“Adulting”: Effectively Preparing Individuals with ASD
MaryE.McDonald,Ph.D.,BCBA-D,LBAEdenII/GenesisPrograms&HofstraUniversity
What Happens to Our Sweet Little Kids?
THEY GROW UP!
“Adulting”
• What do we mean by ”adulting?”
• Adulting (v): to do grown up things and hold responsibilities such as, a 9-5 job, a mortgage/rent, a car payment, or anything else that makes one think of grown ups.
• to behave in an adult manner; engage in activities associated with adulthood
• to make someone behave like an adult; turn someone into an adult
TheNeedisReal• 1in68childrenhaveautism
• Thenumberscontinuetoincrease….
• Overthenext10-years,500,000childrenwithautismwillbecomeadults
• 90%ofadultswithautismareunemployedorunderemployed
WHATWEKNOW
Preschool
Classroomroutines
Playskills
Kindergarten
Classroomroutines
Pre-academicskills
Basicsocialskills
ElementarySchool
SocialSkills
Academicskills
WHATWENEEDtoKNOW
AdolescentandAdultServices
Socialnavigating
Academicskills
Beginningofindependence
Advancedsocialskills
Academicskills
Independence
Organization
Self-monitoring
Vocationalskills
EssentialSkillsNeeded:
SomeImportantSkillAreas• Communication &Socialskills
• Selfhelp/independentlivingskills• Communityawareness/CommunityParticipation
• SelfAdvocacy• Jobskills• jobreadinesstoobtainingand
retainingpaidemployment
• Leisureskills
What does it meant to be independent?
Do you consider yourself to be independent? Why?
This is a Problem!
These are all important skills but some of the most
difficult for individuals with ASD
Do WE Sometimes Limit or Prevent Independence? How can we Move along a
Continuum to Promote Independence?• From 1:1 supervision to independence
• Time on task and transitions
• Personal care
• Behavior and self- monitoring
• Leisure skills
• Vocational preference and choice
Independence vs. Interdependence
• The student is able to complete the task completely by him/herself
• The student is able to complete the task with interaction with others in his/her environment
TheImportanceofInterdependenceSomeSocially-RelatedVocationalSkills
• Askingforhelpwithatask
• Askingforclarificationofatask
• Askingforamissingitem
• Askingforfeedback
• Acceptingfeedback/criticismofwork
• Notifyingsomeoneifmoreworkisneeded
DiscriminatingwhentoASKforHELP(“Ineedhelp”or“Workalone”)
NineGuidingPrinciples(TheAdultWorld)• NADSP(NationalAllianceforDirectServiceProfessionals)codeofethicsforadult
services.AnationalpanelofDSPs,advocates,families,professionals,andresearchersconstructedtheseguidelines.Standardsofconductandprofessionalismareoutlinedacrossnineareas:
1.Person-CenteredSupports:
• Firstcommitmentistotheindividual,everythingthatwedoflowsfromthispremise
2.PromotingPhysicalandEmotionalWell-Being:
• Ensuretheemotional,physical,andpersonalwell-beingoftheindividualsreceivingsupport
• Avoidaversiveordeprivationtechniqueswhenpossible,ifinanapprovedBSPfadeoutASAP
NineGuidingPrinciples3.IntegrityandResponsibility:
• Assistpeopleinleadingself-directedlivesandfosteraspiritofpartnershipwiththeindividualsweserve,otherprofessionals,andthecommunity
4.Confidentiality:
• Safeguardandrespecttheconfidentialityandprivacyoftheindividuals
5.Justice,Fairness,andEquity:
• Promoteandpracticejustice,fairness,andequityfortheindividualsandthecommunityasawhole
6.Respect:
• Respectthehumandignityanduniquenessoftheindividuals.Recognizeeachindividualasvaluableandhelpothersunderstandtheirvalue
NineGuidingPrinciples7.Relationships:
• Assistindividualstomakeandmaintainrelationships
• Assurethatindividualshavetheopportunitytomakeinformedchoicesinsafelyexpressingtheirsexualitywithoutjudgment
8.Self-Determination:
• Assistindividualswithdirectingthecourseoftheirownlives
• Workinpartnershipwithothers
• Honortheindividual'srighttoassumeriskinaninformedmanner
9.Advocacy:
• Advocatewithindividualsforjustice,inclusion,andfullcommunityparticipation
• Promotehuman,legal,andcivilrightsofallindividualsandassistotherstounderstandtheserights
EthicalProcedures• Individualswhoarerecipientsorpotentialrecipientsoftreatment
designedtochangetheirbehaviorhavetherightto
1. Atherapeuticenvironment
2. Serviceswhoseoverridinggoalispersonalwelfare
3. Treatmentbyacompetentbehavioranalyst
4. Programsthatteachfunctionalskills
5. Behavioralassessmentandongoingevaluation
6. Themosteffectivetreatmentproceduresavailable(VanHouten etal.,1988)
Whataresomeoftheissues?• Startingtoteachtheseskillstoolate
• Transitioningat21yearsold
• Can’tstartteachingthislate….
• Communicationskills
• Selfhelp/independentlivingskills
• Socialskills
• Jobskills
• Leisureskills
• 1:1instructionnotprovidedinadultprograms
• Studentsnotusedtofunctioningingroups
• Staffturnovercanbeanissue
Staffing and Fading Supports
SCHOOL-AGEPROGRAMS
•Master’slevelteachersrequired• 1:1and2:1staffratio• Instruction-based/direct
ADULTSERVICES
• H.S.degreerequired• Lowerstaffingpatterns/groups• Experience/community-based
Goals of Adult Services
• Foster skills that develop greater independence for our clients throughout their lives
• Secure opportunities for volunteer job sampling within the community• Teach skills to grow and develop to their maximum workforce potential• Teach skills to develop self-help and independent leisure activities • Teach clients the intricacies of appropriate behavior in the community
The Importance of CHOICE
THISISAMUSTREADARTICLE….
PreferenceAssessment
• Assesspreferenceofspecificskills(e.g.,cuttingfoodvs.stockingitems)• Assesspreferenceforspecificlocationsandconditions(e.g.,noisy,crowded)• Assesspreferencesofparticularjobs(non-verbally&verballyifpossible)• Musthavechoices toassesspreferences• Makeconsiderationsforstudentswhoareverbal/non-verbal
HowtoAssessPreference• Ask• Observe• Interview (family/teachers)• Give choices (e.g., forced choice selections or sample one at a time)• Note behavior/affect in different situations• Very often students let us know we just need to listen!
ChoiceAssessmentoComputer
oPolish Nails
oCut vegetables
oPolish Nails
oEat a snack
oPolish Nails
oClean shelves
oPolish Nails
oEat a snack
oCut vegetables
Polish Nails
Polish Nails
Cut vegetables
Eat a snack
Eat a snack
Transition Skills
AcademicsLifeSkills/SocialSkills
WherearetheeffortsbeingfocusedforstudentswithASD?
SkillsFortransition- AutismSpeaks(Baker,et.al,2015)• Communication
• Schedules
• Self-care
• Breaks
• Chores/household
• Moneyskills
• Safety/communitysafety
• Leisureskills
• Vocationalskills
ISP(IndividualizedServicePlan)Areas(alwaysconsiderpre-requisiteskillsneededforactivities)
• Communicationskills(e.g.,requestforhelp)
• Socialskills(e.g.,turntaking,conversationalskills,bathroometiquette,personalrelationships)
• Socialappropriateness(e.g.,usingpublicrestrooms,eatinginrestaurantswithutensils)
• Lifeskills(e.g.,health,safety&firstaid,personalinformation/identification)
• Self-regulation(e.g.,copingstrategies,deepbreathing,relaxationskills)
• Financial(e.g.,moneymanagement)
• Selfcare(e.g.,leisure,
grooming,toileting,dressing)• selfmanagement(e.g.
medication)• Vocationalskills(e.g.,
answeringphone)• Recreation/leisure(e.g.,
treadmill)• Communityawareness(e.g.,
safetysigns,identificationofcommonstores/grocery)
• Transportation(e.g.traveltraining)
Target across all Settings
üIndependence and Self-Help
üSkill Acquisition and Retention
üFUNCTIONAL Academics
üSocial Skills, Leisure
üQuality of Life
ThingstoThinkAbout…
FortheResume(JobSpecific)
• Collating,sorting,filing,folding,stapling,holepunching,wrapping,cleaning, mailing,ordering,selling,stocking, pricing,alphabetizing,takingcareofplants,sortinglibrarybooks,typing, editingtext,takinginventory etc...
SkillsForLife(AcrossAllEnvironments)• Remainingontask,endurance,
requesting,problemsolving,independence,navigatingenvironment,tolerating, monitoringappearance,monitoringbehavior,statingpreference,beingflexible,respondingtounexpectedcircumstances,greetingpeople, introducingself,usingpolitebehavioretc..
StayCalmandTeach!• Beginteachingearly…REALLYearly!• Communication,Communication,Communication…
• Bythetimetheygettoadulthoodallofthosesmall“problems”becomeBIGones• Fade1:1/2:1instructionasquicklyaspossible(ASAPPROPRIATE)• CommunityIntegration- startwithoutingsatayoungage• ThinkFUNCTIONALeachandeveryday• ThinkINDEPENDENCE/INTERDEPENDENCEeachandeveryday
ISWHATIAMTEACHINGGOINGTOCREATEINDEPENDENCE?ISITFUNCTIONAL???WILLTHEINDIVIDUALUSEIT?
What are some lifelong skills that we can begin TO FOCUS ON at an early age?
• Waiting
• Requesting/needs
• Play----Leisure
• Snack---Meal preparation
• Tolerating groups
• Tolerating crowds/noise
• Tolerating no
• Following a schedule
• Using technology
• Asking for help
• Bathroom skills/ hygiene
• Increased engagement/duration
Sample IEP Goals Related to Transition
* Teach functional and relevant skills*
• Maintain appropriate hygiene and grooming
• Use a public bathroom independently
• Respond appropriately to co-worker and supervisors
• Remain “on-task” at a work-site
• Eat appropriately with co-workers
• Develop Leisure Skills
• Develop ability to use public transportation
• Follow a work schedule
• Job-sampling
• Increase duration on task
• Perform building maintenance skills
• Perform office skills
• Follow directions of co-worker or job coach/instructor
• Develop exercise/fitness skills
A Case for Teaching Functional SkillsMy Other Brother Daryl, by Preston Lewis
“He can put 100 pegs in a board in less than 10 minutes while in his seat with 95% accuracy.”
“But he can’t put quarters in vending machines.”“He can sort blocks by color, up to 10 different colors!”“But he can’t sort clothes; whites from colors for washing.”“He can tell letters of the alphabet with 80% accuracy.” “But he can’t tell the men’s from the ladies’ room when we go out.”
• AssessmentofFunctionalLivingSkills–AFLS(Partingtonbehavioranalysts.com)
• AutismSpeaks- Toolkits• TransitionandEmployment
• Edmark FunctionalSightwords
• ThankYouforCalling(Imaginart)
• CheckWritingPractice(PCI)
• CareerFolio(CareerInfo.CollectionSystem)
• MasteringMath:StepbyStep
• CoinULator Math(worksheetsandProgressChart)
• TheNewspaper(Remedia)
• CatalogsandMailOrders(Remedia)
• MenuMath(Remedia)
• SurvivalSightwords (Remedia)
• Look&CookMicrowave• (Remedia- madefornon-readers)
• CookingtoLearn(PCI)
FunctionalCurriculumResources
FunctionalCurriculumIdeas…
Math
• Addition/ Calculator Use• Counting Money• Making Purchases In-House• Making Purchases in the
community
Reading
• Functional Sight Words• Reading Street Signs• Reading Menus• Reading Recipes
JasonThen&Now
• Addswithnumberline
• Sortsshapes
• Matchesletters
• Writespersonalinformation
• Addswithcalculator
• Sortssilverware
• Playsboggle
• Fillsoutapplication
Using Visual Supports
VISUALS
• Icons
• Pictures
• Graphics
• Visual TA
• Schedules
• Structured Work Systems
UsingMatchingforFull-DayActivitySchedule
SampleSchedules
SampleLeisureSchedule
StructuredWorkSystems(SWS)?• Worksystemsareanevidence-basedpracticethatvisuallystructuresequencesofskillsthatcanbepracticedacrosssettings(Hausler&Bernard-Opitz,2011).
- Providesopportunitiesforindependence- Allowsformoreindividualized/flexibleroomscheduling- HighlightsthestrengthsofindividualswithASD- Supportsthedeficitsofexecutivefunctioning
- Organization- Distractibility- Sequencing- Generalization- Initiation
StructuredWorkSystems1) Tasksmustfollowalefttorightortoptobottomformat.
2) ToDotasksaresetupontheleft.3) Finishedtasksareplacedontheright.4) Giveonlytheamountoftasksthatanindividualcancompleteduringthetime
given.(Planforsuccess!)
5) Onlygiveareasonableamountofworkpertask.
6) Onlyincludemasteredskills.Iftheindividualrequirespromptingtocompletethetask- workononetaskatatime.
7) Ifpromptingisneededtoinitiateatask- promptfrombehind.Limitverbalprompts.
8) Changeouttasksotheindividualcanworkonmoreskills.
The Importance of the CommunityStart this early too!
Adults in the Community
o Access through visiting local restaurants, stores, etc.
o Access through attending community events
o Access through vocational volunteer work-sites: job carve as needed to create individualized tasks in order to participate
o Identify reinforcing locations and activities within the community
o GET OUT THERE!!!
Gaining Community AccessParticipation & Integration
Society/Community
Home/Independent Living:
Daily LivingLeisure/Rec Participation
Vocational Integration:EmploymentJob sample
Participation
Community Integration
Fitness
Participation
Genesis In and Out of House • Newbridge Inn, Taco Tuesday, Food cart
• Mailings/Office work
• Data entry
• Off site- white post farms, movies, home depot…etc
• Social enterprise- in progress- Kiosk at local mall
Behavioral Assessment and Proactive Strategies
KeepinMind…• Challengingbehaviorservesafunctionforanindividual
• individualscanusebehaviortoaccesssomethingorsomeone(obtain/request)oravoidsomethingorsomeone(escape/protest)
• Theprocessofdeterminingthefunctionallowsyoutodeterminereplacement/preventionstrategies
Whattoteach
• Takeaproactiveapproach,lotscanbedonethroughprevention
• Teachalternative/replacementbehaviors
• Teachcommunication- relatedtoeachpossiblefunction
•
Supports/Systems
REMINDERS
DevelopingSocialCompetence
Clubs- toAddressSocialSkillsandPersonalInterests
• ComicBookClub
• GamersClub
• WomanWellnessClub
• BasketballClub
• TalentClub
• GardeningClub
• PhotographyClub
• Scrapbooking
• Jewelrymaking
• Bingo
• Karaoke
• BookClub
• Cardclub
• Currentevents
WhyareClubsImportant…• GroupActivities/Participation• Socialskills• Toleranceforothers• Waitingyourturn(i.e.;largegroups&limiteddevices)• Developinginterests(exposuretonewactivities)• Developingleisureskills• Buildingrelationshipsonsharedinterests
References• Bannerman,D.J.,Sheldon,J.B.,Sherman,J.A.,&Harchik,A.E.(1990).Balancingtherighttohabilitationwiththerightto
personalliberties:therightsofpeoplewithdevelopmentaldisabilitiestoeattoomanydoughnutsandtakeanap. JournalofAppliedBehaviorAnalysis, 23(1),79–89.
• Carr,E.G.,Levin,L.,McConnachie,G.,Carlson,J.I.,Kemp,D.,Smith,C.(1994).Communication-basedinterventionforproblembehavior.Baltimore,MD:BrookesPublishing.
• Cipiani,E.(Ed.).(1989).Thetreatmentofseverebehaviordisorders.Washington,D.C.:AAMR.
• CooperJ.O,HeronT.E,Heward W.L. (2007).Appliedbehavioranalysis(2nded.) UpperSaddleRiver,NJ:Pearson.
• Durand,M.V.(1990).Severebehaviorproblems.Afunctionalcommunicationtrainingapproach.NewYork,NY:TheGuilfordPress.
• Hausler,A.,&Brenard-Opitz,V.(2011).Visualsupportforchildrenwithautismspectrumdisorders. ShawneeMission,KS:AAPCPublishing.
• Holmes,D.L.(1998).Autismthroughthelifespan.Bethseda,MD:WoodbineHouse.
• Maurice,C.,Green,G.,&Luce,S.C.(Eds.).(1996).Behavioralinterventionforyoungchildrenwithautism.Austin,TX:Pro-Ed.
• Reichle,J.&Wacker,D.P.(1993).Communicativealternativestochallengingbehavior.Baltimore,MD:BrookesPublishing.
• Roux,A.M.,Shattuck,P.T.,Cooper,B.P.,Anderson,K.A.,Wagner,M.,&Narendorf,S.C.(2013).PostsecondaryEmploymentExperiencesAmongYoungAdultsWithanAutismSpectrumDisorderRH:EmploymentinYoungAdultsWithAutism. JournaloftheAmericanAcademyofChildandAdolescentPsychiatry, 52(9),931–939.
• VanHouten R,AxelrodS,BaileyJ.S,Favell J.E,FoxxR.N,IwataB.A,etal. (1988).Therighttoeffectivebehavioraltreatment. JournalofAppliedBehaviorAnalysis. ;21:381–384.
VisualSupportVisualSchedules/Communication:• http://www.setbc.org/download/Public/VSS.pdf• http://mrsriley.com/• http://www.google.com/imghpSocialStories:• http://209.197.91.184/socialstories/Independenttasks:• http://www.angelfire.com/pa5/as/asteachersites.html• http://www.positivelyautism.com/free/• http://www.worksheetworks.com/• http://www.tlsbooks.com/
FurtheryourKnowledge• Videodepictingclassroommanagementcomponents:
• http://www.youtube.com/watch?v=SLIpCJybXLI
• CAST(CenterforAppliedScienceTechnology)GuidelinesforUDL:• http://www.cast.org/publications/UDLguidelines/version1.html
• AutismSpeaksTransitionToolKit:• https://www.autismspeaks.org/family-services/tool-kits/transition-tool-kit
• Behaviorallessons:• http://712educators.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.teachers.net%2Flessons%
2Fposts%2F285.htm
• EnforcingClassRules:• http://712educators.about.com/cs/backtoschool/a/classrules.htm
• InteractiveBehavioralAdvisor:• http://712educators.about.com/cs/backtoschool/a/classrules.htm
• GeneralAdviceforTeachers(slideshow)• http://www.teachervision.fen.com/slideshow/teaching-methods-and-management/52294.html?detoured=1