AAC and ASD: Engineering Perspective-Taking and Emotional Regulation

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AAC and ASD Engineering Perspective-Taking and
Emotional Regulation

• Marcia Weber-Olsen, Ph.D., CCC-SP
• Monterey County SELPA
• Verjene Kalashian, M.A.,
• CCC-SP
• San Lorenzo Valley USD

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THE BIG PICTUREour vision for the future

• Engaging Learning Environments that promote
• communicative, social, and cognitive growth
• for learners with Social Learning Disabilities
• Strong receptive base to support comprehension
• Behavior management to support student engagement
• Frequent expressive AAC use to support social
  interactive communication
• Strong language and literacy training to support
  learning

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Agenda

• Social Cognitive Learning (SCL) Deficits
• Perspective-taking and mind blindness in SCLD
• Different pathways to SCLDs
• Developmental prerequisites for
  perspective-taking
• Social Communication, Executive functioning and
  Emotional Regulation Challenges in students with
  SCLDs
• AAC as a framework to support perspective-taking,
  emotional regulation and social-communication

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Agenda- continued

• Engineering AAC supports for
• Social Communication
• Social Scripting Partner Focused Questions
• Small Talk
• Sharing the Day/Visual Bridges (Hodgson)
• Perspective-Taking
• Social Stories
• Comic Strip Conversations
• Video Social Review
• Emotional Regulation
• Identifying/Recognizing Emotions
• Grading of emotions
• Cognitive Behavior Therapy Behavior guides,
  Calming Strategies
• Contingency Maps

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Language comprehension perspective-taking
deficits .at the root of social learning
difficulties (Mirenda Beukelman,2000)

• Comprehension drives language sense-making
• Perspective-taking drives our thoughts about
  others thoughts, beliefs, knowledge, intentions
  desires
• Mindblindness Deficits in mentalizing about
  others (Baron-Cohen, 1995)

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What Do We Mean By.Perspective Taking?

• Perceptual perspective ability to visualize what
  others can see or hear
• Conceptual perspective ability to know what
  others are thinking and keep track of what others
  know

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PERSPECTIVE-TAKING a range of complex social
scenarios
Source Carol Gray.
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• Theory of the Mind .a system for inferring and
  predicting a full range of mental states from
  anothers behavior - Baron-Cohen, 1995
• ToM a social executive function
• Understanding ones own and others emotions,
  thoughts, beliefs, prior experiences, motives,
  and intentions and inferring plausible causal
  factors for these states (Rubin Laurent,2001)
• Inner language executive functions assist
  perspective-taking
• Without ToM the world is an unpredictable
  place

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Mindblindness deficits in mentalizing about
others (Baron-Cohen,1995)

• Difficulty establishing shared knowledge for
  learner to process ongoing social interaction, or
  account for what others know
• Difficulty understanding and predicting others
  intentions, actions or intended meanings
• Inability to understand misunderstandings
• Difficulty anticipating what others think of
  ones actions
• Difficulty understanding deception, or being
  deceptive

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Empathy Perspective-taking

• Difficulty reading others emotional states
  comprehending others feelings
• Insensitivity to others feelings

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Pragmatic symptoms and Perspective-Taking

• Poor ability to share topics obsessive,
  circumscribed interests, sticky topics
  problems linking to new topics (R. Paul, 2008)
• Poor ability to infer what others already know
  what they need to know in running conversation
  (pre-suppositional knowledge)

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Different Pathways to SCLDs

• Students with social-learning difficulties
• High Functioning Autism
• Asperger Syndrome
• PDD-Not Otherwise Specified Atypical Autism

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• AUTISM SPECTRUM DISORDERS

Asperger Syndrome
High functioning
Autism
Pervasive Developmental Disorder-NOS
Source Wetherby Prizant, 2000
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Behavior Social-Cognitive Characteristics in
Autism Spectrum Disorders

• Inflexible learning style
• Do not accommodate well to change or novelty
• Strongly desire routine in their environment
  respond best with predictability and structure
  (Rubin Lennon, 2004)
• Sensory processing and behavioral modulation
  difficulties (Wetherby Prizant, 2001)
• Unique perspective-taking difficulty predicting
  or correctly inferring what others feel or
  think
• Genuine inability to understand others beliefs
  and emotions (Baron-Cohen,95)
• May expect others to know their thoughts,
  experiences, opinions

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Other groups at risk for Social-Cognitive
Learning challenges

• Attention Deficit Disorder both hyperactive and
  inattentive types
• Traumatically Brain Injured
• Emotionally Disabled
• Schizotypal affective disorder
• Bipolar disorder
• Genetic syndromes Fragile X Syndrome 33 of
  children with this genetically inherited
  condition also have a co-morbid ASD and
  associated social-cognitive deficits (Hagerman,
  U.C.Davis M.I.N.D. Institute)
• The quirky kid

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Students with Social Cognitive Learning
Challenges

• Desire social contact, but have limited social
  pragmatic skills to establish and maintain
  friendships
• May appear indifferent to peer pressure
• Unaware of unwritten social rules (hidden
  curriculum)
• May lack intuitive empathy insensitivity to
  others feelings
• Often victims of bullying by middle school
  because of pronounced social learning problems
• Significantly at risk for mood disorders
  (Anxiety, depression)
• Sources Twachtman-Cullen, 2000 Atwood, 2003)

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Developmental Prerequisites between 9-18 mos.

• Joint Attention social communicative behavior in
  which two people share attentional focus on an
  object or event
• Joint Attn Child responds to anothers
  attentional directive or initiates shared
  attention with another
• Most massive deficits in autism are evident in
  shared referencing/joint attention (Curcio,1975)
• Eye gaze three-way gaze shifts
• Pointing gestures
• Other declarative gestures (showing, or showing
  offinviting interaction from others)

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Joint or Shared Attention in Autism

• Initially ASD children use pointing/showing
  gestures to get what they want in an instrumental
  way, not to share attention with social
  partners
• Discrepancy in use of early pragmatic functions
• Requesting Commenting functions (to share
  topics/
• invite interaction) do not develop concurrently
  as in typically developing children - Wetherby et
  al., 1998
• Disrupted joint auditory attention some ASD
  children speak too loudly, or too softly, or with
  little modulation (Frith, 1989)

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Social Language features in Autism Spectrum
Disorders (ASDs)

• Pragmatics social communication are core areas
  of deficit
• Conversational and pragmatic skills such as,
• Staying topic-focused, turn-taking in
  conversation establishing and following the
  conversational focus of their social partners
• Reading non-verbal cues
• Social Communication Skills include
• Pragmatic skills Paralinguistics prosody,
  gaze, gestures, proximity - R. Paul, 2008
• AND.Social Behaviors include
• Conventional gestures
• Facial expression and body language
• Avoiding socially unacceptable behaviors

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Language Features in Asperger Syndrome

• Grammatical syntactic expression is on par with
  age often fluent, syntactically mature
  utterances
• Speech may be lengthy say too much-
• Intense and narrow restricted interests drive
  conversational topics
• Overly formal (pedantic) vocabulary
• Caveat superficial verbal skills often mask
  cavernous weaknesses in comprehension
  (Twachtman-Cullen, 2000)
• Prosody shows high rates of impairment in ASDs
• Atypical intonation flat pitch contour, robotic
• Poorly modulated volume overly loud or too soft
• Speech rate hyperverbal
• Difficulty with figurative language humor and/or
  abstract verbal concepts

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The Invisible Disabilityqualitatively assessing
social pragmatic skills

• SLPs standardized assessments measure basic
  technical language skillsdo not capture if
  student shows communicative competence in these
  skills.
• For students with social pragmatic deficits, the
  optimal assessment is a qualitative one
• Observe student across environments and contexts
• Compare social functioning to the level of their
  peers
• Incorporate pragmatic language samples into the
  assessment battery
• No assessment of a student with AS can be valid
  if it is completely based on standardized tools
  (this is also true for all child-based
  assessments to include psychological and
  educational)

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Social Cognitive Assessment

• Emotional Intelligence Protocol. Source/author
  (VK) 2003, Thinking Publications
• The Social Thinking Dynamic Assessment Protocol-
  Garcia Winner, M. in Thinking about you thinking
  about me. 2nd edition.2007

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Behavioral Social-Cognitive Characteristics in
ASDs

• Difficulty with
• Emotional regulation ability to self-regulate
  ones arousal and emotional state, or seek
  assistance from others (mutual regulation) for
  availability and for social engagement (Rubin
  Lennon, 2004)
• ER is another CORE developmental challenge in all
  students with ASDs
• Developmental progression from more basic
  physiological/biological need states (e.g.,
  sucking thumb, averting gaze when stressed) to
  sophisticated behavioral strategies and the use
  of language meta-cognition to self-regulate
  arousal levels
• ASD learners demonstrate idiosyncratic motor
  strategies used to self-regulate (to increase
  or decrease their arousal level) (e.g. flapping,
  toe walking crashing into someone) that are
  misinterpreted as socially deviant behavior
• Social partners often isolate themselves from
  such individuals

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Supporting dysregulation in a Middle school
student
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Emotions Stress

• Neurotypicals
• Mildly/moderately stressful situations activate
  frontal
• lobe functions use cognitive rehearsal
  language to
• verbally mediate/modulate their emotions
• Autistic Individuals
• Get neurologically stuck in an attempt to
  manage a rigid set of expectations or to avoid
  novel ambiguous events (Corbett,2003)
• Sensory or processing overload, anxiety/fear,
  increased novelty (change) or ambiguity elicits
  unregulated emotional reactivity (Levine
  Wiener,1989)
• Frontal lobe activity shuts down amygdala
  activates ignites a cerebral fire storm
• Explosive meltdowns
• Aggressive and/or panic behaviors- flight/fight
  response
• Escape behaviors
• Withdrawal
• Sensory shutting down (plugging ears, shutting
  eyes)
• Significantly elevated stress circuits (limbic
  system-cortisol levels) compared to neurotypicals
  when stressed (Corbett,2004)

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Executive Functions, Emotions and the brain.

• FRONTAL LOBE AREA
• Office manager judgment, planning,
  organization, shifting attention, initiating,
  task completion
• Mental flexibility
• Not consistently related to intellectual
  functioning or language skills, which may be
  quite high (Samuelson, 2004)
• Theory of the Mind (perspective-taking) driven by
  exec.functioning in autism this reflects as
  mind-blindness (thinking about you thinking
  about me)
• Behavioral self-regulation inhibition, impulse
  control
• Executive Function Deficits occur singly
  co-occur in ADHD, Aperger Syndrome, ASDs,
  Fragile X, brain injuries, auditory processing
  disorder
• fMRI studies show decreased frontal lobe activity
  in individuals in autism

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• Structurally denser neurons in autistic brains
  Medial temporal lobe
• Amygdala almond-shaped structure
• aggression emotion
• interpretation of facial recognition and
  non-verbal social cues
• Hippocampus sea-horse shaped structure
• memory functions

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Designing AAC Intervention Strategies
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Range of Skills to become competent
communicators- Light, J. Bilger, C, 1998

• Linguistic Skills
• Receptive and expressive skills
• Linguistic code
• Operational Skills
• Form signs or gestures correctly
• Social Skills
• Skills to initiate, maintain, develop, and
  terminate interactions
• Skills to develop positive relationships and
  interactions
• Skills to express range of communication
  functions (e.g., comments,requests,
  protests,etc.)
• Skills to develop perspective taking
• Prerequisite turn-taking skill
• Strategic Skills
• Compensatory strategies

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Augmented OutputMay either supplement speech or
act as a primary communication mode

• GESTURES
• Natural Gestures
• Sign Systems
• Sign Language

• GRAPHICS
• Traditional Orthography
• Photographs
• Line Drawings

Augmented InputCan play an important role in
producing and/or comprehending speech
Visual Language Systems successfully used for
students with autism, etc. to visually augment
language input and output
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Core to all intervention strategies

• present a combination of visual and verbal cueing

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Middle School SDC Program
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AAC Visual Supports Enhance Receptive and
Expressive Communication

• Prompt joint attention
• Enhance attention to, and understanding of social
  messages and behavior
• Establish conversational referents
• Promote memory recall
• Increase comprehension of language concepts
• Facilitate social initiation and communicative
  intent
• Johnston, S., Nelson, C., Evans, J., and
  Palasolo, K (2003).

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Aided Language Stimulation

• A legitimate second language involving a
  paradigm shiftvisual language is a real language
  and must be available as an essential aspect of
  each life activity
• Infuses the environment with visual language to
  assist in the receptive and expressive processing
  for students with autism
• Goosens et al., 1992 and Cafiero, 1998

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Encourages and Organizes Facilitators
Input Systematic AAC Intervention which provides
child with multiple models and opportunities to
make meaningful connections

• Pool of Response Options a scaffold that
  organizes adult input for
• Modeling
• Recasting
• Slower delivery rate
• Repetition
• Concentrated versus diluted message pool

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Pool of Response Optionsa scaffold that aids the
students

• Repeated exposure to input-comprehension
• Initiation of communication
• Expression
• Retention/memory
• Communicative functions beyond requesting
• Expansion of syntax words into complete
  sentences
• Segmentation breaking sentences into individual
  parts

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How Many Symbols?

• ALS is appropriate for students with autism who
  can process many picture symbols compared to
  those who are at the one-to-three symbol level.
• Students with joint attention and able to point
  can handle up to 50 symbols on a language board.
• Students not yet able to establish joint
  attention can use 2 to 6 symbol language boards
• Because ALS is initially receptive language
  training, more symbols are used than student can
  verbalize or understand
• Students with autism who are speakers also
  benefit from ALS as a means to stimulate more
  complex receptive and expressive language skills.
  Words can be used in place of symbols for those
  with literacy skills.
• Cafiero 1998

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Engineering AAC supports forSocial Communication

• Social Scripting
• Vocabulary for turn taking
• Sequence of a social script
• Partner focused questions
• Small Talk
• Sharing the Day Visual Bridges (Hodgon,1998)

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Vocabulary to Support Participation in Social
Interactions

• social vocabulary can be used to take a turn in
  the conversation and participate more frequently.
• focus on turns that are quick to produce
• communicates to the partner that the AAC user is
  involved and interested in the conversation

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Vocabulary to Facilitate Turn Taking
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Turn Taking

• Turns include spoken messages, sign or gestures,
  messages on a communication board or
  speech-generating device.
• Obligatory turns follow a partners question
• What are you doing?
• Nonobligatory turns follow a partners comment or
  statement or they can be turns that extend or
  change a conversational topic Cool! I have
  another idea

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Anatomy of a Sequenced Social Script

• Attention Getters
• Hi there!
• Theres Nancy!
• Starters
• Whats up?
• Did you see Lost last night?
• Maintainers, Holders and Interjectionsadd
  interest to story and prompts listener to make a
  comment.
• It was awesome!
• Ill give you a clue.
• Turn Transfers(partner focused questions)
• What did you see?
• How about you?
• Closing

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PATHS to Starting a Conversation

• P Prepare ahead keep fact files with
  important facts about people you know
• Birth datefamily membersfavorite food, color,
  school subjectinterestsreading computer games
• Later on keep invisible files
• A Ask your self what you are going to say and
  how you are going to day it before you day it
• Conversation starters
• T Time is right
• H Hello
• S Signals - smile, gaze, body

Source J. McAffee, 2002
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Social CoachingSmall Talk
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Determine the Content of the Introduction Message

• Attention-getting message
• Excuse me.
• Greeting(s)
• Hi, hello
• The individuals name
• Full name for formal situations
• Nickname for informal situations
• The purpose of the interaction
• Id like to introduce myself.
• Id like to place an order.

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Partner-Focused Questions

• Those questions an individual ask his or her
  communication partners about their thoughts,
  feelings, and experiences
• How are you?
• Whats up?
• Whats new?
• What did you do this weekend?
• What do you think?
• How about you?
• Whats wrong?
• Howd you do?
• Shows partners they are interested in them
• Fosters social closeness and enhances interaction

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Social Scripts to Promote Social Interaction

• Scripts used for joke-telling, sharing life
  stories and general conversations
• Scripts help AAC users move beyond wants and
  needs
• Support students in learning to claim, start, and
  maintain turns in a conversation
• Pre-programmed turns on speech-generating devices
  (SGDs)

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Sharing the day Visual bridges
Hodgson,1998
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Where you may never have gone before in therapy

• Perspective training Social Skills Instruction
• Social Scripts Social Stories (C. Gray,1995)
• Comic Strip Conversations (C. Gray, 1996)
• Video Modeling
• Emotional Regulation Training
• Recognizing/labeling feelings
• Grading of Emotions
• Teaching calming coping strategies
• Contingency Maps (Mirenda, 2005)

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Designing Tools for Perspective-Taking and Social
Success

• 3 Goals
• Improving the understanding and consideration
  others have of the unique perspective of the
  person with ASD
• 2. Providing accurate social information,
  including Assistance in predicting,
  understanding and reading social situations
• 3 Supporting the individual in making more
  effective responses to social situations
• Source Carol Gray,1996

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Sample goals-attentional focus, perspective and
intentions of others
State Standard L/S Interpret speakers verbal
and nonverbal messages, purposes, and
perspectives (5.1.2)

• Sample Student Goals
• Shares internal thoughts or mental plans with a
  partner
• Modifies language based on what partner has
  seen or heard

• Sample Partner Goals
• Shares emotions, internal states, and mental
  plans with student
• Uses AAC supports to foster understanding of
  language behavior

Source Prizant, B. et al. 2006 The SCERTS Model
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Social Stories

• provide scripted events of social situations
  that challenge the student
• provide a positive statement of what the student
  can do
• are written from the students perspective 

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Whats a Social Story?

• Social stories help the student understand why
• Social Stories answer questions that students
  dont ask or dont ask well
• Expected outcome increase in participation in a
  novel routine when the student has reviewed the
  Social Story
• Also hoping for a decrease in resistance to change

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3 purposes for Social Stories

• Describe a situation and appropriate behavior
• Explain fictional qualities realistic
  interactions with people
• When the principal wears a funny hat, it usually
  means theres a special event at school
• Explain the environmentindicate location or
  environmental surroundings where events happen
• At church, my family usually sits in the back
  row of pews
• At a restaurant, a waiter/waitress hands me a
  menu
• Teach new routines and anticipated actions
• Help student to translate a goal
• I will try to stay calm when the fire alarm
  rings
• I can ask for a break when my work is finished
• (Ivey, Heflin, Juane, Alberto , 2004)

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• I sit at my desk until my work is finished.
• I know that I am finished because I have answered
  all of the questions on my page.
• When Im finished, I can take a break.

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Social Stories

• are perspective driven try to correct what
  the child is misperceiving, or give additional
  information the child needs to respond
  appropriately in a given situation
• teach social understanding over rote compliance
  (Gray, 2003)
• Goal is to describe the target situation, not to
  direct the childs behavior

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• Show electronic ALS social stories
• Playing Fair - AT activity
• My Social Stories Book (Gray White, Aided
  Language Supports)
• Can incorporate into lyrics of stories or songs
• Some students respond to stories written on a
  single page, while others respond to book style
  stories with one concept and a picture or icon on
  each page

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Problem

• How do we get the student to retrieve the
  script on the fly?
• A visual support that travels with the student?
• A visual support that starts the video-tape
  rolling?
• Show Find a Friend Who
• Give students models and scaffolds upon which to
  build their oral cognitive communication and
  writing.
• Thinking Feeling Writing Prompts

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Comic Strip Conversations

• A Social Story on the fly
• Goal to assist students who struggle to
  understand the quick exchange of information in
  conversation
• Instant replay of the Who (was present), What
  (they were doing), Words (spoken),
  Thoughts/Beliefs (of those interacting)  

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Comic Strip Conversations

• Illustrate social situations abstract or
  non-verbal conversational concepts (e.g.,
  interruptions)
• Visually scaffold dialogue exchanges (speech
  bubbles)
• Convey emotional content/motivation through use
  of color coding
• Target from the students perspective  

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Where you may never have gone before in therapy!

• Perspective training Emotional Regulation
  Instruction
• Social Stories (C. Gray,1995)
• Comic Strip Conversations (C. Gray, 1996)
• Video Modeling
• Emotional Regulation Training
• Recognizing feelings
• Grading of Emotions
• Calming coping strategies
• Behavior Guides Contingency Maps

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Video Modeling(NIKOPOULOS KEENAN, 2003)

• Video modeling utilizes medium of
  television/video to teach a variety of skills
  (Corbett, 2003)
• Teaches social referencing
• Attention selectively focusing childs behavior
  on relevant stimuli (tone of voice, proximity,
  loudness, verbal content, facial expression)
• Retention maintaining learned social l through
  video review
• Use video clips from TV shows to exemplify
  interactions
• Rehearse with written scripts first
• Verbal rehearsal - example asking a girl out on
  a date
• Paraphrase rehearsal
• Re-enact the scene with clinician
• Re-enact the scene with peer
• Use VM and role-play to become aware of listener
  cues
• Yawning, taking a breath
• Swirming in a chair
• Looking toward door looking at watch

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Where you may never have gone before in therapy!

• Perspective training Emotional Regulation
  Instruction
• Social Stories (C. Gray,1995)
• Comic Strip Conversations (C. Gray, 1996)
• Video Review
• Emotional Regulation Training
• Recognizing labeling feelings
• Grading of Emotions
• Calming coping strategies
• Contingency Map (Pat Mirenda, 2005)

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Emotional Regulation

• Child must have emotional regulatory capacities
  to
• Avoid a state of too high or too low based on
  expectations of a social situation
  (Self-Regulation)
• Seek assistance and/ or respond to others
  attempts to provide support when faced with
  stressful, overly stimulating, or distressful
  circumstances (Mutual Regulation)
• Recover from being pushed over the edge into
  states of emotional dysregulation or attentional
  shutdown through self-regulation and/or mutual
  regulation strategies.
• Source E. Rubin. Addressing Social
  communication in Students with HFA and AS.
  Monterey SELPA. Feb. 2005

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Ways to teach emotional regulation

• Teach a continuum of emotional vocabulary
  happy, content, excited, thrilled (How
  Do You Feel? posters, Mood Swings)
• Grading of emotions identify salient cues for
  a particular level of emotion (tone of voice,
  body language, facial expression, muscle tension,
  breathing)
• Teach mutual regulation Requesting
• assistance from others - seeking
  comfort/sympathy (Rubin Lennon,2004)
• Regardless of language level, the student may be
• unable to adequately express himself in
  stressful/highly charged situations
• Provide an escape plan
• Walk and no talk (Atwood,2004 McAffee, 2002)
• Provide distracting pleasurable activities(
  Atwood, 2004)

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Grading of Emotions
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Emotional Key Rings
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Recognizing Feelings Stress Activities

• Happy and Sad
• The Stress Thermometer (McAffee,2002) and Social
  Story When I have stress

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Software that Supports Concept Development

• IntelliTools Classroom Suitesuite of programs
• IntelliTalk
• IntelliPics Studio
• IntelliMathics
• Concept development is supported with graphic,
  text, and/or animation
• Very useful for students with ASD in particular
  due to the programs visual and auditory supports

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COGNITIVE BEHAVIOR THERAPY to Manage Emotional
Regulation Atwood, 2004

• Affective Education Component
• Teach why we have emotions
• Explore one emotion at a time, starting with
  happiness progressing to others anxiety,
  anger, etc.
• Teach a continuum of emotional vocabulary
  happy, content, excited, thrilled
• Teach Grading of emotions in response to
  stress-inducing situations

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Additional Tools to Address ER Atwood, 2004

• Record enjoyable activities photo and
  communication scrapbooks
• Sensory tools
• Pleasures box
• Sensory Calming areas
• Special interest tools solitude a devoted
  interest in a topic can be calming (example
  interest in Japanese culture tea ceremony)
• Drama
• Autobiographies of adolescents/adults with HFA/AS
• Mood diaries
• Medication

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Pleasures Box

• A form of cognitive distraction/redirection
• Refocuses student on calming things
• Sensory calming tools
• Photographs pet, family members, favorite toy,
  favorite vacations or locations
• Stories,music or calming sequences

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REMEMBER TRANSITIONS!

• The single most challenging part of every
  students and teachers day they cant be avoided

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• WHY ARE TRANSITIONS SO DIFFICULT?
• The student
• doesnt want to or is unable to stop a preferred
  activity/give up a reinforcer
• doesnt like change
• doesnt like losing control
• protests to avoid activities he perceives as
  too hard or frustrating
• Source L. Hogdgon. Solving Behavior Problems in
  Autism.

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Increasing flexibility at transitions

• Make transitions part of the daily routine ask
  students to prep materials for the next day
• Verbally announce natural endings (only 2
  problems left, then we will be done)
• Refer back to the visual schedule
• Behavior self-monitoring guides

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Modify the length of instructional periods...

• Short instructional intervals
• Intermittent breaks, or alternate work and
  break intervals
• Show student the duration of an activity

Time Timer www.Timetimer.com
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• Teach meaning of gestures or facial expressions
  commonly used with oral language
• Photos of students making gestures or facial
  expressions in IntelliPics Studio with a label
  description of what the gesture or facial
  expression communicates then an interactive
  quiz
• Theory of MindIntelliPics Studio demonstrating
  relationship between behavior and thoughts (a
  person who is sad may cry, have down-turned
  mouth, downcast eyes, little talking) then a
  quiz
• Basic social rulesIntelliPics Studio to create
  activities that give instructions for appropriate
  behaviors when initiating conversations, waiting
  for conversation partner, taking turns, changing
  topic and finishing a conversation
• Functional skillsIntelliTalk or IntelliPics
• Name of clothes, order of dressing, how to wash
  clothes, clothes to wear in different weather
  conditions, how to put clothes away, how to
  compliment someone on their clothes
• Food preparation
• Develop literacy skillsIntelliTalk with its
  visual supports for text helps reinforce the
  understanding of both the original text and the
  reading comprehension activity.

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Cognitive Restructuring Component to Manage
Emotional Regulation Atwood, 2004

• Correct distorted conceptualizations of an event,
  situation, or person
• Challenge false beliefs or assumptions
• Example being deliberately hit by someone vs.
  considering the context nice guy who was
  running, tripped accidentally bumped into me
• Building an Emotional Toolbox to repair
  restructure feelings and beliefs
• Physical Tools for self regulation (tools to
  release emotional energy)
• Relaxation Tools for self-regulation
• Social Tools for mutual regulation using other
  people as a means to manage feelings
• Thinking Tools for self-regulation self-talk,
  reality checks using logic/facts

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Where you may never have gone before in therapy!

• Perspective training Emotional Regulation
  Instruction
• Social Stories (C. Gray,1995)
• Comic Strip Conversations (C. Gray, 1996)
• Video Self-Review
• Emotional Regulation Training
• Recognizing labeling feelings
• Grading of Emotions
• Calming coping strategies
• Contingency Maps (Mirenda, 2005)

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Contingency Maps

• Similar to visual schedules, only more detailed
  and with a different purpose
• Goal to provide information about the current
  problem and desired behavioral pathways related
  to problem behavior
• Will help the individual understand why he or she
  should engage in the behaviors associated with
  the desired pathway!

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86
Contingency Map

• A contingency map depicts
• The antecedent that typically triggers a problem
  behavior
• The problem behavior
• The consequences that will follow if it occurs
• Ideally, the natural consequences if not,
  artificial
• A functionally-related (desired) alternative
  behavior
• The consequences that will follow if it occurs
• Again, ideally, the natural consequences

87
Antonia

• Grade 2 student with autism, little speech
• Included for half of the day remainder spent in
  resource room because of problem behavior
• Problem behaviors head-butting, hitting, and
  pinching classmates and adults when she had to
  wait
• For her turn during buddy reading
• In line
• For the computer to boot up, etc.
• Waiting was also an enormous problem at home

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88
Wait Signal

• Antonias SLP taught her to wait, using a wait
  symbol (a red circle that symbolized wait)
• SLP provided systematic instruction in a
  simulated buddy reading activity to teach A.
  the meaning of the red circle you will get what
  you want, but not quite yet
• Wait symbol was then used in real buddy reading
  by both A. and her classmates, along with other
  visual supports

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89
Contingency Map Waiting in Line
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90
Generalization

• Once A. learned what the wait signal meant in
  buddy reading, contingency maps were created to
  help her generalize this understanding to other
  situations at school and at home.

_at_ Pat Mirenda, PhD., 11/05
91
Del

• 6-year-old boy with autism, good verbal skills,
  high need for predictability and order
• Prob Behavs screaming, crying yelling,
  self-injurious behavior
• Triggers paper-and-pencil tasks in grade 1 and
  PE class on Thursdays in the gym (unpredictable,
  chaotic)
• Function escape from difficult activities
• Impact Del was socially isolated from his
  classmates because they were afraid of him

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92
Intervention

• Paper-and-pencil task teach Del to ask for a
  short break, as needed
• PE class teach Del to ask the teacher for
  permission to sit and watch the class instead of
  participating, as needed
• Verbal explanations given regarding the new,
  desired behaviors before each relevant activity
• No changes in Dels behavior

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93
Contingency Map
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94
Contingency Map PE
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95
Result

• Immediate and dramatic reduction in Dels problem
  behavior as he began to use the new, desired
  behaviors
• Lasted throughout grade 1 and into grade 2
• Del received the most votes when the class was
  asked to choose who they wanted to sit next to
  for a new seating plan

96
We have the tools to develop...A deep tool chest
of intervention strategies

For more information email vkalashian_at_slvusd.org
mwolsen_at_monterey.k12.ca.us
97
Resources to Get Started

• Atwood, T. 2004. Exploring Feelings Cognitive
  Behavior Therapy to Manage ANXIETY. Arlington,
  TX Future Horizons.
• Atwood, T. 2004. Exploring Feelings cognitive
  Behavior Therapy to Manage ANGER. Arlington, TX
  Future Horizons.
• Baker, J.E. 2003. Social Skills Training for
  Children and Adolescents with Asperger Syndrome
  and Social-communication problems. Shawnee
  Mission, KS Autism-Asperger Publishing.
• Baker, J.E., 2001. The Social Skills Picture
  Book Teaching play, emotions and communication
  to children with autism. Arlington, TX Future
  Horizons.
• Boardmaker Plus Mayer-Johnson, Inc. Solana
  Beach, CA
• www.mayer-johnson.com
• Britton Reese, P., and Challenner, N., 2002.
  Autism PDD Social Skills Lessons.
  Primary.Intermediate and Adolescent. Moline, IL
  LinguiSystems, Inc.

98
More Resources...

• Brown, K., Mirenda, P. (2006). Contingency
  mapping A novel visual support strategy as an
  adjunct to functional equivalence training.
  Journal of Positive Behavior Interventions.
• Elder, P., Crain, S. Goossens, C. (1999).
  Engineering the preschool environment for
  interactive symbolic communication. Birmingham,
  AL Southeast Augmentative Communication
  Conference
• Erickson, K. Casey, K. (1998). Literacy,
  Augmentative Communication Children with Autism
  and/or Pervasive Developmental Disorders. AAC in
  the Mountains Conference. Park City, UT.
• Fullerton, A., Stratton, J., Coyne, P. and Gray,
  C. 1996. Higher Functioning Adolescents and Young
  Adults with Autism. Austin, TX Pro-Ed.
• Gray, C. 2003. The New Social Story Book
  Illustrated. Arlington, TX Future Horizons, Inc.
• Gray, C. White, L. 2002. My Social Stories
  Book. London Jessica Kingsley Publishers.

99

• Gray, C. 1994. Comic Strip Conversations.
  Arlington, TX Future Horizons, Inc.
• Gray, C. 1995. Teaching children with autism to
  read social situations. In K.A. Quill (Ed.).
  Teaching Children with Autism Strategies to
  Enhance Communication and Socialization. New
  York Delmar Publishers.
• Hodgdon, L. Visual Strategies for Improving
  Communication. Solving Behavioral Problems in
  Autism. QuirkRoberts Publishing.
• Ivey, M.L., Heflin, Juane, I., and Alberto P,
  2004. The use of social stories to promote
  independent behaviors in novel events for
  children with PDD-NOS. Focus On Autism and Other
  Developmental Disabilities, 19, 164-176.
• Johnson, A.M. and Susnik, J.L., 1995. Social
  Skills Stories Functional Picture Stories for
  Readers and Nonreaders K-12. Solana Beach, CA
  Mayer-Johnson, Inc.
• Johnston, S., Nelson, C., Evans, J., and
  Palasolo, K (2003). The use of visual supports in
  teaching young children with autism spectrum
  disorder to initiate interactions. Augmentative
  and Alternative Communication, 19, 86-103.

100

• Light, J., Roberts, B., Dimarco, R., Greiner,
  N. (1998). Augmentative and alternative
  communication to support receptive and expressive
  communication for people with autism. Journal of
  Communication Disorders, 31, 153-80.
• Light, J.C. and Bilger, C. 1998. Building
  Communicative Competence with Individuals Who Use
  Augmentative and Alternative Communication.
  Baltimore Paul Brookes.
• McAfee, J. 2002. Navigating the Social World A
  Curriculum for Individuals with Aspergers
  Syndrome, High Functioning Autism and Related
  Disorders. Arlington, TX Future Horizons.
• McClannahan, L. E., Krantz, P. J. (1999).
  Activity schedules for children with autism
  Teaching independent behavior. Bethesda, MD
  Woodbine House.

101

• Mirenda, P. Schuler, A. (1998). Teaching
  individuals with autism and related disorders to
  use visual-spatial symbols to communicate. In S.
  Blackstone, E. Cassatt-James D. Bruskin (Eds.),
  Augmentative communication Intervention
  Strategies, (pp.5.1-17-5.1-25). Rockville, MD
  American Speech-Language-Hearing Association.
• Moyes. R. A. 2003. Incorporating Social Goals in
  the Classroom A guide for Teachers and parents
  of Children with High-Functioning Autism and
  Asperger Syndrome. C. Thomas Publishing.
• Rubin, E., Asperger Syndrome and High-Functioning
  Autism Addressing Social Communication and
  Emotional Regulation. 2004. Topics in Language
  Disorders, 24 (4).
• Rubin, E. Laurent, A. 2002. Feelings Book.
  Communication Crossroads. www.commxroads.com
• Smith Myles, B., Trautman, M., Schelvan, R. 2004.
  The Hidden curriculum Practical Solutions for
  Understanding Unstated Rules in Social
  Situations. Shawnee Mission, KS Autism-Asperger
  Publishing Co. www.asperger.net

102

• Twachtman, D.,1995. Methods to enhance
  communication in verbal children. In K.A. Quill
  (Ed.). Teaching Children with Autism Strategies
  to Enhance Communication and Socialization. New
  York Delmar Publishers.
• Prizant, B., Wetherby, A. Rubin, E., Rydell, A.
  and Rydell, P. 2006. The SCERTS Model Volume 1
  Assessment Vol.2-Program Planning and
  Intervention.Brookes Publishers.
• Winner-Garcia, M. 2008. Thinking About YOU
  Thinking About ME. Volume 2. San Jose, CA Center
  for Social Thinking. www.socialthinking.com
• Winner-Garcia, M. 200 _. Think Social! A Social
  Thinking Curriculum for School-Age Students. San
  Jose, CA Center for Social Thinking.
  www.socialthinking.com
• Winner-Garcia, M. 200_ Think Social! Worksheets.
  San Jose, CA Center for Social Thinking.
  www.socialthinking.com
• Winner-Garcia. 2008. Sticker Strategies to
  Encourage Social Thinking and Organization.
  www.socialthinking.com

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Web resources

• www.portacom.bc.ca
• www.disabilitysolution.org
• www.news-2-you.com
• www.sandbox-learning.com
• www.socialthinking.com
• www.thegraycenter.com
• www.usevisualstrategies.com

• www.adaptedlearning.com
• www.aheadwithautism.com
• www.asperger.net
• www.aspergersyndrome.com
• www.autism-society.org
• www.CommXRoads.com
• www.do2learn.com