Auditory Prompting Systems to Reduce Problem Behaviour

Results of this study confirm self-operated auditory prompting systems to be a socially valid function-based intervention for use in public community settings with
students with moderate mental retardation who have attention- or escape-maintained behavior when the prompts provide functionally equivalent reinforcement. This study
expands the literature on self-operated auditory prompting systems by matching the prompts to the function of problem behavior and confirming the social validity of the
intervention by including nondisabled coworkers.

Although previous studies (Alberto et al., 1999; Davis et al., 1992) documented that self-operated auditory prompts were an effective intervention for the reduction of
problem behavior in public community settings for students with moderate mental retardation, the function of behavior was not determined prior to intervention. It was unclear if the prompts inadvertently achieved functional equivalence or if stimuli other than the prompts were responsible for the behavioral change. Results of this study suggest that self-operated prompts function as an effective behavior intervention for students with mental retardation and attention- or escape-maintained behavior by systematically introducing prompts that provide functionally
equivalent reinforcement. Attention-maintained behavior reduced to criterion only during conditions with prompts providing attention in the form of verbal praise. Escape maintained behavior reduced to criterion only during conditions with prompts providing reminders of escape in the form of a break from the task. Problem behaviors were reduced for escape-maintained behavior during the attention prompt condition, but behavior only reduced to criterion during escape prompts.

Alberto P, Frederick L, & Hughes M (2006). Self operated auditory prompting systems as a function based intervention in public settings. Journal of Positive Behavioural Interventions. 8(4)230-243.

Auditory Prompting
Taber et al., (1999) provide a notable example of using auditory prompts to decrease off-task behavior for a student with autism and moderate mental retardation. Using a multiple probe across settings design, a 12-year old male student with autism was taught to use a self-operated auditory prompting system. The system contained recorded music interspersed between auditory verbal prompts (e.g., "keep working," "pay attention," etc.). The result was a decrease in inappropriate and off-task behavior at home and school with a concurrent decrease in teacher-delivered prompts.

A more recent study used auditory prompts to cue in-class self-monitoring as an intervention for decreasing off-task behavior in a classroom setting (Coyle & Cole, 2004). For three children with autism (aged between 9 and 11), an auditory timer (available from Jadco[R] was used to prompt self-monitoring of on-task behavior every 30 s of a 5 min work interval, with interval time increasing to 1 min for 1 of the participants. Using reversal designs, researchers were able to show that off-task behavior was significantly decreased during intervention phases.

Auditory prompting devices often require less manpower to result in positive change which is a critical benefit given the increasing number of children with autism served in local school settings where teacher resources may be scarce. Modern auditory prompts such as auditory pagers, portable compact disc players, and MP3 players are relatively small and unobtrusive and are used by enough children to minimize any stigma associated with carrying one for therapeutic purposes. Despite these apparent benefits, the paucity of literature focusing on technology-based auditory prompting for children with autism makes generalization of current findings difficult. Future research, as suggested by Taber et al. (1999), should continue to examine the effectiveness of self-operated auditory prompting systems with this population. Although Taber et al. (1999) & Coyle and Cole (2004) focused on decreasing off-task behavior, future investigations should also evaluate the effectiveness of auditory prompting for skill acquisition.

Goldsmith T, & Leblanc L(2004). Use of technology in intervention with children with autism. Journal of Early and Intensive Behavioural Intervention.

Contingency Mapping

Contingency mapping is a new type of visual support strategy that has not been reported in the research literature to date (Brown, 2004). Contingency maps are graphic (i.e., pictorial) representations of the environment–behavior relationships inherent in PBS plans that involve FET. The aim of a contingency map is to make a behavior support plan more transparent by graphically depicting both the current and the alternative antecedent–behavior–consequence pathways related to the problem behavior. As such, contingency maps must represent all of—and the relationships between—the following components: (a) the common antecedent that precedes both the problem and the replacement behavior, (b) the topography of both the
problem and alternative behavior, (c) the functional reinforcer that will be provided contingent on alternative behavior, and (d) the previously available functional reinforcer that will no longer be provided contingent on problem behavior.

Brown, K. & Mirenda, P (2006). Contingency mapping: Use of a novel visual strategy as an adjunct to functional equivalence training. Journal of Positive Behaviour Interventions,
8 (3).

Classroom Strategies for FASD

Classroom Strategies (this list is a start)

Work with student’s developmental age not his chronological age

• Repeat, repeat, repeat. Repeat, re-teach, repeat, reteach. Adapt the curriculum expectations
• If she repeatedly has outbursts look for the inciting stimuli and steer her away from them
• Alternate times of calm with activity, mini breaks for “brain gym” activities could be helpful
• Reduce stimuli in classroom. Have him looking at a blank wall up near you, not a colourful display
• Use a ruler, paper to cover everything except what is being read at that moment
• Colourful, attractive displays are very, very distracting for children with fasd. Low stimulus works
• Be prepared to handle clothes that itch (distract) — turn t-shirt inside out and tell parent/caregiver
• Figure out what she is good at and build on these functional skills
• Hands-on learning
• Small class size if possible
• Minimize transitions and prepare him for them in advance, “we are going to get out the red book”
• Transitions — forewarn, auditory cue (same song), visual cue (coat), action cue (hold coat open)
• Laminated visual cues — eg. coat, bathroom sink, lunch are helpful — visual learners
• Easy read labels — symbols, be organized, aim for an uncluttered classroom
• Create a personal bubble with tape, carpet square etc. to minimize poking, hitting, touching
• Lots of time, “10-second children in a 1-second world.” (Diane Malbin)
• Use only one book for writing in to minimize trying to find the right book in a disordered desk
• If he can handle it colour code books, get out your yellow book not Language Arts
• Have a quiet, soft place for de-stressing (not punishment) — bean bag chair, pillows, pup tent etc.
• If an assembly will be too stimulating, provide muted ear phones or keep child out of environment
• Do not ask why she did something or moralize. She does not know and morals are meaningless

Minimize homework. If it is causing too much stress it should not be done
• Let him have quiet “fiddle” toys — squishy balls, pocket full of rubber bands
• Sipping water from a sports bottle (straw attached, no spills) may help her attend to lesson
• If he can’t sit still a weighted blanket (large bean bag) may help him anchor his body in space
• Ensure you have eye contact with her when giving instructions, ask her to repeat simple directions
• Simplify complex directions and avoid multiple commands
• Make directions clear and concise and be consistent with daily instructions
• Develop some quiet cues (signs) to help him settle down, go to the quieting place when overstimulated
• Be firm when needed and give only limited choices.
• Make students feel comfortable with seeking assistance (most children will not ask for help)
• These children will need more help for a longer period
of time than the average child
• Remember he is not “misbehaving” on purpose to make you mad, “think brain not blame” (7)
• Analyzing, moralizing and traditional disciplinary methods do not work
• Behaviour modification and /or rewards/punishment will not work!
• Communication, patience, compassion, understanding and creativity do work — think fasd first!
• Provide transition help when switching over to middle, junior or high school
• Focus on life skill training, health and nutrition, job skills not higher academics
• Focus on communication, problem-solving, social and life skills — reality based education
• Try to incorporate math and literacy skills into life skills, eg. cooking, shopping, advertising etc.
• Continue to address high school student’s developmental, not chronological age (35)
• Routines are critical, these students may benefit from an “external brain buddy” to get to next class
• Fewer classrooms, classrooms close to each other works best
• Help her organize her locker and backpack
• Colour code subjects, yellow–math, red–English, blue– Family Studies — coloured stickers on texts


A special classroom for students with FASD features small class size, “personal bubbles” marked off with carpeting or tape, a low stimulus environment, easy read labels and laiminated cues, private spaces for de-stressing, private “time-in” spaces, and large bean bags for use as weighted blankets.

• Same locker and adult “external brain” year after year is helpful
• Use technology wherever practicable with these students — usually technologically savvy
• Provide fasd-aware tutors
• If what you are doing is not working, don’t try harder,
try differently!

FROM FASD TOOLKIT FOR ABORIGINAL FAMILIES PREPARED BY THE ONTARIO FEDERATION OF INDIAN FRIENDSHIP CENTERS

Strategies for FASD

Whole School Strategies (this represents a minimum)

• All staff in the school trained to understand how fasd affects students
• Substitute personnel trained to understand and deal with students with fasd
• Emergency support for substitute personnel and students if “the wheels fall off.”
• Teachers and aides with realistic expectations of functional development
• Ideal staff will have nurturing, flexible personalities and a sense of humour
• Full-time Educational Assistants
• Make student records easily accessible (understandable) to professionals within privacy limits
• Whole school behaviour expectations, eg. Tribes ™ or “With All Due Respect”
• Mark boundaries on floors, hallways if inappropriate touching and poking is a problem
• Direct supervision of all meals, snacks, recess, bathrooms, on the bus – 24/7 supervision
• Structure program as much as possible, no surprises, structure all routines and be consistent
• Buddy Program of fasd-affected student with unimpaired peer
• Direct supervision, if required, of all transit from place to place within the school
• Each fasd student should have an adult “buddy” within the school
• Be overcautious with safety — expect the unexpected — lock up all dangerous items
• Have these students “do in-school errands” (if capable) to use energy acceptably
• Prepare students carefully for assemblies, guest speakers or fire drills (provide ear protection)
• Communication books that go home and come back every day
• Work closely with parent(s)/caregiver(s) — “everyone on the same page” — “iron-clad” consistency
• The same teacher for more than one school year, minimizing transitions
• “Time-in” spots that are private, safe, easily supervised, low-stimulus and comfortable
• Aim for fun and enjoyment, enjoy good times with all students, Carpe diem.
• Staff need to learn to like the students with fasd as people
• Remember that students who are impaired teach life lessons to those who are less challenged
• Remember that students with fasd do not know why they do things, don’t ask!
• Foster interdependence not independence in the fasd affected, learn to use ‘external brains’
• When things are going poorly try something different, don’t try harder
• Life skills curriculum blending academic, daily living, personal/social and occupational skills
• Focus on helping students function well in the community with a minimal amount of supervision

FASD Reflections

FASD the preventable disability. Working with people with FASD can be extremely challenging. Not only do they have neurological deficits but social and learning difficulites as well.

Compromised executive functioning D
Difficulty planning, predicting, organizing, prioritizing, sequencing, initiating, and following through. Difficulty setting goals, complying with contractual
expectations, being on time, or adhering to a schedule.

➤ Difficulty with memory
Information input, integration, forming associations, retrieval, and output. Difficulty learning from past experiences. Often repeat the same mistake over and over again in spite of increasingly severe punishment. Inconsistent memory or performance; may remember on Monday, forget by Tuesday.

➤ Difficulty with abstract concepts
Such as time, math, or money.

➤ Impaired judgment
Often unable to make decisions. Difficulty understanding safety and danger, friend and stranger, or differentiating fantasy from reality.

➤ Inability to generalize information
Difficulty forming links and associations, unable to apply a learned rule in a new setting; learns to not take Johnny’s bike, but then takes Mary’s bike.

➤ Communication challenges
Appears to understand instructions, nod and agree, but is unable to comprehend. Often repeats rules verbatim, then fails to apply the rules — “talks the talk” but doesn’t “walk the walk.”

➤ Language problems
Difficulty comprehending the meanings of language and accurately answering questions. May agree or confabulate — comply or fill in the blanks. Many talk
excessively, yet are unable to engage in a meaningful exchange. The sheer volume of words creates the impression of competence.

➤ Slow cognitive pace
May think more slowly, say “I don’t know,” shut down, or require minutes to generate an answer rather than seconds. Those with fasd are “Ten‑second people in a one second world.”

➤ Slow auditory pace
Central auditory delays means language is processed more slowly, requiring more time to comprehend. Many only grasp every third word of normally paced speech.

➤ Preservation
May be rigid, get stuck, have difficulty switching gears, stopping an activity, or transforming to a new activity. Often react strongly to changes in setting, program or personnel.

➤ Dysmaturity
Often function socially, emotionally, and cognitively at a much younger level developmentally than their chronological age. A 5-year old may be developmentally more like a 2-year old, a 12-year old more like a 6-year old; and a 25-year old more like a 13-year old.

➤ Impulsivity
Coupled with inability to abstract and predict outcomes; acts first and then is able to see the problem after the fact.

➤ Sensory systems dysfunctions
May be over-reactive to stimuli — e.g. tactile defensiveness. May be easily overwhelmed by sensory input, may be unable to filter out extraneous stimuli; symptoms include increased agitation, irritability, and aggression. May under-react to pain — may not complain of earaches, broken bones, and be unable to experience painful stimuli.

Secondary Behaviours

Secondary behaviours are defensive behaviours that develop over time when there is a chronic “poor fit” between the person and his environment. Defensive behaviors are normal protective reactions to frustration and are helpful cues for identifying points of intervention.

By definition, these are preventable when a good fit is provided. Again, these are not exclusive of fasd.

• Inappropriate humor — the “class clown.”
• Pseudo-sophistication; may echo words, phrases, manners, and dress in order to “pass” as competent beyond their actual ability, often to their detriment.
• Fatigued, irritable, resistant, argumentative.
• Anxious, fearful, chronically overwhelmed.
• Frustrated, angry, aggressive, destructive.
• Poor self-concept, often masked by unrealistic goals or self-aggrandizement.
• Isolated, few friends, picked on.
• Family or school problems including fighting, suspension, or expulsion.
• May run away, have other forms of avoidance.
• Trouble with the law, addictions.
• Depressed, may be self-destructive, suicidal.

Secondary behaviors often develop in early childhood, frequently becoming patterns of behavior by adolescence. Secondary conditions come at a high cost to the individual, their family, and the community. Early identification of both primary symptoms and secondary behaviors is necessary in order to develop appropriate
interventions, or “accommodations” that prevent or resolve secondary behaviors.
Section 4 of this document (“Reason”) provides a useful table outlining primary and secondary behaviours and the kinds of interventions or “accommodations”
that work and don’t work in coping with them

(This breakdown of primary and secondary behaviours has been adapted from a presentation by Diane Malbin at the 2005 FASD National

Special Class An example of a school that has special classrooms for students with fasd is the David Livingstone Community School in Winnipeg, Manitoba.

“This is an Early Childhood Behavioural Treatment Program … designed for students who display severe behaviour resulting from fas/fae or other neurological difficulties. A description of the program is as follows:
low stimulus environment,low enrolment classroom, focus on social skills, behaviour and academics, strong consistent classroom agenda, individual education plans, predictable routines and expectations, behaviour plan consistently reinforced by Teacher Assistants and Support personnel, consistent consequencing, speech therapy on site two times a week, occupational therapy on site once a week.”

This program has had demonstrated success with students seriously affected with fasd.
Conference, “Equality of Access: Rights and the Right Thing to Do.”

INCREASING SUCCESS IN SCHOOL THROUGH PRIMING

Research has shown that for some students a method that could be more beneficial is to provide information that is to be presented in the near future rather than continually focusing on what has already been presented. Some students may engage in behaviours to escape or avoid due to the anxiety they experience when faced with new material. The important feature of priming is to target pivotal behaviours such as motivation, interest and attention.

Koegal et al. (1997) defines priming as an intervention which previews material or activities that a child is likely to have difficulties with. The goal of priming is to increase the child’s competence in a given learning field before inappropriate behaviour can surface. Material is presented as closely as possible to the way it will be presented the following day. The child is then prompted to respond to questions or evoke responses that they have already been prepared for.

Specific session lengths have not currently been assessed systematically but short, meaningful sessions tend to be more effective than lengthy sessions. The more pleasant the experience the more likely it is that the child will retain the information and be motivated to continue the learning. When the information is more challenging for the individual, specific sections should be targeted in order to prevent anxiety from escalating. If the child has difficulty with complex sentences or words the point than is to familiarize the student with words or names that they can easily recall and prompt them the following day for that information. The child can then experience success without having to fully comprehend all the information being presented. Priming becomes about participation in learning not getting “it right”.

There are four general steps used in the priming program:

1. Collaboration – Who will be responsible giving assignments to primer? Conducting the sessions?
2. Communication – How often? Where will the materials be left? Where will the materials be returned?
3. Priming – Place, Time, Duration, Mood
4. Feedback – Is priming working? From teachers, parents, child’s perspective
The main component of the priming method is to understand that it is not necessarily about teaching the new information but the importance is to introduce new material. The child does not need to grasp the entire concept of what is being presented. Priming is about involving the child in positive interactions around their learning to hopefully encourage motivation for further learning experiences.
When to do the priming may cause some concern. Certain information can be delivered just hours before they need to utilize it but other time priming may have to occur the night before. Setting up a specific routine initially may help to alleviate some of the confusion around when priming should occur.

Helping Children With Autism Learn

When deciding a treatment program for an child with autism it can become very distressing and confusing. Lacking is the research in relation to long term treatment outcomes for the various treatments.. Don't get me wrong there is research in relation to treatment programs like ABA, drug therapies, Floortime, Dietary Modifications, Play Therapy, Behaviour Modification Programs, but not conclusive for all children with Autism. The point I am trying to make is that not one particular method may be the most beneficial for children with Autism. However it seems fairly clear that early intervention in key areas may be the most beneficial.

The core skill deficits for children with Autism may be referred to as "Autism Specific Learning Disablities"(Seigal, 2003). It is necessary to treat the individual symptoms not the diagnosis.
When preparing a treatment intervention it is vital to consider the following areas to determine the child's individual deficits or "learning styles" and to identify the child's strengths/ weaknesses:

1. Cognitive: How is the brain functioning?
2. Developmental: Social, communication, engagement, emotional functioning
3. Educational: Plans, Learning, Assessments
4. Medical: What are the child's physiological differences?

When a holistic assessment has been completed the planning process can be developed. The underlying philosophy of any treatment/program or individual/agency/professional must also be examined prior to commencement of intervention. Motivation to learn is enhanced by providing enriching experiences for the child. Encouraging the child to seek out pleasurable experiences and continue seeking those experiences should be a main goal of those providing learning environments for children with special needs.

It may also be important to consider providing activites for the child to move from a situation of forced responding to active responding. Providing time for activities that are self-initiated encourage the development of problem solving skills which enhances higher level learning capapbilities. Forcing children to respond to stimuli may acheive the desired outcome but does it actually show that the child has learned a new skill or can transfer that learning to different environments?

BEST PRACTICE EDUCATIONAL STRATEGIES:

The three "P"'s may be helpful for children with Autism Specific Learning Disabilities:

1. Priming: Pre-practice is an excellent way to introduce material to children before they have to activley engage in learning the material. Priming may also be beneficial to encourage peer or social interactions, initiation of social interactions or becoming familiar with a story from a social situation before it given to the entire class.

2. Prompting: The teacher can use prompting strategies for the child with autism while also including "neurotypical" peers in the process. Prompt the "neurotypical" child who then in turn prompts the child with Autism. Prompts can also be used directly with the child with autism.

Research has also been conducted on using a tactile prompt like a device in the student's pocket that vibrates when the child should intiate a social / verbal interaction.

3. Pictures: Picture schedules increase predictability and is an alternative to verbal or written communication. Can serve as effective cues for children with autism to commence or deter them from a certain behaviour. Is also helpful in transitions and times that may cause increased stress or frustration.

4. Delayed or Contingent Reinforcement: Research has shown that students with disabilities are less likely to engage in inappropriate behaviour while being supervised by an adult. The removal of the adult also removes the positive reinforcement that is given to the student. Research has been completed that uses unpredictable schedules of supervision and found an increase in appropriate behaviours as the student was unaware of when supervision would be occuring. This may conclude that "thinning" supervision may be required to increase on task behaviour without supervision. (See Dunlap, Pilienis, and Williams 1987)

5. Self-Management Strategies: These strategies are requried to encourage independence and self responsibility from the student. Self monitoring forms or sheets to encourage self-analysis on inappropriate/appropriate behaviours can be utilized. Students with disabilities were taught ot use a wrist counter to record their correct responsed to questions and rewarded.

6. Peer Tutoring: Classwide Peer Tutoring (CPT) involves pairing of children and who then work together to complete a project.

7. Peer Support: Training specific children to interact with children with Autism on a regular basis. Increased the probability that children will engage and interact.

8. Cooperative Learning: Teaching academic and social skills to both children with autism and their "neurotypical" peers.

MULTICOMPONENT INTERVENTION:

Educators have utilized a multicomponent intervention to target increased inclusion for the child with autism.

Hunt, Alwell, Farron-Davis and Goetz (1996) evalualted a multicomponent intervention that comprised of the following:

a. weekly club meetings to discuss interactions between peers and students with autism
b. various media used for communicative purposes
c. rotating buddy system

Dramatically increseased reciprocal interaction between peers and students with disabilities.

PRETASK SEQUENCING:

Precede a difficult task with a series of smaller tasks and reinforcing compliance with these easy requests.

Pivotal Response Training and Naturalistic Teaching Strategies:

Increasing motivation to learn by incorporating choices, reinforcing attempts, using adequate modeling, natural consequences, and natural language teaching interactions.

Research in relation to outcomes of these strategies and new innovative strategies need to become priorities as children with ASD, ADHD, and oppositional behaviour are entering our classrooms at staggering rates. Full inclusion requires appropriate resourcing and funding to allow children with disabilities to meet their full potential.