The Ziggurat Model - Texasautism.com€¦ · Cool Down Strategies 5-Point Scale Reinforcement…. Not a New Concept Reinforcement is essential component of Positive Behavior Support

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Comprehensive Intervention Planning: Matching Interventions to

Individuals with ASD Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D., &

Brooke Wright, B.S., M.A.

The Ziggurat Model

Ziggurat n: (zig·gu·rat) from Assyrian ziqquratu, height, pinnacle

1.  a temple having the form of a terraced pyramid of successively receding stories, erected by the ancient Assyrians and Babylonians

2.  a framework for designing comprehensive interventions for individuals with autism spectrum disorders

Three Areas of Expertise for Effective Intervention Planning

 Characteristics of ASD  Range of effective interventions  Comprehensive planning process

One More Thing . . .

Willingness to change

Why was the Ziggurat Model Developed?

 Difficulty “Seeing the Autism”  Tendency to apply one strategy to address all

needs  Tendency to ignore critical areas when

designing an intervention

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... the core of autism is sometimes missed, due to a tendency to focus too much on the behavior of people with

autism (often even details of that behavior) without sufficiently taking into account the context of what is

taking place in the mind of people with autism. 

- Peter Vermeulen

© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.

Intervention Ziggurat

Interventions Characteristics

© Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D.

  Social  Communication  Repetitive Patterns

Associated Features   Sensory  Motor  Cognitive  Emotional Vulnerability  Medical and Biological

Factors

Characteristics Interventions

The Ziggurat Model

  Sensory and Biological Needs

 Reinforcement   Structure and

Visual/Tactile Supports

 Task Demands   Skills to Teach

ASA Literary Award

Winner

Who is Involved in Comprehensive Planning?

 Parents   Student  General Education Teacher   Special Education Teacher  Para-professional   Speech Language Pathologist  Occupational Therapist   School Psychologist  Administrator   Social Worker  Other as needed

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3 Keys to Comprehensive Intervention Planning

Characteristics

Characteristics

A quality plan addresses the Autism – not just behavior

You must KNOW what the ASD looks like in an individual to design a plan

Design

Characteristics

A quality plan is designed to comprehensively address identified needs.

Avoid “band-aid” plans that only partially address needs

Design

Implementation

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Characteristics

A quality plan is IMPLEMENTED

No matter how well an intervention is planned, it is useless if it is not well-implemented

Design Implement Implmt. Design Characteristics 1 2 3 4

5 Steps to Designing a Comprehensive Intervention Plan

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1

 Helps you to “see” the autism

 Provides a “snapshot” of how autism is expressed for an individual

 A descriptive instrument  May be completed by a

team  Provides a tool for

assessing progress/change

Underlying Characteristics Checklist The UCC Areas

  Social  Restricted Patterns of Behavior, Interests,

and Activities  Communication   Sensory Differences  Cognitive Differences  Motor Differences   Emotional Vulnerability  Known Medical or other Biological Factors

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UCC-HF for HFA and AS 1 UCC-CL for Autistic Disorder 1

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UCC-EI Early Intervention 1 UCC-SR 12-18

Self-Report 1

UCC-SR-Adult Self-Report 1

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 Social  Behavior, Interests,

and Activities  Communication  Sensory  Cognitive  Motor  Emotional  Biological

Individual Strengths & Skills Inventory

Case Study

Mark   10 year old male   Previously identified with speech impairment  Currently served under category of OHI for

ADHD   Experiencing increasing behavioral difficulties

and disciplinary responses.  Our report identified ASD

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Fidgets and Seating Options

Provide written script for joining play and greetings

Special Interests

Train and assign peer buddy

Teach language used in playground

games/activities

Mark Matching Interventions to Characteristics

We don’t want to just throw multiple interventions at a problem and hope

something sticks.

Keep in Mind…

1.  Reinforcement 2.  Special Interests

Social

1. Has difficulty recognizing the feelings and thoughts of others (mindblindness)

7. Is naïve, easily taken advantage of, or bullied

4. Lacks tact or appears rude 8. Tends to be less involved in group activities than most same age individuals

5. Has difficulty making or keeping friends

9. Has difficulty understanding others’ Nonverbal communication

6. Has difficulty joining an activity

Social Narratives

Social narratives are visually represented stories that describe social situations and socially appropriate responses or behaviors to help individuals with autism spectrum disorder acquire and use appropriate social skills.

Comic Strips / Cartooning 1. Drawing: This can be done by you or the student. Either way, artistic ability is not required; stick figures work fine.

2. Guide with questions: The adult guides the student’s drawing or what needs to be drawn by asking a series of questions:

• Where are you? • Who else is there? • What did you do? • What did others do?

3. Insight: The adult shares his/her personal insights during the cartooning process when the natural opportunity occurs.

4. Provide sequence or structure – adult provide boxes, structure of cartoon

5. Summarize the cartoon: discuss the comic strip in chronological order. The student should as much as possible, with the adult clarifying as needed.

6. Identify new solutions: adult and student working together (Myles, Trautman, & Schelvan, 2004, p. 28-29)

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http://www.makebeliefscomix.com/Comix/

Social  Autopsies  

Texas  Au)sm  Resource  Guide  for  Effec)ve  Teaching  

• Helps  show  cause  and  effect  of  the  situa)on  • Uses  posi)ve  reinforcement  • Teaches  problem  solving  framework  • U)lizes  pictures  or  words  

Social  Autopsies  Examples

What happened? I yelled at the teacher because he asked me to do a lot of math problems. What was the social error or mistake? Yelling at the teacher Who was hurt by the error? The Teacher. Maybe my peers. What can be done to correct the error or the hurt? Apologize? Explain that too many problems make me anxious. What can be done differently the next time? (Initially, this can be very difficult) Stop, Think. Respond, “Can I please do half of the problems?” or “Can I do some of the problems now and some later?”

Visual Supports

Video Modeling / Role Playing

www.9thplanet.org Joining-a-Conversation-9th-Planet-autism-social-skills-video.mp4

•  www.modelmekids.com

Video and Pictures Continued

 Review video clips from TV or movies and use the “pause” button to discuss social concepts and feelings

 Use real photographs to teach feelings  Allow Mark to review video of social events in

which he has participated in.

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Playing Games

  Pre-teach skills such for joining an activity and playing age appropriate playground and card or board games

 Teach language associated with these games  Role play situations   Practice – use a script  Video practice or role play and then review

Power Card   Games should be fun for

everyone.   If you win a game, you can: Smile,

give high fives, or say, "Alright!"   If you lose a game, you can: Take a

deep breath and say, "Good job" to the opponent or say, "Maybe next time."

  Play games the Survivor way and your friends will have fun playing games with you!

[front] [back]

Power Cards - Script

The contestants on Survivor love to play games! In fact, playing games on the show is how they win rewards or win immunity. Sometimes the players and teams win their games, but sometimes, they lose. When they win, they give each other "high fives," smile or say, "Alright!" When they lose their game, the Survivors might not be happy. They could take a deep breath and say, "Maybe next time," or say "Good job" to their opponent. The contestants on Survivor think everyone should have fun playing games. They also want you to remember three things when playing games with other people:

 Games should be fun for everyone.  If you win a game, you can: Smile, give high fives, or say, "Alright!"  If you lose a game, you can: Take a deep breath and say, "Good job" to the opponent or say, "Maybe next time."  Play games the Survivor way and your friends will have fun playing games with you!

The Hidden Curriculum

By Brenda Smith Myles, Melissa Trautman & Ronda Schalvin

By Brenda Smith Myles

Restricted Patterns of Behavior, Interests and Activities

12. Expresses strong need for routine or “sameness”

18. Has problems handling transition and change

14. Has eccentric or intense preoccupations/absorption in in own unique interests.

19. Has strong need for closure or difficulty stopping a task before it is completed

17. Displays repetitive motor movements (e.g., flaps hands, flicks fingers in front of eyes)

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Written Schedules / Checklists Checklists

Timers

Time Timer App

More Strategies

  Practice transitions  Warning before transitions occur  Warning before changes occur  Write changes on schedule if possible

19. Has difficulty stopping a task before it is completed

  Priming  Make a chart that shows what to do with

unfinished work   Put a post-it note on it   Incorporate time to finish work into the daily

written schedule

Communication

25. Has difficulty with rules of conversation (e.g., interrupts others, asks inappropriate questions, makes poor eye contact, has difficulty maintaining conversation)

34. Talks incessantly, little back-and-forth

26. Fails to initiate or respond to social greetings

39. Has difficulty talking about others’ interests

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Checklists Think Back to the Social Domain   Scripts   Video modeling and video taping   Visual supports   Social behavior maps

Sensory Differences

41. Responds in an unusual manner to sounds (e.g., ignores sounds or overreacts to sudden, unexpected noises, high pitched sounds or complex noises)

47. Seeks activities that provide touch, pressure or movements (e.g., swinging, hugging, pacing)

42. Responds in an unusual manner to pain (e.g., overreacts or seems unaware of illness or injury)

49. Makes noises such as humming or singing frequently

43. Responds in an unusual manner to taste (e.g., resists certain textures, flavors or brands)

* Consult with your Occupational Therapist for type, frequency and duration of sensory activities

Seeking Touch or Pressure

Body Sox Steam Roller

chewy pencil topper

Heavy work opportunities

Seeking Touch or Pressure

Weighted lap pad Weighted blanket Shoulder Snake Weighted vest

Medicine ball

Under Armour Chair with Theraband

Fidgets and Seating Options

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  Hearing protectors   Headphones   Soft music   CD, radio or MP3 player

Responds in an unusual manner to: Sounds

Makes noises such as humming or singing frequently

  Toobaloo or PVC pipe   Tape recorder   Visual rules   Schedule a time and place   Headphones

Cognitive Differences

63. Has difficulty understanding the connection between behavior and resulting consequences

•  Cartooning •  Priming •  Social Stories

Behavior Mapping

Emotional Vulnerability

76. Is easily stressed – worries obsessively

81. Injures self (e.g., bangs head, picks skin, bites nails until they bleed, bites self)

80. Exhibits rage reactions or “meltdowns”

89. Has difficulty managing stress and/or anxiety

Problems?

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Stress Thermometer Home Base

An environmental structure that allows students with ASD to:  Prepare for or review the day's events  Take a break from a stressful situation  Regain emotional control to avoid a meltdown  Recover after a meltdown  Successfully cope with an unpredictable world

  Is a consistent place   Always individualized

  Reduces environmental demands   May be used as a proactive

strategy   Place for schedule review and

priming   May include sensory strategies   Can be scheduled or used “as

needed”; initiated by adult or student

  NOT the same as “time out”

Anxiety is the First Stage of a Crisis

Use preventative strategies   adults need to identify and address triggers   Use a “cool down space”   Teach how to use a Break Card   Increase structure   Reduce demands   Reduce talking and use visual supports   Teach skills when calm

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Special Interests

  Power Cards   Video Clips   Pictures   Comic Strips   Games   Reinforcement   Cool Down Strategies   5-Point Scale

Reinforcement…. Not a New Concept

  Reinforcement is essential component of Positive Behavior Support

  Broad range of systematic and individualized strategies for achieving important social and learning outcomes while preventing problem behavior

  Horner, 2000: Lewis & Sugai 1999; Sugai, et al., 2000: Weigle, 1997

  Reinforcement is recognized as an Evidence-Based Practice for children and youth with autism spectrum disorders

National Professional Development Center on Autism Spectrum Disorders

Types of Reinforcement

  Social reinforcers

  Activity reinforcers

  Tangible reinforcers

  Token reinforcement

Reinforcement Cont.   When teaching new skills, practicing skills and when skills

are used independently   Complete a reinforcer assessment   Provide a personal reinforcer menu and allow for student

choice   Set up a reinforcement schedule, using a visual “token”

economy

References "9th Planet Autism Social Skills Videos." 9th Planet. 9th Planet, 2011. Web. 31 May 2012. <http://9thplanet.org/index.html>.

"Alert Program ®." Alert Program. Therapy Works Inc. Web. 01 June 2012. <http://www.alertprogram.com/products.php>.

Buron, Kari Dunn., and Mitzi Curtis. The Incredible 5-point Scale: Assisting Students with Autism Spectrum Disorders in Understanding Social Interactions and Controlling Their Emotional Responses. Shawnee Mission, KS: Autism Asperger Pub., 2003. Print.

Coffin, Amy B. "Home Base." Autism Internet Modules. OCALI. Web. 05 June 2012. <http://www.autisminternetmodules.org/mod_view.php?nav_id=99>.

Gray, Carol. The New Social Story Book: Illustrated Edition. Arlington, TX: Future Horizons, 1994. Print.

Hudson, Jill, and Amy Bixler Coffin. Out and About: Preparing Children with Autism Spectrum Disorders to Participate in Their Communities. Shawnee Mission, Kan.: Autism Asperger Pub,

2007. Print.

Hume, K. (2006) Change is good! Supporting students on the autism spectrum when introducing novelty. The Reporter , 11(1), 1-4, 8.

References Cont. Johnston, Don. "Start-to-Finish Core Content." Start-to-Finish Core Content. Don Johnston Inc. Web. 31 May 2012. <http://www.donjohnston.com/products/start_to_finish/core_content/index.html>.

Kabot, Susan, Christine E. Reeve, and Juane Heflin. Setting up Classroom Spaces That Support Students with Autism Spectrum Disorders. Shawnee Mission, KS: AAPC Pub., 2010. Print.

Keri. "The Home Teacher: Don't Be An Angry Bird: Slingshot, Pigs, Blue Birds, Big Red Bird and Introducing Ice Bird." The Home Teacher. Web. 06 June 2012. <http://

thehometeacher.blogspot.com/2012/03/dont-be-angry-bird-slingshot-pigs- blue.html>.

McAfee, Jeanette L. Navigating the Social World: A Curriculum for Individuals with Asperger's Syndrome, High Functioning Autism and Related Disorders. Arlington, TX: Future Horizons, 2002. Print.

McClannahan, Lynn E., and Patricia J. Krantz. Teaching Conversation to Children with Autism: Scripts and Script Fading. Bethesda, MD: Woodbine House, 2005. Print.

Morris, Barry K. "DEALING WITH REPETITIVE QUESTIONS." Autism, PDD-NOS & Asperger's Fact Sheets. Www.autism-help.org, 2008. Web. 05 June 2012. <http://www.autism-help.org/communication-repetitive-questions.htm>.

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References Cont. Myles, Brenda Smith. "Lists of Curriculum Items." The Hidden Curriculum: Practical Solutions for Understanding Unstated Rules in Social Situations. Shawnee Mission, KS: Autism Asperger Pub., 2005. Print.

"Social Skills/Pragmatics." Speakingofspeech. Web. 01 June 2012. <http://www.speakingofspeech.com/Social_Skills_Pragmatics.html>.

"Video Modeling DVDs." Model Me Kids. Model Me Kids LLC. Web. 02 June 2012. <http://www.modelmekids.com/autism-video-samples.html>.

"What Are Stress Triggers?" Do2Learn: Educational Resources for Special Needs. 2010. Web. 01 June 2012. <http://www.do2learn.com/activities/SocialSkills/Stress/StressTriggers.html>.

Williams MS, CCC-SLP, Stephanie. "Can Scripts and Visuals Help Teach Social Interaction?" Autism Community. 2011. Web. 05 June 2012. <http://www.autism-community.com/can-scripts- and-

visuals-help-teach-social-interaction/>.

Wrobel, Mary J., and Patricia Rielly. Taking Care of Myself: A Hygiene, Puberty and Personal Curriculum for Young People with Autism. Arlington, TX: Future Horizons, 2003. Print.

Zimmerman, Bill. "MAKE BELIEFS COMIX!" MAKE BELIEFS COMIX! Online Educational Comic Generator for Kids of All Ages. Guarionex Press Ltd., 2011. Web. 05 June 2012. <http://www.makebeliefscomix.com/Comix/>.

Contact Information

Ruth Aspy, Ph.D. [email protected] 214-227-7741

Barry G. Grossman, Ph.D. [email protected] 214-227-7741

www.texasautism.com

Brooke Wright, M.A. [email protected] 214-227-7741