Problem Based Learning - Marcia

Asperger’s at age 6
Likes: reading
perfectionism with writing tasks
Marcia will yell in class and want to start tasks
over if one mistake is made
Marcia’s School Experience
Fine motor difficulties
interventions
and others do not
‘special classroom’ but Marcia has said she,
“doesn’t want to be with the slow kids.”
Anxiety in Autism
characteristic of autism (White, Oswald, Ollendick and
Scahill, 2009)
children with Asperger’s (White et al., 2009)
And more so in those with high IQ’s who are
aware of their disability (White et al., 2009)
Anxiety effects about 42% of people with
Autism (studies range from 11 to 84%) (White
et al., 2009)
Anxiety and Perfectionism
manifested
Parents who rated their children as having a lack of
social skills also deemed their kids as having a more
perfectionist personality (Greenaway, and Howlin, 2010).
Strong correlation between perseveration on a topic
or activity and perfectionism (Greenaway and Howlin,
2010).
continuing or repeating behavior” http://www.thefreedictionary.com/perseveration
(Juranek, Filipek, Berenji, Modahl, and Osann, 2006)
Reduction in serotonin levels due to genetic defects or
environmental stressors (Ramboz et al, 1998
Genetic
Possible Causes of Anxiety
Pragmatic Language Deficits
anxiety (Baren-Cohen, 1988)
Phrases such as: “Don’t hand your work in unless it
is your absolute best” can cause anxiety if you
believe you can always do better.
Functional Assessment
(yell in class until she is able to start work
over).
Escape
Intermittently negatively reinforced when written work
is sometimes taken away and given in the form of oral
reports and tests.
the rate of reinforcement received from each
choice alternative.” (Cooper, Heron, Heward, 2007, p.319).
Our main goal is to make doing her work, mainly
writing tasks, with the absence of problem behaviour
more reinforcing than engaging in problem behaviour
to escape the work.
and CBT treatment and, if appropriate, their diagnosis
Goals are to engage individuals in treatment
collaboration and help them identify their responses
and provide a rationale for the techniques to be
implemented
Modeling
provoking situation
may be offered reinforcement
triggers and anxious responses in order to respond
appropriately
(i.e., what success looks like)
Individual records their own progress and compares
with a therapist or parent
Initially more guidance is delivered but is faded out as
the individual is able to accurately assess themselves
independently
picture rehearsal
be stressful
In Vivo Exposure/Desensitization
created
experience each with appropriate responding
Cognitive/Behavioural Therapy
inappropriate behaviours in stressful situations
To be effective, individuals must be able to:
Recognize the early physiological signs
Be capable of achieving a relax state quickly
Use relaxation strategies in anxiety-provoking situations
Goals: Gain self-control and self-management
evaluate their accuracy, generate appropriate
alternative thoughts and implement them in situations
Accuracy is evaluated through:
rehearsal and role-play
positive interactions with others and reduces anxiety
while interacting
understanding by explaining specific skills and
preparing an individual for what to expect in situations
Components of social skills training include:
Modeling
What could a solution be?
What's another solution?
What's another solution??
Why?
their wants and needs
Incorporating disorder specific hierarchies
Integrating specific interests
Children with ASD who received CBT showed
significant reductions in anxiety symptoms as
compared to a randomized control group (e.g.,
Chalfant, Rapee, and Carroll, 2006; Reavan et al., 2009, Wood et
al., 2009)
evaluators use a Clinical Global Impression
Improvement Scale to rate anxiety symptoms pre and
post-treatment
information as a foundation for learning new skills
Sensory Diet
sensory-based activities aimed at fulfilling their
sensory needs
system to facilitate behavior changes
Sensory Strategies
Visual Therapy
associated with ASD
Auditory Integration Therapy
through earphones that may be helpful to alleviate
hypersensitivities and rectify overall auditory
processing difficulties that may be related to
behaviours associated with ASD
Limited support for effectiveness (e.g., Edelson et al.,
1999)
sizes (e.g., Wells and Smith., 1983)
Lack of empirical support in comparison studies
Those studies comparing behavioural strategies versus
sensory strategies have found behavioural strategies to be
significantly more effective in reducing problem behaviour (Mason & Iwata, 1990; Devlin et al., 2009; Devlin et al., 2011)
Pharmacological Strategies
antidepressants
anxiolytics
beta-blockers
antipsychotics
is Buspar or the selective serotonin reuptake
inhibitors (SSRI) including Prozac, Zoloft and
Luvox.
antidepressants including Valium and Ativan
Dosage depends on type of drug, body chemistry,
age, and weight
Start with low dosages and gradually increase until
reaching the desired effect without the appearance of
side effects
May take several days to weeks to see an effect
The individual should take the maximum dosage for
several weeks before determining if the treatment is
not working
Limitations: Must be used in combination with other therapies
High amount of effort to monitor the individual at all times
Potential for tolerance and dependence
Potential for abuse and withdrawal reactions
Potential side-effects such as causing cognitive difficulties,
agitation, hyperactivity, tics
and irreversible effects
may be stigmatized
communication deficits (Tsai, 2006)
What Does the Research Say?
Limited effectiveness in reducing problem behaviours (e.g., Posey et al., 2004)
Case reports show decreases in problem behaviours (e.g., McDougle et al., 1992)
Severe side effects that interfered with daily
functioning (Cook et al., 1992)
Only short term effects of behaviour change (Steingard
et al., 1997)
preferences
(e.g., think about volume level, peer
perception, etc. in a typical high school class)
All this needs to be kept in mind, moving
forward, to maximize buy-in from Marcia
SEA Support
provides 1:1 support to Marcia in her classes
This person could also serve as a
“Classroom helper” to reduce the stigma for
Marcia
and coping skills
Show how participating in sessions can lead to
goal of becoming a librarian and reduce stress at
school
Modeling:
calmly handles these situations
Imagery
“Imagine you’re in Science class, and your teacher hands out a worksheet and you realize you wrote the wrong date. Rats! Just as you’re supposed to get stressed, you tell yourself- ‘This is just a little mistake! It’s no big deal! I can totally be cool with this. Bella Swan would do the same, in my place. I’ll just scribble it out and keep going. That will help my stress level reduce and keep it cool at school.” And WOW! You just re-wrote the date and kept going.”
“I bet Edward would think that’s amazing.”
CBT Strategies
Use a script to teach tensing and relaxing of
muscles
App Options
CBT Strategies
Self Monitoring/Evaluation/Reinforcement
Proactive CBT Strategies
Reinforcement Strategies
strategies
incentive to engage in alternative and desired
behaviors
additional reinforcement
Reactive Strategies
SEA Support
CBT Strategies
Reinforcement Strategies
first signs of problem behavior
To assist with coping skills (i.e., the deep breathing,
PMR, etc.)
To pull out if needed to another space (to maintain
Marcia’s privacy) for major problem behavior
CBT Strategies
What could a solution be?
What's another solution?
What's another solution??
Why?
strategies and problem solving activities
Provide reinforcement for re-entering class
and confronting the antecedent
Will require prompting and reinforcement by the
SEA
problem behavior)
Out of Class:
Model, prompt and reinforce coping skills
Work through antecedent with problem solving sheet
Discuss how to re-enter and work through antecedent
Marcia Refresher
Needs fine motor intervention, but only sees resource
room teacher minimally
Many teachers think she would be better off in ‘special
classes’
underlying skill deficit with fine motor abilities
Occupational Therapist Assessment
Difficulties Autism Characteristic
Syndrome had significant motor impairments in
both fine and gross motor skills (Manjiviona and Prior, 1995).
Neurological
involved in writing (Katanoda, Yoshikawa and Sugishita, 2001)
Anxiety related
right’
higher IQ’s scored significantly lower on
written expression sections of IQ tests
63% had a specific LD in written expression
They did not score significantly lower on any other
subtest
(Mayes and Calhoun, 2007)
High School Self Reports
History
long task
groups versus large groups
medium, eliminating the need for constant erasing
or rewriting as students synthesize their
brainstormed ideas when organizing information
from multiple sources” (Montgomery and Marks, 2006, pp.
34).
print/write or knowing the answer?” (Broun, 2009, pp.
17)
classroom
tests and assignments
Editing features allow for quick revisions (e.g.,
grammar and spell checking)
Typing allows for collaboration between peers as the
words are easily consumed by everyone and
contributors are not readily identified
Allows for direct and effective support from the
teacher as the student’s work is clear and neat
(MacArthur, 1996)
Technological Strategies
Junior High students with learning disabilities and
writing disabilities revealed less spelling mistakes,
less reading errors, higher overall quality of
organization and structure with computers (Hetzroni and
Schrieber, 2004)
attention and task performance when activities were
computer-based (Cardona et al., 2000)
Anecdotal reports for ease of use of iPads for
individuals with autism who have fine motor difficulties (Shah, 2011)
Occupational Therapy
interfere with self-care, play, and school
performance.
Threading beads, inserting pegs, posting coins,
screws, pinching clothespegs, worksheets with
activities such as connecting numbers, dots, or
arrows, coloring by numbers, and tracing mazes.
children with ASDs, we know of no major
studies that have quantified the effects of
motor interventions on motor and social
communication outcomes of children with
autism.” (Bhat et al., 2011, pp. 1124)
Students in 1st grade with fine motor delays improved
their fine motor skills after 12 sessions of OT
compared to a control group whose skills remained
stable (Ratzon et al., 2007)
Kindergarten students, with and without disabilities,
showed improvement in fine motor and early
emergent literacy skills after 7 months of OT (Bazyk et
al., 2009)
tests)
smaller components (as per Julee’s slides)
Technological Adaptations
documented in the media
Considerations for technological adaptations?
SET BC
opportunities for success by providing access to
curriculum through the use of appropriate
educational and communication technologies.”
Mandate SET-BC is a Ministry of Education Provincial Resource
Program established to assist school districts in educating students whose access to the curriculum is restricted primarily due to the following disabilities: physical disabilities or chronic health impairments
visual impairments
dependent handicaps
A) to lend assistive technologies (reading, writing, and communication tools) where required to ensure students' access to educational programs, and
B) to assist school districts in providing the necessary training for students and educators in the use of these technologies
From: http://www.setbc.org/about/default.html
1. District Screening
criteria
Often, no training OR training time provided for
support staff/teachers/parents unless parents
Benefits: Faster application and qualification process
Do not have to prove need as much as SET BC
Parents own the equipment; more choices
Disadvantages: Lose almost $1,000 of a paltry $6,000 of funding
If lost, broken, damaged, stolen, no recourse for parents
Technological issues with school (some schools will now let in)
In conclusion…
iPad Options
Mac’s/PC’s)
selection, easy output)
To Do (Free, list app for organizing)
OT Support
Twilight plot summaries
Fine Motor exercises
technological adaptations appropriately and
Reactive Strategies
SEA Support
or to chunk smaller components)
To model, prompt and reinforce coping skills
Reinforcement
appropriate adaptations and engaging in coping
skills
District Screening
goals, may refer that a student to the school district's
SET-BC screening committee. A school-based team
(which may include a parent) should use the school
district's Screening Checklist which establishes the
student's eligibility and helps the committee determine
if the student will be selected for SET-BC service.
How To Apply for SET BC
Request for Service
screening committee to receive SET-BC services, the
school-based team will be asked to complete a
Request for Service. SET-BC will also provide a
Student Profile Package to describe the student's
strengths and needs. The Student Profile Package
helps the SET-BC regional consultant prepare for the
Collaborative Action Plan meeting.
Collaborative Action Plan
The school team will then take part in developing a
Collaborative Action Plan (CAP) with the SET-BC
regional consultant. The consultant will assist the team
in determining what strategies and technology best
meet the needs of the student. The completion and
submission of the CAP initiates the technology request
and loan and a copy of the original CAP is kept with
the student’s IEP and official records.
Technology Request
for use with specific students. As such, it is considered
part of the school district’s IT equipment and is
supported jointly by SET-BC and the IT department
staff. All SET-BC equipment is shipped or delivered to
the school team and is identified by a SET-BC bar
code sticker with a 5 or 6-digit id number. Once the
technology arrives at the school, it can be set up and
the SET-BC regional consultant contacted to provide
training on the technology.
Training and Support When SET-BC provides a student equipment loan, the
student's school team receives training on the implementation of the technology in the classroom. This training is arranged at CAP meetings, or during follow-up contact and implementation support provided by the SET- BC consultant.
School district staff and school team members can also attend SET-BC workshops on a wide range of topics, such as Augmentative and Alternative Communication (AAC) issues, alternate access, or vision technologies. A wide variety of online or web-based training resources are also available through the SET-BC website. SET-BC regional teams circulate information on these training opportunities through the SET-BC District Partners.
Technical support for the SET-BC loaned technology
is provided jointly by the school district IT department
and the SET-BC provincial technical support team. If a
piece of SET-BC loaned technology is not functioning
properly, school teams can contact the SET-BC
technical support team for troubleshooting assistance,
repair services or replacement.
o http://www.setbc.org/about/procedures.html
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Problem Based Learning - Marcia