THE WORLD OF THE “D’S”

ASD, ADHD, LD, DD & IDD

Emily Boncek M.S., CRC & Lucy Gafford M.S., CRC

Training Developed by

Jennifer Kaut M.Ed.,BCBABoard Certified Behavior AnalystDARS-DRS Developmental Disorder Specialist

Looking at July 2014 TEA DATA: Our Total Numbers Age Group with the Greatest Numbers Rate of Growth Percentage by Age, Grades and Severity Level Numbers Graduating in 3 -5yrs. & 10 -12 yrs. Possible Financial Effects

Created by: Jennifer Kaut, M.Ed. BCBA Data obtained by TEA July 2014. Data reporting Levels of Severity are based on the DSM 5 definitions.

Data for Levels of Severity nor financial costs are not validated.

5 yrs 6 yrs 7 yrs 8 yrs 9 yrs 10 yrs 11 yrs

2,308

3,396 3,675 3,719 4,011 4,055 3,768

Number of ASD Elementary School Age Students: 24,932

12 yrs 13 yrs 14 yrs

3,590 3,242 2,977

Number of ASD Middle School Age Students: 9,809

15 yrs 16 yrs 17 yrs 18 yrs

2,6432,300 2,054

1,278

Number of ASD High School Age Students: 8,275

19 yrs 20 yrs 21 yrs

689

488402

Number of ASD 18 + Age Students:1,579

Pre-K(3-4)6%

Elem (6-11)53%

Middle (12-14)21%

High School(15-18)18%

18 +(19-21)3%

Percentange of ASD Students in Pre-K, Elem, Middle, High & 18 +

3-5 yrs (4,986) 6-14 yrs (32,433) 15-18 yrs (8,259) 19-21 yrs (1,579) In total: 47,527 broken down by level

Level 1 "Requiring Support" 1114 14296 3662 87 19159

Level 2 "Requiring Substantial Support" 2122 5938 1540 114 9714

Level 3 "Requiring Very Substantial Sup-port"

1750 12199 3057 1378 18384

2,500

7,500

12,500

17,500

22,500

Current Number of ASD Students Ages 3-21 broken down by the DSM Level of Severity

Data provided by TEA July

2014. The lev-els are esti-mates only. They are not

reported num-bers

DSM Definition of Level 1: DSM Definition of Level 2: DSM Definition of Level 3:Social communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. Restricted, repetitive behaviors: Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

Social communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication. Restricted, repetitive behaviors: Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.

Social communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. Restricted, repetitive behaviors: Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.

Level 141%

Level 221%

Level 339%

Percentage of Students with ASD by Level of Serverity

How Many Are We Sending for 18 + Services?18 yrs:Total: 2,296

19 yrsTotal: 688 (30%)

20 yrsTotal: 488(21%)

21 yrs.Total: 392(17%)

Level 1: 434 71Percentage that go on to 18 + services: 16%

10Percentage that go on to 18 + services:.02%

6Percentage that go on to 18 + services:.01%

Level 2: 201 70Percentage that go on to 18 + services:35%

30Percentage that go on to 18 + services:15%

4Percentage that go on to 18 + services:.02%

Level 3: 661 547Percentage that go on to 18 + services: 86%

448Percentage that go on to 18 + services: 68%

382Percentage that go on to 18 + services: 58%

In the next 10-12 years… Texas will TRIPLE the numbers of students graduating with Autism 2017-2019, Texas will have 9,838 students with Autism graduating.2024-2026, Texas will have 32,433 students with Autism graduating 

3 to 5 years 10 to 12 years

9,838

32,433

Number of ASD Students GraduatingSeries 1

Level 1(needs supports)

Level 2 (substantial supports)

Level 3 (very substantial supports)

3,789

1,654

4,435

14,296

5,938

12,199

Number of ASD Students Graduating by Level of Severity

10 to 12 years 3 to 5 years

What Supports Did These Graduates Need in School and How Will These Reflect Their Transition Needs?

(Predications based on the DSM 5 Levels of Severity) 

LEVEL 1’s (Need Supports)

In 3 to 5 years

3,749 students received their instruction in the least restrictive instructional setting. They were in their regular classroom appr oximately 80% of the time. They may need to stay in school 1 or 2 more years to further develop life and social skills, if their a cademics, were the primary focus during high school. They may need VR services in order to obtain/maintain employment or attend higher education

In 10 to 12 years

14, 296 students

LEVEL 2’s (Substantial Supports)

In 3 to 5 years

1,654 students received their instruction in a moderate restrictive instructional setting. They were in their regular classroom approximately 40% - 79% of the time. They will most likely need 18 plus school services, as well as, VR services in order to obtain or maintain emp loyment. These students are at a crossroad: there are 3 directions these students can take.

1) If provided, intense intervention with the expectation of independence, they could move up to a Level 1 2) They stay the same and will most likely never reach full independence 3) Or due to a lack of intervention and supports, this group is at risk for dropping to a Level 3, thus needing lifelong supp orts.

In 10 to 12 years

5,938 students

LEVEL 3’s (Very Substantial Supports)

In 3 to 5 years

4,435 students received their instruction in the most restrictive instructional setting. They were in their regular classroom less than 40%. These students will require intense long term supports.

In 10 to 12 years

12,199 students

Created by: Jennifer Kaut M.Ed.,BCBA

2012’s Top 5 Reasons for ASD Unsuccessful closures…

1. Making eligibility decisions largely based on a psychological report

People with ASD need time to transition to new people & places and struggle to generalize skills from one environment to another. In this contrived setting, with an unfamiliar person & place, it is not possible to get a valid snapshot of this person’s ability to work.

2. Ignoring the validity of school assessments

Instead sending for a psychological even though the school assessment was recent and accurate.

3. Problem behaviors that were identified but not treated

2 main types: Challenging behaviors or social skill deficits.

4. Problem behaviors that were identified but treated with psychotherapy

Research tells us that traditional psychotherapy has little success at decreasing problem behaviors and increasing skill deficits. It is unlikely that an ASD individual can replicate a skill learned in a contrived setting and generalize it. Furthermore, the only way to decrease problem behavior is determine what factor/s are maintaining them, and address the environment in which it is occurring.

5. Failure to recognize characteristics of ASD

63 year old consumer “failed to cooperate” when he would not work anywhere but the one county he has lived in his entire life . ASD causes rigid patterns of behaviors and inability to be flexible.

Consumer “refused services” after his 3rd new counselor introduced herself. Inability to transition is part of ASD.

Consumer “failed to cooperate” when he missed several appointments. Social phobia & severe anxiety is a characteristic of ASD.

Consumer was closed because he was “happy” with his Whataburger job and did not want to change (he got it himself). ASD causes a person to resist change.

Consumer stopped showing up to DARS appointments after being fired. Closed as “refused services”. Once a negative event occurs, people with ASD will associate all involved with that negative experience.

What’s with all this Autism Stuff?? Why does it matter to me? I don’t have that many on my

caseload!

WHY? Because anything you do for ASD, is best practice for ANY developmental disorder.

They are the largest disability population and we are the least successful with them….

OLD Way What WORKS

Immediately sending for psychological If they are not college bound, what will this tell you?

Using the same psychological tools If you need a diagnosis for Autism, use the ASD psychological battery

Traditional vocational assessment Viewing these consumers in a contrived setting will not give you an accurate assessment of work abilities, many are not “generalists”

No other vocational assessment options IN PROGRESS: Environmental Work Assessment that measures HOW a work envirnoment either increases the disability characteristics or decreases.

Treating with psychotherapy Only use if the mental illness is barrier not the developmental delay

Not treating social skill deficits and/or challenging behaviors

Use Applied Behavior Analysis (ABA) providers to address these issues BEFORE work. IN PROGRESS: Updated policy

Using CRP’s who have little experience with developmental disorders

IN PROGRESS: Creating ASD/DD CRP specialists

No choices if the consumer needed specialized support that was not therapy but outside the duties of a job coach

IN PROGRESS: ASD/DD Supports

APPLIED BEHAVIOR ANALYSIS(ABA)…..WHAT IS IT?

Simply put:

ABA is a methodology whose goal is to

socially significant behavior.

IMPROVE

So what is “socially significant behaviors”?Any behavior that effects a person’s quality of life

Communication Verbal Language Academics

Self Help Skills Social Skills Vocational Skills

Problem Behaviors

WHAT DOES ABA STAND FOR?

•Applied: ABA takes what we know about behavior and uses it to bring about real-world, meaningful change

•Behavior: Behaviors are defined in observable and measurable terms in order to assess change over time

•Analysis: Behaviors are analyzed within the environment to determine what factors are influencing the behavior

WHO IS THE PROFESSIONAL THAT CONDUCTS ABA?

BOARD CERTIFIED BEHAVIOR ANALYSTS (BCBA’S)

3 levels:• BCaBA: Bachelor’s + behavior classes +supervised hrs.+

board exam• BCBA: Master’s + behavior classes +supervised hrs

+board exam• BCBA-D: Doctorate +board exam

All must have degree’s in Education, Sp. Education, Psychology , Social Work or Behavior Analysis.

BOARD CERTIFIED BEHAVIOR ANALYSTS (BCBA’S)

What they can do:• BCaBA/graduate student in a behavior analysis program

• Cannot do assessments• Can only conduct intervention plans supervised by a BCBA & all

reports on progress must be signed by a BCBA

• BCBA:• Can do assessments• Can do all interventions

• BCBA-D:• Can do assessments• Can do all interventions

BOARD CERTIFIED BEHAVIOR ANALYSTS (BCBA’S)

How do I find one in my area? 2 ways:

1. Check Rehab Works

2. www.bacb.com (click on the page that says “find certificates”)

WHO DO I USE IT FOR?...

WHAT TYPES OF CONSUMERS TYPICALLY BENEFIT FROM ABA?

To consider

•Autism Spectrum Disorder•AD/HD•Developmental Delays•Intellectual Delays•Obsessive Compulsive Disorder•Panic or Anxiety Disorder

Do not consider

•Depression•Personality Disorders•Bi Polar Disorder•Schizophrenia•Can consider if these are a co-morbidity, for example, autism

IF YOU HAVE A CONSUMER THAT…

• Has a problem behavior that presents a barrier to employment

• You need to DECREASE these behaviors

• Has a deficit in social skills that present a barrier to employment.

• You need to INCREASE these behaviors

WHAT IF I HAVE NO CLUE IF THEY CAN WORK?

What if it looks like there is several problem behaviors and several deficits?

You can call in a behaviorist to assess:• Skill level• Social skill level• Communication ability • Environments that would support their autism• Environments to avoid• Determine the function of any problem behaviors• Identify triggers • Identify preferred interests & reinforcers• Determine if they have natural supports• IF needed, provide a treatment plan to address these behaviors

WHAT IF I BELIEVE THEY CAN WORK BUT…

Their parents are glued to them and speak for my consumer

Parents might sabotage what we are doingNeed more information to develop a planCCSA is a great pairing with a FBA

A behaviorist would work with ALL environments- if the environment presents a barrier to employment then we

can address it.

BUT STOP AND THINK…..

What is the work goal?

EX. If your consumers work goal is to work at a gaming company that provides tele-work or cubicles, little

interaction, low lighting, then what social skills does he need? If he can respond when spoken to, follow supervisor’s instructions, accept feedback, has

transportation and shows up dressed appropriately, then does he have a barrier?

Autism DOES NOT = ABA

ABA SERVICES..WHAT IT SHOULD LOOK LIKE?

2 CHOICES

• Social Skills Support (Consumer does not have challenging behavior but displays skill

deficits) • Social Skill Assessment (up to 4 hrs)• Intervention (group or individual up to 30 hrs)

• Behavioral Intervention(Consumer has challenging behaviors that need to be decreased)

• Functional Behavior Assessment(FBA) (up to 8 hrs)• Behavior Intervention Plan(BIP) (group or individual up to 30 hrs)

***Any combination of individual or group can be used but the total is not to exceed 30 hours ***

Challenging

Behavior

Skill Deficits

TIPS

• ABA is short term• You should see progress • Receive frequent updates on the mastery of the

consumer’s goal• A good therapist will redo the plan if progress is not shown

quickly• You should see generalization of skills in all environments • People in the environment that is being treated should be

trained in any plan or recommendations

WHERE CAN I FIND THE POLICY & PURCHASE THE SERVICE?

RPM: Chapter 5 (5.3.7)• Located after Mental Restoration Services

Rehab Works• Level 1- Evaluation Services• Level 2-Behavior Analysis (will be changed to APPLED

Behavior Analysis)

DARSCOMMON MYTHS REVIEWED

 MYTH: YOU MUST BE AT LEAST 16 YEARS OLD TO APPLY FOR DARS SERVICES MYTH: HIGH SCHOOLS SHOULD REFER A STUDENT TO DARS ONLY WHEN THEY ARE A SENIOR

MYTH: DARS IS A SCHOLARSHIP PROGRAM MYTH: DARS CAN’T ASSIST A TRANSITION AGED STUDENT WITH FINDING WORK, UNTIL THEY GRADUATE HIGH SCHOOL MYTH: DARS IS A LONG TERM SERVICE PROVIDER MYTH: DARS PROVIDES EMERGENCY SERVICES MYTH: DARS CAN’T WORK WITH A STUDENT IF THEY ARE RECEIVING 18+ SERVICES WITH THE HIGH SCHOOL MYTH: APPLIED BEHAVIOR ANALYSIS(ABA) SERVICES ARE RELEVANT ONLY TO INDIVIDUALS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER MYTH: ABA CAN ONLY BE APPLIED TO BEHAVIOR PROBLEMS MYTH: ABA SERVICES ARE ONLY EFFECTIVE FOR YOUNG CHILDREN

DD Regional Point of Contacts…

Region 1 Rick Bullard

Region 2 Gena Swett

Region 3 Dae Eun

Region 4 Marilyn Gilbreath

Region 5 Emily Boncek

2014 Statewide Developmental (ASD/DD/IDD/ADHD) Disorders Team Region 1TOTAL: 7 & 2 VACANTw/CRPs: 13

Region 2TOTAL: 14w/CRPs: 24

Region 3TOTAL: 12w/CRPs: 20

Region 4TOTAL: 7 & 1 VACANTw/CRPs: 9

Region 5 TOTAL: 16w/CRPs: 23

Ellen DingusWichita Falls

Trinetta PowellPlano

Michael MarlerRound Rock

VACANTConroe

Ruby Wilkins/ Cinda AlvaradoSan A. Northeast

Jonathan Perkin(UPS)Abilene

Tina ShafferGarland

Elsa Perez/Stanley BellSouth Austin

Veronica ComeauxNorth Houston

Erlinda Leal/Blanca Perez/Becky AshtonSan A North

Mary Ellen PateSan Angelo

Diana Terry Ft. Worth South Lori Charlton Cleburne

Debbie BrowneEast Austin

Karen WilliamsSouthwest Houston

Steven Martinez/Alma AlvarezSan A South

Della Moore & David EnriqueEl Paso Central

Kelly HollowayLewisville

Patrice RabalaisBeaumount

Eligio HinojosaHouston Central

Debbie RodriguezSan A West

Ashley RichardsonLubbock South

Mary FaltaousCarrollton

Teresa FrechetteTemple

Kristie SekmistrzSouth Houston

Sherri EddyHarlingen

Debbie EdwardsLubbock West

Kellie Harrison/Lucy Gafford(AM)Denton

Jennifer McCurleyTyler

Catherine GuilloryHouston West

Gabby MartinezMcAllen

VACANTOdessa

Katharine BowdreSherman

Lhea HomesleyWaco

Solomon AmbaniHouston West

Leigh Ann GodinezMcAllen

VACANTAmarillo

Deanna LayfieldDallas Southeast

Giovanne BellCollege Station

Nichole RideuxHumble

Sasha Esparza/Michael DayCorpus Christi

Angela GonzalezDallas Northeast

LeAnn BolwerkLongview

Nick BoykoTexas City

Jacqueline Gutierrez/Esmeralda LopezLaredo

Jennifer Reynolds/Brian Loftus/Virginia Shutt Arlington

Susan Payne Paris/Texarkana

Salynda Bryson Rosenberg

Maricela PonceNew Braunfels

Jacklyn MeadeFort Worth West

Kelley DowneyLufkin

Regional Point Person:Rick Bullard El Paso Area & Back up: David Enrique

Regional Point Person:Gena Swett Back up’s: Audra Ressel & Lucy Gafford

Regional Point Person:Dae Shin

Regional Point Person:Marilyn Gilbreath Back up’ s Nick Boyko

Regional Point Person:Emily Boncek Back up: Blanca Perez

Additional Regional staff:Joe Morris, Mike LawsonShannon Johnson (trainer)

Additional Regional staff:Rosla Hocker, Betty Davis

Additional Regional staff:Merry Straube, ,Frank Donaldson, Kelly Yarbrough

Additional Regional staff:Stephanie Jenkins

Additional Regional Staff:Ron Garza, David Dehoyos, Johnny Weddington

Team Lead: Jennifer Kaut M.Ed., BCBA Total ASD VR Counselors: 56 (updated 9/4/14) Total CRPs: 33(updated 9/4/14) Total: VR/CRP: 89

2014 Statewide Developmental (ASD/DD/IDD/ADHD) Disorders Team CRPs

Region 1

Region 2

Region 3

Region 4

Region 5

ASD CRP TOTAL: 6

ASD CRP TOTAL: 10

ASD CRP TOTAL: 8

ASD CRP TOTAL: 2

ASD CRP TOTAL: 7

-Texas Employment Consultants-El Paso Helping People-Strassler Employment Services-After Mile Inc.-Ability Solutions-Burkhart Center (pending CRP status)

-LauchAbility-Autism Treatment Center-Easter Seals-temple mays-UNT JobFit-Life Path Systems-Ability Solutions-Association for Independent Living-Bryant Guidry-Spectrum Services- Work Ready

-Client Services of East Texas-Dverse Solutions-Goodwill(Central)-Debby Puckette-Bruce Bloom-Ability Solutions-Opportunity Center -Austin Dog Alliance

-Easters Seals Greater Houston-University of Houston at Clearlake

-Job Adventures-Goodwill (South TX)-Compass Resource Group-Autism Treatment Center-Gatehouse Supportive Services-HELP-Business Resource Center