Increasing Learning Opportunities for Young Children with Autism Spectrum Disorders during Play and Daily Routines Jamie Owen-DeSchryver, Ph.D. & Amy.

Increasing Learning Opportunities for Young Children

with Autism Spectrum Disorders during Play and Daily Routines

Jamie Owen-DeSchryver, Ph.D. & Amy Matthews, Ph.D.Grand Valley State University

Introductions & Agenda

Introductions

Agenda:• Foundations

– Brief introduction to the START project– Brief introduction to core characteristics of young children with

ASD

• Primary Content– Increasing learning opportunities and engagement during daily

routines and play activities– Increasing communication opportunities during daily routines

and play activities– Increasing imitation skills during daily routines and play activities

START Project

Thinking Different about Autism Spectrum Disorders, Professional

Development, and Statewide Support

Purpose of START

START serves as a coordinating and supporting entity for schools and

regional networks across the state of Michigan to increase access to local

training and resources for students with autism spectrum disorder.

START Primary Components

START Early InterventionIntensive Training

• Targets preschool age, ECSE classrooms supporting children with ASD

• Strategies:– Are good for children with a variety of

developmental disabilities– Will benefit children 0-3– Were developed based on review of

Evidence-Based practices

Autism Spectrum Disorders

Michigan Students with an ASD Eligibility Label

0

2000

4000

6000

8000

10000

12000

14000

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Nu

mb

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f st

ud

ents

1,208

13,839

Autism Spectrum Disorders

• Numbers of students with ASD are increasing• 1 in 150 (CDC)• 1 in 91 (Health Resources & Services Administration)

• Age of diagnosis is earlier– This leads to more and more students with ASD

served in birth-3 and preschool-age programs

Autism Spectrum Disorders

• Fastest-growing developmental disability

• $90 billion annual cost

• 90% of current costs are in adult services

• Cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention

Autism Society of America, 2006

DSM-IV Definition Core Deficits of Autism

Differences in behavior

Differences in socialization

Differences in communication

Triad of ASD

Joint Attention

• The core symptoms of autism are represented in the triad of impairments. Yet the earliest sign of autism is often manifested as a deficit in joint attention, which has a significant and pervasive impact on all developmental domains.

Intervention for Young Children with ASD

The Foundations

A Model Program for Children with ASD age 0-3

Boulware, et al. (2006):

Project DATA for Toddlers

Integrated playgroup (5 typical peers, 2 children with ASD, 3 children with other disabilities)

3 hours per week (2, 1.5 hour sessions)

Individualized instruction (1:1)

6 hours per week (2 hours 3x/wk)

Family support in home or community

2 hours per week by Project DATA staff, 5 by family

16 hours of total intervention

Barriers to Implementingthis Model?

• Financial

• Personnel

• Philosophical

• Status quo

• Other??

Given these issues, what CAN we do?

We can provide supported opportunities for learning that

lead to better outcomes for children

We can increase

Neurotypical Child Child with Autism 1,000 learning opportunities a day Few learning opportunities a day Learn from their environment Poor observational learners Specific instruction not needed Specific instruction necessary Strong speaking skills Weak speaking skills Strong listening skills Weak listening skills

*A child with autism has to learn at a faster rate than typical peers just to catch up.

What does a Learning Opportunity Look Like?

1. Instruction/activity/ situation is presented to the child

2. Child has an opportunity to respond

3. Child is given feedback – Acknowledgement that response was correct

or situation went well– Correction/prompt to help the child give a

correct response or improve the situation

Engaged Time

• It may not be possible to provide learning opportunities all the time, but we can increase time engaged.

• Engaged time: Active involvement in productive activities that lead to learning. Provide pre-teaching, interesting materials, and adult and peer support

Reaching Our Ultimate Goals

Why do we work so hard to increase learning opportunities?

• Independence

• Socialization

• Preparation for typical school experiences

• Quality of life

Increasing Learning Opportunities & Engagement

during Daily Routines and Play Activities

Increasing Learning Opportunities & Engagement during Daily Routines & Play Activities

Strategies for Daily Routines & Play Activities:• Goal Cards (CAMPS)• Teach Play Skills- 3 Rs; goal cards• Incorporate Child Interests• Use Visual Supports (play schedule books, sequencing

cards, visual schedule, computer book)

Strategies for the Playground or Backyard• Preteach Skills• Use Visual Supports (schedule, first-then)• Interrupt & Redirect

Strategies to Increase Learning Opportunities & Engagement:

Goal CardsPreschool Age:C – Communication goalsL – Literacy goals (letters,

pre-reading)A – Academic goals

(numbers, shapes, colors)

M – Motor goals (gross, fine)

S – Social goals

Birth – 3:C – Communication (verbal,

PECS or sign language; choice-making, yes/no)

A – Academic/pre-academic (colors, pre-numeracy skills)

M – Motor (gross, fine)P – Play (basic toy play skills,

e.g., building, imitation, simple pretend play)

S – Social (turn-taking; fill-ins, joint attention)

Goal Card for Bath Time

C: Communication goal– Requests water “on/off”, “duck”, “pour”, “yes/no”

A: Academic/Preacademic goal– Counts or sorts bath toys/objects, Fills in words in songs: “this is

the way we wash our _____ tummy”, points to body parts

M: Motor goal– Scoops and pours water

P: Play goal– Washes a baby doll

S: Social goal– Plays peek-a-boo with caregiver using the washcloth; fills in or

participates in game “ready, set, ___(go)” (then pours water out of a cup or drops a toy in the water to make a splash)

Goal Card for Riding in the Car

C: Communication goal– Verbalizes or signs for seatbelt “on/off”, music “on/off”, window

“up/down”, signs “all done” before having seat belt removed

A: Academic/Preacademic goal– Labels or points to objects in the environment (red car, yellow

house, big truck, moon, etc.); points to picture that indicates destination

M: Motor goal– Claps hands “yeah, we’re here”, uses pointer finger to touch

colorforms/window decals on window

P: Play goal– Sings songs with caregiver, “if you’re happy…”; looks at

book/listens to book on tape; moves or plays with window decals

S: Social goal– Waving to people or objects (“wave bye-bye to the truck”)

Goal Card for Putting Shoes On

C: Communication goal– Labels “shoes,’ “socks”, requests “help me”, signs “all done”

when finished putting shoes on

A: Academic/Preacademic goal– Labels or points to colors (where’s the red shoe?); counts “how

many shoes do you have?”; finds item, “where’s the BIG shoe”

M: Motor goal– Pushes foot into shoe; straps velcro; pulls on socks using two

hands

P: Play goal– “Yay, you have your shoes on, let’s pretend we’re ice-skating”,

“let’s hop like a bunny”, “let’s tiptoe”

S: Social goal– Responds to absurdities: e.g., caregiver putting shoe on her

head; fills in words: “all ____ (done)” time to ___(go)”

Goal Card for Breakfast

C: Communication goal– Chooses items (food, bowl, etc.,) either verbally or by pointing

A: Academic/Preacademic goal– Sits in a chair for the meal, labels or points to colors/pictures on

placemat

M: Motor goal– Holds and uses spoon, uses a cup, drinks from straw

P: Play goal– Pretends to feed stuffed animal/animal figurine; feeds baby doll

S: Social goal– Shares food (hands food to caregiver/sibling when requested);

takes turns (“my turn/your turn”);

Strategies to Increase Learning Opportunities & Engagement: Identify and Teach Appropriate

Play Skills

• Children with ASD often:– Have play skill deficits– Have a small play repertoire– Engage in stereotyped behavior when given

the opportunity to play

Identify and Teach Age-Appropriate Play Activities

(Examples for children ages 2-3) Toys/Equipment Games Social Interaction

See and Say Simple puzzles Dolls Characters Shape sorter Swings Cars Musical videos Music

Peek-a-boo Interactive songs Coloring Busy ball

Solitary play Ball Tea party Chase Ring Around the Rosie

Basic Play Skill Targets

Domain Example Play Activities

Early toy play Put together/take apart

Put in/ take out

Play with blocks and manipulatives

Builds/connects

Makes pretend objects

Play with vehicles One action play with vehicles

Plays in a scene with vehicles

Play with figures or stuffed animals

One action play with figures

Plays in a scene with figures

Pretend Play Pretends with one object

Pretends without props

For More Information onBasic Play Skill Targets

• Teach 2 Play http://www.teach2talk.com/teach2talk-teach2play-series.html

• Smith, M. (2001). Teaching playskills to children with ASD

• The Assessment of Basic Language and Learning Skills (ABLLS)

Blanc et al., 2005

• The effects of adult guidance during play were beneficial for children with ASD, children with CI and for typical children, but more particularly for children with autism.

• Children with autism showed more complex, and higher developmental levels of play when they were supported/ prompted by adults.

An Applied Behavior Analysis (ABA) Approach to Presenting

Instruction

Request (Stimulus)

Response

Reaction(Consequence)

The 3 Rs are the same as a “Learning

Opportunity”

Using the 3 Rs

• 100% Success is expected

• A child will be assisted until he is successful

• Failure is not an option

• Don’t make a request unless you are going to follow through

What Does this Look Like with Play Targets?

• REQUEST: Make the request – “Put the cups together”– “Stack the blocks”– “Make a train”– “Fly the airplane”– “Feed the baby”

• RESPONSE: If the child doesn’t respond, or responds incorrectly, prompt the correct response

• REACTION: Praise and reward the child for the correct response

Incorporating an ABA Approach within Classroom

Activities

• McBride & Schwartz (2003)- embedded instructional episodes (“Learning Opportunities” or “Request, Response, Reaction sequences”) into ongoing classroom routines and activities– Teachers identified individualized IEP/IFSP

goals– Addressed the target goals during classroom

activities using an ABA approach

Goal cards can also focus on play: Building with Blocks

C: Communication goal– Requests block; says “uh-oh” when blocks fall

A: Academic/pre-academic goal– Touch counts blocks (with help); labels colors of blocks

M: Motor goal– Coordinates motor movements to build tower

P: Play goal– Crashes tower with toy car; imitates tower or model made

by caregiver; figurine “jumps” off of tower

S: Social goal– Hands block to caregiver; plays peek-a-boo behind the

tower

Strategies to Increase Learning Opportunities & Engagement:

Incorporate Child Interests

Braiding the ABA and developmental approaches

Developmental Practices

• DAP Position Statement (NAEYC.org)

• Pivotal Response Treatment (Koegel et al., 2003)

• Naturalistic Instruction– Capitalizes on children’s interests; natural

consequences– Targets functional skills

Developmentally Appropriate Practice National Association for the Education of Young

Children, 2009 (naeyc.org)

Teaching to enhance development and learning• “Developmentally appropriate teaching

practices provide an optimal balance of adult-guided and child-guided experiences… child-guided experience proceeds primarily along the lines of children’s interests and actions, with strategic teacher support” (p. 17).

Incorporate Child Interests

• If you’re working with a child who likes Thomas the Tank Engine, how can you teach important skills using Thomas?– Communication - requests Thomas– Academic – sorts engines by color; completes

a Thomas puzzle with help– Motor - jumps over Thomas– Play - re-enacts a scene from a Thomas video– Social – tolerates turn-taking with Thomas

Strategies to Increase Learning Opportunities & Engagement:

Use Visual Supports

• Visual supports can be used to teach early play skills

• Early learners may not understand symbolic representations in pictures

• Initially, these students may require additional repetition, prompting and feedback (the 3 Rs) to use the visual supports effectively

• Identify specific functional play targets for the student; use pictures to cue the activities

Visual Supports: Play Schedule Book

Play Schedule Book:Where are you going with it?

Play Schedule Book:Where are you going with it?

Visual SupportsPlay Sequences

• Create picture schedules of play scenarios with sequenced steps

Get cupcakes

Share with Jaden

Eat them up – YUM!

3-Step Sequencing

Cards:

Cooking

Visual SupportsEmerging Dramatic Play

Visual Supports:Emerging Dramatic Play

Going Fishing

Put on hatPut on boots Get bucket and fishing pole

Catch a fish

It’s Time for a Picnic!

Emerging Dramatic Play

Computer Book for “Going on a Picnic”

Strategies to Increase Learning Opportunities & Engagement:

Preteach Skills

• Preteach play skills that are useful during outdoor play

Using Visual Supportson the Playground/ in the Backyard

• Create appropriate routines; expose the child to new activities; incorporate social opportunities

Visual Supports

First: Sandbox Then: Swing

Interrupting and Redirecting

• Get in the way!– Make the path to the desired item or

equipment through you

• Prompt and reinforce the child for appropriate play

SUMMARYIncreasing Learning Opportunities

& Engagement during Daily Routines & Play Activities

Strategies for Daily Routines & Play Activities:• Goal Cards (CAMPS)• Teach Play Skills- 3 Rs; goal cards• Incorporate Child Interests• Use Visual Supports (play schedule books, sequencing

cards, visual schedule, computer book)

Strategies for the Playground or Backyard• Preteach Skills• Use Visual Supports (schedule, first-then)• Interrupt & Redirect

Increasing Communication Opportunities during Daily Routines & Play Activities

Increasing Communication Opportunities during Daily Routines & Play Activities

• Identify and teach a Functional Communication system

• Increase motivation for communication (natural and contrived events)

• Plan for and create communication opportunities (e.g., MITS approach, multiple domains)

• Prompt and fade support

Communication

• Communication needs to be taught throughout the day, every day, by all adults in all environments

• Communication should be a TOP priority of 0-3 programming– Decreases problem behaviors– Associated with better prognosis

Each Child should have a Functional Communication System

The ability to request:• Desired items (e.g., “Want train”)• Necessary items (e.g., “I need a fork”)• Assistance (e.g., “Help please”)• Attention (e.g., “Watch me!”)• Actions (e.g., “Swing me”)• Information (e.g., “What is it?”)• Negative reinforcement – removing something

unwanted (e.g., “Go away”, “Take a break”)

What is the “Right” Communication System?

1. Individualized

2. Total communication

3. What’s better, signing or pictures?

4. Should we use alternative systems or just focus on language development?

Using Natural Events to Increase Motivation for

CommunicationWhen is a child most likely to be hungry? Thirsty?• If the child is thirsty, what has become more

valuable?• What behaviors might the child show?

– Good communication behaviors: opening cabinet, going to sink, getting a cup

– Poor communication behaviors: screaming, crying

• This scenario provides us with opportunities to teach requesting (e.g., cup, open cabinet, pour juice, etc.)

Using Contrived Events to Increase Motivation for Communication

• Create a situation that makes something more valuable– Give the child his yogurt without a spoon– Give the child only a small amount of her

drink – Before recess, provide the child with only

one of his boots– Hand the child a preferred item that’s been

placed in a clear box that she can’t open on her own

Other Strategies to Increase Motivation for Communication

• In sight, but out of reach• Begin favorite activity, then pause for

communication• Missing materials• Offer choices• Display pictures of preferred items and

activities throughout the environment • Expectant look• Show an interesting but unfamiliar item,

prompt the child to ask questions (e.g., “What is it?”)

MITS: Creating Learning Opportunities for Communication

• Multiple Incidental Teaching Sessions (MITS) (Charlop-Christy & Carpenter, 2000)– Child initiates request by using adult as tool (child

grabs adult’s arm and attempts to reach to the upper shelf for the cars)

– Adult verbally models “I want cars” and hands child one car

– Adult immediately implements two more trials of requesting: adult verbally models “I want cars” and provides more cars to the child after each appropriate request

Increasing CommunicationSkills

• Plan for and create communication opportunities

• Focus on initiation of communication--requesting is more important than labeling

• Identify motivating items from multiple domains (not just food)

Communication Targets from Multiple Domains

Foods/Drinks/Snacks:Chips

Pretzels

Juice

Water

Toys with Multiple Pieces:Puzzles

Play-doh

Train tracks

Cars

Interactive/Motor Activities:Tickles

Swinging

Trampoline

“blanket slide”

Bouncing on therapy ball

Toys Requiring Help:Bubbles

Balloons

Spinning tops, toys

How to Teach Requesting Using Sign Language

• Begin with the preferred item present

• First opportunity: Provide a freebie while verbally labeling the item, “bubbles”!

• Next opportunity:– Model the sign while verbally labeling the item,

“bubbles” – Then physically prompt the student to sign for

the item; label it again, “bubbles”– Provide the item and label it again, “bubbles”

Teaching Verbal Requesting

• Again, the first opportunity is a freebie • The label is provided, “tickle”• Child receives item/activity immediately

upon approximating the word

SUMMARY:Increasing Communication Opportunities during Daily Routines & Play Activities

• Identify and teach a Functional Communication system

• Increase motivation for communication (natural and contrived events)

• Plan for and create communication opportunities (e.g., MITS approach, multiple domains)

• Prompt and fade support

Increasing Imitation Skills during Daily Routines and Play Activities

Increasing Imitation Skills during Daily Routines and Play Activities

Strategies to Increase Imitation

• Reciprocal imitation

• Teach imitation using the 3 Rs

• Observational play with matched toy sets

• Observational play through video modeling

Imitation• Due to impairments in joint attention &

possibly, due to differences in a region of the brain that holds “mirror neurons” children with ASD often show deficits in imitation

• Like other early learner skills, imitation may need to be systematically taught

For Children who Show Limited Awareness of Others:

Use Reciprocal Imitation

• Reciprocal imitation involves the adult (or a peer) imitating the actions of the child using matched or similar toys (appropriate play actions, not inappropriate behaviors)

Teach Imitation Using the 3Rs

• Adult: Says “Do this” and pushes a bus

• Child: (no response)

• Adult: physically assists child to push the bus and says “This is pushing the bus”

Learning through Observation

• Learning observationally, or learning from the environment– Watching peers and/or adults and imitating their

behaviors

SUMMARY:Increasing Imitation Skills during Daily Routines and Play Activities

Strategies to Increase Imitation

• Reciprocal imitation

• Teach imitation using the 3 Rs

• Observational play with matched toy sets

• Observational play through video modeling

THANKS!!Please complete an evaluation form

Our Contact Information:

• Jamie Owen-DeSchryver, Ph.D.

[email protected]

• Amy Matthews, Ph.D.

[email protected]

Selected References

• Blanc, R., Adrien, J., Roux, S., Barthelemy, C. (2005). Dysregulation of pretend play and communication development in children with autism. Autism, 9, 229-245.

• Boulware, G., Schwartz, I., Sandall, S & McBride, B. (2006). Project DATA for toddlers: An inclusive approach to very young children with Autism Spectrum Disorder. Topics in Early Childhood Special Education, 26, 94-105.

• McBride, B.J. & Schwartz, I.S. (2003). Effects of teaching early interventionists to use discrete trials during ongoing classroom activities. Topics in Early Childhood Special Education, 23, 5-17

• National Association for the Education of the Young Children (NAEYC, 2009). Developmentally Appropriate Practice in early childhood programs serving children from birth to age 8. Draft Position Statement, adopted 2009.