinforcer that would occur out in the natural environment without therapeutic intervention. They are either spontaneous or come after time with delayed gratification. For example, you work you get paid. There is a natural connection between the behavior and the reinforcement. Any child in a healthy environment would likely receive the reinforcement. Generally speaking, when you are nice to people, they are nice to you. Generally speaking, when you say please and thank you, you get a more reinforcing response. You learn to make a PB&;J sandwich and you get to eat it. You appropriately ask an appropriate person for a hug in an appropriate manner and you get a hug. If you are a child and you appropriately ask for a glass of milk in the right place and time from the right person, you get a glass of milk. You put together a model airplane or a car, you get to keep it and feel good about what you have accomplished. As a child, you ask for what you want that is appropriate, in an appropriate way from the right person and at the appropriate time and you get it if possible. You learn to do something for yourself and you develop independence and feel good about that. You play "nice" (I know that has to be defined) and other children want to play with you. You do things that are appropriate and people say thank you and I'm proud of you. (This one is kind of in-between)
Contrived reinforcers are those provided by or arranged by the therapist and in some cases the parent or teacher. "High fives" (plus some additional strange behaviors usually only seen in football players and avid fans) are also in-between. You ask for a hug and get an m&m. You complete a task or step and get a sticker. You are quiet in class and you get a star while other children who are quiet do not get stars.You do something appropriate and get points and eventually get to buy something with those points. The "point" here is that there is an artificial connection created between the behavior and a reinforcement that would not typically occur for a child not in therapy, or an artificial reinforcement that would not typically occur.

Supplimental Information:
Artificial and Natural Reinforcement

Desensitization

Desensitization is also a fairly simple concept; however it requires the coordination of a number of interventions. As you help someone to desensitize you build self efficacy. You do this by first helping them to relax, this can be through play and doing an activity they both enjoy and for which they already have high self efficacy. Using successive approximations you then gently introduce the concept or activity that you and/or they want to build self efficacy for and be desensitized to. For example, you may help someone to relax with music and relaxation techniques or through play and/or an enjoyable activity, without making a bid deal about it and perhaps even a little in the distance, uncover the picture of a spider. Over time and a few sessions you would hand them a picture of a spider then have a toy spider and eventually have a real (safe) spider in a jar and continue this to the point needed. It would probably never be needed that they actually hold the spider. It is the same thing with almost anything else. If it is fear of flying this would continue until they actually took a short flight with someone they trusted and who would help them to relax. They may carry relaxing music with them or even a relaxing and enjoyable video to watch. This of course is all individualized. If someone does not have a problem with pictures of spiders but is afraid of spiders, you would not need to start by uncovering a picture of a spider. Starting with a toy spider may be more appropriate.